Guidelines for Vesicoamniotic Shunting

Inclusion criteria

  1. Identification of an isolated lower urinary tract obstruction in a male fetus
  2. Singleton pregnancy
  3. Normal male karyotype (normal male FISH results might be acceptable in specific circumstances)
  4. Presence of oligohydramnios (AFV <5%)
  5. Gestational age >16wks and <24wks
  6. Serial vesicocentesis data indicate renal function in the good prognosis range as outlined below

Good prognosis (as measured at gestational age 18-22 weeks):

  • Sodium <90 mmol/L 
  • Cloride <80 mmol/L 
  • Osmolality <180 mOsm/L 
  • Total protein <20mg/dl 
  • Beta 2 microglobulin <6mg/L
  • Calcium <7 mg/dl 

Poor prognosis (as measured at gestational age 18-22 weeks):

  • Sodium >100 mmol/L
  • Cloride >90 mmol/L
  • Osmolality >200 mOsm/L
  • Total protein >40 mg/dl
  • Beta 2 microglobulin >10 mg/L
  • Calcium >8 mg/dl

*Wu and Johnson, Clin Perinatol 36(2009), p.377-390

Exclusion criteria

  1. Multi-fetal pregnancy
  2. Presence of additional major anomalies unrelated to lower urinary tract obstruction
  3. Evidence of fibrocystic renal dysplasia
  4. Normal amniotic fluid volume
  5. Serial vesicocentesis data indicating renal electrolytes in the poor prognosis range as outlined above
  6. Maternal contraindications

Find more professional resources for managing complex genitourinary anomalies.

Reviewed May 1, 2017

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