Skip to main content
SpringerLink
Log in

Fetal Urology

  • Chapter
  • First Online:
Kidney and Urinary Tract Diseases in the Newborn

  • 1346 Accesses

Abstract

With the advent of prenatal screening, a new population of urological patients has been identified – the fetus. In fact, genitourinary tract anomalies are among the most common congenital anomalies, noted in 1:250–1:1,000 pregnancies. Prenatal ultrasound detects 73–82 % of these anomalies [16, 54]. Many of these patients have transient hydronephrosis that will resolve without medical intervention either during pregnancy or in infancy. Others, such as those with unilateral problems have correctable anomalies that do not warrant intervention during pregnancy as they can be corrected postnatally without any adverse consequences to the child. Consequently, the dilemma following prenatal identification of a urological problem is to identify patients who have a clinical anomaly that is significant enough that prenatal treatment is required and further still in whom the treatment will be beneficial.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Adzick SN, Harrison MR, Glick PL, Flake AE (1985) Fetal urinary tract obstruction: experimental physiology. Semin Perinatol 9:79–90

    CAS  PubMed  Google Scholar 

  2. Agarwal SK, Fisk NM (2001) In utero therapy for lower urinary tract obstruction. Prenat Diagn 21:970–976

    Article  CAS  PubMed  Google Scholar 

  3. Aoba T, Kitagawa H et al (2008) Can a pressure-limited vesico-amniotic shunt tube preserve normal bladder function? J Pediatr Surg 43:2250–2255

    Article  PubMed  Google Scholar 

  4. Bernardes LS, Aksnes G, Saada J et al (2009) Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol 34:419–423

    Article  CAS  PubMed  Google Scholar 

  5. Biard JM, Johnson MP, Carr MC et al (2005) Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction. Obstet Gynecol 106(3):503–508

    Article  PubMed  Google Scholar 

  6. Clark TJ, Martin WL et al (2003) Prenatal bladder drainage in the management of fetal LUTO: a systematic review and meta-analysis. Obstet Gynecol 102:367–382

    Article  PubMed  Google Scholar 

  7. Coplen DE, Hare JY, Zderic SA et al (1991) 10 year experience with prenatal intervention for hydronephrosis. J Urol 156:1142–1145

    Article  Google Scholar 

  8. Crombleholme TM, Harrison MR, Golbus MS et al (1990) Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention. Am J Obstet Gynecol 162:1239–1244

    Article  CAS  PubMed  Google Scholar 

  9. Crombleholme TM, Harrison MR, Langer JC et al (1988) Early experience with open fetal surgery for congenital hydronephrosis. J Pediatr Surg 23:1114–1121

    Article  CAS  PubMed  Google Scholar 

  10. Deprest JA, Flake AW et al (2010) The making of fetal surgery. Prenat Diagn 30:653–667

    Article  PubMed  Google Scholar 

  11. Duckett JW (1997) Are valve bladders congenital or iatrogenic? Br J Urol 79:271–275

    Article  CAS  PubMed  Google Scholar 

  12. Elder JS, Duckett JW Jr, Snyder HM (1987) Intervention for fetal obstructive uropathy: has it been effective? Lancet 2:1007

    Article  CAS  PubMed  Google Scholar 

  13. Farrugia MK, Woolf AS (2010) Congenital urinary bladder outlet obstruction. Fetal Matern Med Rev 21:55–73

    Article  Google Scholar 

  14. Freedman AL, Bokowski TP, Smith CA et al (1996) Fetal therapy for obstructive uropathy: specific outcome diagnoses. J Urol 156:720–723

    Article  CAS  PubMed  Google Scholar 

  15. Freedman AL, Johnson MP, Smith CA et al (1999) Long-term outcomes in children after antenatal intervention for obstructive uropathies. Lancet 354:374–377

    Article  CAS  PubMed  Google Scholar 

  16. Garne E, Loane M, Wellesley D et al (2009) Congenital hydronephrosis: prenatal diagnosis and epidemiology in Europe. J Pediatr Urol 5:47–52

    Article  PubMed  Google Scholar 

  17. Gilpin SA, Gosling JA (1983) Smooth muscle in the wall of the developing human urinary bladder and urethra. J Anat 137:503–512

    PubMed Central  PubMed  Google Scholar 

  18. Gloor JM (1995) Management of prenatally detected fetal hydronephrosis. Mayo Clin Proc 70:145–152

    Article  CAS  PubMed  Google Scholar 

  19. Golbus MS, Harrison MR, Filly RA et al (1982) In utero treatment of urinary tract obstruction. Am J Obstet Gynecol 142:383–388

    CAS  PubMed  Google Scholar 

  20. Harrison M, Ross N, Hoall R, de Lorimer A (1983) Correction of congenital hydronephrosis in utero 1. The model: fetal urethral obstruction produces hydronephrosis and pulmonary hypoplasia in fetal lambs. J Pediatr Surg 18:247–256

    Article  CAS  PubMed  Google Scholar 

  21. Hislop A, Hey E, Reid L (1979) The lung in congenital bilateral renal agenesis and dysplasia. Arch Dis Child 54:32–39

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Holmes N, Harrison MR, Baskin LS (2001) Fetal surgery for posterior urethral valves: long term postnatal outcomes. Pediatrics 108:36–42

    Article  Google Scholar 

  23. Johnson MP, Bokowski TP, Reitleman C et al (1994) In utero surgical treatment of fetal obstructive uropathy: a new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy. Am J Obstet Gynecol 170:1770–1776

    Article  CAS  PubMed  Google Scholar 

  24. Johnson MP, Corsi P et al (1995) Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy. Am J Obstet Gynecol 173:59–65

    Article  CAS  PubMed  Google Scholar 

  25. Kitagawa H, Pringle KC et al (2007) Is a vesicoamniotic shunt intrinsically bad? Shunting a normal fetal bladder. J Pediatr Surg 42:2002–2006

    Article  PubMed  Google Scholar 

  26. Kumar S, Fisk NM (2003) Distal urinary obstruction. Clin Perinatol 30:507–519

    Article  PubMed  Google Scholar 

  27. Lissauer D, Morris RK, Kilby MD (2007) Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med 12:464–470

    Article  PubMed  Google Scholar 

  28. Macdonald MS, Emery JL (1959) The late intrauterine and postnatal development of human renal glomeruli. J Anat 93:331–340

    PubMed Central  CAS  PubMed  Google Scholar 

  29. Mahony BS, Callen PW, Filly RA (1985) Fetal urethral obstruction: ultrasound evaluation. Radiology 157:221–224

    Article  CAS  PubMed  Google Scholar 

  30. Mann S, Johnson MP, Wilson RD (2010) Fetal thoracic and bladder shunts. Semin Fetal Neonatal Med 15:28–33

    Article  PubMed  Google Scholar 

  31. Manning FA, Harrison MR, Rodeck C (1986) Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. N Engl J Med 315:336–340

    Article  CAS  PubMed  Google Scholar 

  32. Melo BF, Aguiar MB, Bouzada MCF et al (2012) Early risk factors for neonatal mortality in CAKUT: analysis of 524 affected newborns. Pediatr Nephrol 27:965–972

    Article  PubMed  Google Scholar 

  33. Morris RK, Kilby MD (2009) An overview of the literature on congenital LUTO and introduction to the PLUTO trial: percutaneous shunting in lower urinary tract obstruction. Aust NZ J Obstet Gynecol 49:6–10

    Article  Google Scholar 

  34. Morris R, Kilby M (2012) The PLUTO trial: percutaneous shunting in lower urinary tract obstruction. Am J Obstet Gynecol 206:S14

    Article  Google Scholar 

  35. Morris RK, Malin GL, Kjan KS et al (2009) Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG 116:1290–1299

    Article  CAS  PubMed  Google Scholar 

  36. Morris RK, Quinlan-Jones E et al (2007) Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn 27:900–911

    Article  CAS  PubMed  Google Scholar 

  37. Nakayama DK, Harrison MR, deLorimier AA (1986) Prognosis of posterior urethral valves presenting at birth. J Pediatr Surg 21:43

    Article  CAS  PubMed  Google Scholar 

  38. Nicolini U, Spelzini F (2001) Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn 21:964–969

    Article  CAS  PubMed  Google Scholar 

  39. Paduamo L, Giglio L, Bambi B et al (1991) Clinical outcomes of prenatal echography positive for obstructive uropathy. J Urol 146:1094–1096

    Google Scholar 

  40. Park JM (2012) Chapter 111: Normal development of the Genitourinary tract. In: Wein AJ, Kavoussi LR et al (eds) Campbell-Walsh urology, 10th edn. Saunders, Philadelphia

    Google Scholar 

  41. Poutamo J, Vanninen R et al (2000) Diagnosing fetal urinary tract anomalies: benefits of MRI compared to ultrasonography. Acta Obstet Gynecol Scand 79:65–71

    Article  CAS  PubMed  Google Scholar 

  42. Quintero RA, Castro LAG, Bermudez C et al (2010) In utero management of fetal LUTO with a novel shunt: a landmark development in fetal therapy. J Matern Fetal Neonatal Med 23:806–812

    Article  PubMed  Google Scholar 

  43. Quintero RA, Johnson MP, Munoz H et al (1998) In utero endoscopic treatment of posterior urethral valves: preliminary experience. Prenat Neonatal Med 3:208–216

    Google Scholar 

  44. Quintero RA, Johnson MP, Romero R et al (1995) In utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy. Lancet 346(8974):537–540

    Article  CAS  PubMed  Google Scholar 

  45. Quintero RA, Shukla AR, Homsy YL, Bukkapatnam R (2000) Successful in utero endoscopic ablation of posterior urethral valves: a new dimension in fetal urology. Urology 55:774

    Article  CAS  PubMed  Google Scholar 

  46. Qureshi F, Jacques SM et al (1996) In utero fetal urine analysis and renal histology do correlate with the outcome in fetal obstructive uropathies. Fetal Diagn Ther 11:306–312

    Article  CAS  PubMed  Google Scholar 

  47. Reuss A, Wladirmiroff J et al (1987) Antenatal diagnosis of renal tract anomalies by ultrasound. Pediatr Nephrol 1:546–552

    Article  CAS  PubMed  Google Scholar 

  48. Robyr R, Benachi A, Daikha-Dahmane F et al (2005) Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol 25:478–482

    Article  CAS  PubMed  Google Scholar 

  49. Ruano R (2011) Fetal surgery for severe LUTO. Prenat Diagn 31:667–674

    Article  PubMed  Google Scholar 

  50. Ruano R, Duarte S, Bunduki V et al (2010) Fetal cystoscopy for severe lower urinary tract obstruction – initial experience of a single center. Prenat Diagn 30:30–39

    PubMed  Google Scholar 

  51. Sebire N, Kaisenbery CV, Rubio C, Snijders R, Nicolaides K (1996) Fetal megacystis at 10–14 weeks of gestation. Ultrasound Obstet Gynecol 8:387–390

    Article  CAS  PubMed  Google Scholar 

  52. Shimada K, Hosokawa S (1996) Renal development in fetal hydronephrosis. Dialogues Pediatr Urol 2:2–3

    Google Scholar 

  53. Welsh A, Agarwal S, Kumar S et al (2003) Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre. Prenat Diagn 23:1033–1041

    Article  PubMed  Google Scholar 

  54. Wiesel A, Queisser-Luft A et al (2005) Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: an analysis of 709,030 births in 12 European countries. Eur J Med Genet 48:131–144

    Article  CAS  PubMed  Google Scholar 

  55. Wilkins IA, Chitkara U, Lynch L et al (1987) The nonpredictive value of fetal urinary electrolytes: preliminary report of outcomes and correlations with pathologic diagnosis. Am J Obstet Gynecol 157:694–698

    Article  CAS  PubMed  Google Scholar 

  56. Yiee J, Wilcox DT (2008) Abnormalities of the fetal bladder. Semin Fetal Neonatal Med 13:164–170

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Department of Pediatric Urology, Children’s Hospital Colorado, 13123 East 16th Avenue, 463, Aurora, CO, 80045, USA

    Amy Hou & Duncan Wilcox MD

Authors
  1. Amy Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Duncan Wilcox MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Duncan Wilcox MD .

Editor information

Editors and Affiliations

  1. Division of Pediatric Nephrology, Hypertension and Renal Transplantation, Kentucky Children’s Hospital, University of Kentucky, Lexington, Kentucky, USA

    Aftab S. Chishti

  2. Urogenital Center, Division of Pediatric Urology, Cincinnati Children’s Medical Center, Cincinnati, Ohio, USA

    Shumyle Alam

  3. Division of Pediatrics, University of Kentucky Children's Hospital, Lexington, Kentucky, USA

    Stefan G. Kiessling

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Hou, A., Wilcox, D. (2014). Fetal Urology. In: Chishti, A., Alam, S., Kiessling, S. (eds) Kidney and Urinary Tract Diseases in the Newborn. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39988-6_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-39988-6_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-39987-9

  • Online ISBN: 978-3-642-39988-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation