In utero management of fetal lower urinary tract obstruction with a novel shunt: A landmark development in fetal therapy

Ruben A. Quintero, Libardo Augusto Gomez Castro, Carlos Bermudez, Ramen H. Chmait, Eftichia V. Kontopoulos

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Objective. Fetal lower urinary tract obstruction occurs in ∼1:3000 pregnancies. Standard vesicoamniotic shunting is fraught with malfunctioning in upto 60% of cases. We hereby report the development and application of a novel and reliable shunt. Materials and Methods. Patients with lower urinary tract obstruction were offered the novel shunt among other standard management options. Shunting involved the placement of a double disk device with a standard double pig-tail catheter. All patients signed informed consent. Results. Four patients have been treated with the novel shunt. In three patients, shunting was conducted between the bladder and amniotic cavity. In one patient (dichorionic-discordant twins) with a prior dislodged shunt causing urinary ascites, shunting was conducted between the peritoneal and amniotic cavities ('bridge shunt'). In all cases, correct and stable shunt placement was confirmed endoscopically and sonographically and in all patients, the fetal bladder remains effectively drained. Conclusion. Reliable and effective vesico or peritoneoamniotic shunting can be achieved with the novel shunt. This shunt cannot become dislodged into the peritoneal cavity or the amniotic cavity, and cannot be pulled out by the fetus. Further experience is necessary to determine the risks and benefits of this novel treatment for fetal lower urinary tract obstruction.

Original languageEnglish
Pages (from-to)806-812
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume23
Issue number8
DOIs
StatePublished - Aug 1 2010

    Fingerprint

Keywords

  • fetal lower urinary tract obstruction
  • fetal therapy
  • Operative fetoscopy
  • prenatal diagnosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this