Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Fetus

Poster Session 4

(1093) Management and Core Outcomes Set of Fetal Lower Urinary Tract Obstruction: Delphi Consensus

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Hiba J. Mustafa, MD (she/her/hers)

Assistant Professor of Fetal Surgery and Maternal-Fetal Medicine
Indiana University, Riley Children's Hospital
Carmel, IN, United States

Coauthor(s)

SJ

Sonia Johnson, MD

Oxford University, England, United Kingdom
SG

Sanne J. Gordijn, MD, PhD

Gynecologist perinatologist (MFM)
UMCG
Groningen, Groningen, Netherlands
WG

Wessel Ganzevoort, MD, PhD

University of Amestrdam
Amestrdam, Limburg, Netherlands
CK

Chester Koh, MD

Professor of Urology, Pediatrics, and OB/GYN. Director, Pediatric Robotic Surgery Program Executive Director, SouthWest national Pediatric Device innovation Consortium (SWPDC) Texas Children's Hospital | Baylor College of Medicine
Houston, TX, United States
GM

George T. Mandy, MD

Texas Children's Hospital, Baylor College of Medicine
Houston, TX, United States
CM

Charlotte Melling, BSc, FRCS, MD

Consultant Paediatric Surgeon & Urologist Honorary Clinical Lecturer University of Liverpool
Liverpool, England, United Kingdom
Asma Khalil, MD, MSc (she/her/hers)

Professor of Maternal Fetal Medicine
Fetal Medicine Unit, St. George's Hospital, St. George's University of London
London, England, United Kingdom
Ahmed A. Nassr, MD, PhD

Associate professor
Baylor College of Medicine
Houston, TX, United States

Objective: We aimed to reach a Delphi-generated international expert consensus on the diagnosis, management and core outcomes set (COS) of Fetal Lower urinary tract obstruction (LUTO).

Study Design: A three-round Delphi procedure was conducted among international panel of LUTO experts from Fetal Medicine and subspecialties of Pediatrics. Panel was provided with a list of literature review generated parameters for diagnosing and management. A parallel procedure was conducted along with patient groups to produce COS.

Results: A total of 160 experts were approached, of whom 99 completed the first round and 80 (80/99, 80.8%) completed all three rounds. Regarding diagnosis, in the first trimester, objective assessment with a longitudinal bladder diameter of ≥7 mm should be used to suspect LUTO. While in the second trimester, imaging parameters of obstructive uropathy include enlarged bladder, keyhole sign, bladder wall thickening, bilateral hydronephrosis and male sex. There was lack of consensus on the current prognostic scoring literature, however, experts agreed on the value of amniotic fluid volume < 24 weeks to predict survival. While experts endorsed the role of sonographic parameters of renal dysplasia (cortical cysts, loss of corticomedullary differentiation), at least one bladder tap, and renal biochemistry for counselling, these items did not reach consensus for fetal intervention candidacy. Consensus for fetal intervention candidacy were absence of life-limiting fetal anomalies, imaging parameters of obstructive uropathy, minimum gestational age of 16 weeks, and oligohydramnios with DVP < 2 cm. If bladder refill was assessed, it should be assessed subjectively. In the presence of suspected renal failure, serial amnioinfusion should only be offered under IRB protocols. Core outcome set for future studies was agreed upon.

Conclusion: International diagnostic, prognostic and management criteria for fetal LUTO have reached consensus. Consensus-based criteria and the Core Outcome Set should inform clinical care and research to optimize perinatal outcomes.