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Therapeutic intervention for fetal lower urinary tract obstruction: Current evidence and future strategies

  • Marie-Klaire Farrugia
    Correspondence
    Correspondence to: Marie-Klaire Farrugia, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
    Affiliations
    Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK

    Imperial College London, Exhibition Road, London SW7 2AZ, UK
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  • Mark D. Kilby
    Affiliations
    Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, B15 2TG, UK

    College of Medical & Dental Sciences, University of Birmingham, B15 2TT, UK
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Published:January 31, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.01.034

      Summary

      In-utero vesica-amniotic shunting for fetal lower urinary obstruction (LUTO) is known to improve perinatal survival. More recently, studies including centres performing fetal cystoscopy, have suggested benefit on longer-term survival and renal outcome – within the limitations of small numbers and limited follow-up. These interventions carry significant risk, and therefore patient selection, and optimal timing, are key. The aim of this article is to explore ways of improving the accuracy of prenatal diagnosis, and of identifying risk factors for fetal and postnatal renal failure. The next step is that of using established staging and classification systems to select the patient group that may benefit from intervention, based on published outcomes. Several factors come into play when selecting the timing of intervention, especially if the aim is that of renal, and not only pulmonary, preservation. Lastly, current technologies and their shortfalls are discussed.

      Keywords

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