Fetal bladder morphology as a predictor of outcome in fetal lower urinary tract obstruction

Kara J. Shannon, Sarah VanLoh, Jimmy Espinoza, Magdalena Sanz-Cortes, Roopali Donepudi, Alireza A. Shamshirsaz, Chester J. Koh, David R. Roth, Michael C. Braun, Joseph Angelo, Michael A. Belfort, Ahmed A. Nassr

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: We evaluate survival of fetuses with severe Lower Urinary Tract Obstruction (LUTO) based on bladder morphology. We hypothesize that fetuses with a "floppy" appearing bladder on initial prenatal ultrasound will have worse infant outcomes than fetuses with full/rounded bladders.

METHOD: We retrospectively reviewed all cases of LUTO evaluated in our fetal center between January 2013 and December 2021. Ultrasonographic assessment, renal biochemistry, and bladder refilling contributed to a "favorable" or "unfavorable" evaluation. Bladder morphology on initial ultrasound was classified as "floppy" or "full/rounded." Vesicoamniotic shunting was offered for favorably evaluated fetuses. Baseline demographics, ultrasound parameters, prenatal evaluations of fetal renal function, and infant outcomes were collected. Fetuses diagnosed with severe LUTO were included in analysis using descriptive statistics. The primary outcome measured was survival at 6 months of life.

RESULTS: 104 LUTO patients were evaluated; 24 were included in analysis. Infant survival rate at 6 months was 60% for rounded bladders and 0% for floppy bladders (p = 0.003). Bladder refill adequacy was lower in fetuses with floppy bladders compared with rounded bladders (p value < 0.00001).

CONCLUSION: We propose that bladder morphology in fetuses with severe LUTO may be a prognostication factor for predicting infant outcomes and provides a valuable, noninvasive assessment tool.

Original languageEnglish (US)
JournalPrenatal Diagnosis
Early online dateMar 15 2023
StateE-pub ahead of print - Mar 15 2023

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Genetics(clinical)


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