What Are Fetal Lower Urinary Tract Obstructions (LUTO)?
During detailed prenatal ultrasonography, urinary tract obstructions can sometimes be detected in the fetus.
In cases where amniotic fluid levels are severely reduced, and chromosomal or structural abnormalities have been ruled out, these findings may still carry significant risks for the baby.
In such situations, severe impairment of lung development (pulmonary hypoplasia) may occur after birth, dramatically reducing the baby’s chances of survival.
Therefore, after comprehensive counseling with the family, interventional treatment options may be offered when appropriate.
Assessment of Fetal Kidney Function
Fetal kidney function can be evaluated through:
- Ultrasonographic examination
- Fetal bladder aspiration (vesicocentesis)
In cases where renal function is preserved, a vesicoamniotic shunt may be placed between the bladder and the amniotic cavity to:
- Bypass the obstruction, and
- Restore the normal level of amniotic fluid.
At our center, we effectively perform this shunting procedure and follow-up protocol in suitable cases.
Innovative Treatment Approaches
One of the new techniques still in the experimental stage is fetal cystoscopy, which involves direct endoscopic visualization of the fetal bladder.
In this method:
- The interior of the bladder is examined using an optical device, and
- Obstructive tissue folds in the urethra can be cauterized and treated.
However, this advanced procedure is currently performed in only a few specialized centers worldwide.
Other Conditions Requiring Intrauterine Shunting
In addition to urinary tract obstructions, intrauterine shunt placement may also be indicated in certain non-urinary conditions, including:
- Pleural effusion (fluid accumulation around the lungs)
- Fetal ascites (excessive fluid in the abdominal cavity)
In these situations, excessive fluid can:
- Severely compromise the baby’s health, and
- Negatively affect oxygenation.
By inserting a catheter to drain the fluid into the amniotic cavity, the pressure is relieved, and in some cases, this procedure contributes directly to the resolution of the underlying condition.
Case Example
In one of our cases, we treated a 6-month-old fetus with massive ascites that was impairing oxygenation while still in the womb.
Before an emergency cesarean section became necessary, a shunt procedure was performed.
As a result:
- The pressure on the baby’s organs was relieved, improving oxygenation,
- Preterm delivery and its potential complications were prevented,
- Once the fluid was drained, the underlying abnormality could be more clearly identified, and
- The pregnancy was successfully prolonged until the 8th month.
Following delivery, the baby underwent the required surgical procedures and is now 2 years old and in good health.
