title: Pressure limited vesico-amniotic shunt allows normal lung growth in a fetal lamb model of obstructive uropathy.
abstract: BACKGROUND
  In our fetal lamb model of lower urinary tract obstruction, a pressure limited shunt preserves bladder function and renal development. This study investigates the effects on pulmonary histology.
  
  
  METHODS
  We created obstructive uropathy (OU) in 60-day gestation fetal lambs, ligating the urethra and urachus, and delivering them at term (130-145days). We compared pulmonary histology in 4 groups: group A, OU without shunt; group B, pressure limited shunt; group C, non-valved shunt. Shunts were inserted 3weeks post-obstruction. Group D were normal controls.
  
  
  RESULTS
  We compared 27 fetuses: 7 fetuses in group A, 4 fetuses in group B, 2 fetuses in group C, and 14 fetuses in group D. There was no significant difference in lung volume in any group. In group A, there were some areas of atelectasis and incomplete alveolar formation histologically. The alveoli in group A lambs lungs had a predominance of type II cells, whereas group B lambs lungs were lined by type I epithelial cells and were essentially indistinguishable from controls.
  
  
  CONCLUSIONS
  This study suggests that using a pressure-limited vesico-amniotic shunt in OU may preserve the renal tract and the lungs.
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Junki
authors.initials: J
authors.lastname: Koike
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Juma
authors.initials: J
authors.lastname: Obayashi
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Seki
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nagae
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Shutaro
authors.initials: S
authors.lastname: Manabe
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ohyama
authors.affiliation: Institute for Ultrastructural Morphology, St. Marianna University School of Medicine, Postgraduate School, Kawasaki, Japan.
authors.forename: Chizuko
authors.initials: C
authors.lastname: Sasaki
authors.affiliation: Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan; Institute for Ultrastructural Morphology, St. Marianna University School of Medicine, Postgraduate School, Kawasaki, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Jane
authors.initials: J
authors.lastname: Zuccollo
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Pringle
authors.affiliation: Division of Pediatric Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. Electronic address: h2kita@marianna-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitagawa
mesh_terms: D000650:Amnion / Q000601:surgery*; D000714:Anastomosis, Surgical; D000818:Animals; D005315:Fetal Diseases / Q000601:surgery*; D046128:Fetal Therapies / Q000379:methods*; D008168:Lung / Q000196:embryology*; D011312:Pressure; D012756:Sheep; D014524:Urethral Obstruction / Q000196:embryology* / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*
keywords: Fetal surgery; LUTO; Lung hypoplasia; Vesicoamniotic shunt