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

Juliane Richter; Fabian Doktor; Hayley Good; Lauren Erdman; Jin K. Kim; Joana Dos Santos; Natasha Brownrigg; Michael Chua; Armando J. Lorenzo; Mandy Rickard; Tim Van Mieghem; Shiri Shinar

doi:10.1055/s-0043-1772172

European Journal of Pediatric Surgery, Table of Contents

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

Juliane Richter

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Fabian Doktor

²Developmental and Stem Cell Biology Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada

³University of Leipzig, Department of Pediatric Surgery, Leipzig, Germany

,

Hayley Good

⁴Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

,

Lauren Erdman

⁵Department of Computer Science, University of Toronto, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada

⁶Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Jin K. Kim

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

⁷Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada

,

Joana Dos Santos

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Natasha Brownrigg

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Michael Chua

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

⁸Institute of Urology, St. Luke's Medical Center, Philippines

,

Armando J. Lorenzo

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

⁷Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada

,

Mandy Rickard

¹Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Tim Van Mieghem

⁹Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

,

Shiri Shinar

⁹Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

› Author Affiliations

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.

Keywords

lower urinary tract obstruction (LUTO) - fetal obstructive uropathy - trend analysis - antenatal diagnosis - pediatric urology

Full Text

References

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Supplementary Material

Supplementary Material