From prenatal LUTO intervention to postnatal surgery: complication rates and operative requirements

Abstract Objectives Fetal lower urinary tract obstruction (LUTO) has been demonstrated to be associated with significant morbidity and mortality. As a result, vesicoamniotic shunts are placed prenatally to relieve the urinary tract. The aim of this study was to evaluate the postnatal complications of prenatal vesicoamniotic shunt placement and the need for pediatric surgical intervention. Methods The retrospective study included all male patients with LUTO, and prenatal intervention treated at the Department of Pediatric Surgery and Pediatric Urology, University Hospital Marburg, between January 1st, 2013, and December 31st, 2022. In addition to the demographic data, the complications due to the prenatal intervention and the postnatal pediatric surgical treatment due to the complication were evaluated. Results A total of 23 male infants were included in the study. In 22/23 patients (96 %), a vesicoamniotic shunt was placed. In one case, only amniotic fluid refilling was performed. Shunt-related complications were frequently observed, with dislocation occurring in 68 % of cases and abdominal wall defects in 21 %. Postnatal management proved to be a complex undertaking, with the majority of patients requiring surgical intervention for implant removal. Of these patients, 78 % underwent laparotomy or laparoscopy. The presence of vesicoperitoneal and vesicorectal fistulas, renal and ureteral injuries, and bowel perforations often necessitated immediate surgical intervention. Despite the implementation of early decompression efforts, a significant proportion of patients exhibited the development of chronic kidney disease, with a notable percentage requiring peritoneal dialysis (57 %) and a considerable number undergoing kidney transplantation during subsequent follow-up (22 %). Conclusions Prenatal intervention for LUTO is associated with high rates of peri- and postnatal complications, frequent need for surgical intervention, and poor long-term renal outcomes. These findings support the need for improved prenatal counseling, technical innovation, and multidisciplinary postnatal management to optimize care for affected infants.