الفهرس 
Normal Embryological development of the Lower Urinary TractOnly 14 pages are availabe for public view
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Abstract
Assessment of fetal and maternal outcomes in women who had interventions (vesicoamniotic shunting or serial ultrasound-guided vesicocentesis) to relieve their fetal lower urinary tract obstruction Vs those who underwent conservative management (follow up)
Lower urinary tract obstructions (LUTO) are caused by a narrowing at some point in the urinary tract that slows or stops the flow of urine. They are one of the most commonly identified abnormalities at the antenatal ultrasound scan with an estimated incidence of 1:250 to 1:1000 pregnant women. The majority of these abnormalities are because of obstruction, obstructive uropathy, which may occur at the uretero-pelvic junction or uretero-vesical junction or at the level of bladder neck. The most common identifiable causes of LUTO are urethral atresia and posterior urethral valves (PUVs). Other less common causes of lower urinary tract obstructions include urethral atresia (the second most common cause of lower urinary tract obstructions), anterior urethral valves, meatal stenosis, epispadias, and hypospadias.
The idea of the vesico-amniotic shunting or the PLUTO trial is the insertion of catheter with its proximal end in the amniotic fluid and its distal end in fetal urinary bladder to relieve the fetal urinary obstruction in an attempt to avoid renal parenchymal damage and chronic oligohydramnios that in turn adversely affect the pulmonary development. The indicator for immediate success of the procedure is the immediate de-compression of the distended fetal bladder. The mother is to be followed every two weeks till delivery, recording the fetal bladder dimensions, amniotic fluid volume and any observed fetal renal cystic or dysplastic changes till the baby is delivered and the obstruction is relieved surgically in post-natal life.
The most important question was the effectiveness of in-utero therapy and the correct timing, as its management constitutes an ongoing challenge in obstetric and pediatric practices. Although many suggested that prenatal intervention in cases of congenital bladder neck obstruction improves perinatal survival but when considering the effect on long-term survival with normal postnatal renal function, the results suggested that intervention have adverse sequalae (in terms of morbidity), although this finding was not statistically significant.