Valved shunt as a treatment for obstructive uropathy: does pressure make a difference?

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A valved ventriculo-peritoneal shunt (V-P shunt) as a vesico-amniotic shunt (V-A shunt) preserves the filling/emptying cycle and normal bladder development in fetallambs with bladder outlet obstruction. We created obstructive uropathy in 60-day gestation fetal lambs.A V-A shunt was placed 3 weeks later,using a low-pressure (L:15-54 mm H2O) or a high-pressure (H:95-150 mm H2O) V-P shunt. We included non-shunted (O) and control (C) lambs. All were delivered at 130 days. Bladder volumes,bladder thickness, renal and bladder histology were compared. Five Group L (4 survived),four Group H (3 survived) and 5 Group O survived.Group H lambs had a dilated urachus,urinary ascites and severe ureteral dilatation similar to Group O lambs. There were 4 Group C lambs. Bladder volume was 10,15 and 1,150ml in Group H,115+-67.9 ml in Group L,128+-99.8 ml in Group O and 24.5+-3.84 ml in Group C.Low-pressure shunts preserved both bladder volume and renal development. High-pressure shunts did neither.