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

带瓣脑室-腹腔分流术（V-P分流术）作为膀胱-羊膜分流术（V-A分流术）保留了膀胱出口梗阻胎儿的充盈/排空周期和正常膀胱发育。我们在妊娠60天的胎儿中建立梗阻性尿路病，3周后放置V-A分流管，使用低压（L：15-54 mm H2O）或高压（H：95-150 mm H2O）V-P分流管。我们包括非分流（O）和对照（C）羔羊。全部在130天内交付。比较膀胱体积、膀胱厚度、肾脏和膀胱组织学。L组5只（4只存活），H组4只（3只存活），O组5只存活。C组羔羊4只。膀胱容量H组为10、15和1, 150 ml，L组为115 ± 67.9ml，O组为128 ± 99.8ml，C组为24.5 ± 3.84ml。高压分流器也没有。

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.