In utero intervention for urologic diseases.

The burgeoning use of prenatal ultrasonography has prompted discussion of the feasibility and capabilities of fetal intervention for urologic disorders. On the basis of the capabilities of fetal intervention, three prenatally diagnosed anomalies are of primary interest to urologists: congenital adrenal hyperplasia (CAH), lower urinary tract obstruction (LUTO) and myelomeningocele. Various interventions (surgical or pharmacological) are being developed for fetuses with these diagnoses. For fetuses with CAH or LUTO, successful outcomes have certainly been demonstrated, although no results from prospective randomized trials have been published. In utero treatment of CAH is accomplished through oral administration of glucocorticoids to the expectant mother. However, the long-term effects of this strategy have been insufficiently studied and remain undetermined. In the fetus with a LUTO, prenatal intervention has primarily been accomplished by placement of a vesicoamniotic shunt. Although this technique results in improved perinatal survival according to several systematic reviews of the literature, the data originate from small, heterogeneous populations of patients. By contrast, a randomized controlled trial of fetal myelomeningocele closure resulted in greatly reduced rates of both ventriculoperitoneal shunt placement and hydrocephalus. The future of fetal intervention in urology is contingent upon improved methods of studying the clinical outcomes of such treatments.