Abstract
Purpose
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.
Materials and methods
We created obstructive uropathy in 60-day gestation fetal lambs. A V-A shunt was placed 3 weeks later, using a low-pressure (Group L: 15–54 mmH2O) or a high-pressure (Group H: 95–150 mmH2O) V-P shunt. We included non-shunted (obstructive uropathy, Group O) and control lambs (Group C). All were delivered at 130 days. Bladder volumes, bladder thickness, renal and bladder histology were compared.
Results
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 1,150 ml in Group H, 115 ± 67.9 ml in Group L, 128 ± 99.8 ml in Group O and 24.5 ± 3.84 ml in Group C. Unlike Group O lambs, Group L did not have urinary ascites, urinomas or renal dysplasia.
Conclusion
Low-pressure shunts preserved both bladder volume and renal development. High-pressure shunts did neither.
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Acknowledgments
This study was supported by the Japanese Society for Grant-in-aid of Scientific Research (C) and by a grant from “Phil & Teds” through the Wellington Surgical Research Trust. Suture materials were supplied by COVIDIEN Japan. All animals are consistently bred to timing of 24 h by Doug Jensen in Wairarapa, New Zealand. The authors thank Shigeko Ohnuma and the other staff in the Department of Pathology in St. Marianna University school of Medicine for assistance in processing the histology.
Conflict of interest
The authors declare that they have no conflict of interest.
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Kitagawa, H., Seki, Y., Nagae, H. et al. Valved shunt as a treatment for obstructive uropathy: does pressure make a difference?. Pediatr Surg Int 29, 381–386 (2013). https://doi.org/10.1007/s00383-012-3249-5
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DOI: https://doi.org/10.1007/s00383-012-3249-5