Intermediate outcomes of children (4-10 years) with postnatally preserved renal function after vesico-amniotic shunt insertion for lower urinary tract obstruction (LUTO).

Abstract

Purpose: The purpose of this retrospective study was to examine the intermediate outcomes and renal development of children (four to ten years) who had undergone prenatal vesico-amniotic shunt insertion (VAS) for lower urinary tract obstruction (LUTO), and later demonstrated preserved kidney function as neonates.

Patients & methods: Of 63 fetuses that underwent VAS for LUTO, 47 survived both the pregnancy and the neonatal period. Twenty-four of them were born with preserved renal function as defined by normal laboratory values for creatine, urea, and/or GFR. Twenty of them (83.3 %) were available for our study. We analyzed their pediatric general, surgical, urological, and radiological medical records with a particular emphasize on renal function.

Results: All children of the cohort are still alive. None of the pediatric study subjects have required renal replacement therapy after four to ten years of follow-up. In 90 % of the cases, renal function as defined by laboratory values for creatine, urea, and/or GFR remained preserved. Only two children (10 %) demonstrated impaired renal function.

Conclusion: The findings of our retrospective study suggest that when normal laboratory values for creatine, urea, and/or GFR are observed in the neonatal period following prenatal VAS for LUTO, these parameters will likely remain normal in most patients for the first four to ten years of their life. Confirming our previously published novel management strategy, the highest preservation rates can be achieved when after early detection of LUTO, VAS can be performed prior to the completion of 16 weeks of gestation.