Urologic Fetal Intervention: Cincinnati Fetal Center
▶Ep 3 · 2:04
guidelineNot all fetuses with urinary tract obstruction are candidates for intervention; those too healthy (normal AFI, non-obstructive dilation, unilateral UPJ) or too sick (cystic dysplasia, abnormal karyotype, multiple anomalies) should not be offered fetal surgery.↗
▶Ep 3 · 2:04
quoteNot all fetuses with urinary tract obstructions are candidates for interventions.↗
▶Ep 3 · 2:04
quoteNot all fetuses with urinary tract obstructions are candidates for interventions.↗
▶Ep 3 · 2:04
guidelineNot all fetuses with urinary tract obstruction are candidates for intervention; those too healthy (normal AFI, non-obstructive dilation, unilateral UPJ) or too sick (cystic dysplasia, abnormal karyotype, multiple anomalies) should not be offered fetal surgery.↗
▶Ep 3 · 2:33
quoteAll of the risk is accountable to the mother.↗
▶Ep 3 · 2:33
quoteAll of the risk is accountable to the mother.↗
▶Ep 3 · 4:00
clinicalVesicoamniotic shunts have not improved renal outcomes because the long, thin tubes do not adequately reduce bladder pressure; they provide pulmonary survivors but not renal protection.↗
▶Ep 3 · 4:00
clinicalVesicoamniotic shunts have not improved renal outcomes because the long, thin tubes do not adequately reduce bladder pressure; they provide pulmonary survivors but not renal protection.↗
▶Ep 3 · 4:49
clinicalIn adult studies, bladder pressure exceeding 40 cm H₂O (29 mmHg) causes renal injury and abolishes net glomerular filtration.↗
▶Ep 3 · 4:49
clinicalIn adult studies, bladder pressure exceeding 40 cm H₂O (29 mmHg) causes renal injury and abolishes net glomerular filtration.↗
▶Ep 3 · 4:49
quoteIf the pressure in a bladder exceeds 40 centimeters of water, that does injure the kidneys.↗
▶Ep 3 · 4:49
quoteIf the pressure in a bladder exceeds 40 centimeters of water, that does injure the kidneys.↗
▶Ep 3 · 5:13
quoteWhat are the pressures that are safe in a bladder for a fetus and the fetal kidneys to continue to develop, we don't know.↗
▶Ep 3 · 5:13
quoteWhat are the pressures that are safe in a bladder for a fetus and the fetal kidneys to continue to develop, we don't know.↗
▶Ep 3 · 5:13
clinicalSafe bladder pressures for fetal kidneys are unknown; adult thresholds are used by extrapolation.↗
▶Ep 3 · 5:13
clinicalSafe bladder pressures for fetal kidneys are unknown; adult thresholds are used by extrapolation.↗
▶Ep 3 · 6:53
quoteThe shunts have not really provided the improvement in renal function, they have provided us with pulmonary survivors.↗
▶Ep 3 · 6:53
quoteThe shunts have not really provided the improvement in renal function, they have provided us with pulmonary survivors.↗
▶Ep 3 · 16:39
clinicalBladder cycling enabled by fetoscopic valve ablation is physiologically important for bladder health, not for upper-tract protection.↗
▶Ep 3 · 16:39
clinicalBladder cycling enabled by fetoscopic valve ablation is physiologically important for bladder health, not for upper-tract protection.↗
▶Ep 3 · 17:57
opinionA urethral fistula from fetoscopic laser ablation can be repaired surgically with minimal morbidity, whereas renal dysplasia cannot be reversed.↗
▶Ep 3 · 17:57
opinionA urethral fistula from fetoscopic laser ablation can be repaired surgically with minimal morbidity, whereas renal dysplasia cannot be reversed.↗
▶Ep 3 · 17:59
quoteI would rather have to deal with a fistula that I can repair surgically than renal dysplasia.↗
▶Ep 3 · 17:59
quoteI would rather have to deal with a fistula that I can repair surgically than renal dysplasia.↗
▶Ep 3 · 18:30
clinicalPosterior urethral valves can sometimes be ablated by blunt mechanical disruption (guidewire and catheter) rather than laser, because the valves are flimsy.↗
▶Ep 3 · 18:30
clinicalPosterior urethral valves can sometimes be ablated by blunt mechanical disruption (guidewire and catheter) rather than laser, because the valves are flimsy.↗
▶Ep 3 · 18:46
quoteIf hydrodistention all by itself could do it, then the amount of pressure developing in the urinary tract should blow open those valves.↗
▶Ep 3 · 18:46
quoteIf hydrodistention all by itself could do it, then the amount of pressure developing in the urinary tract should blow open those valves.↗
▶Ep 3 · 30:18
clinicalA flexible 4.9 Fr ureteroscope can be introduced through a 10 Fr sheath to improve maneuverability when accessing the fetal bladder neck and posterior urethra.↗
▶Ep 3 · 30:18
clinicalA flexible 4.9 Fr ureteroscope can be introduced through a 10 Fr sheath to improve maneuverability when accessing the fetal bladder neck and posterior urethra.↗
▶Ep 3 · 38:44
opinionCurrent algorithms reserve the most invasive interventions (open vesicostomy) for the worst-prognosis fetuses, which may be flawed because these patients are least likely to benefit and most likely to suffer maternal and fetal harm.↗
▶Ep 3 · 38:44
opinionCurrent algorithms reserve the most invasive interventions (open vesicostomy) for the worst-prognosis fetuses, which may be flawed because these patients are least likely to benefit and most likely to suffer maternal and fetal harm.↗
▶Ep 3 · 41:06
clinicalOpen fetal vesicostomy predisposes the mother to shortened gestation (~10 additional weeks) and very high risk of preterm labor.↗
▶Ep 3 · 41:06
clinicalOpen fetal vesicostomy predisposes the mother to shortened gestation (~10 additional weeks) and very high risk of preterm labor.↗
▶Ep 3 · 41:33
epidemiologicalCincinnati performed open fetal vesicostomy in six anhydramniotic fetuses; four died from preterm delivery, one has normal renal function at age 5, and one required transplant.↗
▶Ep 3 · 41:33
epidemiologicalCincinnati performed open fetal vesicostomy in six anhydramniotic fetuses; four died from preterm delivery, one has normal renal function at age 5, and one required transplant.↗
quoteIn the one instance where we've got this incredibly successful outcome, I think that that was the right choice for them.↗
▶Ep 3 · 44:46
quoteIn the one instance where we've got this incredibly successful outcome, I think that that was the right choice for them.↗
▶Ep 3 · 47:57
opinionBetter biomarkers of fetal renal function are urgently needed to guide intervention selection and predict outcomes.↗
▶Ep 3 · 47:57
quoteWe really need to identify a better marker of renal function, fetal renal function.↗
▶Ep 3 · 47:57
quoteWe really need to identify a better marker of renal function, fetal renal function.↗
▶Ep 3 · 47:57
opinionBetter biomarkers of fetal renal function are urgently needed to guide intervention selection and predict outcomes.↗
▶Ep 3 · 56:35
quoteThe creatinine at the time of discharge from the hospital is very misleading.↗
▶Ep 3 · 56:35
quoteThe creatinine at the time of discharge from the hospital is very misleading.↗
▶Ep 3 · 56:52
clinicalInfants with LUTO triple their birth weight in the first year, revealing the true extent of renal reserve; discharge creatinine does not account for this growth.↗
▶Ep 3 · 56:52
clinicalCreatinine at hospital discharge is misleading; creatinine at age 1 year is a better predictor of long-term renal function. A creatinine <1.0 mg/dL at age 1 suggests the child will not require renal replacement therapy.↗
▶Ep 3 · 56:52
clinicalInfants with LUTO triple their birth weight in the first year, revealing the true extent of renal reserve; discharge creatinine does not account for this growth.↗
▶Ep 3 · 56:52
clinicalCreatinine at hospital discharge is misleading; creatinine at age 1 year is a better predictor of long-term renal function. A creatinine <1.0 mg/dL at age 1 suggests the child will not require renal replacement therapy.↗
▶Ep 3 · 57:14
quoteIf their creatinine at age one is less than one, most likely that they will not need renal replacement therapy.↗
▶Ep 3 · 57:14
quoteIf their creatinine at age one is less than one, most likely that they will not need renal replacement therapy.↗
▶Ep 3 · 57:31
quoteThe bladder is often underestimated in terms of its importance.↗
▶Ep 3 · 57:31
clinicalPolyuria from fetal concentrating defects causes high bladder storage pressures, which damage the upper tracts in a vicious cycle; aggressive postnatal bladder management is required to break this cycle.↗
▶Ep 3 · 57:31
quoteThe bladder is often underestimated in terms of its importance.↗
▶Ep 3 · 57:31
clinicalPolyuria from fetal concentrating defects causes high bladder storage pressures, which damage the upper tracts in a vicious cycle; aggressive postnatal bladder management is required to break this cycle.↗
Urologic Fetal Intervention: Cincinnati Fetal Center
▶Ep 2 · 2:04
guidelineNot all fetuses with urinary tract obstruction are candidates for intervention; those too healthy (normal AFI, non-obstructive dilation, unilateral UPJ) or too sick (cystic dysplasia, abnormal karyotype, multiple anomalies) should not be offered fetal surgery.↗
▶Ep 2 · 2:04
quoteNot all fetuses with urinary tract obstructions are candidates for interventions.↗
▶Ep 2 · 2:33
quoteAll of the risk is accountable to the mother.↗
▶Ep 2 · 4:00
clinicalVesicoamniotic shunts have not improved renal outcomes because the long, thin tubes do not adequately reduce bladder pressure; they provide pulmonary survivors but not renal protection.↗
▶Ep 2 · 4:49
clinicalIn adult studies, bladder pressure exceeding 40 cm H₂O (29 mmHg) causes renal injury and abolishes net glomerular filtration.↗
▶Ep 2 · 4:49
quoteIf the pressure in a bladder exceeds 40 centimeters of water, that does injure the kidneys.↗
▶Ep 2 · 5:13
clinicalSafe bladder pressures for fetal kidneys are unknown; adult thresholds are used by extrapolation.↗
▶Ep 2 · 5:13
quoteWhat are the pressures that are safe in a bladder for a fetus and the fetal kidneys to continue to develop, we don't know.↗
▶Ep 2 · 6:53
quoteThe shunts have not really provided the improvement in renal function, they have provided us with pulmonary survivors.↗
▶Ep 2 · 16:39
clinicalBladder cycling enabled by fetoscopic valve ablation is physiologically important for bladder health, not for upper-tract protection.↗
▶Ep 2 · 17:57
opinionA urethral fistula from fetoscopic laser ablation can be repaired surgically with minimal morbidity, whereas renal dysplasia cannot be reversed.↗
▶Ep 2 · 17:59
quoteI would rather have to deal with a fistula that I can repair surgically than renal dysplasia.↗
▶Ep 2 · 18:30
clinicalPosterior urethral valves can sometimes be ablated by blunt mechanical disruption (guidewire and catheter) rather than laser, because the valves are flimsy.↗
▶Ep 2 · 18:46
quoteIf hydrodistention all by itself could do it, then the amount of pressure developing in the urinary tract should blow open those valves.↗
▶Ep 2 · 30:18
clinicalA flexible 4.9 Fr ureteroscope can be introduced through a 10 Fr sheath to improve maneuverability when accessing the fetal bladder neck and posterior urethra.↗
▶Ep 2 · 38:44
opinionCurrent algorithms reserve the most invasive interventions (open vesicostomy) for the worst-prognosis fetuses, which may be flawed because these patients are least likely to benefit and most likely to suffer maternal and fetal harm.↗
▶Ep 2 · 41:06
clinicalOpen fetal vesicostomy predisposes the mother to shortened gestation (~10 additional weeks) and very high risk of preterm labor.↗
▶Ep 2 · 41:33
epidemiologicalCincinnati performed open fetal vesicostomy in six anhydramniotic fetuses; four died from preterm delivery, one has normal renal function at age 5, and one required transplant.↗
quoteIn the one instance where we've got this incredibly successful outcome, I think that that was the right choice for them.↗
▶Ep 2 · 47:57
quoteWe really need to identify a better marker of renal function, fetal renal function.↗
▶Ep 2 · 47:57
opinionBetter biomarkers of fetal renal function are urgently needed to guide intervention selection and predict outcomes.↗
▶Ep 2 · 56:35
quoteThe creatinine at the time of discharge from the hospital is very misleading.↗
▶Ep 2 · 56:52
clinicalCreatinine at hospital discharge is misleading; creatinine at age 1 year is a better predictor of long-term renal function. A creatinine <1.0 mg/dL at age 1 suggests the child will not require renal replacement therapy.↗
▶Ep 2 · 56:52
clinicalInfants with LUTO triple their birth weight in the first year, revealing the true extent of renal reserve; discharge creatinine does not account for this growth.↗
▶Ep 2 · 57:14
quoteIf their creatinine at age one is less than one, most likely that they will not need renal replacement therapy.↗
▶Ep 2 · 57:31
quoteThe bladder is often underestimated in terms of its importance.↗
▶Ep 2 · 57:31
clinicalPolyuria from fetal concentrating defects causes high bladder storage pressures, which damage the upper tracts in a vicious cycle; aggressive postnatal bladder management is required to break this cycle.↗
Urologic Fetal Intervention: Cincinnati Fetal Center
▶Ep 1 · 2:04
guidelineNot all fetuses with urinary tract obstruction are candidates for intervention; those too healthy (normal AFI, non-obstructive dilation, unilateral UPJ) or too sick (cystic dysplasia, abnormal karyotype, multiple anomalies) should not be offered fetal surgery.↗
▶Ep 1 · 2:04
quoteNot all fetuses with urinary tract obstructions are candidates for interventions.↗
▶Ep 1 · 2:33
quoteAll of the risk is accountable to the mother.↗
▶Ep 1 · 4:00
clinicalVesicoamniotic shunts have not improved renal outcomes because the long, thin tubes do not adequately reduce bladder pressure; they provide pulmonary survivors but not renal protection.↗
▶Ep 1 · 4:49
clinicalIn adult studies, bladder pressure exceeding 40 cm H₂O (29 mmHg) causes renal injury and abolishes net glomerular filtration.↗
▶Ep 1 · 4:49
quoteIf the pressure in a bladder exceeds 40 centimeters of water, that does injure the kidneys.↗
▶Ep 1 · 5:13
clinicalSafe bladder pressures for fetal kidneys are unknown; adult thresholds are used by extrapolation.↗
▶Ep 1 · 5:13
quoteWhat are the pressures that are safe in a bladder for a fetus and the fetal kidneys to continue to develop, we don't know.↗
▶Ep 1 · 6:53
quoteThe shunts have not really provided the improvement in renal function, they have provided us with pulmonary survivors.↗
▶Ep 1 · 16:39
clinicalBladder cycling enabled by fetoscopic valve ablation is physiologically important for bladder health, not for upper-tract protection.↗
▶Ep 1 · 17:57
opinionA urethral fistula from fetoscopic laser ablation can be repaired surgically with minimal morbidity, whereas renal dysplasia cannot be reversed.↗
▶Ep 1 · 17:59
quoteI would rather have to deal with a fistula that I can repair surgically than renal dysplasia.↗
▶Ep 1 · 18:30
clinicalPosterior urethral valves can sometimes be ablated by blunt mechanical disruption (guidewire and catheter) rather than laser, because the valves are flimsy.↗
▶Ep 1 · 18:46
quoteIf hydrodistention all by itself could do it, then the amount of pressure developing in the urinary tract should blow open those valves.↗
▶Ep 1 · 30:18
clinicalA flexible 4.9 Fr ureteroscope can be introduced through a 10 Fr sheath to improve maneuverability when accessing the fetal bladder neck and posterior urethra.↗
▶Ep 1 · 38:44
opinionCurrent algorithms reserve the most invasive interventions (open vesicostomy) for the worst-prognosis fetuses, which may be flawed because these patients are least likely to benefit and most likely to suffer maternal and fetal harm.↗
▶Ep 1 · 41:06
clinicalOpen fetal vesicostomy predisposes the mother to shortened gestation (~10 additional weeks) and very high risk of preterm labor.↗
▶Ep 1 · 41:33
epidemiologicalCincinnati performed open fetal vesicostomy in six anhydramniotic fetuses; four died from preterm delivery, one has normal renal function at age 5, and one required transplant.↗
quoteIn the one instance where we've got this incredibly successful outcome, I think that that was the right choice for them.↗
▶Ep 1 · 47:57
opinionBetter biomarkers of fetal renal function are urgently needed to guide intervention selection and predict outcomes.↗
▶Ep 1 · 47:57
quoteWe really need to identify a better marker of renal function, fetal renal function.↗
▶Ep 1 · 56:35
quoteThe creatinine at the time of discharge from the hospital is very misleading.↗
▶Ep 1 · 56:52
clinicalCreatinine at hospital discharge is misleading; creatinine at age 1 year is a better predictor of long-term renal function. A creatinine <1.0 mg/dL at age 1 suggests the child will not require renal replacement therapy.↗
▶Ep 1 · 56:52
clinicalInfants with LUTO triple their birth weight in the first year, revealing the true extent of renal reserve; discharge creatinine does not account for this growth.↗
▶Ep 1 · 57:14
quoteIf their creatinine at age one is less than one, most likely that they will not need renal replacement therapy.↗
▶Ep 1 · 57:31
quoteThe bladder is often underestimated in terms of its importance.↗
▶Ep 1 · 57:31
clinicalPolyuria from fetal concentrating defects causes high bladder storage pressures, which damage the upper tracts in a vicious cycle; aggressive postnatal bladder management is required to break this cycle.↗