Potential for correction of fetal obstructive uropathy: time for a randomized, controlled trial?

Abstract

Congenital obstructive uropathy comprises a heterogeneous group of pathologies affecting approximately 1 in 3000 pregnancies1. Although most of the affected fetuses are male (commonly having posterior urethral valves2), females may also be affected, often demonstrating more complex pathologies such as cloacal plate anomalies or urethral atresia3. Chronic lower urinary tract obstruction may result in abnormal renal development and function, prolonged oligohydramnios leading to pulmonary hypoplasia, and postural abnormalities, which are associated with high perinatal morbidity and mortality4. Over the last 30 years many clinical and experimental data have been amassed defining the natural history and pathogenesis of fetal urinary tract obstruction5. The diagnostic methods, predominantly ultrasound, used to define the anatomical diagnosis have constantly improved over this time and in some cases adjuvant techniques, such as fetoscopic cystoscopy, have improved the accuracy of diagnosis6,7. Despite these efforts there is still potential incongruity in terms of the eventual pathology identified in the neonatal period and correlation with the prenatal diagnosis8.