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Fetal Intervention For LUTO: A Chance At The Healthiest Possible Start To Life
This blog was co-written by Jayme Molohon, Nurse Coordinator at Texas Children's Fetal Center.When new patients visit the Texas Children’s Fetal Center for evaluation oftentimes they are scared and confused. For families facing a lower urinary tract obstructions (LUTO) diagnosis, a condition commonly known as bladder outlet obstruction, we have developed a multidisciplinary approach to care that provides the best possible treatment. LUTO is a rare birth defect that occurs in 1 in 5,000 to 7,000 births, most commonly in males with severe consequences to the baby if left untreated. An enlarged fetal bladder with low amounts of amniotic fluid indicates that a complete or partial bladder outlet obstruction is present. This situation is usually diagnosed during a fetal comprehensive ultrasound examination by the identification of a very large bladder, and dilated kidneys. As a result from the lack of the amniotic fluid around the baby, the baby’s lungs do not develop well. This situation is called pulmonary hypoplasia, which is responsible for the elevated mortality rate in this situation. In addition, the bladder outlet obstruction causes backflow pressure on the kidneys leading to permanent damages, and the baby will need dialysis and renal transplantation. When a complete bladder outlet obstruction is present with severe reduce amount of amniotic fluid, this situation is associated with elevated mortality (>90%) and renal damage (>60%). Early detection and intervention can be crucial. It is not uncommon that families are referred to our Fetal Center with minimal hope. In these instances, our wish is to welcome these patients to our center, and thanks to advancements in fetal care, provide realistic hope and practical treatment options. Patients have a one-day complete evaluation with a multidisciplinary team at our center including maternal-fetal medicine specialists, fetal surgeons, pediatric nephrologist, pediatric urologist, pediatric cardiologist, pediatric surgeons, neonatologists and geneticists. After this thorough examination and careful counseling with the family, a course of care is determined. Every family is unique and every situation calls for a patient-specific approach, but when it comes to LUTO the best approach is oftentimes to place a shunt in the fetus’s bladder while still in-utero, which helps balance fluid levels giving the lungs a chance to develop and release the pressure inside the baby’s bladder and kidneys. The first vesicoamniotic shunt took place in 1981. Since then, fetal medicine has become one of the most exciting specialties in medicine. Today, our technology allows us to see incredible detail inside the womb. The previously private life of the fetus can now be revealed to us, and even subtle complications, like LUTO, can be detected before birth. This sophistication in diagnostic imaging has led to remarkable advancements in care. And for complications like LUTO, while they may seem tiny on screen, we are now able to detect, diagnose and intervene before birth. During the procedure, we make a small incision in the mom’s belly and place the shunt in their baby’s bladder through a tiny tube. Families are often amazed how seemingly minimally invasive this procedure actually is, but there are still risks associated with this procedure (as there are with any fetal intervention) and strict post-intervention follow-up is required. The procedure gives babies with LUTO a chance at the healthiest possible start to life. At Texas Children’s Pavilion For Women we are experts in the full spectrum of all fetal interventions including prenatal therapy for LUTO. Our Fetal Center has developed a complete algorithm for babies with LUTO. In a period of less than one year, our Fetal Center evaluated 23 fetuses with this problem, and fetal shunt was placed in 11 babies. Ten babies were already born, and so far all babies survived and had normal renal function. Our success is related to our Fetal Center infrastructure, the multidisciplinary evaluation, the extremely elevated quality of the neonatal intensive care of Texas Children’s Hospital, the correct selection of good candidates for fetal intervention and, especially, our commitment to those babies. For more information about Texas Children’s Fetal Center, please visit our website. You can also watch our Texas Children's Fetal Center Reunion video, here.
Dr. Rodrigo Ruano, Lower Urinary Tract Obstruction (LUTO) and Congenital Diaphragmatic Hernia (CDH) Specialist