Congenital urinary tract obstruction

Research output: Contribution to journalReview articlepeer-review

Authors

Abstract

Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy.

Bibliographic note

Copyright © 2019. Published by Elsevier Ltd.

Details

Original languageEnglish
Pages (from-to)78-92
Number of pages15
JournalBest Practice & Research: Clinical Obstetrics & Gynaecology
Volume58
Early online date11 Jan 2019
Publication statusPublished - Jul 2019

Keywords

  • Congenital abnormalities, Fetal therapy, Prenatal ultrasonography, Urinary bladder neck obstruction