Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Reply to ‘Management of very young fetuses with LUTO’

Nature Reviews Urology volume 19, pages 628–629 (2022)Cite this article

Subjects

We thank Thomas Kohl for his correspondence on our ERKNet Consensus Statement on prenatal LUTO (Capone, V. et al. Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group. Nat. Rev. Urol. 19, 295–303 (2022)1), which raises some important issues (Kohl, T. Management of very young fetuses with LUTO. Nat. Rev. Urol. https://doi.org/10.1038/s41585-022-00636-8 (2022)2). In our paper, we recommend offering prenatal intervention in fetuses with LUTO, as this approach increases perinatal survival (defined as survival at 6 months of age) compared with conservative management (57% versus 39%, respectively), with no evidence of effects on long-term mortality and kidney function. This recommendation is based on published literature reporting intrauterine treatment by vesico-amniotic shunt (VAS) placement at 20–27 weeks of gestational age in most studies1. We are aware of the importance of early treatment in the most severe instances, with the objective to improve kidney function. However, no sufficient evidence is available to make a recommendation on the optimal timing of prenatal intervention.

The study by Kohl and colleagues involves 28 fetuses with severe megacystis treated before 16 weeks’ gestation3. In this study, very early treatment is associated with fetal loss in 9 of 28 instances (32%), with 4 demises after intervention and 5 terminations of pregnancy. Moreover, a high rate of post-natal complications is observed in survivors, including bowel atresia, vesico-cutaneous fistulas and bowel eventration.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

References

  1. Capone, V. et al. Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-Obstructive Uropathy Work Group. Nat. Rev. Urol. 19, 295–303 (2022).

    Article  Google Scholar 

  2. Kohl, T. Management of very young fetuses with LUTO. Nat. Rev. Urol. https://doi.org/10.1038/s41585-022-00636-8 (2022).

    Article  PubMed  Google Scholar 

  3. Kohl, T., Fimmers, R., Axt-Fliedner, R., Degenhardt, J. & Brückmann, M. Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO). J. Pediatr. Urol. 18, 116–126 (2022).

    Article  Google Scholar 

  4. Ghi, T. et al. ISUOG practice guidelines: invasive procedures for prenatal diagnosis. Ultrasound Obstet. Gynecol. 48, 256–268 (2016).

    Article  CAS  Google Scholar 

  5. Farrugia, M.-K. Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO). J Pediatr. Urol. 18, 129–130 (2022).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy

    Valentina Capone & Giovanni Montini

  2. Fetal Medicine and Surgery Service, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Nicola Persico

  3. Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Giovanni Montini

Authors
  1. Valentina Capone
    View author publications

    Search author on:PubMed Google Scholar

  2. Nicola Persico
    View author publications

    Search author on:PubMed Google Scholar

  3. Giovanni Montini
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Valentina Capone.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Capone, V., Persico, N. & Montini, G. Reply to ‘Management of very young fetuses with LUTO’. Nat Rev Urol 19, 628–629 (2022). https://doi.org/10.1038/s41585-022-00637-7

Download citation

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41585-022-00637-7

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing