{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:49:03Z","timestamp":1788306543096,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold> Congenital lower urinary tract obstruction (cLUTO) includes a heterogeneous group of conditions caused by a functional or mechanical outlet obstruction. Early vesicoamniotic shunting (VAS) possibly reduces the burden of renal impairment. Postpartum, pediatric urologists are confronted with neonates who have a shunt in place and a potentially impassable urethra with a narrow caliber. Early management of these patients can be challenging. Here, we would like to share the approach we have developed over time.<\/jats:p><jats:p><jats:bold>Materials and Methods:<\/jats:bold> We conducted a single-center retrospective analysis from 2016 to 2020 and included all patients diagnosed with cLUTO. Data focusing on time point and type of intervention was collected. Furthermore, patients with temporary diversion via a percutaneous VAS were selected for a more detailed review.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In total, 71 cases of cLUTO were identified during the study period. Within this group, 31 neonates received postnatal management and surgical intervention in our center. VAS was performed in 55% of these cases (<jats:italic>N<\/jats:italic> = 17). The postnatal treatment varied between transurethral or suprapubic catheterization and early Blocksom vesicostomy. In five infants with VAS, the urinary drainage was secured through the existing VAS by inserting a gastric tube (<jats:italic>N<\/jats:italic> = 1) or a 4.8 Fr JJ-stent (<jats:italic>N<\/jats:italic> = 4). To our knowledge, this is the first report of a stent-in-stent scheme, which can remain indwelling until the definite treatment.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Having a secure urine drainage through a VAS allows the often premature infant to grow until definite surgery can be performed. This avoids placing a vesicostomy, which requires anesthesia.<\/jats:p>","DOI":"10.3389\/fped.2021.635950","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T07:20:33Z","timestamp":1618384833000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Postnatal Management in Congenital Lower Urinary Tract Obstruction With and Without Prenatal Vesicoamniotic Shunt"],"prefix":"10.3389","volume":"9","author":[{"given":"Marietta","family":"Jank","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimund","family":"Stein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Younsi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1111\/j.1471-0528.2012.03476.x","article-title":"Congenital lower urinary tract obstruction: a population-based epidemiological study","volume":"119","author":"Malin","year":"2012","journal-title":"BJOG"},{"key":"B2","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.purol.2018.06.005","article-title":"Long-term renal outcome in infants with congenital lower urinary tract obstruction","volume":"28","author":"Berte","year":"2018","journal-title":"Prog Urol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1159\/000478011","article-title":"Natural history of fetal lower urinary tract obstruction with normal amniotic fluid volume at initial diagnosis","volume":"44","author":"Johnson","year":"2017","journal-title":"Fetal Diagn Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.1007\/s00467-017-3593-8","article-title":"Lower urinary tract obstruction: fetal intervention based on prenatal staging","volume":"32","author":"Ruano","year":"2017","journal-title":"Pediatr Nephrol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2392","DOI":"10.1016\/j.juro.2011.07.109","article-title":"Long-term risk of end stage renal disease in patients with posterior urethral valves","volume":"186","author":"Heikkil","year":"2011","journal-title":"J Urol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1016\/S0022-5347(01)66186-X","article-title":"The long-term outcome of posterior urethral valves treated with primary valve ablation and observation","volume":"155","author":"Smith","year":"1996","journal-title":"J Urol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.jpurol.2016.05.047","article-title":"Fetal bladder outlet obstruction: embryopathology, in utero intervention and outcome","volume":"12","author":"Farrugia","year":"2016","journal-title":"J Pediatr Urol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1002\/uog.81","article-title":"Megacystis at 10-14 weeks of gestation: chromosomal defects and outcome according to bladder length","volume":"21","author":"Liao","year":"2003","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/0002-9378(83)90685-3","article-title":"Antepartum chronic fetal vesicoamniotic shunts for obstructive uropathy: a report of two cases","volume":"145","author":"Manning","year":"1983","journal-title":"Am J Obstet Gynecol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1159\/000488282","article-title":"Antenatal workup of early megacystis and selection of candidates for fetal therapy","volume":"45","author":"Fontanella","year":"2019","journal-title":"Fetal Diagn Ther"},{"key":"B11","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s00404-020-05598-z","article-title":"Vesicoamniotic shunting for fetal megacystis in the first trimester with a Somatex([R]) intrauterine shunt","volume":"302","author":"Strizek","year":"2020","journal-title":"Arch Gynecol Obstet"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.1016\/S0140-6736(13)60992-7","article-title":"Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial","volume":"382","author":"Morris","year":"2013","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ejogrb.2018.12.007","article-title":"Outcomes in fetuses diagnosed with megacystis: systematic review and meta-analysis","volume":"233","author":"Chen","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"486","DOI":"10.5603\/GP.a2017.0089","article-title":"Early vesico-amniotic shunting - does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?","volume":"88","author":"Debska","year":"2017","journal-title":"Ginekol Pol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.bpobgyn.2019.01.003","article-title":"Congenital urinary tract obstruction","volume":"58","author":"Cheung","year":"2019","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1002\/uog.17422","article-title":"Fetal megacystis: prediction of spontaneous resolution and outcome","volume":"50","author":"Fontanella","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1002\/uog.7646","article-title":"The 11-13-week scan: diagnosis and outcome of holoprosencephaly, exomphalos and megacystis","volume":"36","author":"Kagan","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1002\/uog.19172","article-title":"Antenatal staging of congenital lower urinary tract obstruction","volume":"53","author":"Fontanella","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s004670050035","article-title":"Fetal therapy for obstructive uropathy: past, present.future?","volume":"14","author":"Freedman","year":"2000","journal-title":"Pediatr Nephrol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1002\/uog.14734","article-title":"Fetal urine biochemistry at 13\u201323 weeks of gestation in lower urinary tract obstruction: criteria for in-utero treatment","volume":"46","author":"Abdennadher","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s00467-019-04390-9","article-title":"A single-center study to evaluate the efficacy of a fetal urine peptide signature predicting postnatal renal outcome in fetuses with posterior urethral valves","volume":"35","author":"Buffin-Meyer","year":"2020","journal-title":"Pediatr Nephrol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1093\/ckj\/sfz107","article-title":"The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design","volume":"13","author":"Buffin-Meyer","year":"2020","journal-title":"Clin Kidney J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1002\/pd.4850","article-title":"Factors associated with fetal shunt dislodgement in lower urinary tract obstruction","volume":"36","author":"Kurtz","year":"2016","journal-title":"Prenat Diagn"},{"key":"B24","first-page":"19","article-title":"Improving the vesicoamniotic shunt for fetal lower urinary obstruction","volume":"2020","author":"Kurtz","year":"2020","journal-title":"Dialog Pediatr Urol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/S0022-5347(17)66453-X","article-title":"Bladder pouch for prolonged tubeless cystostomy","volume":"78","author":"Blocksom","year":"1957","journal-title":"J Urol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.635950\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T07:20:35Z","timestamp":1618384835000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.635950\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,14]]},"references-count":25,"alternative-id":["10.3389\/fped.2021.635950"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.635950","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,14]]},"article-number":"635950"}}