Children's Hospital Colorado

Bladder Outlet Obstruction

Bladder outlet obstruction, also known as a lower urinary tract obstruction (LUTO), occurs in approximately 4,000 births per year. It's a fetal condition where urine is unable to pass from the baby's bladder to the amniotic sac surrounding it. It is typically more common in males than in females. This condition occurs when urine made from the baby's kidneys is unable to drain from the bladder due to an obstruction in the urinary tract.

Bladder outlet obstruction in a fetus can impact many aspects of development. Naturally, an obstruction will impact the development of the urinary tract, including the bladder and kidneys. Due to fluid buildup in the bladder, lung development can also be affected by an obstruction, which in turn puts strain on the heart.

When a baby is not releasing urine, it can also result in lower levels of amniotic fluid surrounding the baby. This reduces the "cushion" a baby has, which can delay lung development and limit movement. Other complications from congenital conditions may also be discovered, which is why the fetal care team uses a multidisciplinary approach to care for babies with bladder outlet obstruction.

Bladder outlet obstruction is generally first observed when abnormalities are found during a routine ultrasound. Signs of bladder outlet obstruction in a fetus include:

  • Enlarged bladder
  • Low amniotic fluid
  • Abnormal kidney appearance

If an obstruction is suspected, additional testing will be conducted, including a fetal MRI and a fetal echocardiogram to evaluate damage and rule out any cardiac concerns. Bladder outlet obstruction can also be tied to other congenital and chromosomal abnormalities, so the team at the Colorado Fetal Care Center will make sure to address any other concerns or symptoms.

Treatment for fetal bladder outlet obstruction is determined by the severity and type of obstruction, as well as the gestational age of the baby. Common treatment options include:

  • Shunt placement in the baby's bladder to drain fluid into the amniotic space
  • Fetoscopic laser treatment to remove the blockage
  • Placement of an amnioport to maintain amniotic fluid surrounding the baby

While a bladder outlet obstruction diagnosis may be overwhelming, it is reassuring to know that available treatment options can help your baby thrive both during pregnancy and after birth. At the Colorado Fetal Care Center, we are also pioneering dedicated fetal intervention procedures to ensure the best outcomes for mothers and babies.

What is the long-term outlook for a baby with bladder outlet obstruction?

The baby may require a kidney transplant and surgery to augment the bladder.

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