Effectiveness of Prenatal Intervention on the Outcome of Diseases That Have a Postnatal Urological Impact

• Main Authors: Beatiz Bañuelos Marco, Ricardo González, Barbara Ludwikowski, Anja Lingnau
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2019-04-01
• Series: Frontiers in Pediatrics
• Subjects: LUTO; congenital adrenal hyperplasia (CAH); vesicoamniotic shunt; myelomeningocele; fetal therapy; posterior urethral valves
• Online Access: https://www.frontiersin.org/article/10.3389/fped.2019.00118/full

We reviewed the literature addressing outcomes of fetal intervention of conditions that require post-natal urological management including lower urinary tract obstruction, hydrometrocolpos, congenital adrenal hyperplasia, and myelomeningocele. Despite several decades of fetal intervention for these conditions, benefits remain elusive in part because of the enormous difficulty of conducting prospective randomized studies. In this review, we reached the following conclusions: Prenatal intervention in lower urinary tract obstruction (LUTO) improves survival in the worst cases by improving pulmonary function and it may be advantageous for renal function, particularly in patients with adverse urine parameters.Prenatal treatment of female fetuses at risk of having congenital adrenal hyperplasia (CAH) reduces virilization. Non-invasive fetal DNA analysis allows earlier diagnosis, reducing the risk of treating with dexamethasone males and non-affected fetuses.Fetal treatment of myelomeningocele (MMC) is gaining momentum. Prospective studies including standardized urologic evaluation will determine if the encouraging results reported by some hold on the long term follow-up.