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Chapter 14.3 - Fetal urinary tract obstruction

Fetal cystoscopy

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Rodrigo Ruano ,
Anthony Johnson  and
Mark D. Kilby
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson
Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes
Affiliation:
Department of Obstetrics, Leiden University Medical Center
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Summary

Introduction

Congenital anomalies of the urinary tract are relatively common, affecting approximately 1:500 pregnancies in which obstructive uropathies account for the majority of cases [1–4]. Obstruction may be at different levels, at the ureteropelvic junction (upper level) or ureterovesical junction (mid level) or urethral (lower level). The upper and mid urinary tract obstructions may be unilateral or bilateral with different consequences depending on the laterality. When the obstruction is bilateral or at the level of urethra (bladder outflow obstruction known as lower urinary tract obstruction or LUTO), the perinatal prognosis is poor due to the consequences of reduced fetal micturition and urine retention, leading to severe oligohydramnios and renal damage [1–3].

According to a British study, LUTO affected 2.2 cases in 10 000 births in a northern region of England between 1984 and 1997 [5]. Despite the low incidence, LUTO has the greatest impact on perinatal and child health among the congenital uropathies [6].

The natural history of LUTO is dependent on the degree of bladder outflow obstruction (complete or partial) and gestational age at presentation. These two factors may be inter-related since complete bladder obstruction is associated with earlier manifestations of the obstructive uropathy.

Keywords

urinary tract obstructionobstructive uropathyposterior urethral valves (PUV)urethral atresia (UA)MRIfetal cystoscopybladder obstruction
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 253 - 260
Publisher: Cambridge University Press
Print publication year: 2012

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