Current State of Fetal Intervention for Lower Urinary Tract Obstruction

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.

Keywords: Fetal cystoscopy; Fetal hydronephrosis; Fetal intervention; Fetal lower urinary tract obstruction; Fetal posterior urethral valves; Second trimester oligohydramnios; Vesicoamniotic shunt.