Congenital urinary tract obstruction
Congenital urinary tract obstruction
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DOI：
10.1016/j.bpobgyn.2019.01.003
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发表时间：
2019-07-01
影响因子：
5.5
通讯作者：
Kilby, Mark David
中科院分区：
文献类型：
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作者：
Cheung, Ka Wang;Morris, Rachel Katie;Kilby, Mark David
先天性膀胱颈梗阻（或下尿路梗阻[LUTO]）描述了一组异质性先天性异常，表现为类似的产前超声检查结果，包括后尿道扩张、巨大膀胱、肾积水、羊水过少，通常伴有肾发育不良。未经治疗的LUTO具有较高的围生期发病率和死亡率，其与婴儿期肺发育不全和早发性肾衰竭有关。超声特征和前瞻性胎儿尿分析可能有助于预测先天性LUTO的总体预后。目前，胎儿膀胱羊膜分流术（各种设计），胎儿膀胱镜检查和电灼阻塞是潜在的产前干预措施。回顾性和前瞻性队列研究以及一项相对较小的随机对照试验表明，这些治疗可能会改善围产儿生存率。尽管如此，在儿科幸存者中观察到的高肾损害率仍然令人担忧。临床前瞻性评分/分期系统可以提高产前诊断标准和胎儿治疗的病例选择。皇冠版权所有（C）2019由爱思唯尔有限公司发布。保留所有权利。
Congenital bladder neck obstruction (or lower urinary tract obstruction [LUTO]) describes a heterogeneous group of congenital anomalies presenting with similar prenatal ultrasonographic findings of dilated posterior urethra, megacystis, hydronephrosis, oligohydramnios and often with associated renal dysplasia. Untreated LUTO has high rate of perinatal morbidity and mortality from associated pulmonary hypoplasia and early-onset renal failure in infancy. Ultrasonographic features and prospective fetal urinalysis may help in predicting the overall prognosis of congenital LUTO. Currently, fetal vesicoamniotic shunt (of various designs), and fetal cystoscopy and fulguration of the obstruction are potential prenatal interventions. Retrospective and prospective cohort studies and a relatively small randomized controlled trial have demonstrated these treatments may possibly improve perinatal survival. Despite this, concerns remain as to the high rates of renal impairment observed in paediatric survivors. A clinical prospective scoring/staging system may improve prenatal diagnostic criteria and case selection for fetal therapy. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.