NEW YORK (Reuters Health) - Children who undergo prenatal vesicoamniotic shunting for lower urinary tract obstruction experience normal cognitive development, new research indicates. Moreover, most children have acceptable renal function and report satisfactory quality of life.

Few studies have looked at the long-term outcomes of children treated prenatally for lower urinary tract obstruction, according to the report in the September issue of Obstetrics & Gynecology.

In the current study, Dr. Mark P. Johnson, from The Children's Hospital of Philadelphia, and colleagues describe the outcomes of 23 male children who underwent prenatal vesicoamniotic shunting. In all cases, the pregnancy involved a singleton fetus and oligo/anhydramnios was present.

The 1-year survival rate was 91%, the report indicates. The two neonatal deaths that occurred were the result of severe pulmonary hypoplasia.

Eighteen survivors had data available for follow-up and the mean age at follow-up was 5.83 years. The cause of urinary tract obstruction was posterior urethral valves in 7 children, prune belly syndrome in 7, and urethral atresia in 4. The prenatal urinary prognosis was deemed good in 13, borderline in 2, and poor in 3.

At follow-up, 8 children had acceptable renal function, 4 had mild insufficiency, and 6 had required dialysis and ultimately underwent renal transplantation. Eleven children had normal bladder function, 6 required catheterization, and 1 child remained with a vesicostomy.

Although respiratory problems, musculoskeletal difficulties, and urinary tract infections were common among the children, their quality of life was similar to that of a healthy child population. Moreover, the children had normal cognitive development.

"Given our data, parents can be counseled that, although their children will require attentive medical and surgical care throughout childhood, they can be expected to have normal cognitive development and maintain a satisfactory quality of life," the researchers conclude.

Obstet Gynecol 2005;106:503-508

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