One of the great success stories in pediatrics is the increasing ability of doctors to diagnose kidney and bladder anatomic abnormalities before a child is born and still developing inside the mother. Sometimes we need to surgically treat these fetal abnormalities; however, more commonly children are born normally, additional testing is performed and a treatment plan is created. Riley Hospital for Children Urology at Indiana University Health has been a performing fetal interventions and surgery for 16 years.
Prenatal Urologic Care
Few urologic abnormalities in fetuses require antenatal (before birth) intervention. In many cases, problems resolve and all that is needed is confirmation of this resolution by ultrasound. Most children are born normally and our doctors can examine the newborn, perform additional testing and decide then whether any interventions are necessary. Sometimes we decide that the best course is simply to monitor the condition with the possibility of treatment later.
Expectant parents can become anxious knowing that their child may be born with a serious condition that will need surgery. We can calm that anxiety for many with the knowledge that many conditions resolve. While waiting for the birth of their child, expectant parents can get to know the team who will treat their child. This builds trust and understanding and can lead to a better outcome as parents learn what may be expected of them and their child after birth.
Fetuses that require surgical intervention are usually males with severe bladder blockage, a condition that can cause harm to the developing lungs and kidneys. Early surgical intervention can remove the blockage and may allow the fetus to develop normally.
Perinatal Urologic Care
When a fetus has a problem that may need surgery soon after birth, we advise the mother to give birth at the Perinatal Center at Indiana University Health. This allows us to examine the newborn immediately and perform appropriate testing without delay. We can determine quickly whether surgery or other treatment is needed right away.
Newborns with urologic conditions can also have other problems that complicate treatment. For example, premature newborns often have underdeveloped lungs, which means that we need to work closely with the child’s pulmonologist.
Sometimes surgery soon after birth is necessary. This is true for infants born with conditions that impair their kidney function or who have a high risk of infection if their condition isn’t dealt with quickly. Sometimes a minor surgery can stabilize a child and allow them to develop before a more extensive, definitive surgery is needed later. Other times, if their condition improves, they may not need surgery at all.
Always Improving Care
We keep long-term databases that track the children we treat. These databases enable us to learn what interventions, both medically and surgically, have been most successful over years and into adulthood. We can also learn whether intervention is really necessary. In some cases we decide, with a child’s parents, to wait and see whether their child’s condition improves. Sometimes this approach works, and this information helps us, too. It’s critical to know how things have worked out for other children when deciding what to do about a newborn with a critical urologic condition.
We’re constantly sharing what we learn with the larger urologic community. This helps build the knowledge base that doctors share and enables them to learn about new treatments that are more effective. Our specialists have written on many topics, making us an important resource for urologists nationwide.