A New Look at the Tactics of Managing Patients with Obstructive Uropathies in Fetus
https://doi.org/10.31550/1727-2378-2023-22-5-26-33
Abstract
Aim: to describe modern methods of diagnosis, therapy and surgical correction of urinary system obstruction in the fetus, as well as gestational outcomes for the fetus with various options for intrauterine correction or without it.
Key points. Obstructive uropathy in fetuses is a complex of intrauterine morphological and functional changes in the urinary tract, which develop as a result of a violation of the passage of urine of various origins. The authors studied modern approaches to the management of patients with obstructive fetal uropathy and methods of intrauterine correction of this pathology. The pathogenesis, emerging complications, key diagnostic biomarkers are considered based on the materials of domestic and foreign articles on this topic, posted in the eLibrary and PubMed databases.
Conclusion. Conducting intrauterine bypass surgery in obstructive fetal uropathology can help reduce the risk of adverse perinatal outcomes, prevent the development of complications from other organs and systems and prevent disability of children.
About the Authors
N. V. Kosovtsova
Urals Scientific Research Institute for Maternal and Child Care
Russian Federation
Russian Federation
620028; 1 Repina Str.; Yekaterinburg
E. S. Kuklin
Urals Scientific Research Institute for Maternal and Child Care
Russian Federation
Russian Federation
620028; 1 Repina Str.; Yekaterinburg
N. A. Fedorova
Urals Scientific Research Institute for Maternal and Child Care
Russian Federation
Russian Federation
620028; 1 Repina Str.; Yekaterinburg
References
1. Aylamazyan E.K., Baranov V.S. Prenatal diagnostics of hereditary and congenital diseases. M.: MEDpress-inform; 2006. 416 p. (in Russian)
2. Gus A.I., Kostyukov K.V. The value of modern three-dimensional echographic technologies in the diagnosis of congenital obstructive uropathy in the fetus. Journal of Obstetrics and Women's Diseases. 2014;63(1):50–1. (in Russian). DOI: 10.17816/JOWD63150-51
3. Deryugina L.A., Churakov A.A., Krasnova E.I. The fatal abnormalities of the kidney and urinary tract of the fetus. The prenatal diagnosis — the difficult decision. Modern Problems of Science and Education. 2012;2:92. (in Russian)
4. Kosovtsova N.V., Markova T.V., Bashmakova N.V., Chistyakov M.A. Kidney bypass surgery in animal fetuses in experimental condition. Experimental and Clinical Urology. 2017;2:20–5. (in Russian)
5. Mikhailova O.I., Kirsanova T.V., Amiraslanov E.Yu., Kurchakova T.A. Anomalies of the urinary tract and pregnancy. Obstetrics and Gynecology. News. Views. Education. 2014;4(6):15–21. (in Russian)
6. Vasiliev A.O., Govorov A.V., Pushkar D.Yu. Embryological aspects of сongenital anomalies of the kidney and urinary tract (CAKUT): review. Urology Herald. 2015;2 47–60. (in Russian)
7. Kosovtsova N.V., Pavlichenko M.V., Bashmakova N.V, Markova T.V. The results of surgical correction of fetal obstructive uropathy. Disease Treatment and Prevention. 2018;8(3):33–9. (in Russian)
8. Ivanova I.E., Trefilov A.A., Gusev R.V. Modern understanding of anomalies in the development of the kidneys in children and the possibilities of their early detection. Public Health of Chuvashia. 2011;1:62–70. (in Russian)
9. Chechneva M.A., Titchenko Yu.P., Lysenko S.N. The clinical significance of ultrasound study of amniotic fluid. Russian Bulletin of Obstetrician-Gynecologist. 2013;13(1):12–16. (in Russian)
10. Cohen J., Levasseur S., Simpson L., Miller R. et al. Fetal cardiac findings and hemodynamic changes associated with severe lower urinary tract obstruction in utero. Ultrasound Obstet. Gynecol. 2019;24(6):780–5. DOI: 10.1002/uog.20271
11. Rychik J., McCann M., Tian Z., Bebbington M. et al. Fetal cardiovascular effects of lower urinary tract obstruction with giant bladder. Ultrasound Obstet. Gynecol. 2010;36(6):682–6. DOI: 10.1002/uog.7664
12. Gilyarevsky S.R., Golshmid M.V., Kuzmina I.M. The role of aldosterone receptor antagonists in the prevention and treatment of cardiovascular and renal diseases: reality and prospects. Russian Medical Journal. 2014;22(23):1689–98. (in Russian)
13. Monteiro S., Nassr A.A., Yun P.S., Voigt R. et al. Neurodevelopmental outcome in infants with lower urinary tract obstruction based on different degrees of severity. Fetal Diagn. Ther. 2020;47(8):587–96. DOI: 10.1159/000504977
14. Romero R., Pilu D., Genti F., Gidini A. et al. Prenatal diagnosis of congenital malformations of the fetus. M.: Medicine; 1994. 448 p. (in Russian)
15. Vinokurova E.A., Mateikovich E.A., Eremeeva T.A., Gurina A.V. et al. Modern methods of antenatal treatment of obstructive kidney pathology in the fetus. Medical Science and Education of Ural. 2020;21(4):145–53. (in Russian). DOI: 10.36361/1814-8999-2020-21-4-145-153
16. Adamenko O.B., Khalepa Z.A., Kotova L.Y. Ultrasound monitoring in prenatal diagnosis of anomalies of the urinary system and determining the tactics of managing children. Pediatria n.a. G.N. Speransky. 2008;87(3):13–16. (in Russian)
17. Stolova E.N., Imelbaev A.I. The role of ultrasonography in diagnostics of obstructive uropathy in children. Visualization in Medicine. 2020;2(2):26–33. (in Russian)
18. Prokopovich A.V., Savitsky S.E., Krotkov O.V. Principles of ultrasonic investigation in the first trimester of the pregnancy. Journal of the Grodno State Medical University. 2005;3:182–4. (in Russian)
19. Rozhkova D.V., Deryugina L.A., Guseva E.B, Ivchenkova N.P. Prenatal diagnosis of megacystis syndrome in the first trimester of gestation, taking into account the contractility of the bladder. In: Proceedings of the VII International Student Scientific Conference “Student Scientific Forum”. Saratov 15 February — 31 March 2015. Saratov; 2015. (in Russian)
20. Johnson M.P., Danzer E., Koh J., Polzin W. et al. North American Fetal Therapy Network (NAFTNet). Natural history of fetal lower urinary tract obstruction with normal amniotic fluid volume at initial diagnosis. Fetal Diagn. Ther. 2018;44(1):10–17. DOI: 10.1159/000478011
21. Nassr A.A., Shamshirsaz A.A., Erfani H., Espinoza J. et al. Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in second trimester of pregnancy. Ultrasound Obstet. Gynecol. 2019;54(4):500–5. DOI: 10.1002/uog.20288
22. Fontanella F., van Scheltema P.N.A., Duin L., Cohen-Overbeek T.E. et al. Antenatal staging of congenital lower urinary tract obstruction. Ultrasound Obstet. Gynecol. 2019;53(4):520–4. DOI: 10.1002/uog.19172
23. Sinha A., Bagga A., Krishna A., Bajpai M. et al. Revised guidelines on management of antenatal hydronephrosis. Indian J. Nephrol. 2013;23(2):83–97. DOI: 10.4103/0971-4065.109403
24. Grignon A., Filion R., Filiatrault D., Robitaille P. et al. Urinary tract dilatation in utero: classification and clinical applications. Radiology. 1986;160(3):645–7. DOI: 10.1148/radiology.160.3.3526402
25. Morris R.K., Kilby M.D. Long-term renal and neurodevelopmental outcome in infants with LUTO, with and without fetal intervention. Early Hum. Dev. 2011;87(9):607–10. DOI: 10.1016/j.earlhumdev.2011.07.004
26. Duin L.K., Fontanella F., Groen H., van Scheltema P.N.А. et al. Prediction model of postnatal renal function in fetuses with lower urinary tract obstruction (LUTO) — development and internal validation. Prenat. Diagn. 2019;39(13):1235–41. DOI: 10.1002/pd.5573
27. Ruano R., Sananes N., Sangi-Haghpeykar H., Hernandez-Ruano S. et al. Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet. Gynecol. 2015;45(4):452–8. DOI: 10.1002/uog.14652
28. Kostyukov K.V., Gus A.I. The anatomic and functional features of a healthy kidney in unilateral fetal obstructive uropathy. Obstetrics and Gynecology. 2015;1:18–24. (in Russian)
29. Pavlova V.S., Kryuchko D.S., Podurovskaya Yu.L., Pekareva N.A. Congenital anomalies of the kidney and urinary tract: an analysis of modern diagnostic principles and prognostically significant markers of renal tissue damage. Neonatology: News, Views, Education. 2018;6(2):78–86. (in Russian). DOI: 10.24411/2308-2402-2018-00020
30. Dreux S., Rosenblatt J., Moussy-Durandy A., Patin F. et al. Urine biochemistry to predict long-term outcomes in fetuses with posterior urethral valves. Prenat. Diagn. 2018;38(12):964–70. DOI: 10.1002/pd.5359
31. Nassr A.A., Koh C.K., Shamshirsaz A.A., Espinoza J. et al. Are ultrasound renal aspects associated with urinary biochemistry in fetuses with lower urinary tract obstruction. Prenat. Diagn. 2016;36(13):1206–10. DOI: 10.1002/pd.4958
32. Avtandilov G.G. Medical morphometry. M.: Medicine; 1992. 36 p. (in Russian)
33. Matsell D.G. Congenital urinary tract obstruction — diagnosis and management in the fetus. In: Oh W., Baum M., eds. Nephrology and fluid electrolyte physiology. 2019:391–409. DOI: 10.1016/B978-0-323-53367-6.00021-2
34. Nekrasova E.S. Prenatal ultrasound diagnosis and management of fetal lower urinary tract obstruction. Ultrasonic and Functional Diagnostics. 2011;2:57–62. (in Russian)
35. Nassr A.A., Shazly S.A.M., Abdelmagied A.M., Araujo Junior E. et al. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction : an updated systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2017;49(6):696–703. DOI: 10.1002/uog.15988
36. Bañuelos Marco B., González R., Ludwikowski B., Lingnau A. Effectiveness of prenatal intervention on the outcome of diseases that have a postnatal urological impact. Front. Pediatr. 2019;7:118. DOI: 10.3389/fped.2019.00118
37. Jank M., Stein R., Younsi N. Postnatal management in congenital lower urinary tract obstruction with and without prenatal vesicoamniotic shunt. Front. Pediatr. 2021;9:635950. DOI: 10.3389/fped.2021.635950
38. Strizek В., Gottschalk I., Recker F., Weber E. et al. Vesicoamniotic hunting for fetal megacystis in the first trimester with a Somatex intrauterine shunt. Arch. Gynecol. Obstet. 2020;302(1):133–40. DOI: 10.1007/s00404-020-05598-z
39. Morris R.K., Ruano R., Kilby M.D. Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction : a systematic review. Ultrasound Obstet. Gynecol. 2011;37(6):629–37. DOI: 10.1002/uog.8981
40. Ruano R., Dunn T., Braun M.C., Angelo J.R. et al. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr. Nephrology. 2017;32(10):1871–8. DOI: 10.1007/s00467-017-3593-8
41. Kosovtsova N.V., Pavlichenko M.V., Makarov R.A., Pospelova Ya.Yu. et al. Intrauterine correction of obstructive uropathies by bilateral nephroamnial bypass grafting of the fetal kidneys. Obstetrics and Gynecology. 2020;12:200–8. (in Russian). DOI: 10.18565/aig.2020.12.200-208
42. Sidelnikova K.N., Solomakha K.I. Congenital malformations of the urinary system of the fetus. Features of the course of pregnancy. Bulletin of Medical Internet Conferences. 2019;9(4):162–3. (in Russian)
Review
For citations:
Kosovtsova N.V., Kuklin E.S., Fedorova N.A. A New Look at the Tactics of Managing Patients with Obstructive Uropathies in Fetus. Title. 2023;22(5):26-33. (In Russ.) https://doi.org/10.31550/1727-2378-2023-22-5-26-33
Views:
34
Email this article 