The PLUTO trial: a missed opportunity

Abstract

Posterior urethral valves and urethral atresia are the most common causes of fetal lower urinary tract obstruction (LUTO). These congenital anomalies are associated with severe oligohydramnios in utero, which in turn results in fetal lung hypoplasia, respiratory insufficiency at birth, and often neonatal death. If the urethral obstruction is incomplete, oligohydramnios and lung hypoplasia can be less severe, and therefore compatible with neonatal survival. These infants, however, have variable degrees of renal dysplasia and an almost 30% lifetime risk of end-stage kidney disease. 1 Heikkila J Holmberg C Kyllonen L Rintala R Taskinen S Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol. 2011; 186: 2392-2396 Summary Full Text Full Text PDF PubMed Scopus (84) Google Scholar Moreover, because of poor bladder cycling during fetal life, one in three surviving children will have bladder dysfunction (urinary retention, incontinence, or both). 2 Sarhan O Zaccaria I Macher MA et al. Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol. 2008; 179: 307-312 Summary Full Text Full Text PDF PubMed Scopus (73) Google Scholar Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trialSurvival seemed to be higher in the fetuses receiving vesicoamniotic shunting, but the size and direction of the effect remained uncertain, such that benefit could not be conclusively proven. Our results suggest that the chance of newborn babies surviving with normal renal function is very low irrespective of whether or not vesicoamniotic shunting is done. Full-Text PDF Open Access