Effect of vasico-amniotic shunt for fetal obstructive uropathy in lambs

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Purpose : The long term outcome for children after antenatal intervention for obstructive uropathies 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 ligating 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 compliance were measured. The urinary tract was processed for histological examination.Results: Twenty two fetuses were shunted. Nine miscarried or were still-born. Thirteen survived and eleven 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 submucosal connective tissue with hypertrophied muscle. Histology of the renal tissue demonstrated relatively well-preserved renal architecture with reduced nephron mass (oligonephronia) in two lambs and multycystic dysplastic change (MCDK) in three. Six (55%) had normal nephrogenesis.Conclusions : In our model, shunt operations after obstructive uropathy fail to preserve bladder function. Shunting ameliorated the development of cystic dysplasia but half of the lambs had oligonephronia or MCDK. Thiese might develop renal failure later in life.