R Ruano1, N Sananes2, C Wilson3, J Au3, C J Koh3, P Gargollo3, A A Shamshirsaz2, J Espinoza2, A Safdar4, A Moaddab2, N Meyer5, D L Cass6, O O Olutoye6, O A Olutoye7, S Welty8, D R Roth3, M C Braun4, M A Belfort2. 1. Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. ruano@bcm.edu, rodrigoruano@hotmail.com. 2. Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. 3. Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. 4. Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. 5. Department of Public Health, Strasbourg University Hospital, Strasbourg, France. 6. Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. 7. Department of Anesthesiology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. 8. Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
Abstract
OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported. RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival. CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.
OBJECTIVE: To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. METHODS: This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported. RESULTS: Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival. CONCLUSIONS: Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed.
Authors: Valentina Capone; Nicola Persico; Alfredo Berrettini; Stèphane Decramer; Erika Adalgisa De Marco; Diego De Palma; Alessandra Familiari; Wout Feitz; Maria Herthelius; Vytis Kazlauskas; Max Liebau; Gianantonio Manzoni; Michal Maternik; Giovanni Mosiello; Joost Peter Schanstra; Johan Vande Walle; Elke Wühl; Elisa Ylinen; Aleksandra Zurowska; Franz Schaefer; Giovanni Montini Journal: Nat Rev Urol Date: 2022-02-08 Impact factor: 16.430
Authors: Jeffrey T White; Kunj R Sheth; Aylin N Bilgutay; David R Roth; Paul F Austin; Edmond T Gonzales; Nicolette K Janzen; Duong D Tu; Angela G Mittal; Chester J Koh; Sheila L Ryan; Carolina Jorgez; Abhishek Seth Journal: Front Pediatr Date: 2018-07-03 Impact factor: 3.418
Authors: Kavita Narang; Elizabeth Ann L Enninga; Madugodaralalage D S K Gunaratne; Eniola R Ibirogba; Ayssa Teles A Trad; Amro Elrefaei; Regan N Theiler; Rodrigo Ruano; Linda M Szymanski; Rana Chakraborty; Vesna D Garovic Journal: Mayo Clin Proc Date: 2020-05-30 Impact factor: 7.616