Prenatal predictors of prognosis in congenital LUTO

Abstract

Background: Congenital lower urinary tract obstruction (LUTO) is a rare but significant cause of morbidity and mortality. Establishing the prognosis of LUTO remains a challenge, due to the lack of consensus regarding which parameters can predict fetal outcome. Objetive: To discuss factors that would be able to predict perinatal prognosis and, therefore, provide both practitioners and parents with some guidance regarding fetal outcome. Methods: We performed a review of the current literature, including 30 articles written in English and published between 01/01/2000 and 20/02/2020. Results: Several parameters are correlated with prognosis in LUTO including bladder dimension, renal appearance, renal parenchymal area, amniotic fluid volume, gestational age at the appearance of oligohydramnios, renal vascularization, gestational age at diagnosis and several parameters in the analytic studies. Recently, two LUTO staging systems were introduced and they comprise several of these parameters, improving prognosis accuracy. Conclusion: A single marker cannot accurately predict LUTO fetuses prognosis, and a multiple markers approach is a more prudent way to evaluate those cases. Further studies are needed to compare the staging systems previously proposed and to validate them in routine practice.