Distal urinary obstruction

Kumar, Sailesh and Fisk, Nicholas M. (2003) Distal urinary obstruction. Clinics in Perinatology, 30 3: 507-519. doi:10.1016/S0095-5108(03)00060-5


Author Kumar, Sailesh
Fisk, Nicholas M.
Title Distal urinary obstruction
Journal name Clinics in Perinatology   Check publisher's open access policy
ISSN 0095-5108
1557-7864
1557-9840
Publication date 2003-09-01
Year available 2003
Sub-type Article (original research)
DOI 10.1016/S0095-5108(03)00060-5
Open Access Status Not yet assessed
Volume 30
Issue 3
Start page 507
End page 519
Total pages 13
Place of publication Philadelphia, PA, U.S.A.
Publisher W.B. Saunders
Language eng
Subject 111401 Foetal Development and Medicine
111402 Obstetrics and Gynaecology
1103 Clinical Sciences
Abstract Despite the sound experimental basis and initial promise of early animal models, the results of antenatal intervention have been disappointing, with high rates of misdiagnosis of urethral valves, complications from vesicoamniotic shunting, perinatal mortality, and long-term renal impairment and bladder dysfunction in survivors. The recent development of a cystoscopic approach might obviate some of these problems, but to date the procedure has been limited by technical difficulty in negotiating the urethrovesical angle. Overcoming these difficulties through equipment modifications might allow definitive testing of whether or not alleviating distal urinary obstruction in utero is beneficial.
Formatted abstract
Fetal urethral abnormalities manifesting as lower urinary tract obstruction (LUTO) might result in significant morbidity and mortality because of progressive irreversible renal damage secondary to dysplasia of the developing kidney and pulmonary hypoplasia caused by prolonged oligohydramnios or anhydramnios. The adverse effect of anhydramnios on fetal lung development is well documented in animal models [1] and in neonates born with bilateral renal agenesis who die of lung hypoplasia. Severe oligohydramnios from 16 weeks' gestation onward precludes most further pulmonary development. In contrast, oligohydramnios after the second trimester is unlikely to result in pulmonary hypoplasia because the crucial canalicular phase of lung development (between 16 and 25 weeks) has largely been completed by this stage. The other main problem, renal dysfunction, arises early in uterine life and progresses in utero with renal damage in survivors that persists into childhood and renal impairment that is exacerbated in adolescence. The treatment of LUTO depends largely on the etiology of the underlying condition. In males, the most common cause of LUTO is posterior urethral valves, whereas in females urethral atresia accounts for the majority of cases. The second problem causing increased morbidity and mortality is renal dysfunction, which can persist into early childhood. Severe oligohydramnios, defined as a deepest vertical pool of less than 1 cm for more then 14 days before 25 weeks' gestation, is associated with neonatal mortality of more than 90%. Although it might be possible to salvage renal function with early fetal intervention, the results to date have been disappointing. This article covers the etiology of LUTO, the experimental basis for fetal therapy, the controversy surrounding case selection for treatment, and general management principles.
Copyright © 2003 Elsevier Inc. All rights reserved.

Keyword Fetal urethral abnormalities
Lower urinary tract obstruction
Anhydramnios
Oligohydramnios
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 23 Mar 2009, 23:33:47 EST by Maria Campbell on behalf of Faculty Of Health Sciences