Is vesicoamniotic shunt for complete urinary tract obstruction is partially effective?

点击翻译按钮获取中文摘要

Purpose : The long-term outcome for children after antenatal intervention for obstructive uropathy is disappointing. We reported that renal dysplastic changes are well-established 3 weeks after obstruction in a fetal lamb model. We used this model to explore renal development and bladder function after fetal intervention.Methods : We created an obstructive uropathy in fetal lambs at 60 days gestation by legating the urethra and urachus. A vesicostomy (female) or urethrostomy (male) were performed 21 days later. The fetuses were sacrificed at term (145 days) and bladder volume and were measured. The urinary tract was processed for histological examination.Results : Forty fetuses created an obstructive uropathy. Eleven miscarried or were stillborn. Twenty-nine survived and twenty-four had a successful shunt with a small bladder (8±5ml) compared to controls (71±19ml), p<0.05. Shunted bladders had poor compliance. Histologically, they had thickened sub mucosal connective tissue with hypertrophied muscle. Histology of the renal tissue demonstrated relatively well-preserved renal architecture with reduced nephrons mass (oligonephronia) in nine lambs and multicystic dysplastic change (MCDK) in three. Thirteen (54%) had normal nephrogenesis or slightly dilated pelvis as a Hydronephrosis.Conclusions : In our model, shunt operations after obstructive uropathy fail to preserve bladder function. Shunting ameliorated the development of cystic dysphasia but half of the lambs had oligonephronia or MCDK. These might develop renal failure later in life but 54% had normal nephrogenesis after shunting.