Prenatal diagnosis and outcomes of congenital Lower Urinary Tract Obstruction (LUTO) at Tygerberg Hospital Fetal Medicine Unit: an audit of 12 years
| dc.contributor.advisor | Urban, M. | en_ZA |
| dc.contributor.advisor | Geerts, L. | en_ZA |
| dc.contributor.author | Bezuidenhout, Heidre | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology. | en_ZA |
| dc.date.accessioned | 2021-06-03T10:38:55Z | |
| dc.date.available | 2021-06-03T10:38:55Z | |
| dc.date.issued | 2015-12 | |
| dc.description | Thesis (MMed)--Stellenbosch University, 2015. | en_ZA |
| dc.description.abstract | ENGLISH ABSTRACT: Objective: To determine the frequency, etiology, survival and associated morbidity of prenatally detected Lower Urinary Tract Obstruction (LUTO) to predict outcome and guide prenatal counselling and management. Methods: Retrospective record review of prenatal LUTO cases at the Tygerberg Hospital Fetal Medicine Unit between January 2003 and June 2014. Results: A total of 75 prenatal LUTO cases were detected in 12 years, giving an approximate frequency of 1.2 per 10,000 births calculated over a 3 year period. The median gestation at diagnosis was 22.4 weeks. Prenatally 39 (52%) were classified as ‘Isolated’, 16 (21%) as ‘Isolated with marker’ and 20 (27%) as ‘Complex’. Gender difference observed with predominance of males (60/68) (88%), male:female ratio 7.5:1. Males had predominantly ‘Isolated LUTO’ (n=36, 60%), and females ‘Complex LUTO’ (n=5, 63%). Survival outcomes included: TOP 26 (35%), IUD 1 (1%), Stillbirths 8 (11%), NND 12 (16%), Infant deaths 4 (5%), alive >1 year 16 (21%), Lost to follow-up/Unknown 8 (11%). The most common etiology was PUV (51%). Chromosomal aneuploidy was found in 9.3% (7/75), all in males, with Trisomy 21 the most common anomaly (4/7) (57%). Prenatal findings shown to be significantly associated with a ‘Poor outcome’ are bilateral renal cortex echogenic/cystic changes (p=0.029), anhydramnios (p=0.011) and pulmonary hypoplasia (p=0.003). Morbidity measures showed survivors beyond 1 year of age (n=16) had renal impairment (n=6, 37%), bladder dysfunction (n=4, 25%), recurrent UTI’’s (n=9, 56%). Conclusion: This study adds novel data on the burden and impact of congenital LUTO in a South African, developing country setting. It confirms high mortality and significant morbidity, and supports the predictive value of specific antenatal ultrasound findings. Recommendations for clinical practice include; systematic ultrasound examination for other major anomalies, including soft markers to better define the risk of underlying chromosomal anomalies, determination of gender and karyotyping. The overall poor prognosis makes extensive counselling of the parents essential, especially if detected late in pregnancy, and supports the development of standardised guidelines for congenital anomalies. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Doel: Om die frekwensie, etiologie, oorlewing en geassosieerde morbiditeit van voorgeboorte Laer Urinêre Obstruksie (LUO) te bepaal ten einde die finale uitkoms te voorspel en inligting vir voorgeboorte berading en hantering te bepaal. Metode: Retrospektiewe rekord oorsig van voorgeboorte LUO gevalle by Tygerberg Hospitaal Fetale Medisyne Afdeling tussen Januarie 2003 en Junie 2014. Resultate: Vyf en sewentig prenatale LUO gevalle is gediagnoseer in ‘n 12 jaar tydperk, met ‘n berekende frekwensie van 1.2 per 10,000 oor ‘n 3 jaar periode. Die mediane gestasie van diagnose was 22.4 weke. In die voorgeboorte tydperk is 39 (52%) gevalle as ‘Geisoleerd’ geklassifiseerd, 16 (21%) as ‘Geisoleerd met merker’ en 20 (27%) as ‘Kompleks’. Manlike geslag was die algemeenste waargeneem (60/68) (88%), met ‘n manlik:vroulik verhouding van 7.5:1. Manlike geslag het veral ‘Geisoleerde’ LUO’ gehad (n=36, 60%), en vroulike geslag ‘Kompleks’ (n=5, 63%). Uitkomste rakende oorlewing sluit in: Terminasies 26 (35%), Intrauteriene sterftes 1 (1%), Stilgeboortes 8 (11%), Neonatale sterftes 12 (16%), Baba sterftes 4 (5%), Oorleef>1 jaar 16 (21%), Onbekend 8 (11%). Die algemeenste etiologie was Pelviese Urethra Kleppe (51%). Chromosomale aneuploidie was gevind in 9.3% (7/75), almal manlik, met Trisomie 21 die mees algemeen (4/7) (57%). Voorgeboorte bevindings wat statisties geasosieerd was met ‘n ‘Swak uitkoms’ is bilaterale renale korteks egogene of sistiese veranderinge (p=0.029), anhidramnios (p=0.011), en pulmonale hipoplasie (p=0.003). Morbiditeit in oorlewendes> 1 jaar (n=16) sluit in; abnormale nier funksie n=6 (37%), enurese n=4 (25%), herhaalde blaasinfeksies n=9 (56%). Gevolgtrekking: Die studie dra nuwe kennis by tot die bestaande literatuur aangaande die las en impak van kongenitale LUO in Suid Afrika, ‘n ontwikkelende land. Dit bevestig die hoë mortaliteit en morbiditeit, en steun die voorspellende waarde van spesifieke prenatale ultraklank bevindinge. Praktiese aanbevelings vir kliniese praktyk behels die volgende; sistematiese ultraklank ondersoek om ander major kongenitale afwykings uit te skakel, insluitende sagte merkers om die risiko vir ‘n onderliggende chromosomale afwyking te bepaal, asook geslag bepaling en kariotipering. Aangesien die prognose van LUO swak is, is berading van die ouers belangrik, veral as die diagnose laat in swangerskap gemaak word, en daarom moet daar gestandardiseerde riglyne rakende hantering van kongenitale afwykings ontwikkel word. | en_ZA |
| dc.description.version | Masters | en_ZA |
| dc.format.extent | 75 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/110536 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Congenital anomalies | en_ZA |
| dc.subject | Child mortality | en_ZA |
| dc.subject | Prenatal diagnosis | en_ZA |
| dc.title | Prenatal diagnosis and outcomes of congenital Lower Urinary Tract Obstruction (LUTO) at Tygerberg Hospital Fetal Medicine Unit: an audit of 12 years | en_ZA |
| dc.type | Thesis | en_ZA |