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Obstrução do trato urinário inferior fetal: Diagnóstico, abordagem e seguimento
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Advisor(s)
Abstract(s)
A obstrução do trato urinário inferior é uma das mais frequentes anomalias congénitas
do trato urinário. Trata-se de uma perturbação geniturinária fetal complexa, que abrange
um grupo heterogéneo de anomalias. Esta condição ocorre quando a saída da bexiga fetal
encontra-se bloqueada. A obstrução desencadeia uma sequência de eventos que pode
resultar na interrupção do fluxo urinário normal do feto, levando a oligoidrâmnio, entre
outras complicações. Estas contribuem para uma maior morbimortalidade neonatal e
podem acarretar efeitos negativos, a longo prazo, no funcionamento renal, além de
aumentar o risco de prematuridade e hipoplasia pulmonar neonatal.
Avanços no diagnóstico e na gestão dessas anomalias são cruciais para melhorar os
desfechos fetais. Uma compreensão mais aprofundada da fisiopatologia, aliada ao
desenvolvimento de ferramentas diagnósticas e terapêuticas, possibilita, atualmente, a
oferta de terapias in utero para determinadas malformações. Além disso, a previsão
precisa da gravidade da doença influencia significativamente a eficácia das intervenções
fetais e constitui um dos fatores mais determinantes do prognóstico pré-natal e pós-
-natal. Contudo, a raridade desta condição, a falta de uniformização no diagnóstico e
abordagem, bem como o precário seguimento dos desfechos pós-natais, prejudicam
esses fundamentos e logo o estado de conhecimento atual.
Contextualizando a epidemiologia e causas de LUTO pré-natal, esta monografia tem
como principais objetivos caracterizar os métodos e sinais de diagnóstico e identificar
possíveis ações e os seus prognósticos quando na presença de LUTO pré-natal.
Para a introdução e contextualização complementar desta revisão da literatura, foi
realizada, de forma não sistemática, uma análise de um conjunto de artigos científicos
publicados nas bases de dados “PubMed” e “Scopus”, utilizando os termos de pesquisa
“LUTO”, “CAKUT” e “hydronephrosis”, além de operadores booleanos (“AND” e “OR”).
Para a realização dos objetivos estabelecidos, foram utilizados os seguintes termos e
operadores booleanos:
(("lower urinary tract obstruction" OR "fetal lower urinary tract obstruction" OR LUTO)
AND (diagnos* OR "diagnos* and examination*" OR "diagnostic techniques and
procedures" OR treatment* OR therap* OR "follow-up" OR methods OR "treatment
outcome") NOT (adult* OR aged OR elderly)). Para este fim, foram selecionados apenas artigos de revisão, revisão sistemática e meta-
-análises, pois procurou-se analisar conteúdos concisos e relevantes. Considerando
maior interesse pelos últimos 20 anos, foram aferidos 44 artigos.
The obstruction of the lower urinary tract is one of the most frequent congenital anomalies of the urinary system. It is a complex fetal genitourinary disorder encompassing a heterogeneous group of abnormalities. This condition occurs when the fetal bladder's outlet becomes blocked. The obstruction triggers a sequence of events that may disrupt the fetus's normal urinary flow, leading to oligohydramnios and other complications. These complications contribute to increased neonatal morbidity and mortality and can have long-term negative effects on renal function, while also heightening the risk of prematurity and neonatal pulmonary hypoplasia. Advances in the diagnosis and management of these anomalies are crucial for improving fetal outcomes. A deeper understanding of the pathophysiology, combined with the development of diagnostic and therapeutic tools, currently enables the provision of in utero therapies for specific malformations. Furthermore, an accurate assessment of disease severity significantly impacts the efficacy of fetal interventions and is one of the most critical determinants of prenatal and postnatal prognosis. However, the rarity of this condition, the lack of standardized diagnostic and management approaches, and the insufficient follow-up of postnatal outcomes undermine these foundations and, consequently, the current state of knowledge. In the context of prenatal LUTO epidemiology and causes, this monograph aims to characterize diagnostic methods and indicators and identify possible actions and their prognoses in the presence of prenatal LUTO. For the introduction and complementary contextualization of this literature review, a non-systematic analysis was conducted on a set of scientific articles published in the "PubMed" and "Scopus" databases, using the terms “LUTO,” “CAKUT,” and “hydronephrosis,” along with Boolean operators (“AND” and “OR”). To achieve the established objectives, the following terms and Boolean operators were used: (("lower urinary tract obstruction" OR "fetal lower urinary tract obstruction" OR LUTO) AND (diagnos* OR "diagnos* and examination*" OR "diagnostic techniques and procedures" OR treatment* OR therap* OR "follow-up" OR methods OR "treatment outcome") NOT (adult* OR aged OR elderly)). For this purpose, only review articles, systematic review articles and meta-analysis were selected, as the aim was to analyze concise and relevant content. Considering a greater interest in the last 20 years, 44 articles were assessed.
The obstruction of the lower urinary tract is one of the most frequent congenital anomalies of the urinary system. It is a complex fetal genitourinary disorder encompassing a heterogeneous group of abnormalities. This condition occurs when the fetal bladder's outlet becomes blocked. The obstruction triggers a sequence of events that may disrupt the fetus's normal urinary flow, leading to oligohydramnios and other complications. These complications contribute to increased neonatal morbidity and mortality and can have long-term negative effects on renal function, while also heightening the risk of prematurity and neonatal pulmonary hypoplasia. Advances in the diagnosis and management of these anomalies are crucial for improving fetal outcomes. A deeper understanding of the pathophysiology, combined with the development of diagnostic and therapeutic tools, currently enables the provision of in utero therapies for specific malformations. Furthermore, an accurate assessment of disease severity significantly impacts the efficacy of fetal interventions and is one of the most critical determinants of prenatal and postnatal prognosis. However, the rarity of this condition, the lack of standardized diagnostic and management approaches, and the insufficient follow-up of postnatal outcomes undermine these foundations and, consequently, the current state of knowledge. In the context of prenatal LUTO epidemiology and causes, this monograph aims to characterize diagnostic methods and indicators and identify possible actions and their prognoses in the presence of prenatal LUTO. For the introduction and complementary contextualization of this literature review, a non-systematic analysis was conducted on a set of scientific articles published in the "PubMed" and "Scopus" databases, using the terms “LUTO,” “CAKUT,” and “hydronephrosis,” along with Boolean operators (“AND” and “OR”). To achieve the established objectives, the following terms and Boolean operators were used: (("lower urinary tract obstruction" OR "fetal lower urinary tract obstruction" OR LUTO) AND (diagnos* OR "diagnos* and examination*" OR "diagnostic techniques and procedures" OR treatment* OR therap* OR "follow-up" OR methods OR "treatment outcome") NOT (adult* OR aged OR elderly)). For this purpose, only review articles, systematic review articles and meta-analysis were selected, as the aim was to analyze concise and relevant content. Considering a greater interest in the last 20 years, 44 articles were assessed.
Description
Keywords
Anomalias Congénitas Diagnóstico Pré-Natal Intervenções Fetais Obstrução do Trato Urinário Inferior Seguimento Pós-Natal