Valved shunt as a treatment for obstructive uropathy: does pressure make a difference?

Abstract

A valved ventriculo-peritoneal shunt (V-P shunt) as a vesico-amniotic shunt (V-A shunt) preserves the filling/emptying cycle and normal bladder development in fetal lambs with bladder outlet obstruction. The optimal pressure for such shunts is unknown. We created obstructive uropathy in 60-day gestation fetal lambs. A V-A shunt was placed 3weeks later, using a low-pressure (Group L: 15-54mmH2O) or a high-pressure (Group H: 95-150mmH2O) V-P shunt. We included non-shunted (obstructive uropathy, Group O) and control lambs (Group C). All were delivered at 130days. Bladder volumes, bladder thickness, renal and bladder histology were compared. Seventeen lambs had an obstructive uropathy created. Five Group L (four survived), four Group H (three survived) and five Group O survived. Body weight and crown-to-rump lengths of the three groups were not significantly different. Group H lambs had a dilated urachus, urinary ascites and severe ureteral dilatation similar to Group O lambs. There were four Group C lambs. Bladder volume was 10, 15 and 1,150ml in Group H, 115±67.9ml in Group L, 128±99.8ml in Group O and 24.5±3.84ml in Group C. Unlike Group O lambs, Group L did not have urinary ascites, urinomas or renal dysplasia. Low-pressure shunts preserved both bladder volume and renal development. High-pressure shunts did neither.