Congenital lower urinary tract obstruction: a population-based epidemiological study

Authors

  • G Malin,

    1.  School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Birmingham, UK
    2.  Academic Department of Obstetrics, Queen’s Medical Centre, Nottingham, UK
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  • AM Tonks,

    1.  West Midlands Perinatal Institute, Birmingham, UK
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  • RK Morris,

    1.  School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Birmingham, UK
    2.  West Midlands Fetal Medicine Centre, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, UK
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  • J Gardosi,

    1.  West Midlands Perinatal Institute, Birmingham, UK
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  • MD Kilby

    1.  School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Birmingham, UK
    2.  West Midlands Fetal Medicine Centre, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, UK
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Dr M Kilby, Academic Department, Theme of Reproduction, Genes and Development, School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Birmingham, B15 2TT, UK. Email m.d.kilby@bham.ac.uk

Abstract

Please cite this paper as: Malin G, Tonks A, Morris R, Gardosi J, Kilby M. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG 2012;119:1455–1464.

Objective  To determine the prevalence and outcome of lower urinary tract obstruction (LUTO), including the sensitivity of antenatal diagnosis.

Design  A retrospective population-based study.

Setting  Regional population-based congenital anomalies register (WMCAR).

Population  Fetuses affected by LUTO delivered between 1995 and 2007 to women resident in the West Midlands.

Methods  Cases were selected from the WMCAR using codes and keyword terms from the International Classification of Diseases, tenth revision (ICD10). Diagnoses were validated using additional data sets from Regional Fetal Medicine, Perinatal Pathology and Paediatric services.

Main outcome measures  Rates of prevalence, prenatal diagnosis and mortality, with trends.

Results  There were 284 LUTO cases in 851 419 births during the study period, representing a total prevalence of 3.34 (2.953.72) per 10 000 births, and this prevalence did not change significantly over time. The prevalence of LUTO was significantly higher in Black and minority ethnic groups when compared with white Europeans (OR 2.38; 95% CI 1.873.03), and are associated with area-based deprivation measures (< 0.01). Of all LUTO cases, 221 (77.8%) were isolated, and the remainder were associated with other structural or chromosomal anomalies. The most common subtype was posterior urethral valves (PUVs; n = 179, 63%). In total there were 211 (74.3%) cases of isolated, non-female, singleton fetuses that fitted the referral criteria for in utero vesico-amniotic shunting, giving a prevalence of 2.48 (2.14–2.81) per 10 000 live births. Within this group, the prenatal diagnosis rate was 46.9% (99/211).

Conclusion  This is the largest population-based study of LUTO that has been performed to date, and provides accurate estimates for prevalence. The low prevalence and relatively low rate of antenatal detection limit the number of cases amenable to prenatal surgical intervention.

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