Eur J Pediatr Surg 2024; 34(01): 091-096
DOI: 10.1055/s-0043-1772172
Original Article

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

1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Fabian Doktor
2   Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
3   University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany
,
Hayley Good
4   Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
,
Lauren Erdman
5   Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada
6   Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Jin K. Kim
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
7   Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
,
Joana Dos Santos
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Natasha Brownrigg
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Michael Chua
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
8   Institute of Urology, St. Luke's Medical Center, Philippines
,
Armando J. Lorenzo
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
7   Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
,
Mandy Rickard
1   Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Tim Van Mieghem
9   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Shiri Shinar
9   Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Preview

Abstract

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.

Supplementary Material



Publication History

Received: 08 May 2023

Accepted: 04 July 2023

Article published online:
22 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany