Fetal Lower Urinary Tract Obstruction (LUTO)

The Stanford Medicine Children’s Health Fetal and Pregnancy Health Program provides multidisciplinary prenatal evaluation and management of fetal lower urinary tract obstruction. Our maternal-fetal medicine experts partner with pediatric urology, pediatric nephrology, perinatal genetics, and neonatology to deliver comprehensive prenatal and postnatal management of posterior urethral valves, urethral atresia and stenosis, and prune belly syndrome.

What is a fetal LUTO?

This finding indicates a blockage in the fetus’s urinary tract, causing the bladder, ureters, and kidneys to swell with urine that can’t drain as it should. This can severely damage the kidneys and the developing lungs if the fluid around the baby decreases over time.

The decision to treat fetal lower urinary tract obstruction during pregnancy is often a complicated one for parents. A multidisciplinary team of pediatric experts from maternal-fetal medicine, urology, pediatric nephrology, perinatal genetics, and neonatology guides the treatment plan. 

How is fetal LUTO diagnosed?

Usually an ultrasound, as early as the first trimester, can detect a lower urinary tract obstruction. Then, kidney function tests and genetic studies are performed.

How common is fetal LUTO?

A fetal lower urinary tract obstruction happens in 1 out of 5,000 to 7,000 births, often in male fetuses.

What problems can a fetal LUTO cause after birth?

Your baby will have imaging studies to see how well his or her kidneys and bladder are functioning. Our team will talk to you about what to expect in both the short and long term.

How does the Lucile Packard Children’s Hospital Stanford team typically care for fetal LUTO?

Our comprehensive team diagnoses fetal lower urinary tract obstruction through same-day imaging, multidisciplinary counseling, and diagnostic procedures as early as the first trimester. A thorough in utero evaluation guides prognosis and treatment options specific to each case, including consideration for fetal vesicoamniotic shunt placement.

If the evaluation shows that the mother and fetus are candidates for in utero therapy, we are able to perform this innovative shunt treatment for fetuses with lower urinary tract obstruction.

• During a fetal vesicoamniotic shunt placement, a small pigtail shunt is inserted into the fetal bladder with the other end placed in the amniotic cavity.
• The shunt diverts the urine from the fetal bladder to the amniotic cavity surrounding the fetus. The shunt is then removed after the baby is born.

Criteria for vesicoamniotic shunt placement:

• Normal fetal karyotype or microarray
• Isolated anomaly
• Bladder refilling following vesicocentesis and favorable bladder/renal analytes
• Oligohydramnios/anhydramnios

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Our Fetal and Pregnancy Health Program manages care for fetuses with rare kidney anomalies by partnering with our NephroNICU program to care for babies with CAKUT (LUTO and other kidney conditions) after birth.