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Current State of Fetal Intervention for Lower Urinary Tract Obstruction

  • Pediatric Urology (D Weiss, Section Editor)
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Abstract

Purpose of the Review

In this article, we explore the origins of intervention of fetal lower urinary tract obstruction, and we specifically discuss the background and recent outcomes of vesicoamniotic shunt placement and fetal cystoscopy. The article seeks to provide a comprehensive overview of the field while bringing the reader quickly up to speed on the pertinent literature and the critical data that are available to guide decision-making regarding intervention.

Recent Findings

Appropriate patient selection for fetal intervention remains challenging despite advances in prenatal imaging. Both a randomized controlled trial and multiple systematic reviews show evidence of a perinatal survival benefit following fetal intervention but rates of renal morbidity remain very high.

Summary

Despite 30 years of research, fetal lower urinary tract obstruction remains a difficulty entity to treat. Intervention may lead to survival, but physicians and caregivers must remain alert for the distinct possibility of long-term renal morbidity in survivors.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Clementi M, Stoll C. The Euroscan study. Ultrasound Obstet Gynecol. 2001;18(4):297–300. https://doi.org/10.1046/j.0960-7692.2001.00555.x.

    Article  CAS  PubMed  Google Scholar 

  2. Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181(2):446–54. https://doi.org/10.1016/S0002-9378(99)70577-6.

    Article  CAS  PubMed  Google Scholar 

  3. Stefos T, Plachouras N, Sotiriadis A, Papadimitriou D, Almoussa N, Navrozoglou I, et al. Routine obstetrical ultrasound at 18-22 weeks: our experience on 7,236 fetuses. J Matern Fetal Med. 1999;8(2):64–9. https://doi.org/10.1002/(SICI)1520-6661(199903/04)8:2<64::AID-MFM7>3.0.CO;2-D.

    CAS  PubMed  Google Scholar 

  4. Anumba DO, Scott JE, Plant ND, Robson SC. Diagnosis and outcome of fetal lower urinary tract obstruction in the northern region of England. Prenat Diagn. 2005;25(1):7–13. https://doi.org/10.1002/pd.1074.

    Article  PubMed  Google Scholar 

  5. Malin G, Tonks AM, Morris RK, Gardosi J, Kilby MD. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG Int J Obstet Gynaecol. 2012;119(12):1455–64. https://doi.org/10.1111/j.1471-0528.2012.03476.x.

    Article  CAS  Google Scholar 

  6. Leithner K, Maar A, Fischer-Kern M, Hilger E, Löffler-Stastka H, Ponocny-Seliger E. Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome. Ultrasound Obstet Gynecol. 2004;23(3):240–6. https://doi.org/10.1002/uog.978.

    Article  CAS  PubMed  Google Scholar 

  7. Donald I, Macvicar J, Brown TG. Investigation of abdominal masses by pulsed ultrasound. Lancet. 1958;1(7032):1188–95.

    Article  CAS  PubMed  Google Scholar 

  8. Siddique J, Lauderdale DS, VanderWeele TJ, Lantos JD. Trends in prenatal ultrasound use in the United States: 1995 to 2006. Med Care. 2009;47(11):1129–35. https://doi.org/10.1097/MLR.0b013e3181b58fbf.

    Article  PubMed  Google Scholar 

  9. Hsieh MH, Lai J, Saigal CS. Trends in prenatal sonography use and subsequent urologic diagnoses and abortions in the United States. J Pediatr Urol. 2009;5(6):490–4. https://doi.org/10.1016/j.jpurol.2009.07.002.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grandjean H, Larroque D, Levi S. Sensitivity of routine ultrasound screening of pregnancies in the Eurofetus database. Ann N Y Acad Sci. 1998;847(1 ULTRASOUND SC):118–24. https://doi.org/10.1111/j.1749-6632.1998.tb08932.x.

    Article  CAS  PubMed  Google Scholar 

  11. Farrugia MK. Fetal bladder outlet obstruction: embryopathology, in utero intervention and outcome. J Pediatr Urol. 2016;12(5):296–303. https://doi.org/10.1016/j.jpurol.2016.05.047.

    Article  PubMed  Google Scholar 

  12. Krishnan A, De Souza A, Konijeti R, Baskin LS. The anatomy and embryology of posterior urethral valves. J Urol. 2006;175(4):1214–20. https://doi.org/10.1016/S0022-5347(05)00642-7.

    Article  PubMed  Google Scholar 

  13. Heikkilä J, Holmberg C, Kyllönen L, Rintala R, Taskinen S. Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol. 2011;186(6):2392–6. https://doi.org/10.1016/j.juro.2011.07.109.

    Article  PubMed  Google Scholar 

  14. Routh JC, Huang L, Retik AB, Nelson CP. Contemporary epidemiology and characterization of newborn males with prune belly syndrome. Urology. 2010;76(1):44–8. https://doi.org/10.1016/j.urology.2009.12.072.

    Article  PubMed  Google Scholar 

  15. Caldamone AA, Woodard J. Prune belly syndrome. In: McDougal WS, Wein AJ, Kavoussi L, Novick A, Partin A, Peters C, et al., editors. Campbell-Walsh Urol. Philladelphia: Elsevier; 2012. p. 3310–24. https://doi.org/10.1016/B978-1-4160-6911-9.00123-7.

    Chapter  Google Scholar 

  16. Gonzalez R, De Filippo R, Jednak R, Barthold JS. Urethral atresia: long-term outcome in 6 children who survived the neonatal period. J Urol. 2001;165(6):2241–4. https://doi.org/10.1016/S0022-5347(05)66174-5.

    Article  CAS  PubMed  Google Scholar 

  17. Reinberg Y, Chelimsky G, Gonzalez R. Urethral atresia and the prune belly syndrome. Report of 6 cases. Br J Urol. 1993;72(1):112–4. https://doi.org/10.1111/j.1464-410X.1993.tb06470.x.

    Article  CAS  PubMed  Google Scholar 

  18. Kuga T, Esato K, Sase M, Nakata M, Kaneko J, Inoue T. Prune belly syndrome with penile and urethral agenesis: report of a case. J Pediatr Surg. 1998;33(12):1825–8. https://doi.org/10.1016/S0022-3468(98)90297-4.

    Article  CAS  PubMed  Google Scholar 

  19. Nguyen HT, Herndon CDA, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6(3):212–31. https://doi.org/10.1016/j.jpurol.2010.02.205.

    Article  PubMed  Google Scholar 

  20. Zee RS, Herndon CDA, Cooper CS, Kim C, McKenna PH, Khoury A, et al. Time to resolution: a prospective evaluation from the Society for Fetal Urology hydronephrosis registry. J Pediatr Urol. 2017;13(3):316.e1–5. https://doi.org/10.1016/j.jpurol.2016.12.012.

    Article  CAS  Google Scholar 

  21. Mahony BS, Callen PW, Filly RA. Fetal urethral obstruction: US evaluation. Radiology. 1985;157(1):221–4. https://doi.org/10.1148/radiology.157.1.3898218.

    Article  CAS  PubMed  Google Scholar 

  22. Bernardes LS, Aksnes G, Saada J, Masse V, Elie C, Dumez Y, et al. Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol. 2009;34(4):419–23. https://doi.org/10.1002/uog.6413.

    Article  CAS  PubMed  Google Scholar 

  23. Underwood MA, Gilbert WM, Sherman MP. Amniotic fluid: not just fetal urine anymore. J Perinatol. 2005;25(5):341–8. https://doi.org/10.1038/sj.jp.7211290.

    Article  PubMed  Google Scholar 

  24. Smith LJ, McKay KO, van Asperen PP, Selvadurai H, Fitzgerald DA. Normal development of the lung and premature birth. Paediatr Respir Rev. 2010;11(3):135–42. https://doi.org/10.1016/j.prrv.2009.12.006.

    Article  PubMed  Google Scholar 

  25. Morris RK, Malin GL, Khan KS, Kilby MD. Antenatal ultrasound to predict postnatal renal function in congenital lower urinary tract obstruction: systematic review of test accuracy. BJOG Int J Obstet Gynaecol. 2009;116(10):1290–9. https://doi.org/10.1111/j.1471-0528.2009.02194.x.

    Article  CAS  Google Scholar 

  26. Pico H, Dabadie A, Bourliere-Najean B, Philip N, Capelle M, Aschero A, et al. Contribution of the foetal uro-MRI in the prenatal diagnosis of uronephropathies. Diagn Interv Imaging. 2014;95(6):573–8. https://doi.org/10.1016/j.diii.2014.02.011.

    Article  CAS  PubMed  Google Scholar 

  27. Alamo L, Laswad T, Schnyder P, Meuli R, Vial Y, Osterheld MC, et al. Fetal MRI as complement to US in the diagnosis and characterization of anomalies of the genito-urinary tract. Eur J Radiol. 2010;76(2):258–64. https://doi.org/10.1016/j.ejrad.2009.06.030.

    Article  PubMed  Google Scholar 

  28. Shipp TD, Bromley B, Pauker S, Frigoletto FD, Benacerraf BR. Outcome of singleton pregnancies with severe oligohydramnios in the second and third trimesters. Ultrasound Obstet Gynecol. 1996;7(2):108–13. https://doi.org/10.1046/j.1469-0705.1996.07020108.x.

    Article  CAS  PubMed  Google Scholar 

  29. Mercer LJ, Brown LG. Fetal outcome with oligohydramnios in the second trimester. Obstet Gynecol. 1986;67(6):840–2. https://doi.org/10.1097/00006250-198606000-00019.

    Article  CAS  PubMed  Google Scholar 

  30. Barss VA, Benacerraf BR, Frigoletto FD. Second trimester oligohydramnios, a predictor of poor fetal outcome. Obstet Gynecol. 1984;64(5):608–10.

    CAS  PubMed  Google Scholar 

  31. Hobbins JC, Romero R, Grannum P, Berkowitz RL, Cullen M, Mahoney M. Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy. Am J Obstet Gynecol. 1984;148(7):868–77. https://doi.org/10.1016/0002-9378(84)90528-3.

    Article  CAS  PubMed  Google Scholar 

  32. Reuss A, Stewart P, Wladimiroff J, Scholtmeijer R. Non-invasive management of fetal obstructive uropathy. Lancet. 1988;332(8617):949–51. https://doi.org/10.1016/S0140-6736(88)92609-8.

    Article  Google Scholar 

  33. Nicolini U, Spelizini F. Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn. 2001;21(11):964–9. https://doi.org/10.1002/pd.212.

    Article  CAS  PubMed  Google Scholar 

  34. Crombleholme TM, Harrison MR, Golbus MS, Longaker MT, Langer JC, Callen PW, et al. Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention. Am J Obstet Gynecol. 1990;162(5):1239–44. https://doi.org/10.1016/0002-9378(90)90026-4.

    Article  CAS  PubMed  Google Scholar 

  35. Evans M, Sacks A, Johnson M, Robichaux A, May M, Moghissi K. Sequential invasive assessment of fetal renal function and the intrauterine treatment of fetal obstructive uropathies. Obstet Gynecol. 1991;77(4):545–50.

    CAS  PubMed  Google Scholar 

  36. Johnson MP, Bukowski TP, Reitleman C, Isada NB, Pryde PG, Evans MI. In utero surgical treatment of fetal obstructive uropathy: a new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy. Am J Obstet Gynecol. 1994;170(5):1770–9. https://doi.org/10.1016/S0002-9378(12)91847-5.

    Article  CAS  PubMed  Google Scholar 

  37. Johnson MP, Corsi P, Bradfield W, Hume RF, Smith C, Flake AW, et al. Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy. Am J Obstet Gynecol. 1995;173(1):59–65. https://doi.org/10.1016/0002-9378(95)90170-1.

    Article  CAS  PubMed  Google Scholar 

  38. Biard J-M, Johnson MP, Carr MC, Wilson RD, Hedrick HL, Pavlock C, et al. Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction. Obstet Gynecol. 2005;106(3):503–8. https://doi.org/10.1097/01.AOG.0000171117.38929.eb.

    Article  PubMed  Google Scholar 

  39. Morris RK, Quinlan-Jones E, Kilby MD, Khan KS. Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn. 2007;27(10):900–11. https://doi.org/10.1002/pd.1810.

    Article  CAS  PubMed  Google Scholar 

  40. Klein J, Lacroix C, Caubet C, Siwy J, Zürbig P, Dakna M, et al. Fetal urinary peptides to predict postnatal outcome of renal disease in fetuses with posterior urethral valves (PUV). Sci Transl Med. 2013;5:198ra106.

    Article  PubMed  Google Scholar 

  41. Luton D, Delezoide AL, Leguy MC, Gobeaux C, Vuillard E, Grangé G, et al. Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney. Clin Biochem. 2013;46(15):1607–10. https://doi.org/10.1016/j.clinbiochem.2013.04.017.

    Article  CAS  PubMed  Google Scholar 

  42. Berry SM, Smith RS, Dombrowski MP, Puder KS, Cotton DB, Johnson MP, et al. Predictive value of fetal serum β2-microglobulin for neonatal renal function. Lancet. 1995;345(8960):1277–8. https://doi.org/10.1016/S0140-6736(95)90928-1.

    Article  CAS  PubMed  Google Scholar 

  43. Dommergues M, Muller F, Ngo S, Hohlfeld P, Oury JF, Bidat L, et al. Fetal serum β2-microglobulin predicts postnatal renal function in bilateral uropathies. Kidney Int. 2000;58(1):312–6. https://doi.org/10.1046/j.1523-1755.2000.00167.x.

    Article  CAS  PubMed  Google Scholar 

  44. Holmes N, Harrison MR, Baskin LS. Fetal surgery for posterior urethral valves: long-term postnatal outcomes. Pediatrics. 2001;108(1):e7. https://doi.org/10.1542/peds.108.1.e7.

    Article  CAS  PubMed  Google Scholar 

  45. Freedman AL, Bukowski TP, Smith CA, Evans MI, Johnson MP, Gonzalez R. Fetal therapy for obstructive uropathy: specific outcomes diagnosis. J Urol. 1996;156(2):720–4. https://doi.org/10.1016/S0022-5347(01)65795-1.

    Article  CAS  PubMed  Google Scholar 

  46. McLorie G, Farhat W, Khoury A, Geary D, Ryan G. Outcome analysis of vesicoamniotic shunting in a comprehensive population. J Urol. 2001;166(3):1036–40. https://doi.org/10.1016/S0022-5347(05)65913-7.

    Article  CAS  PubMed  Google Scholar 

  47. Quintero RA, Johnson MP, Romero R, Cotton DB, Evans MI, Smith C, et al. In-utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy. Lancet. 1995;346(8974):537–40. https://doi.org/10.1016/S0140-6736(95)91381-5.

    Article  CAS  PubMed  Google Scholar 

  48. Salam MA. Posterior urethral valve: outcome of antenatal intervention. Int J Urol. 2006;13(10):1317–22. https://doi.org/10.1111/j.1442-2042.2006.01555.x.

    Article  PubMed  Google Scholar 

  49. Ruano R, Sananes N, Wilson C, Au J, Koh CJ, Gargollo P, et al. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol. 2016;48(4):476–82. https://doi.org/10.1002/uog.15844.

    Article  CAS  PubMed  Google Scholar 

  50. • Ruano R, Dunn T, Braun MC, Angelo JR, Safdar A. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr Nephrol. 2017;32(10):1871–8. https://doi.org/10.1007/s00467-017-3593-8. Proposes a new staging system for assessing patients with fetal LUTO. The authors suggest intervention is only indicated for Stage II patients.

    Article  PubMed  Google Scholar 

  51. Ruano R, Safdar A, Au J, Koh CJ, Gargollo P, Shamshirsaz AA, et al. Defining and predicting “intrauterine fetal renal failure” in congenital lower urinary tract obstruction. Pediatr Nephrol. 2016;31(4):605–12. https://doi.org/10.1007/s00467-015-3246-8.

    Article  PubMed  Google Scholar 

  52. • Morris RK, Middleton LJ, Malin GL, Quinlan-Jones E, Daniels J, Khan KS, et al. Outcome in fetal lower urinary tract obstruction: a prospective registry. Ultrasound Obstet Gynecol. 2015;46(4):424–31. https://doi.org/10.1002/uog.14808. Parallel registry that accompanied the PLUTO trial. Explores data and outcomes from women not randomized to participate in the PLUTO trial.

    Article  CAS  PubMed  Google Scholar 

  53. Crombleholme TM, Harrison MR, Langer JC, Longaker MT, Anderson RL, Slotnick NS, et al. Early experience with open fetal surgery for congenital hydronephrosis. J Pediatr Surg. 1988;23(12):1114–21. https://doi.org/10.1016/S0022-3468(88)80325-7.

    Article  CAS  PubMed  Google Scholar 

  54. Holmes NM, Nguyen HT, Harrison MR, Farmer DL, Baskin LS. Fetal intervention for myelomeningocele: effect on postnatal bladder function. J Urol. 2001;166(6):2383–6. https://doi.org/10.1016/S0022-5347(05)65596-6.

    Article  CAS  PubMed  Google Scholar 

  55. Galati V, Beeson JH, Confer SD, Frimberger D, Campbell JB, Ramji FG, et al. A favorable outcome following 32 vesicocentesis and amnioinfusion procedures in a fetus with severe prune belly syndrome. J Pediatr Urol. 2008;4(2):170–2. https://doi.org/10.1016/j.jpurol.2007.04.003.

    Article  PubMed  Google Scholar 

  56. • Nassr AA, Shazly SAM, Abdelmagied AM, Araujo Júnior E, Tonni G, Kilby MD, et al. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;49(6):696–703. https://doi.org/10.1002/uog.15988. Most recent systematic review and meta-analysis of the available VAS literature. Highlights the challenges to improve postnatal renal function following intervention.

    Article  CAS  PubMed  Google Scholar 

  57. Sananes N, Cruz-Martinez R, Favre R, Ordorica-Flores R, Moog R, Zaloszy A, et al. Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 2016;36(4):297–303. https://doi.org/10.1002/pd.4771.

    Article  PubMed  Google Scholar 

  58. Harrison MR, Ross N, Noall R, de Lorimier AA. Correction of congenital hydronephrosis in utero I. The model: fetal urethral obstruction produces hydronephrosis and pulmonary hypoplasia in fetal lambs. J Pediatr Surg. 1983;18(3):247–56. https://doi.org/10.1016/S0022-3468(83)80094-3.

    Article  CAS  PubMed  Google Scholar 

  59. Harrison MR, Nakayama DK, Noall R, de Lorimier AA. Correction of congenital hydronephrosis in utero II. Decompression reverses the effects of obstruction on the fetal lung and urinary tract. J Pediatr Surg. 1982;17(6):965–74. https://doi.org/10.1016/S0022-3468(82)80476-4.

    Article  CAS  PubMed  Google Scholar 

  60. Golbus MS, Harrison MR, Filly RA, Callen PW, Katz M. In utero treatment of urinary tract obstruction. Am J Obstet Gynecol. 1982;142(4):383–8. https://doi.org/10.1016/S0002-9378(16)32377-8.

    Article  CAS  PubMed  Google Scholar 

  61. Harrison MR, Golbus MS, Filly RA, Callen PW, Katz M, de Lorimier AA, et al. Fetal surgery for congenital hydronephrosis. N Engl J Med. 1982;306(10):591–3. https://doi.org/10.1056/NEJM198203113061006.

    Article  CAS  PubMed  Google Scholar 

  62. Kurtz MP, Koh CJ, Jamail GA, Sangi-Haghpeykar H, Shamshirsaz AA, Espinoza J, et al. Factors associated with fetal shunt dislodgement in lower urinary tract obstruction. Prenat Diagn. 2016;36(8):720–5. https://doi.org/10.1002/pd.4850.

    Article  PubMed  Google Scholar 

  63. Ruano R, Sananes N, Sangi-Haghpeykar H, Hernandez-Ruano S, Moog R, Becmeur F, et al. Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol. 2015;45(4):452–8. https://doi.org/10.1002/uog.14652.

    Article  CAS  PubMed  Google Scholar 

  64. Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Diwakar L, Hemming K, et al. The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction. Health Technol Assess. 2013;17(59):1-232. https://doi.org/10.3310/hta17590.

  65. Morris RK, Malin GL, Khan KS, Kilby MD. Systematic review of the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction. BJOG Int J Obstet Gynaecol. 2010;117(4):382–90. https://doi.org/10.1111/j.1471-0528.2010.02500.x.

    Article  CAS  Google Scholar 

  66. • Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K, Burke D, et al. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013;382(9903):1496–506. https://doi.org/10.1016/S0140-6736(13)60992-7. Represents the only randomized trial of fetal intervention for LUTO in the literature. Highlights the difficulties in performing randomized studies for rare diseaes such as LUTO.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Manning FA, Harrison MR, Rodeck C. Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. N Engl J Med. 1986;315(5):336–40. https://doi.org/10.1056/NEJM198607313150532.

    Article  CAS  PubMed  Google Scholar 

  68. Morris RK, Ruano R, Kilby MD. Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review. Ultrasound Obstet Gynecol. 2011;37(6):629–37. https://doi.org/10.1002/uog.8981.

    Article  CAS  PubMed  Google Scholar 

  69. Clark TJ, Martin WL, Divakaran TG, Whittle MJ, Kilby MD, Khan KS. Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis. Obstet Gynecol. 2003;102(2):367–82.

    PubMed  Google Scholar 

  70. Morris RK, Daniels J, Deeks J, Field D, Kilby MD. The challenges of interventional trials in fetal therapy. Arch Dis Child Fetal Neonatal Ed. 2014;99(6):F448–50. https://doi.org/10.1136/archdischild-2013-305624.

    Article  PubMed  Google Scholar 

  71. Martínez JM, Masoller N, Devlieger R, Passchyn E, Gómez O, Rodo J, et al. Laser ablation of posterior urethral valves by fetal cystoscopy. Fetal Diagn Ther. 2015;37(4):267–73. https://doi.org/10.1159/000367805.

    Article  PubMed  Google Scholar 

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  1. Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children’s Way, 4102 Doctor’s Office Tower, Nashville, TN, 37232, USA

    Douglass B. Clayton & John W. Brock

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Clayton, D.B., Brock, J.W. Current State of Fetal Intervention for Lower Urinary Tract Obstruction. Curr Urol Rep 19, 12 (2018). https://doi.org/10.1007/s11934-018-0760-9

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