Fetal Therapy for Obstructive Uropathy: Specific Outcomes Diagnosis

Abstract

No AccessJournal of UrologyObstructive Uropathy/Imaging1 Aug 1996Fetal Therapy for Obstructive Uropathy: Specific Outcomes Diagnosis Andrew L. Freedman, Timothy P. Bukowski, Craig A. Smith, Mark I. Evans, Mark Paul Johnson, and Ricardo Gonzalez Andrew L. FreedmanAndrew L. Freedman , Timothy P. BukowskiTimothy P. Bukowski , Craig A. SmithCraig A. Smith , Mark I. EvansMark I. Evans , Mark Paul JohnsonMark Paul Johnson , and Ricardo GonzalezRicardo Gonzalez View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)65795-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Attempts to evaluate prenatal vesico-amniotic shunt therapy have been hampered by inconsistencies in patient selection, treatment and termination criteria, and outcomes measurement. Outcomes have generally been measured against those of patients with postnatally detected posterior urethral valves. The purpose of this report was to evaluate the influence of the underlying diagnosis on the clinical outcomes of fetuses undergoing evaluation for prenatal intervention for suspected obstructive uropathy. Furthermore, specific outcomes diagnosis was compared to the published natural history of these disorders to begin to establish a basis for measuring the efficacy of prenatal intervention. Materials and Methods: We retrospectively reviewed the outcomes of 55 consecutive patients undergoing prenatal evaluation using structured outcome measures stratified by specific diagnoses to provide a comparison to the reported natural history for each underlying disorder. Results: All fetuses had early onset of oligohydramnios/anhydramnios representing the worst end of the spectrum. Compared to postnatally diagnosed patients, prenatally diagnosed patients with posterior urethral valves had lower survival (60 versus 93 percent) but similar postnatal renal failure rates (31 versus 33 percent). Cases of prenatally detected but untreated posterior urethral valves had a 44 percent renal failure rate. In fetuses with the prune-belly sundrome survival (86 versus 72 percent) and renal function rates (17 versus 27 percent renal failure) compared favorably with the postnatal experience, although 55 percent of the cases had significant urethral obstruction. All patients with urethral atresia died. Conclusions: The underlying etiology of obstruction appears to have a marked influence on clinical outcome independently of treatment. When evaluated by specific diagnosis, intervention appears to provide outcomes in these high risk fetuses that are comparable to those for disease detected postnatally. Interpretation of series that do not distinguish cases by onset, severity and specific pathological process is problematic. 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Link, Google Scholar From the Department of Pediatric Urology, Children's Hospital of Michigan and Center for Fetal Diagnosis and Therapy, Departments of Obstetrics and Gynecology, Molecular Medicine and Genetics and Pathology, Hutzel Hospital, Wayne State University, Detroit, Michigan.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAcar Ö, Uluocak N, Ziylan O, Kalelioğlu İ, Yüksel A and Ander H (2009) Is Cystatin C a Promising Parameter to Determine Postnatal Outcome of Prenatally Diagnosed Infravesical Obstruction?Journal of Urology, VOL. 182, NO. 4, (1542-1547), Online publication date: 1-Oct-2009.HOFMANN R, BECKER T, MEYER-WITTKOPF M, TEKESIN I, SIERRA F and SCHMIDT S (2018) Fetoscopic Placement of a Transurethral Stent for Intrauterine Obstructive UropathyJournal of Urology, VOL. 171, NO. 1, (384-386), Online publication date: 1-Jan-2004.Herndon C and Casale A (2018) Early Second Trimester Intervention In A Surviving Infant With Postnatally Diagnosed Urethral AtresiaJournal of Urology, VOL. 168, NO. 4 Part 1, (1532-1533), Online publication date: 1-Oct-2002.McLORIE G, FARHAT W, KHOURY A, GEARY D and RYAN G (2018) OUTCOME ANALYSIS OF VESICOAMNIOTIC SHUNTING IN A COMPREHENSIVE POPULATIONJournal of Urology, VOL. 166, NO. 3, (1036-1040), Online publication date: 1-Sep-2001.GONZÁLEZ R, De FILIPPO R, JEDNAK R and BARTHOLD J (2018) URETHRAL ATRESIA: LONG-TERM OUTCOME IN 6 CHILDREN WHO SURVIVED THE NEONATAL PERIODJournal of Urology, VOL. 165, NO. 6 Part 2, (2241-2244), Online publication date: 1-Jun-2001.HERNDON C, FERRER F, FREEDMAN A and McKENNA P (2018) CONSENSUS ON THE PRENATAL MANAGEMENT OF ANTENATALLY DETECTED UROLOGICAL ABNORMALITIESJournal of Urology, VOL. 164, NO. 3 Part 2, (1052-1056), Online publication date: 1-Sep-2000.EL-GHONEIMI A, DESGRIPPES A, LUTON D, MACHER M, GUIBOURDENCHE J, GAREL C, MULLER F, VUILLARD E, LOTTMANN H, NESSMANN C, OURY J and AIGRAIN Y (2018) OUTCOME OF POSTERIOR URETHRAL VALVES: TO WHAT EXTENT IS IT IMPROVED BY PRENATAL DIAGNOSIS?Journal of Urology, VOL. 162, NO. 3 Part 1, (849-853), Online publication date: 1-Sep-1999.FEITZ W, STEEGERS E, de GIER R, AARNINK R, THEO A and van der WILDT B (2018) FEASIBILITY OF MINIMALLY INVASIVE INTRAUTERINE FETAL ACCESS IN A MONKEY MODELJournal of Urology, VOL. 161, NO. 1, (281-285), Online publication date: 1-Jan-1999.BROCK J, HUNLEY T, ADAMS M and KON V (2018) ROLE OF THE RENIN-ANGIOTENSIN SYSTEM IN DISORDERS OF THE URINARY TRACTJournal of Urology, VOL. 160, NO. 5, (1812-1819), Online publication date: 1-Nov-1998.Hutton K, Thomas D and Davies B (2018) Prenatally Detected Posterior Urethral Valves: Qualitative Assessment of Second Trimester Scans and Prediction of OutcomeJournal of Urology, VOL. 158, NO. 3, (1022-1025), Online publication date: 1-Sep-1997.Coplen D (2018) Prenatal Intervention for HydronephrosisJournal of Urology, VOL. 157, NO. 6, (2270-2277), Online publication date: 1-Jun-1997.Greenfield S (2018) Editorial: Posterior Urethral Valves-New ConceptsJournal of Urology, VOL. 157, NO. 3, (996-997), Online publication date: 1-Mar-1997. Volume 156Issue 2SAugust 1996Page: 720-724 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Andrew L. Freedman More articles by this author Timothy P. Bukowski More articles by this author Craig A. Smith More articles by this author Mark I. Evans More articles by this author Mark Paul Johnson More articles by this author Ricardo Gonzalez More articles by this author Expand All Advertisement PDF downloadLoading ...