Studie zum Outcome von Patienten mit LUTO (Lower Urinary Tract Obstruction) nach interventioneller antenataler Therapie

Background: The term lower urinary tract obstruction (LUTO) encompasses congenital malformations of the lower urinary tract. The most common cause are posterior urethral valves (PUV). Early antenatal manifestation is associated with a high mortality and morbidity rate. Prenatal therapy in specialized centers includes placement of a vesicoamniotic shunt (VAS). Methods: Longitudinal data of 22 children probands with prenatal diagnosed and with VAS therapied LUTO was obtained in a unicenter approach. Results: Postnatal mortality in this study was low with 14%. Postnatal renal function was significantly impaired despite fetal therapy. At 1 year, 59% of the children had stage 5 chronic kidney disease (CKD); all patients had a CKD, at least stage 2. Accordingly, in our study cohort at 3 years of age, 43% of the patients had dialysis and 29% had already undergone kidney transplantation. In 6/8 patients (75%), we found below-average development in motoric skills at 12 months of age. In both language and cognition, we saw average development in 5/8 patients (62.5%). In addition, we observed a limited somatic development (MW < 20. P.). In the PedsQL questionnaire, there was a mean Total Score of 74 (max. 100) for family impact, indicating good family functioning. For Health-Related Quality of Life (QoL), it was a mean Total Score of 85. Conclusion: These data support the results of other studies, which showed no advantage of VAS therapy in the 2nd trimester with respect to renal function. Furthermore, there are comorbidity aspects, which should be also considered.