>> ONE OF THE KEY ISSUES FOR FAMILIES IS,
OK, IF WE HAVE A SUCCESSFUL SHUNT AND WE'RE
ABLE TO DRAIN THE BLADDER IN THE URINARY TRACT SO THAT,
YOU KNOW, WE GET GOOD LUNG GROWTH FOR PULMONARY
FUNCTION AFTER BIRTH, HOW DO THESE KIDS DO AFTER THEY'RE BORN?
>> WHAT WAS RECOGNIZED IN SOME OF THESE BOYS THAT HAD
VALVES IS THAT THEY REALLY DIDN'T HAVE THE ABILITY OR
THE AWARENESS THAT THEIR BLADDER WAS FULL.
>> SIXTY PERCENT OF THESE KIDS THAT WERE TREATED IN UTERO
WERE ABLE TO SPONTANEOUSLY VOID ON THEIR OWN AND THE
REST OF THEM EITHER REQUIRED OCCASIONAL USE OF THE
CATHETER TO COMPLETELY EMPTY THE BLADDER OR THEY WERE
CATHETER DEPENDENT.
>> LONG-TERM OUTCOME STUDIES THAT WE HAVE DONE HAVE SHOWN
THAT MOST OF THOSE CHILDREN THAT WERE PRENATALLY TREATED
HAVE ACCEPTABLE RENAL FUNCTION BUT,
30 PERCENT ALSO HAVE PROGRESSED TO RENAL
TRANSPLANT.
>> THESE ARE CHILDREN THAT DON'T HAVE NORMAL URINARY
TRACTS AND WILL ALWAYS BE AT RISK OF FURTHER KIDNEY
INJURY EITHER BECAUSE OF REFLUX OR BECAUSE THEY'RE
MUCH, MUCH MORE AT RISK AND SUSCEPTIBLE TO INFECTIONS.
>> THERE ARE CHANGES THAT CAN OCCUR OVER TIME THAT
UNLESS YOU'RE REALLY TRACKING THEM AND FOLLOWING
THEM, YOU MAY NOT RECOGNIZE WHICH CAN THEN ULTIMATELY
LEAD TO DAMAGE TO THE KIDNEYS.
>> HE'S AT INCREASED LEVEL OF HURTING HIS KIDNEYS IF HE
GETS INFECTIONS.
HE IS ON AN ANTIBIOTIC.
>> THESE BABIES MAY REQUIRE LONG-TERM FOLLOW-UP FOR
THEIR KIDNEY FUNCTION.
USUALLY RESPIRATORY ISSUES ARE MORE BLACK AND WHITE AT
THE TIME OF BIRTH.
>> HALF OF THEM HAVE SOME TYPE OF RESPIRATORY SYMPTOMS
LONG TERM, LOW INCIDENCE OF ASTHMA.
MOST OF THEM HAVE A HIGHER FREQUENCY OF REACTIVE AIRWAY
DISEASE.
SO THEY GET COLDS AND UPPER RESPIRATORY INFECTIONS MORE
OFTEN AND COMMONLY THAN OTHER KIDS.
>> WHILE THAT CERTAINLY CAN BE A CHALLENGING TIME,
MOST FAMILIES AND MOST CHILDREN WILL REPORT TO US
THAT THEY'RE DOING WELL AND THEY'RE ADJUSTING AND
DEALING WITH THE CHALLENGES OF DAILY LIFE.
>> MICHAEL NOW IS 18 MONTHS OLD.
HE IS RUNNING, NO LONGER WALKS,
HE JUST RUNS.
>> IF YOU LOOKED AT HIM TODAY, YOU WOULDN'T KNOW ON
THE SURFACE THAT THERE'S ANYTHING WRONG WITH THE KID.
I MEAN, HE EATS LIKE A TANK.
>> HE'S JUST A CRAZY, HIGH-ENERGY BOY.
HE'S REALLY INDEPENDENT, BUT CONTINUES TO BE VERY,
VERY HAPPY.
SO TO HAVE BEEN ABLE TO GO THROUGH THIS REALLY CRITICAL
SITUATION AND COME OUT ON THE OTHER SIDE AS HEALTHY AS
HE IS, HE'S JUST SO FORTUNATE.
>> WE NOW HAVE A WHOLE COHORT OF WHAT WERE UNBORN
PATIENTS WITH A PREVIOUSLY, COMPLETELY FATAL DIAGNOSIS
WHO HAVE BEEN HELPED BY WHAT WE AND OTHERS HAVE DONE
BEFORE BIRTH.
>> THE NATURAL HISTORY OF LOWER URINARY TRACT
OBSTRUCTIONS IS QUITE DIVERSE.
>> WE CONTINUE TO LEARN AND NOW I THINK WE HAVE A MUCH
BETTER PERSPECTIVE ON THINGS,
UNDERSTANDING WHAT HAPPENS IN TERMS OF HOW THE KIDNEYS
ARE DEVELOPING, WHAT HAPPENS TO THE LUNGS.
>> FOR LOWER URINARY TRACT OBSTRUCTION,
WE CAN SELECT WHICH FETUSES WILL BENEFIT AND WE CAN HELP
THEM IN MOST CIRCUMSTANCES.
>> THERE ARE LOWER URINARY TRACT OBSTRUCTIONS THAT ARE
ASSOCIATED WITH NORMAL AMNIOTIC FLUID VOLUME,
MAYBE DUE TO AN INCOMPLETE OBSTRUCTION,
AND THOSE AT THIS POINT ARE NOT CANDIDATES FOR IN UTERO
INTERVENTION.
>> SO ONE OF THE STUDIES THAT'S PRESENTLY UNDERWAY,
IS TO LOOK AT THE NATURAL HISTORY OF THE OUTCOMES IN
THESE CHILDREN THAT HAVE OBSTRUCTED UROPATHIES BUT
HAVE NORMAL AMNIOTIC FLUID VOLUME TO DETERMINE WHETHER
THERE MIGHT BE BENEFITS FOR INTERVENING IN THOSE CASES
AS WELL.
>> A CLINICAL EFFORT AT THE CURRENT TIME IS TO ATTEMPT
BEFORE BIRTH TO DIRECTLY TREAT POSTERIOR URETHRAL
VALVES.
>> FETAL CYSTOSCOPY WHERE WE CAN ACTUALLY LOOK INSIDE THE
BLADDER, TRY TO IDENTIFY THE SOURCE OF THE OBSTRUCTION
AND POTENTIALLY TREAT IT, AND THEN NOT HAVE TO LEAVE A
SHUNT IN PLACE AFTERWARDS.
>> I THINK THE FUTURE IS BRIGHT FOR FAMILIES WITH
THIS DISORDER.
>> THE FAMILIES THAT THE CENTER FOR FETAL DIAGNOSIS
AND TREATMENT REALLY SERVE AS THE INSPIRATION FOR EACH
AND EVERY ONE OF US.
>> THAT'S WHAT IT'S REALLY ALL ABOUT.
IT'S ABOUT THE AMAZING FAMILIES THAT TEACH US WHAT
WE NEED TO KNOW TO OFFER HOPE FOR FUTURE GENERATIONS.