Fetal Genitourinary Diseases and Bladder Outlet Obstruction: Fetal...

Intervention, I think when you talk about genitourinary diseases, bladder outlet obstruction, sort of the historical paradigm for diagnosis, evaluation, and treatment is a good introduction to this topic. And so we'll be starting with that. There is a lot of published data that provides an excellent historical perspective for uh coaching conversations about other genitourinary diseases that we're able to diagnose, for instance, cloaca in the female. It gives us a, a language that we can speak and opportunities to um Put the diagnostic and treatment ideas and concepts into perspective for the families. We'll explore bladder outlet obstruction specifically in detail, but remember that uh 50% rule, 50% of fetuses with this disorder will survive to birth with therapy, and 50% of those that survive to live birth will survive infancy and childhood. Hence, the need to have uh neonatologists, urologists, transplant surgeons, and nephrologists as part of your team. We have no good predictors of survival. Many things have been tried. They work with limited ability to predict which uh fetuses will survive into childhood. Uh, but we're working always within the research realm to try to come up with better ideas in that arena as well. There are now options for neonates. Prior to this, neonates that survived the birth period and into the early infancy, uh, really had no opportunity to have additional treatment beyond that. So many of the children that made it through fetal life would die of uh end-stage renal disease in infancy. These disciplines will be the focus of this live event. We'll have speakers from all these areas covering uh those topics. If you look at just the basic flow diagram, the bladder outlet obstruction patient, uh, that has normal fluid at the time of evaluation, historically, all we've been doing is observing them regarding treatment, and we've been counseling them regarding the diagnosis and disease. We have, uh, as more survived, we've been preparing for chronic medical care. Uh, we've been preparing the family and the child for that. And this is the area that is probably most rapidly expanding. And then, when they have normal fluid, or at least some fluid throughout the pregnancy, we deliver them close to term, because complicating prematurity, uh, would be an additional challenge for the child to make it out of the nursery. And then, if we look at those with abnormal fluid at evaluation, uh, we would typically evaluate the renal fluid production and the quality of the fluid. We'd prepare the child for chronic medical care along with their family, and we would restore the fluid to normal levels if that was chosen by the family as an intervention. But now we have, I think, some other opportunities as we prepare these children for chronic medical care, we also know that we need to prepare the mother and the father, and the rest of the family for that chronic medical care. We have diseases now with survivors of the lungs, the kidneys, and the bladders that need this multidisciplinary team of neonatologists, pulmonologists, urologists, nephrologists, and transplant surgeons. And then we need to deal with the growing population of now adult survivors of these disorders. So, as we think about this continuity of care, uh, we'll pick up the conversation then with our panelists in Philadelphia and Toronto, Doctors Johnson and Ryan.