title: Factors associated with fetal shunt dislodgement in lower urinary tract obstruction.
abstract: OBJECTIVE
  To identify factors associated with fetal shunt dislodgement in lower urinary tract obstruction (LUTO).
  
  
  METHODS
  We conducted a retrospective study of 42 consecutive fetuses with a diagnosis of LUTO in a tertiary fetal center between April 2013 and November 2015. Possible factors associated with prenatal shunt dislodgment were evaluated in fetuses who underwent shunt placement, including gestational age at diagnosis, gestational age at procedure, presence of 'keyhole sign', initial fetal bladder volume and wall thickness, prenatal ultrasonographic renal characteristics, amniotic fluid volume, presence of ascites prior to shunting, and type of fetal shunt.
  
  
  RESULTS
  Nineteen (46.3%) fetuses underwent shunt placement at a median gestational age of 19 (range: 16.3-31.1) weeks. Shunt dislodgement occurred in 10 (52.6%) patients. A total of 35 procedures were performed; among which 16 (45.7%) were repeat procedures. The only prenatal factor associated with shunt dislodgement was the type of the shunt; Kaplan-Meier analysis indicated that the Rocket was associated with increased likelihood of remaining orthotopic (p = 0.04).
  
  
  CONCLUSIONS
  Fetal shunt dislodgement occurs in approximately half of the patients and appears to be associated with the type of the shunt. Future research is necessary to develop better shunt systems and to investigate different fetal therapeutic approaches. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Urology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kurtz
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Koh
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Grace Anne
authors.initials: GA
authors.lastname: Jamail
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.affiliation: Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Oluyinka 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: Olutoyin A
authors.initials: OA
authors.lastname: Olutoye
authors.affiliation: Renal Section, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Braun
authors.affiliation: Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Roth
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
mesh_terms: D000328:Adult; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D005548:Foreign-Body Migration / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014524:Urethral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D055815:Young Adult