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In the past, fetal intervention studies aimed at mitigating the disease sequelae of cLUTO have yielded inconclusive results, which contributed to the current heterogeneous antenatal management of fetuses with cLUTO across fetal surgery centers. The recent development of first-trimester diagnostics and early vesico-amniotic shunting (VAS) (i.e.,\u2009&lt;\u200917\u00a0weeks of gestation) in Germany to decompress the urinary tract and preserve amniotic fluid volume throughout pregnancy has added another dimension to this heterogeneity, as retrospective studies suggest a potential benefit of this procedure for overall survival as well as postnatal pulmonary and kidney function. Despite these promising results, many questions remain unanswered before early VAS can be implemented as a standard antenatal treatment for cLUTO. These questions need to be addressed by large-scale, multidisciplinary prospective studies, which are difficult to conduct for various reasons. Here, we describe the current state of the art in cLUTO management, providing a multidisciplinary perspective that includes risks and benefits of early fetal medicine approaches in the clinical management of affected newborns. Furthermore, we outline future directions to overcome challenges in optimizing our approach to improve outcomes for children with cLUTO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-025-06994-w","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:44:38Z","timestamp":1763037878000},"page":"1937-1950","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Early diagnosis and intervention in congenital lower urinary tract obstruction: time to revise our approach?"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5404-9203","authenticated-orcid":false,"given":"Jaap","family":"Mulder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9600-8231","authenticated-orcid":false,"given":"Stefan","family":"Kohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Fontanella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0354-7584","authenticated-orcid":false,"given":"Alina C.","family":"Hilger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3591-5265","authenticated-orcid":false,"given":"Heiko","family":"Reutter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3217-5089","authenticated-orcid":false,"given":"Raimund","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6633-8464","authenticated-orcid":false,"given":"Eva C.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4960-4078","authenticated-orcid":false,"given":"Rik","family":"Westland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"6994_CR1","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1038\/s41585-022-00563-8","volume":"19","author":"V Capone","year":"2022","unstructured":"Capone V, Persico N, Berrettini A, Decramer S, De Marco EA, De Palma D, Familiari A, Feitz W, Herthelius M, Kazlauskas V, Liebau M, Manzoni G, Maternik M, Mosiello G, Schanstra JP, Vande Walle J, Wuhl E, Ylinen E, Zurowska A, Schaefer F, Montini G (2022) Definition, diagnosis and management of fetal lower urinary tract obstruction: consensus of the ERKNet CAKUT-obstructive uropathy work group. 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Ultrasound Obstet Gynecol 49:696\u2013703.\u00a0https:\/\/doi.org\/10.1002\/uog.15988","DOI":"10.1002\/uog.15988"}],"container-title":["Pediatric Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-06994-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00467-025-06994-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00467-025-06994-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:01:41Z","timestamp":1779444101000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00467-025-06994-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":98,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["6994"],"URL":"https:\/\/doi.org\/10.1007\/s00467-025-06994-w","relation":{},"ISSN":["0931-041X","1432-198X"],"issn-type":[{"value":"0931-041X","type":"print"},{"value":"1432-198X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]},"assertion":[{"value":"16 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors are affiliated with different German and Dutch University Medical Centers, both where vesico-amniotic shunting for fetuses with cLUTO is currently performed and where it is not. These centers\u00a0are part of the European Rare Kidney Disease Reference\u00a0Network (ERKNet).\u00a0They have been trained in different regions worldwide (incl. North-America) and are actively involved in global research collaborations. ECW designed a currently ongoing, prospective, and multidisciplinary trial on early diagnosis and treatment of fetuses with cLUTO (IUS1st, DRKS00017779) that includes patients from Germany, The Netherlands, Austria, and Uruguay. We here aim to present an unbiased, global, and multidisciplinary perspective on the current and future clinical management of cLUTO. SK is a board member of the ERKNet Working group on CAKUT and Ciliopathies. RW and ACH are board members of the Working Group on CAKUT, urinary tract infection, and bladder dysfunction of the European Society of Pediatric Nephrology (ESPN). RW and JM are members of the NL research consortium Kidnie, which is supported by the Dutch Kidney Foundation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}