Abstract
Purpose: Congenital lower urinary tract obstruction (cLUTO) includes a heterogeneous group of conditions caused by a functional or mechanical outlet obstruction. Early vesicoamniotic shunting (VAS) possibly reduces the burden of renal impairment. Postpartum, pediatric urologists are confronted with neonates who have a shunt in place and a potentially impassable urethra with a narrow caliber. Early management of these patients can be challenging. Here, we would like to share the approach we have developed over time.Materials and Methods: We conducted a single-center retrospective analysis from 2016 to 2020 and included all patients diagnosed with cLUTO. Data focusing on time point and type of intervention was collected. Furthermore, patients with temporary diversion via a percutaneous VAS were selected for a more detailed review.Results: In total, 71 cases of cLUTO were identified during the study period. Within this group, 31 neonates received postnatal management and surgical intervention in our center. VAS was performed in 55% of these cases (N = 17). The postnatal treatment varied between transurethral or suprapubic catheterization and early Blocksom vesicostomy. In five infants with VAS, the urinary drainage was secured through the existing VAS by inserting a gastric tube (N = 1) or a 4.8 Fr JJ-stent (N = 4). To our knowledge, this is the first report of a stent-in-stent scheme, which can remain indwelling until the definite treatment.Conclusion: Having a secure urine drainage through a VAS allows the often premature infant to grow until definite surgery can be performed. This avoids placing a vesicostomy, which requires anesthesia.
Highlights
Congenital lower urinary tract obstruction is an obstructive uropathy that occurs in 3.3/10.000 births and predominantly affects male newborns [1]
After institutional ethical approval (Ethical Approval No 2020873R), we performed a retrospective analysis of patients with Congenital lower urinary tract obstruction (cLUTO) treated at our tertiary care center between 1st of January 2016 and 30th of September 2020
For our initial data collection, we identified male and female patients with cLUTO aged 0–18 years using the ICD-10 code Q64.0-10
Summary
Congenital lower urinary tract obstruction (cLUTO) is an obstructive uropathy that occurs in 3.3/10.000 births and predominantly affects male newborns [1]. Others include anterior urethral valves, obstructive ureterocele, as well as urethral hypoplasia, stenosis and agenesis. Due to the outlet obstruction, severe oligo- or anhydramnios can occur resulting in pulmonary hypoplasia and potentially neonatal death. Of those who survive, up to a third need renal replacement therapy [5,6,7]. Characteristic findings include bilateral hydronephrosis with megacystis +/- thick-walled bladder. Fetal megacystis refers to a bladder diameter of ≥7 mm in the first trimester. It is defined as an abnormal distension of the thick-walled bladder failing to empty within 45 min of observation half the cases of megacystis show spontaneous resolution of the megacystis [8]
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