Vesico-amniotic Shunting

The shunt used is called a 'Pigtail Catheter' because both ends are curled like a pig's tail to hold it in place.

• One end sits inside the baby's bladder.
• The other end sits in the amniotic fluid surrounding the baby.
• The result: As the baby produces urine, it flows through the tube and out into the amniotic sac, restoring 'normal' fluid levels and reducing the internal pressure that would otherwise destroy the kidneys.

This procedure is most effective for babies with LUTO who still have good kidney function.

Before shunting, we perform serial Bladder Taps (Vesicocentesis) to test the chemicals in the baby's urine. If the urine is 'dilute' (containing less salt), it indicates the kidneys are still working well and are worth saving. If the urine is 'concentrated,' it may mean the kidneys have already suffered irreversible damage.

The preparation for shunts involves mapping the 'perfect' path:

1. Ultrasound Guidance: Finding the largest window of the baby's bladder away from vital organs.
2. Amnio-infusion: If there is no fluid around the baby (which is common in LUTO), we must first infuse sterile warm saline into the womb to create a space for the outside end of the shunt to sit.
3. Patient Positioning: Ensuring the baby stays still, often using a tiny dose of fetal muscle relaxant.

The procedure is done under local anesthesia:

• The Introducer: A slightly thicker needle (trocar) is passed through the mother's abdomen into the baby's bladder.
• Deployment: The shunt is pushed through the trocar. We watch as the first 'pigtail' curls inside the bladder.
• The Withdrawal: The trocar is slowly pulled back into the amniotic space, and the second 'pigtail' is deployed.
• Immediate Effect: Within minutes, the bladder begins to shrink as it drains on the ultrasound screen. This is a very rewarding sign for the surgical team and the parents.

Shunting is a life-saving 'bridge' to birth:

• Lung Survival: The primary benefit of the shunt is that it restores amniotic fluid, increasing the survival rate of the baby's lungs from 0-10% to over 60-70%.
• Kidney Preservation: While the shunt protects the kidneys, some degree of long-term kidney issues may still exist after birth.
• Challenges: The biggest challenge is 'shunt migration' or 'blockage.' Because the baby moves, the shunt can sometimes fall out, requiring a second procedure.

LUTO is a progressive disease. The longer the bladder remains blocked, the more damage the kidneys sustain. Early detection and immediate referral to a fetal therapy center are critical.

At the MFM Unit, Dr. Ali Al-Ibrahim and Dr. Werner Diehl provide the comprehensive diagnostic testing and surgical expertise needed to manage LUTO effectively. We work closely with pediatric urologists to ensure that once the baby is born, their care transitions seamlessly into specialist neonatal treatment.