Vesicoamniotic shunt: A small, plastic tube called a shunt is inserted into the bladder to allow the flow of urine from the bladder to the outside of the fetus. One in ten fetuses may require only a single vesicocentesis to resolve LUTO. Multiple procedures may be needed if urine repeatedly builds up in the bladder. Vesicocentesis: A needle is placed into the fetal bladder to remove the urine. The type of treatment used depends on where in the urinary tract the blockage occurs. This prevents urine buildup and helps to normalize amniotic fluid volume. The goal of fetal treatment is to provide constant drainage of urine from the body into the amniotic fluid. If a LUTO seems to be isolated, fetal surgical treatment may help decrease the amount of lung and kidney damage that can occur during pregnancy. Lower Urinary Tract Obstruction Treatment Therefore, LUTO can lead to damage in more than one organ system. This can lead to lung damage because the fetus must move amniotic fluid in and out of the lungs in order for them to develop properly. When urine can no longer be drained, the fluid around the fetus (amniotic fluid) decreases. Over time this blockage can lead to permanent kidney damage. When LUTO occurs, all parts of the urinary tract that lie above the obstruction may become swollen with urine that cannot drain. LUTO occurs when the flow of urine is blocked from exiting the body at the level of the lower urinary tract. The kidneys and ureters are called the upper urinary tract and the bladder and urethra are called the lower urinary tract. When the bladder is full, it pushes the urine out of the body through a tube called the urethra. Urine is stored in the bladder until it gets full. The urinary tract consists of the organs that produce and store urine:Īs a fetus grows in the womb, urine made by the kidneys flows through the ureters into the bladder. A general treatment algorithm for foetal therapy is not available at the moment.A lower urinary tract obstruction (LUTO) is a rare fetal condition that occurs when there is a blockage in the urinary tract of a developing fetus. In the meantime selection of foetuses for prenatal intervention puts high requirements on interdisciplinary counselling in every case. The data from the PLUTO trial (percutaneous shunting in lower urinary tract obstruction) conducted by the University of Birmingham may help to answer these questions. Further studies are necessary to improve case selection of affected foetuses and to evaluate the impact of interventions in earlier gestational weeks. Because of a relevant complication rate and still no clear evidence for foetal benefit, interventions should be performed in specialised centres. Furthermore, there is no randomised trial available at the time of writing. Selection of foetuses who may profit from prenatal intervention is aggravated by the lack of reliable prognostic criteria for the prediction of postnatal renal function in both ultrasound and foetal urine analysis. Previous reports indicate that prenatal therapy is suitable to reduce perinatal mortality but does not improve postnatal renal function. Vesico-amniotic shunting as well as (currently less frequent) foetoscopic cystoscopy and laser ablation of posterior urethral valves are minimally invasive treatment options. Foetal interventions in order to bypass the obstruction are biologically plausible and technically feasible. The degree of renal damage is variable and ranges from mild renal impairment in infancy to end-stage renal insufficiency, necessitating dialysis and transplantation. The natural history of LUTO is characterised by high morbidity and mortality due to the development of severe pulmonary hypoplasia caused by oligo- or anhydramnios affecting the cannalicular phase (16-24 weeks of gestation) of pulmonary development. In female foetuses LUTO is frequently a part of complex malformations. The most common entities are isolated posterior urethral valves or urethral atresia in male foetuses. The aetiology of urinary tract obstructions (LUTO) is heterogeneous.
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