Diagnosis and outcome of fetal lower urinary tract obstruction in the northern region of England.
OBJECTIVE
We reviewed the prenatal and postnatal management of fetal lower urinary tract obstruction (LUTO) in a large geographically defined population.


METHODS
The records of 113 cases of LUTO seen over a 14-year period were examined. The predictive accuracy of prenatal findings for chronic renal failure (CRF) and a comparison of prenatal-suspected and non-suspected cases were made.


RESULTS
The incidence of LUTO was 2.2 in 10 000 births. During the study period, prenatal detection improved from 33 to 62%. Sensitivity of prenatal ultrasound detection of renal dysplasia and fetal urinary sodium, calcium, and beta2-microglobulin for CRF or renal dysplasia on autopsy were 59, 33, 66, and 63% respectively. Compared to undetected cases, those detected prenatally had higher mortality and a higher rate of CRF at 24 months (17% vs 57%, p < 0.01).


CONCLUSIONS
Our observations confirm the poor prognosis associated with fetal LUTO. The value of serial fetal urine biochemistry, other prenatal predictors of postnatal renal function, and the benefits of vesicoamniotic shunting require larger series and longer follow-up.
Anumba
Dilly O
DO
Department of Obstetrics and Gynaecology, University of Sheffield, Sheffield, UK. d.o.c.anumba@sheffield.ac.uk
Scott
John E
JE
Plant
Nick D
ND
Robson
Stephen C
SC
D000328:Adult; D004739:England / Q000453:epidemiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D005865:Gestational Age; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D011237:Predictive Value of Tests; D011247:Pregnancy; D015203:Reproducibility of Results; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014524:Urethral Obstruction / Q000196:embryology* / Q000453:epidemiology / Q000652:urine; D016482:Urinalysis