Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity
ABSTRACT Objective To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity. Methods This was a retrospective cohort study of 25 cons...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2016-10, Vol.48 (4), p.476-482 |
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| creator | Ruano, R. Sananes, N. Wilson, C. Au, J. Koh, C. J. Gargollo, P. Shamshirsaz, A. A. Espinoza, J. Safdar, A. Moaddab, A. Meyer, N. Cass, D. L. Olutoye, O. O. Olutoye, O. A. Welty, S. Roth, D. R. Braun, M. C. Belfort, M. A. |
| description | ABSTRACT
Objective
To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.
Methods
This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.
Results
Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88–70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04–0.35), Pr(OR 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66–24.2), Pr(OR > 1) = 93.3%) were predictors of survival.
Conclusions
Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. |
| doi_str_mv | 10.1002/uog.15844 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03437490v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4203797491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5214-4335a70803776777992babc56cb88e5be4c7327e66b5038cdadb6023c02831953</originalsourceid><addsrcrecordid>eNqN0U1LHTEUBuBQKvXWdtE_UALdtIvRTD4n3YnUD7jgRtchkznXRmYm0ySjXFf96c3tWAuC4CohPHk5hxehTzU5rAmhR3O4OaxFw_kbtKq51BVRRLxFK6IlqZTUdB-9T-mWECI5k-_QPpVSk4bRFfp9Ctn2uA_3EPEc_WjjFudoXcahTTnOLvswfsdTDFNIRW5CxCnbsbOx8w_Q4WHus-98cn7ql-9ThNHuUgc72hsYYMy4tanYMOIiodxxgjuIPm8_oL2N7RN8fDwP0PXpj6uT82p9eXZxcryunKA1rzhjwirSEKaUVEppTVvbOiFd2zQgWuBOMapAylYQ1rjOdq0klDlCG1ZrwQ7QtyX3p-3NFP1QJjXBenN-vDa7N8I4U1yTu7rYr4stW_-aIWUzlP2g7-0IYU6mbqjSlGmtX0Ol5JIqVeiXZ_Q2zHEsS--UUIoLzf7P6WJIKcLmadiamF3bprRt_rZd7OfHxLkdoHuS_-ot4GgB976H7ctJ5vrybIn8AzLttBs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1825774593</pqid></control><display><type>article</type><title>Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Ruano, R. ; Sananes, N. ; Wilson, C. ; Au, J. ; Koh, C. J. ; Gargollo, P. ; Shamshirsaz, A. A. ; Espinoza, J. ; Safdar, A. ; Moaddab, A. ; Meyer, N. ; Cass, D. L. ; Olutoye, O. O. ; Olutoye, O. A. ; Welty, S. ; Roth, D. R. ; Braun, M. C. ; Belfort, M. A.</creator><creatorcontrib>Ruano, R. ; Sananes, N. ; Wilson, C. ; Au, J. ; Koh, C. J. ; Gargollo, P. ; Shamshirsaz, A. A. ; Espinoza, J. ; Safdar, A. ; Moaddab, A. ; Meyer, N. ; Cass, D. L. ; Olutoye, O. O. ; Olutoye, O. A. ; Welty, S. ; Roth, D. R. ; Braun, M. C. ; Belfort, M. A.</creatorcontrib><description>ABSTRACT
Objective
To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.
Methods
This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.
Results
Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88–70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04–0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63–25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66–24.2), Pr(OR > 1) = 93.3%) were predictors of survival.
Conclusions
Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.15844</identifier><identifier>PMID: 26690832</identifier><identifier>CODEN: UOGYFJ</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Bayes Theorem ; cystoscopy ; Cystoscopy - methods ; Disease Management ; Female ; Fetal Diseases - diagnosis ; Fetal Diseases - surgery ; fetal lower urinary tract obstruction ; fetal surgery ; Human health and pathology ; Humans ; Kidney Function Tests ; laser ; Life Sciences ; posterior urethral valves ; Pregnancy ; Prenatal Care - methods ; prenatal diagnosis ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; ultrasonography ; Urinary Bladder Neck Obstruction - diagnosis ; Urinary Bladder Neck Obstruction - surgery ; vesicoamniotic shunt</subject><ispartof>Ultrasound in obstetrics & gynecology, 2016-10, Vol.48 (4), p.476-482</ispartof><rights>Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5214-4335a70803776777992babc56cb88e5be4c7327e66b5038cdadb6023c02831953</citedby><cites>FETCH-LOGICAL-c5214-4335a70803776777992babc56cb88e5be4c7327e66b5038cdadb6023c02831953</cites><orcidid>0000-0001-8494-0697</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.15844$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.15844$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26690832$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-03437490$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruano, R.</creatorcontrib><creatorcontrib>Sananes, N.</creatorcontrib><creatorcontrib>Wilson, C.</creatorcontrib><creatorcontrib>Au, J.</creatorcontrib><creatorcontrib>Koh, C. J.</creatorcontrib><creatorcontrib>Gargollo, P.</creatorcontrib><creatorcontrib>Shamshirsaz, A. A.</creatorcontrib><creatorcontrib>Espinoza, J.</creatorcontrib><creatorcontrib>Safdar, A.</creatorcontrib><creatorcontrib>Moaddab, A.</creatorcontrib><creatorcontrib>Meyer, N.</creatorcontrib><creatorcontrib>Cass, D. L.</creatorcontrib><creatorcontrib>Olutoye, O. O.</creatorcontrib><creatorcontrib>Olutoye, O. A.</creatorcontrib><creatorcontrib>Welty, S.</creatorcontrib><creatorcontrib>Roth, D. R.</creatorcontrib><creatorcontrib>Braun, M. C.</creatorcontrib><creatorcontrib>Belfort, M. A.</creatorcontrib><title>Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>ABSTRACT
Objective
To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.
Methods
This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.
Results
Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88–70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04–0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63–25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66–24.2), Pr(OR > 1) = 93.3%) were predictors of survival.
Conclusions
Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</description><subject>Bayes Theorem</subject><subject>cystoscopy</subject><subject>Cystoscopy - methods</subject><subject>Disease Management</subject><subject>Female</subject><subject>Fetal Diseases - diagnosis</subject><subject>Fetal Diseases - surgery</subject><subject>fetal lower urinary tract obstruction</subject><subject>fetal surgery</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Kidney Function Tests</subject><subject>laser</subject><subject>Life Sciences</subject><subject>posterior urethral valves</subject><subject>Pregnancy</subject><subject>Prenatal Care - methods</subject><subject>prenatal diagnosis</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>ultrasonography</subject><subject>Urinary Bladder Neck Obstruction - diagnosis</subject><subject>Urinary Bladder Neck Obstruction - surgery</subject><subject>vesicoamniotic shunt</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0U1LHTEUBuBQKvXWdtE_UALdtIvRTD4n3YnUD7jgRtchkznXRmYm0ySjXFf96c3tWAuC4CohPHk5hxehTzU5rAmhR3O4OaxFw_kbtKq51BVRRLxFK6IlqZTUdB-9T-mWECI5k-_QPpVSk4bRFfp9Ctn2uA_3EPEc_WjjFudoXcahTTnOLvswfsdTDFNIRW5CxCnbsbOx8w_Q4WHus-98cn7ql-9ThNHuUgc72hsYYMy4tanYMOIiodxxgjuIPm8_oL2N7RN8fDwP0PXpj6uT82p9eXZxcryunKA1rzhjwirSEKaUVEppTVvbOiFd2zQgWuBOMapAylYQ1rjOdq0klDlCG1ZrwQ7QtyX3p-3NFP1QJjXBenN-vDa7N8I4U1yTu7rYr4stW_-aIWUzlP2g7-0IYU6mbqjSlGmtX0Ol5JIqVeiXZ_Q2zHEsS--UUIoLzf7P6WJIKcLmadiamF3bprRt_rZd7OfHxLkdoHuS_-ot4GgB976H7ctJ5vrybIn8AzLttBs</recordid><startdate>201610</startdate><enddate>201610</enddate><creator>Ruano, R.</creator><creator>Sananes, N.</creator><creator>Wilson, C.</creator><creator>Au, J.</creator><creator>Koh, C. J.</creator><creator>Gargollo, P.</creator><creator>Shamshirsaz, A. A.</creator><creator>Espinoza, J.</creator><creator>Safdar, A.</creator><creator>Moaddab, A.</creator><creator>Meyer, N.</creator><creator>Cass, D. L.</creator><creator>Olutoye, O. O.</creator><creator>Olutoye, O. A.</creator><creator>Welty, S.</creator><creator>Roth, D. R.</creator><creator>Braun, M. C.</creator><creator>Belfort, M. A.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><general>Wiley-Blackwell</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-8494-0697</orcidid></search><sort><creationdate>201610</creationdate><title>Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity</title><author>Ruano, R. ; Sananes, N. ; Wilson, C. ; Au, J. ; Koh, C. J. ; Gargollo, P. ; Shamshirsaz, A. A. ; Espinoza, J. ; Safdar, A. ; Moaddab, A. ; Meyer, N. ; Cass, D. L. ; Olutoye, O. O. ; Olutoye, O. A. ; Welty, S. ; Roth, D. R. ; Braun, M. C. ; Belfort, M. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5214-4335a70803776777992babc56cb88e5be4c7327e66b5038cdadb6023c02831953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Bayes Theorem</topic><topic>cystoscopy</topic><topic>Cystoscopy - methods</topic><topic>Disease Management</topic><topic>Female</topic><topic>Fetal Diseases - diagnosis</topic><topic>Fetal Diseases - surgery</topic><topic>fetal lower urinary tract obstruction</topic><topic>fetal surgery</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Kidney Function Tests</topic><topic>laser</topic><topic>Life Sciences</topic><topic>posterior urethral valves</topic><topic>Pregnancy</topic><topic>Prenatal Care - methods</topic><topic>prenatal diagnosis</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>ultrasonography</topic><topic>Urinary Bladder Neck Obstruction - diagnosis</topic><topic>Urinary Bladder Neck Obstruction - surgery</topic><topic>vesicoamniotic shunt</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruano, R.</creatorcontrib><creatorcontrib>Sananes, N.</creatorcontrib><creatorcontrib>Wilson, C.</creatorcontrib><creatorcontrib>Au, J.</creatorcontrib><creatorcontrib>Koh, C. J.</creatorcontrib><creatorcontrib>Gargollo, P.</creatorcontrib><creatorcontrib>Shamshirsaz, A. A.</creatorcontrib><creatorcontrib>Espinoza, J.</creatorcontrib><creatorcontrib>Safdar, A.</creatorcontrib><creatorcontrib>Moaddab, A.</creatorcontrib><creatorcontrib>Meyer, N.</creatorcontrib><creatorcontrib>Cass, D. L.</creatorcontrib><creatorcontrib>Olutoye, O. O.</creatorcontrib><creatorcontrib>Olutoye, O. A.</creatorcontrib><creatorcontrib>Welty, S.</creatorcontrib><creatorcontrib>Roth, D. R.</creatorcontrib><creatorcontrib>Braun, M. C.</creatorcontrib><creatorcontrib>Belfort, M. A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruano, R.</au><au>Sananes, N.</au><au>Wilson, C.</au><au>Au, J.</au><au>Koh, C. J.</au><au>Gargollo, P.</au><au>Shamshirsaz, A. A.</au><au>Espinoza, J.</au><au>Safdar, A.</au><au>Moaddab, A.</au><au>Meyer, N.</au><au>Cass, D. L.</au><au>Olutoye, O. O.</au><au>Olutoye, O. A.</au><au>Welty, S.</au><au>Roth, D. R.</au><au>Braun, M. C.</au><au>Belfort, M. A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2016-10</date><risdate>2016</risdate><volume>48</volume><issue>4</issue><spage>476</spage><epage>482</epage><pages>476-482</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><coden>UOGYFJ</coden><abstract>ABSTRACT
Objective
To present a single center experience of a standardized prenatal multidisciplinary management protocol for fetal lower urinary tract obstruction (LUTO) and to propose a classification of fetal LUTO based on disease severity.
Methods
This was a retrospective cohort study of 25 consecutive fetal patients with prenatal diagnosis of primary LUTO. Fetal intervention was offered after evaluation by a multidisciplinary team. Analyses were conducted using Bayesian methodology to determine predictors of survival at 6 months postpartum. Odds ratios (ORs) with 95% credibility intervals are reported.
Results
Fifteen (60.0%) of the 25 patients referred for assessment survived to postnatal evaluation. Fetal vesicoamniotic shunt was placed in 14 (56.0%) patients with 12 survivors. Multivariable analysis suggested that fetal intervention (OR, 6.97 (0.88–70.16), Pr(OR > 1) = 96.7%), anhydramnios (OR, 0.12 (0.04–0.35), Pr(OR < 1) = 99.9%), favorable fetal urine analysis (OR, 3.98 (0.63–25.15), Pr(OR > 1) = 92.7%) and absence of renal cortical cysts (OR, 3.9 (0.66–24.2), Pr(OR > 1) = 93.3%) were predictors of survival.
Conclusions
Fetal intervention and fetal renal function were independently associated with postnatal survival of fetuses with LUTO. A classification based on the severity of disease is proposed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>26690832</pmid><doi>10.1002/uog.15844</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-8494-0697</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Bayes Theorem cystoscopy Cystoscopy - methods Disease Management Female Fetal Diseases - diagnosis Fetal Diseases - surgery fetal lower urinary tract obstruction fetal surgery Human health and pathology Humans Kidney Function Tests laser Life Sciences posterior urethral valves Pregnancy Prenatal Care - methods prenatal diagnosis Prognosis Retrospective Studies Survival Analysis Treatment Outcome ultrasonography Urinary Bladder Neck Obstruction - diagnosis Urinary Bladder Neck Obstruction - surgery vesicoamniotic shunt |
| title | Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity |
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