PMID- 37607585
OWN - NLM
STAT- MEDLINE
DCOM- 20240226
LR  - 20240226
IS  - 1439-359X (Electronic)
IS  - 0939-7248 (Linking)
VI  - 34
IP  - 1
DP  - 2024 Feb
TI  - Trends in Management of Fetuses with Suspected Lower Urinary Tract Obstruction 
      (LUTO): A High-Risk Fetal and Pediatric Center Experience in a 
      Universal-Access-to-Care System.
PG  - 91-96
LID - 10.1055/s-0043-1772172 [doi]
AB  - INTRODUCTION:  Neonates with lower urinary tract obstruction (LUTO) experience 
      high morbidity and mortality associated with the development of chronic kidney 
      disease. The prenatal detection rate for LUTO is less than 50%, with late or 
      missed diagnosis leading to delayed management and long-term sequelae in the 
      remainder. We aimed to explore the trends in prenatal detection and management at 
      a high-risk fetal center and determine if similar trends of postnatal 
      presentations were noted for the same period. METHODS:  Prenatal and postnatal 
      LUTO databases from a tertiary fetal center and its associated pediatric center 
      between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) 
      at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis 
      using autocorrelation was performed to investigate time trend changes for 
      prenatally suspected and postnatally confirmed LUTO cases. RESULTS:  A total of 
      161 fetuses with prenatally suspected LUTO were identified, including 78 
      terminations. No significant time trend was found when evaluating the correlation 
      between time periods, prenatal suspicion, and postnatal confirmation of LUTO 
      cases (Durbin-Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, 
      respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) 
      and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at 
      initial ultrasound was earlier in terminated fetuses compared to continued (20.0 
      [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO 
      suspicion remained consistently higher than postnatal presentations, the rates of 
      postnatal presentations and terminations remained stable during the study years 
      (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis 
      (p = 0.1710 and 0.1921). CONCLUSION:  This study demonstrated that more severe 
      cases of LUTO are referred earlier and are more likely to undergo TOP. No 
      significant trend was detected between time and prenatally suspected or 
      postnatally confirmed LUTO, highlighting the need for further studies to better 
      delineate factors that can increase prenatal detection.
CI  - Thieme. All rights reserved.
FAU - Richter, Juliane
AU  - Richter J
AUID- ORCID: 0000-0001-6887-0342
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Doktor, Fabian
AU  - Doktor F
AD  - Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and 
      Learning, The Hospital for Sick Children, Toronto, Canada.
AD  - University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany.
FAU - Good, Hayley
AU  - Good H
AD  - Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
FAU - Erdman, Lauren
AU  - Erdman L
AD  - Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; 
      Vector Institute, Toronto, Ontario, Canada.
AD  - Centre for Computational Medicine, The Hospital for Sick Children, Toronto, 
      Ontario, Canada.
FAU - Kim, Jin K
AU  - Kim JK
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
AD  - Division of Urology, Department of Surgery, Temerty Faculty of Medicine, 
      University of Toronto, Ontario, Canada.
FAU - Santos, Joana Dos
AU  - Santos JD
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Brownrigg, Natasha
AU  - Brownrigg N
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Chua, Michael
AU  - Chua M
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
AD  - Institute of Urology, St. Luke's Medical Center, Philippines.
FAU - Lorenzo, Armando J
AU  - Lorenzo AJ
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
AD  - Division of Urology, Department of Surgery, Temerty Faculty of Medicine, 
      University of Toronto, Ontario, Canada.
FAU - Rickard, Mandy
AU  - Rickard M
AD  - Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
FAU - Mieghem, Tim Van
AU  - Mieghem TV
AD  - Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, 
      Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
FAU - Shinar, Shiri
AU  - Shinar S
AD  - Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, 
      Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
DEP - 20230822
PL  - United States
TA  - Eur J Pediatr Surg
JT  - European journal of pediatric surgery : official journal of Austrian Association 
      of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie
JID - 9105263
SB  - IM
MH  - Pregnancy
MH  - Infant, Newborn
MH  - Female
MH  - Child
MH  - Humans
MH  - *Fetal Diseases/diagnostic imaging/surgery
MH  - Retrospective Studies
MH  - Prenatal Care
MH  - *Urinary Tract
MH  - Fetus
COIS- None declared.
EDAT- 2023/08/23 00:42
MHDA- 2024/02/26 06:45
CRDT- 2023/08/22 19:14
PHST- 2024/02/26 06:45 [medline]
PHST- 2023/08/23 00:42 [pubmed]
PHST- 2023/08/22 19:14 [entrez]
AID - 10.1055/s-0043-1772172 [doi]
PST - ppublish
SO  - Eur J Pediatr Surg. 2024 Feb;34(1):91-96. doi: 10.1055/s-0043-1772172. Epub 2023 
      Aug 22.