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Wilpers A, Lynn AY, Eichhorn B, Powne AB, Lagueux M, Batten J, Bahtiyar MO, Gross CP. Understanding Sociodemographic Disparities in Maternal-Fetal Surgery Study Participation. Fetal Diagn Ther 2022; 49:125-137. [PMID: 35272297 PMCID: PMC9117502 DOI: 10.1159/000523867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Although maternal-fetal surgery to treat fetal anomalies such as spina bifida continues to grow more common, potential health disparities in the field remain relatively unexamined. To address this gap, we identified maternal-fetal surgery studies with the highest level of evidence and analyzed the reporting of participant sociodemographic characteristics and representation of racial and ethnic groups. METHODS We conducted a systematic review of the scientific literature using biomedical databases. We selected randomized control trials (RCTs) and cohort studies with comparison groups published in English from 1990 to May 5, 2020. We included studies from across the globe that examined the efficacy of fetal surgery for twin-twin transfusion syndrome (TTTS), obstructive uropathy, congenital diaphragmatic hernia (CDH), myelomeningocele (MMC), thoracic lesions, cardiac malformations, or sacrococcygeal teratoma. We determined the frequency of reporting of age, gravidity/parity, race, ethnicity, education level, language spoken, insurance, income level, and relationship status. We identified whether sociodemographic factors were used as inclusion or exclusion criteria. We calculated the racial and ethnic group representation for studies in the USA using the participation-to-prevalence ratio (PPR). RESULTS We included 112 studies (10 RCTs, 102 cohort) published from 1990-1999 (8%), 2000-2009 (30%), and 2010-2020 (62%). Most studies were conducted in the USA (47%) or Europe (38%). The median sample size was 58. TTTS was the most common disease group (37% of studies), followed by MMC (23%), and CDH (21%). The most frequently reported sociodemographic variables were maternal age (33%) and gravidity/parity (20%). Race and/or ethnicity was only reported in 12% of studies. Less than 10% of studies reported any other sociodemographic variables. Sociodemographic variables were used as exclusion criteria in 13% of studies. Among studies conducted in the USA, White persons were consistently overrepresented relative to their prevalence in the US disease populations (PPR 1.32-2.11), while Black or African-American, Hispanic or Latino, Asian, American-Indian or Alaska-Native, and Native-Hawaiian or other Pacific Islander persons were consistently underrepresented (PPR 0-0.60). CONCLUSIONS Sociodemographic reporting quality in maternal-fetal surgery studies is poor and inhibits examination of potential health disparities. Participants enrolled in studies in the USA do not adequately represent the racial and ethnic diversity of the population across disease groups.
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Affiliation(s)
- Abigail Wilpers
- National Clinician Scholars Program, Yale School of Medicine and Yale School of Nursing, New Haven, Connecticut, USA.,Fetal Care Center, Yale New Haven Hospital, New Haven, Connecticut, USA.,Fetal Therapy Nurse Network, Chicago, Illinois, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anna Y Lynn
- Department of Biomedical Engineering, Yale School of Medicine, New Haven, Connecticut, USA
| | - Barbara Eichhorn
- Fetal Therapy Nurse Network, Chicago, Illinois, USA.,Fetal Diagnosis and Treatment Centers, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania, USA
| | - Amy B Powne
- Fetal Therapy Nurse Network, Chicago, Illinois, USA.,UC Davis Fetal Care and Treatment Center, Sacramento, California, USA
| | - Megan Lagueux
- Fetal Therapy Nurse Network, Chicago, Illinois, USA.,Neonatal Intensive Care Unit, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Janene Batten
- Department of Research and Education Services, Yale University, New Haven, Connecticut, USA
| | - Mert Ozan Bahtiyar
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cary P Gross
- National Clinician Scholars Program, Yale School of Medicine and Yale School of Nursing, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Basak D. Evolution of Management of Posterior Urethral Valve. J Indian Assoc Pediatr Surg 2021; 26:367-369. [PMID: 34912131 PMCID: PMC8637996 DOI: 10.4103/jiaps.jiaps_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dhananjay Basak
- Department of Pediatric Surgery, Park Clinic, Kolkata, West Bengal, India
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Gross Hematuria as a Presenting Feature of Posterior Urethral Valves in a Neonate with Normal Antenatal Sonograms. MEDICINES 2020; 7:medicines7010005. [PMID: 31936198 PMCID: PMC7168229 DOI: 10.3390/medicines7010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
Background: Posterior urethral valves (PUVs) are usually suspected during antenatal sonograms or by postnatal evidence of bilateral hydronephrosis with enlarged bladder. Gross hematuria as an initial manifestation of PUV with a history of normal antenatal sonogram is very rare. Methods: This is a retrospective chart study. Results: We describe a nine-day-old male neonate who presented with gross hematuria and was later found to have a urinary tract infection (UTI) and severe acute kidney injury (AKI). The mother apparently had normal antenatal sonograms with no evidence of fetal hydronephrosis. The child did not have postnatal renal bladder sonogram done until gross hematuria occurred at Day 9 of life. Sonogram showed bilateral severe hydronephrosis and hydroureter with enlarged bladder. The patient underwent ablation of the PUVs after initial bladder decompression with indwelling urethral catheterization. His AKI resolved after prompt treatment of UTI and PUV ablation. Conclusions: This report emphasizes the importance of a high index of suspicion for obstructive uropathy in a newborn with gross hematuria irrespective of prenatal sonogram findings.
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Renal outcomes of neonates with early presentation of posterior urethral valves: a 10-year single center experience. J Perinatol 2020; 40:112-117. [PMID: 31471579 PMCID: PMC7223871 DOI: 10.1038/s41372-019-0489-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/30/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evaluate renal outcomes and early predictive factors in infants with congenital posterior urethral valves who required catheter or surgical urinary tract decompression within the first 7 days of life. STUDY DESIGN A 10-year retrospective study at a single hospital. Primary outcomes were estimated glomerular filtration rate (eGFR) and development of end stage renal disease (ESRD). RESULTS Of 35 infants, 50% developed eGFR <90 mL/min/1.73 m2 and 15% progressed to ESRD. Nadir creatinine, need for invasive ventilation in the newborn period, and need for surgical diversion after catheter diversion were associated with worse outcomes. 50% of infants requiring invasive ventilation as neonates developed eGFR <60 mL/min/1.73 m2 in childhood. CONCLUSIONS Half of infants with early presentation and intervention developed significant renal insufficiency in childhood, similar to children with later presentation or who had fetal intervention. Invasive ventilation in the newborn period and need for surgical urinary diversion are associated with worse outcomes.
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Kim SJ, Jung J, Lee C, Park S, Song SH, Won HS, Kim KS. Long-term outcomes of kidney and bladder function in patients with a posterior urethral valve. Medicine (Baltimore) 2018; 97:e11033. [PMID: 29879071 PMCID: PMC5999499 DOI: 10.1097/md.0000000000011033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We investigated long-term functional changes in the kidney and bladder of patients with posterior urethral valve (PUV) who underwent fetal intervention or postnatal surgery.We retrospectively reviewed the medical records of 28 consecutive patients treated for PUV at our institution. Detailed data on medical and surgical histories, particularly on pre- and postnatal treatment modality, including fetal vesicoamniotic shunt, endoscopic valve ablation, and vesicostomy, were collected and analyzed. Long-term renal function was evaluated based on serum levels of creatinine (sCr), estimated glomerular filtration rate (eGFR), and renal scans. Voiding function was evaluated in urodynamic tests.Vesicoamniotic shunting was performed in 12 (42.8%) patients. Although the mean initial sCr was significantly higher in patients in whom a fetal shunt was placed than in others (2.04 vs 1.17 mg/L, P = .038), the sCr at long-term follow-up was not significantly different between them (0.64 vs 0.40 mg/L, P = .186). The mean maximum detrusor pressure was significantly lower in patients with a fetal shunt than in others (37.7 vs 73.0 cm H2O, P = .019). Postnatal vesicostomy was performed in 14 patients, and primary valve ablation was performed in 13 patients. The mean initial sCr was higher in patients in the vesicostomy group than in the primary valve ablation group (2.08 vs 0.86 mg/L, P = .014). However, no significant differences were found in sCr (0.9 vs 0.3 mg/L, P = .252) or GFR (59.1 vs 68.5 mL/min/1.73 m, P = .338) at long-term follow-up. Bladder capacity was greater and residual urine volume was less in the vesicostomy group than in the primary valve ablation group, but without statistical significance.Vesicostomy is more beneficial in the recovery of renal function and is not inferior in terms of bladder function, even in patients with severe PUV disorder. It is a reliable surgical option that can spare renal function and guarantee adequate bladder function in the long term.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Jaeyoon Jung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Chanwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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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. 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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Affiliation(s)
- Douglass B Clayton
- 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.
| | - John W Brock
- 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
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Kurtz MP, Koh CJ, Jamail GA, Sangi-Haghpeykar H, Shamshirsaz AA, Espinoza J, Cass DL, Olutoye OO, Olutoye OA, Braun MC, Roth DR, Belfort MA, Ruano R. Factors associated with fetal shunt dislodgement in lower urinary tract obstruction. Prenat Diagn 2016; 36:720-5. [PMID: 27247093 DOI: 10.1002/pd.4850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/19/2016] [Accepted: 05/29/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify factors associated with fetal shunt dislodgement in lower urinary tract obstruction (LUTO). METHODS We conducted a retrospective study of 42 consecutive fetuses with a diagnosis of LUTO in a tertiary fetal center between April 2013 and November 2015. Possible factors associated with prenatal shunt dislodgment were evaluated in fetuses who underwent shunt placement, including gestational age at diagnosis, gestational age at procedure, presence of 'keyhole sign', initial fetal bladder volume and wall thickness, prenatal ultrasonographic renal characteristics, amniotic fluid volume, presence of ascites prior to shunting, and type of fetal shunt. RESULTS Nineteen (46.3%) fetuses underwent shunt placement at a median gestational age of 19 (range: 16.3-31.1) weeks. Shunt dislodgement occurred in 10 (52.6%) patients. A total of 35 procedures were performed; among which 16 (45.7%) were repeat procedures. The only prenatal factor associated with shunt dislodgement was the type of the shunt; Kaplan-Meier analysis indicated that the Rocket was associated with increased likelihood of remaining orthotopic (p = 0.04). CONCLUSION Fetal shunt dislodgement occurs in approximately half of the patients and appears to be associated with the type of the shunt. Future research is necessary to develop better shunt systems and to investigate different fetal therapeutic approaches. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Chester J Koh
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Grace Anne Jamail
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Alireza A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Darrell L Cass
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Oluyinka O Olutoye
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Olutoyin A Olutoye
- Department of Anesthesiology, Baylor College of Medicine and Texas Children's Fetal Center - Texas Children's Hospital Pavilion for Women, Houston, TX, USA
| | - Michael C Braun
- Renal Section, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - David R Roth
- Division of Pediatric Urology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Abstract
This article summarizes the most recent literature regarding congenital lower urinary tract obstruction in the fetus and newborn. Lower urinary tract obstruction is a heterogeneous group of rare diagnoses that have significant potential for in utero mortality and long-term morbidity in survivors. The diagnosis and management of the most common causes are reviewed. In addition, the current state of prenatal intervention for congenital lower urinary tract obstruction is discussed.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA.
| | - John W Brock
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA
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Bertin M, Cosmi E, Visentin S, Rampon M, Gizzo S. Fetal posterior urethral valve mechanic perforation using an 18-gauge needle: a case-series. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective: To assess the effectiveness of using an 18-gauge needle inserted through the perineal surface of the fetus to solve magacystis and posterior urethral valve (PUV).
Methods: From February 2008 to January 2012, 15 cases of magacystis were referred to our tertiary referral center, and in ten, PUV was suspected. In the cases where PUV was suspected after a detailed ultrasound scan, women gave consent to proceed with fetal therapy under sonographic guidance using an 18-gauge needle. The procedures lasted for a median time of 30 min (range 15–50 min). The needle was inserted through the perineal surface of the fetus to perforate the dilated posterior ureteral valve, as well as to perform a perineal vescicocentesis.
Results: Median gestational age at time of referral was 17 weeks of gestation (range 16–19 weeks). Five fetuses were female and ten male. Nine cases opted for pregnancy termination, as the kidneys were dysplastic showing hyperechoic structure, while six cases were treated, as the kidneys showed a normal functionality as well as cortico-medullar differentiation. Five fetuses were male and one female. After fetal therapy, there were no stillbirths. All fetuses were delivered at term and the infants were followed up by routine kidney ultrasonography and functionality after a median follow-up of 16 months.
Conclusions: Despite the most commonly used fetal therapy being vesico-amiotic shunting, percutaneous fetal cystoscopy that allows laser valve ablation and mechanical disruption was the procedure used in the present study. This allowed the direct treatment of the urethral obstruction that caused megacystis, without need to repeat the procedure and without the need of any postnatal therapy.
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Affiliation(s)
- Martina Bertin
- Department of Woman and Child Health, Maternal Fetal Medicine Unit, University of Padua, Padua, Italy
| | - Erich Cosmi
- Department of Woman and Child Health, Maternal Fetal Medicine Unit, University of Padua, Padua, Italy
| | - Silvia Visentin
- Department of Woman and Child Health, Maternal Fetal Medicine Unit, University of Padua, Padua, Italy
| | - Michela Rampon
- Department of Woman and Child Health, Maternal Fetal Medicine Unit, University of Padua, Padua, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, Maternal Fetal Medicine Unit, University of Padua, Padua, Italy
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Farmakis SG, Herman TE, Siegel MJ. Neonatal presentation of posterior urethral valves and tethered spinal cord. J Perinatol 2014; 34:647-8. [PMID: 25073498 DOI: 10.1038/jp.2014.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- S G Farmakis
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - T E Herman
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - M J Siegel
- Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
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Kari JA, El-Desoky S, Farag YMK, Mosli H, Altyieb AM, Al Sayad A, Radawi O, Ghabra H, Basnawi F, Bahrawi O, Singh A, Farsi H, Farsi H. Renal impairment in children with posterior urethral valves. Pediatr Nephrol 2013; 28:927-31. [PMID: 23263712 DOI: 10.1007/s00467-012-2390-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Posterior urethral valves (PUV) are a common cause of end-stage renal failure in childhood. Our aim was to describe a cohort of patients with PUV and to investigate the predictors of renal impairment. METHODS We performed a retrospective chart review of children with PUV who were followed at King Abdulaziz University hospital between 2002 and 2011. RESULTS The cohort comprised 68 boys. There was a significant difference in the duration of follow-up (p = 0.024), nadir serum creatinine (p < 0.001), and last known serum creatinine level (p = 0.001) between the patients with and without renal impairment. The duration of follow-up appeared to be a significant predictor for serum creatinine doubling (p = 0.003; odds ratio, 1.8). There was no difference in the age of presentation, age at the time of the study, and first or last serum creatinine between children who initially had vesicostomy and children who had ablation. CONCLUSIONS Ablation of PUV or vesicostomy did not influence kidney function in our study cohort. Children with a normal nadir serum creatinine who presented early had a better outcome.
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Affiliation(s)
- Jameela Abdulaziz Kari
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia.
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Tonni G, Vito I, Ventura A, Grisolia G, De Felice C. Fetal lower urinary tract obstruction and its management. Arch Gynecol Obstet 2012; 287:187-94. [PMID: 23138754 DOI: 10.1007/s00404-012-2615-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Prenatal counselling in case of fetal obstructive uropathies still represents a clinical dilemma, despite ultrasound detection of lower urinary tract obstruction has greatly advanced during recent years as well as fetal intervention techniques. MATERIALS AND METHODS A systematic review of the relevant literature on the topic was performed, with a special focus on the role of antenatal ultrasound, in utero treatment and prognosis. CONCLUSIONS A clinico-diagnostic flow chart was developed, with the specific aim of aiding health care givers in the clinical management and the parental decision-making process.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Gustalla Civil Hospital, AUSL Reggio Emilia Via Donatori Sangue, 2, 42016, Guastalla (RE), Italy.
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Posterior urethral valve treatments and outcomes in children receiving kidney transplants. J Urol 2011; 185:2507-11. [PMID: 21527196 DOI: 10.1016/j.juro.2011.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated the impact of surgical approaches to posterior urethral valves on renal transplant survival and compared transplant survival in children with vs without posterior urethral valves. MATERIALS AND METHODS We reviewed the records of all children who underwent renal transplantation from January 1984 to March 2008 and performed univariate subgroup analysis in those with posterior urethral valves. We evaluated the ureteroneocystotomy method, immunosuppression and valve treatment. In patients with posterior urethral valves we regarded nocturnal and/or daytime incontinence, severe urgency and the need for intermittent catheterization or double voiding for increased post-void residual urine as signs of bladder dysfunction. RESULTS The initial renal transplant was received by 418 children at a mean age of 5.6 years. The 59 boys with posterior urethral valves received a total of 69 kidneys. By 8-year followup the kidney had failed in 24 of 59 boys with and 143 of 359 without posterior urethral valves (OR 0.9665, 95% CI 0.5462-1.692, p = 0.9105). Immunosuppression was consistent in the 2 groups. Outcomes were similar across all ureteroneocystotomy techniques. Initial management for posterior urethral valves was valve ablation alone in 12 boys, vesicostomy in 7 and supravesical diversion in 11. There was no difference in transplant survival or bladder dysfunction based on valve intervention. In 18 boys (55%) we noted overlapping signs of bladder dysfunction, of whom 11 performed intermittent catheterization or had increased post-void residual urine, 4 had severe urgency, 4 had daytime incontinence and 7 had nocturnal incontinence. Bladder dysfunction did not predict increased graft loss (OR 3.306, 95% CI 0.7615-16.27, p = 0.1134). CONCLUSIONS Of children who undergo renal transplantation boys with posterior urethral valves do not have a higher graft failure rate. Treatment for posterior urethral valves did not significantly impact transplant survival or bladder dysfunction.
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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 2010; 117:382-90. [DOI: 10.1111/j.1471-0528.2010.02500.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Merksz M, Kiss A, Réti G, Szabó L. [Is premature induced labour justified in case of fetal urinary tract dilatation?]. Orv Hetil 2008; 149:703-8. [PMID: 18387875 DOI: 10.1556/oh.2008.28263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED There is a decreasing trend in the number of intrauterine interventions performed due to urinary tract dilatations of the foetus diagnosed ultrasonographically. This is due to the low efficacy of the interventions, the high rate of complications and a better knowledge of the foetal physiology. However, the demand for early corrective surgery is still present. In Hungary pre-term caesarean section is performed in many institutions in order to enable the operation of the neonate, despite the fact that the benefits of this intervention have not been established. AIM In order to test the correctness of this practice, the authors conducted a retrospective analysis of the patients of two large case-volume paediatric institutions. PATIENTS In a period of 5 years, 329 neonates were followed due to intrauterine diagnosis of urinary tract dilatations (197 at the Department of Urology, Heim Pál Children's Hospital in Budapest, whereas in Miskolc 132), including 13 cases where the urological anomaly was the indication for pre-term induction of labour. RESULTS Of the 13 neonates who had been delivered prematurely, none were operated before the postconceptional age of 40 weeks, and 3 subsequently required no surgical intervention. Two neonates developed life-threatening conditions that presumably could have been avoided without the premature caesarean section. CONCLUSIONS The authors conclude that there are several arguments against pre-term delivery: 1. Prenatal diagnostics does not always yield as accurate information as the diagnostic procedures performed in infancy; 2. Intrauterine urinary tract dilatation often resolve spontaneously, superseding the need for both pre- and post-natal surgical interventions. 3. Scientific observations have confirmed that there is no difference between the efficacy of postnatal and pre-term interventions. Based on the above-mentioned, authors emphasize that this outdated practice can no longer be accepted, and call for good cooperation between the obstetrician, the paediatric urologist and nephrologist, to coordinate the management of the case.
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Affiliation(s)
- Miklós Merksz
- Fovárosi Onkormányzat Heim Pál Gyermekkórháza, Urológiai-Sebészeti Osztály, Budapest.
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Chowdhary S. Obstructive Uropathy in Newborns. APOLLO MEDICINE 2007. [DOI: 10.1016/s0976-0016(11)60115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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