Optimal timing of fetal therapy for lower urinary tract obstruction in fetal lambs.

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Introduction : Lower urinary tract obstruction causes renal failure bladder dysfunction after birth. We examined the morphological changes of the early obstructive kidney and bladder to determine the optimal timing for fetal therapy.Materials and Methods : We created obstructive uropathy in fetal lambs at 60 days' gestation by ligating the urethra and urachus. The fetuses were delivered at 2, 3, 4, 5, 7, 14 days after obstruction and at term (145 days gestation). We focused on the early structure of the kidney and bladder wall thickness & structure, comparing obstructive and control lambs.Results : Dilation of Bowman's capsule and the proximal tubules started from day two. Acute tubular necrosis (ATN) was also observed up to day 7. Numerous cysts were present throughout the kidney at term. The bladder wall was initially expanded and stretched out but by the 4th day the bladder wall became thicker.Conclusion : Shunting operations to preserve bladder function may be needed earlier than we had expected.