title: Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity.
abstract: OBJECTIVE
  To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.
  
  
  METHODS
  This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.
  
  
  RESULTS
  Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88-70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04-0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63-25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66-24.2), Pr(OR > 1) = 93.3%) were predictors of survival.
  
  
  CONCLUSIONS
  Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA. ruano@bcm.edu, rodrigoruano@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sananes
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: C
authors.initials: C
authors.lastname: Wilson
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Au
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: P
authors.initials: P
authors.lastname: Gargollo
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Shamshirsaz
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Espinoza
authors.affiliation: Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Safdar
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Moaddab
authors.affiliation: Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: N
authors.initials: N
authors.lastname: Meyer
authors.affiliation: Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Department of Pediatric Surgery, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: O O
authors.initials: OO
authors.lastname: Olutoye
authors.affiliation: Department of Anesthesiology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: O A
authors.initials: OA
authors.lastname: Olutoye
authors.affiliation: Department of Pediatrics, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Welty
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Roth
authors.affiliation: Division of Pediatric Nephrology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Braun
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Belfort
mesh_terms: D001499:Bayes Theorem; D003558:Cystoscopy / Q000379:methods*; D019468:Disease Management; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007677:Kidney Function Tests; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000601:surgery*
keywords: cystoscopy; fetal lower urinary tract obstruction; fetal surgery; laser; posterior urethral valves; prenatal diagnosis; ultrasonography; vesicoamniotic shunt