Fetal surgery for lower urinary tract obstruction: The importance of staging prior to intervention

Elizabeth A. Enninga, Rodrigo Ruano

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Fetal lower urinary tract obstruction (LUTO) is a heterogeneous pathology associated with a high morbidity and mortality due to pulmonary hypoplasia. Previously, when a fetus was diagnosed on ultrasound with LUTO, expectant care or termination was the only option; this has changed because of fetal surgical intervention. Vesicoamniotic shunts and cystoscopy are the current methods utilized to treat LUTO; however, it remains difficult to determine whether fetal prognosis favors intervention and long-term outcome follow-up has been limited. This review covers the history and current challenges of fetal intervention for obstructive uropathies. We also present the Ruano's LUTO staging system which integrates information from fetal urine analysis with ultrasound findings to assess whether a specific fetal intervention is recommended. Utilizing a standard staging system that is readily adopted by providers carrying out fetal surgery is crucial for determining the true impact on outcomes intervention has on fetuses diagnosed with LUTO.

Original languageEnglish (US)
Pages (from-to)263-269
Number of pages7
JournalMinerva Pediatrica
Issue number3
StatePublished - Jun 2018


  • Cystoscopy
  • Fetus
  • Lower urinary tract symptoms
  • Oligohydramnios
  • Prenatal diagnosis
  • Urinary bladder neck obstruction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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