Fetal lower urinary tract obstruction: a current overview of intrauterine diagnosis and treatment

Authors: Kunochová I.;  Gábor M.;  Jr Križko M.;  Alföldi M.;  Totka A.;  Ferianec V.
Authors‘ workplace: II. gynekologicko-pôrodnícka klinika LF UK a UN Bratislava, Slovenská republika
Published in: Ceska Gynekol 2021; 86(2): 133-139
doi: 10.48095/cccg2021133


Objective: The aim of this review article is to provide a practical and concise overview of dia­gnosis and management of pregnancy with fetal lower urinary tract obstruction. Methods: Review of literature and current studies. Conclusion: Proper dia­gnosis and management of isolated fetal lower urinary tract obstruction with oligohydramnios allows appropriate implementation of intrauterine treatment in indicated cases. The treatment is a prevention of pulmonary hypoplasia and also improves renal function; this  finally contributes to the improvement of overall perinatal morbidity and mortality.


fetal lower urinary tract obstruction – posterior urethral valve – vesicoamniotic shunting – fetal cystoscopy


1. Nguyen HT, Herndon CD, Cooper C et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010; 6(3): 212–231. doi: 10.1016/ j.jpurol.2010.02.205.

2. Morris RK, Malin GL, Quinlan-Jones E et al. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 2013; 382(9903): 1496–1506. doi: 10.1016/ S0140-6736(13)60992-7.

3. Taghavi K, Sharpe C, Stringer MD. Fetal megacystis: a systematic review. J Pediatr Urol 2017; 13(1): 7–15. doi: 10.1016/ j.jpurol.2016.09.003.

4. Clayton DB, Brock JW. Current state of fetal intervention for lower urinary tract obstruction. Curr Urol Rep 2018; 19(1): 12. doi: 10.1007/  s11934-018-0760-9.

5. Lissauer D, Morris RK, Kilby MD. Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med 2007; 12(6): 464–470. doi: 10.1016/ j.siny.2007.06.005.

6. Sinha A, Bagga A, Krishna A et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr 2013; 50(2): 215–231. doi: 10.1007/ s13312-013-0064-6.

7. Haeri S. Fetal Lower Urinary Tract Obstruction (LUTO): a practical review for providers. Matern Health Neonatol Perinatol 2015; 1(1): 26. doi: 10.1186/ s40748-015-0026-1.

8. Moscardi PR, Katsoufis CP, Jahromi M et al. Prenatal renal parenchymal area as a predictor of early end-stage renal disease in children with vesicoamniotic shunting for lower urinary tract obstruction. J Pediatr Urol 2018; 14(4): 320.e1–320.e6. doi: 10.1016/ j.jpurol.2018.07.004.

9. Ruano R, Sananes N, Sangi-Haghpeykar H 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): 452–458. doi: 10.1002/ uog.14823.

10. Ferianec V, Redecha M, Martanvič P et al. Fetal urinoma: an alternative intrauterine management. In: Puertas A et al (eds). Advances in Perinatal Medicine. 22nd European Congress of Perinatal Medicine, May 26–29, 2010, Granada. Bologna: Monduzzi Editore 2010: 203–207.

11. Marco BB, González R, Ludwikowski B et al. Effectiveness of prenatal intervention on the outcome of diseases that have a postnatal urological impact. Front Pediatr 2019; 7: 118. doi: 10.3389/ fped.2019.00118.

12. Sananes N, Cruz-Martinez R, Favre R et al. Two‐year outcomes after dia­gnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Dia­gn 2016; 36(4): 297–303. doi: 10.1002/ pd.4471.

13. Down CJ, Burns JK, Woodward MN et al. Practical management of fetal obstructive uropathy. J Fetal Med 2018; 5(1): 37–44. doi: 10.1007/ s40556-017-0147-x.

14. Degl’innocenti ML, Piaggio G. Children’s kidney and urinary tract congenital anomalies. In: Martino P, Galosi AB (eds) Atlas of ultrasonography in urology, andrology, and nephrology. Cham: Springer 2017: 107–127.

15. Dos Santos J, Parekh RS, Piscione TD et al. A new grading system for the management of antenatal hydronephrosis. Cli J Am Soc Nephrol 2015; 10(10): 1783–1790. doi: 10.2215/ CJN.12861214.

16. Fontanella F, Maggio L, Verheij JB et al. Fetal megacystis: a lot more than LUTO. Ultrasound Obstet Gynecol 2018; 53(6): 779–787. doi: 10.1002/ uog.19182.

17. Stadié R, Strizek B, Gottschalk I et al. Intrauterine vesicoamniotic shunting for fetal megacystis. Arch Gynecol Obstet 2016; 294(6): 1175–1182. doi: 10.1007/ s00404-016-4152-4.

18. Spaggiari E, Faure G, Dreux S et al. Sequential fetal serum â2‐microglobulin to predict postnatal renal function in bilateral or low urinary tract obstruction. Ultrasound Obstet Gynecol 2017; 49(5): 617–622. doi: 10.1002/ uog.15968.

19. Morris RK, Middleton LJ, Malin GL et al. Outcome in fetal lower urinary tract obstruction: a prospective registry. Ultrasound Obstet Gynecol 2015; 46(4): 424–431. doi: 10.1002/ uog.14808.

20. Ruano R, Sananes N, Wilson C et al. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol 2016; 48(4): 476–482. doi: 10.1002/ uog.15844.

21. Craparo FJ, Rustico M, Tassis B et al. Fetal serum beta2-microglobulin before and after bladder shunting: a 2-step approach to evaluate fetuses with lower urinary tract obstruction. J Urol 2007; 178(6): 2576–2579. doi: 10.1016/ j.juro.2007.08.052.

22. Keswani SG, Wilson RD, Johnson MP. 10 Percutaneous intrauterine fetal shunting. In: Apuzzio JJ, Vintzileos AM, Berghella V et al (eds). Operative Obstetrics. 4th ed. UK: CRC Press 2017: 123–136.

23. Nassr AA, Shazly SA, Abdelmagiet AM 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. doi: 10.1002/ uog.15988.

24. Calda P, Břešťák M, Fischerová D. Vrozené vady uropoetického traktu. In: Calda P (ed). Ultrazvuková dia­gnostika v těhotenství a gynekologii. Praha: Aprofema 2010: 247–256.

25. Ruano R, Yoshisaki CT, Salustiano EM et al. Early fetal cystoscopy for first-trimester severe megacystis. Ultrasound Obstet Gynecol 2011; 37(6): 696–701. doi: 10.1002/ uog.8963.

26. Ruano R, Safdar A, Au J et al. Defining and predicting ‘intrauterine fetal renal failure’ in congenital lower urinary tract obstruction. Pediatr Nephrol 2016; 31(4): 605–612. doi: 10.1007/ s00467-015-3246-8.

27. Ferianec V. Fetálna terapia. Bratislava: Univerzita Komenského 2014: 43–48.

28. Ferianec V, Križko M Jr, Gábor M et al. Ultrasound guided procedures at the 2nd department of obstetrics and gynecology-12-year retrospective overview. Slov Gynek Pôrod 2018; 24: 189–196.

29. Kilby MD, Morris RK. Fetal therapy for the treatment of congenital bladder neck obstruction. Nat Rev Urol 2014; 11(7): 412–419. doi: 10.1038/ nrurol.2014.132.

30. Ruano R. Fetal surgery for severe lower urinary tract obstruction. Prenat Dia­gn 2011; 31(7): 667–674. doi: 10.1002/ pd.2736.

31. 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): 629–637. doi: 10.1002/ uog.8981.

32. Mathis J, Raio L, Baud D. Fetal laser therapy: applications in the management of fetal pathologies. Prenat Dia­gn 2015; 35(7):. 623–636. doi: 10.1002/ pd.4587.

33. Ruano R, Dunn T, Braun MC et al. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr Nephrol 2017; 32(10): 1871–1878. doi: 10.1007/ s00467-017-3593-8.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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