IN-UTERO SURGICAL-TREATMENT OF FETAL OBSTRUCTIVE UROPATHY - A NEW COMPREHENSIVE APPROACH TO IDENTIFY APPROPRIATE CANDIDATES FOR VESICOAMNIOTIC SHUNT THERAPY

OBJECTIVES: We present a new approach to prenatal evaluation and predi ction of renal function and long-term outcomes for fetuses considered candidates for in utero surgery. STUDY DESIGN: A review of 34 cases of obstructive uropathies was made, with analysis of our approach to pre natal evaluation, the predictive value of urinary electrolytes and pro tein analysis in identifying renal dysplasia, and the outcomes of case s with and without in utero surgical intervention. RESULTS: Ten of 11 pregnancies that were terminated had dysplasia; one female had cloacal dysgenesis. In three of eight unshunted cases megacystis resolved aft er vesicocentesis. Eight of 15 shunted fetuses survived. Of those pred icted to have good postnatal outcome, six of six demonstrated good pos tnatal renal function. Of those predicted to have poor outcomes, two o f two had poor postnatal renal function and dysplasia. Seven of 15 shu nted fetuses died, four of four predicted to have dysplasia were confi rmed, and three died of nonrenal causes. CONCLUSIONS: Our prenatal app roach successfully differentiated fetuses with underlying renal dyspla sia from those without irreversible damage who subsequently benefited from in utero vesicoamniotic shunt placement.