Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction.
OBJECTIVE
Limited information is available about long-term outcomes in children treated prenatally for lower urinary tract obstruction. Our aim was to evaluate outcomes in children treated in utero with vesicoamniotic shunts.


METHODS
Clinical outcomes in 20 pregnancies with a singleton male fetus, oligo/anhydramnios, and lower urinary tract obstruction were studied using chart review and phone and written clinical questionnaire for parents, pediatricians, and urologists.


RESULTS
Overall 1-year survival was 91%. Two neonatal deaths occurred from pulmonary hypoplasia. Mean gestational age at delivery was 34.6 weeks, mean days from shunting to delivery were 84.4, and mean birth weight was 2,574 g. Prenatal urinary prognosis was good in 13, borderline in 2, and poor in 3 of the survivors. Mean age at follow-up was 5.83 years. Posterior urethral valves were confirmed in 7 males, urethral atresia in 4, and prune belly syndrome in 7. Eight children had acceptable renal function, 4 had mild insufficiency, and 6 required dialysis and eventual renal transplant. Eleven children had normal bladder function with spontaneous voiding, 6 required catheterization, and 1 child still had a vesicostomy. Height and weight were below the 25th percentile in 9 children. Persistent respiratory problems were present in 8, musculoskeletal problems in 9, and frequent urinary tract infections were reported in 9. Health-related quality of life results in our group with lower urinary tract obstruction were similar to those in a healthy child population.


CONCLUSIONS
Male children who underwent prenatal bladder shunting were neurodevelopmentally normal. Although one third of the surviving babies required dialysis and transplantation, the majority have acceptable renal and bladder function and report satisfactory quality of life.


METHODS
III.
Biard
Jean-Marc
JM
Center for Fetal Diagnosis and Treatment, at The Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4399, USA.
Johnson
Mark P
MP
Carr
Michael C
MC
Wilson
R Douglas
RD
Hedrick
Holly L
HL
Pavlock
Christina
C
Adzick
N Scott
NS
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000601:surgery*; D000714:Anastomosis, Surgical; D003404:Creatinine / Q000097:blood; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D008297:Male; D016104:Oligohydramnios / Q000209:etiology; D011247:Pregnancy; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D001743:Urinary Bladder / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
D003404:Creatinine