Early 2nd trimester vesico-amniotic shunt insertion promises a new era of better outcomes for fetuses with isolated severe lower urinary tract obstruction (LUTO)

Abstract

After decades of treating fetuses with LUTO by late vesico-amniotic shunting with little success for preserving sufficient renal function, my simplified approach of selecting and treating fetuses with severe LUTO prior to the completion of 16 weeks offers light at the end of the tunnel for my patients [ [1] Kohl T. Fimmers R. Axt-Fliedner R. Degenhardt J. Brückmann M. Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO). J Pediatr Urol. 2022 Jan;19; 22 (Online ahead of print): S1477-5131https://doi.org/10.1016/j.jpurol.2022.01.002 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. Nevertheless, further follow-up studies are needed to assess whether and if, for how long, the better neonatal outcomes we have observed may persist. Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO)Journal of Pediatric UrologyVol. 18Issue 2PreviewThis retrospective study by Kohl et al. highlights the feasibility of vesico-amniotic shunting (VAS) before 16 weeks gestation using a Cook pigtail catheter, or the Somatex® nitinol wire mesh shunt. The authors report a technical success rate of 80% before 16 weeks, which they state is similar to the success rates of VAS later in pregnancy. Fetal intervention before 16 weeks is known to be hazardous due to an increased risk of chorioamniotic separation or shunt dislodgement into the fetal abdominal cavity, that can occur with fetal growth, resulting in fetal ascites and requiring further urgent intervention. Full-Text PDF