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


Next Steps
Pregnant Mom and Child

Choosing a Fetal Treatment Center

Know what questions to ask when considering fetal surgery so you can make an informed decision that is right for you and your baby.

Pregnant Mom and Child

What to Expect

From the moment of referral through delivery and postnatal care, your family can expect a supportive experience when you come to us with a diagnosis of a birth defect.