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JU INSIGHT Pathological Findings in Fetuses Terminated for Suspected Lower Urinary Tract Obstruction

By: Juliane Richter, MD, The Hospital for Sick Children, Toronto, Ontario, Canada; Mandy Rickard, NP, The Hospital for Sick Children, Toronto, Ontario, Canada; Hayley Good, University of Toronto, Ontario, Canada; Jin K. Kim, MD, The Hospital for Sick Children, Toronto, Ontario, Canada, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Patrick Shannon, MD, Mount Sinai Hospital, University of Toronto, Ontario, Canada; Joana Dos Santos, MD, MHSc, The Hospital for Sick Children, Toronto, Ontario, Canada; Michael E. Chua, MD, MASc (GH), The Hospital for Sick Children, Toronto, Ontario, Canada, St Luke’s Medical Center, Manila, Philippines; Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS, The Hospital for Sick Children, Toronto, Ontario, Canada, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; Tim Van Mieghem, MD, PhD, Mount Sinai Hospital, University of Toronto, Ontario, Canada; Shiri Shinar, MD, Mount Sinai Hospital, University of Toronto, Ontario, Canada | Posted on: 21 Feb 2024

Richter J, Rickard M, Good H, et al. Pathological findings in fetuses terminated for suspected lower urinary tract obstruction: experience from a high-risk fetal center in Canada. J Urol. 2024;211(2):305-312.

Study Need and Importance

Lower urinary tract obstruction (LUTO) can be associated with significant morbidity and mortality, especially if detected early in pregnancy. Given prenatal uncertainty of the final diagnosis and prognosis, termination rates are high. Therefore, this study aimed to investigate the autopsy findings in fetuses terminated for suspected LUTO to correlate their pathologies to prenatal ultrasound findings.

What We Found

Our data confirmed the high termination rates among this cohort (42%) and demonstrated good prenatal detection rates (84.1%). The most common ultrasound findings included megacystis and bilateral hydroureteronephrosis, while the keyhole sign was found in 52.3% of cases. In addition, postmortem examination demonstrated a high proportion with pulmonary hypoplasia (62.2%), while genetic anomalies were rare (13.6%) and limited solely to fetuses with a confirmed LUTO diagnosis postmortem (Figure).

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Figure. Overview of underlying etiologies found during postmortem examination and genetic anomalies in fetuses with suspected lower urinary tract obstruction. Created with BioRender.com. UVJO indicates ureterovesical junction obstruction.

Limitations

Despite the interesting pathological findings of this study, declined autopsies, unavailable data in terms of underlying etiologies, individual prenatal management, as well as varying severity of findings lead to a limited heterogenous study population and therefore, our results should not be generalized and should be interpreted with caution.

Interpretation for Patient Care

This study highlights the close association between early prenatal detection of significant ultrasound findings and a poor prognosis of LUTO fetuses, demonstrated in the serious pathological findings as well as genetic disorders leading to high termination rates. Despite reasonable prenatal detection rates, future efforts should focus on early detection with timely management and available treatment options to potentially decrease termination rates and optimize prenatal care for affected families.

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