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Lower urinary tract obstruction, congenital(LUTO)

MedGen UID:
1684849
Concept ID:
C5231427
Disease or Syndrome
Synonyms: LOWER URINARY TRACT OBSTRUCTION, CONGENITAL; LUTO
 
Gene (location): BNC2 (9p22.3-22.2)
 
Monarch Initiative: MONDO:0032833
OMIM®: 618612

Definition

Congenital lower urinary tract obstruction (LUTO) is characterized by anatomic blockage of bladder outflow due to urethral stenosis, which may be caused by posterior urethral valves in some families (Kolvenbach et al., 2019). [from OMIM]

Clinical features

From HPO
Urinary incontinence
MedGen UID:
22579
Concept ID:
C0042024
Finding
Loss of the ability to control the urinary bladder leading to involuntary urination.
Urethral stenosis
MedGen UID:
12016
Concept ID:
C0041974
Finding
Abnormal narrowing of the urethra.
Pollakisuria
MedGen UID:
52942
Concept ID:
C0042023
Finding
Increased frequency of urination.
Vesicoureteral reflux
MedGen UID:
21852
Concept ID:
C0042580
Disease or Syndrome
Vesicoureteral reflux (VUR) is characterized by the reflux of urine from the bladder into the ureters and sometimes into the kidneys. It is a risk factor for urinary tract infections. Primary VUR results from a developmental defect of the ureterovesical junction (UVJ). In combination with intrarenal reflux, the resulting inflammatory reaction may result in renal injury or scarring, also called reflux nephropathy (RN). Extensive renal scarring impairs renal function and may predispose patients to hypertension, proteinuria, and renal insufficiency (summary by Lu et al., 2007). Genetic Heterogeneity of Vesicoureteral Reflux A locus designated VUR1 maps to chromosome 1p13. VUR2 (610878) is caused by mutation in the ROBO2 gene (602431) on chromosome 3p12; VUR3 (613674) is caused by mutation in the SOX17 gene (610928) on chromosome 8q11; VUR4 (614317) maps to chromosome 5; VUR5 (614318) maps to chromosome 13; VUR6 (614319) maps to chromosome 18; VUR7 (615390) maps to chromosome 12; and VUR8 (615963) is caused by mutation in the TNXB gene (600985) on chromosome 6p21. A possible X-linked form has been reported (VURX; 314550).
Congenital posterior urethral valve
MedGen UID:
451008
Concept ID:
C0238506
Congenital Abnormality
A developmental defect resulting in an obstructing membrane in the posterior male urethra.

Professional guidelines

PubMed

Morris RK, Malin GL, Khan KS, Kilby MD
BJOG 2010 Mar;117(4):382-90. doi: 10.1111/j.1471-0528.2010.02500.x. PMID: 20374578

Recent clinical studies

Etiology

Flores-Torres J, Sanchez-Valle A, Duncan JR, Panzarino V, Rodriguez JM, Kirby RS
Adv Pediatr 2023 Aug;70(1):131-144. Epub 2023 May 15 doi: 10.1016/j.yapd.2023.03.001. PMID: 37422291
Expert Panel on Urological Imaging, Smith AD, Nikolaidis P, Khatri G, Chong ST, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Kwun R, Lyshchik A, Nicola R, Purysko AS, Savage SJ, Taffel MT, Yoo DC, Delaney EW, Lockhart ME
J Am Coll Radiol 2022 Nov;19(11S):S224-S239. doi: 10.1016/j.jacr.2022.09.017. PMID: 36436954
Syngelaki A, Hammami A, Bower S, Zidere V, Akolekar R, Nicolaides KH
Ultrasound Obstet Gynecol 2019 Oct;54(4):468-476. doi: 10.1002/uog.20844. PMID: 31408229
Cheung KW, Morris RK, Kilby MD
Best Pract Res Clin Obstet Gynaecol 2019 Jul;58:78-92. Epub 2019 Jan 11 doi: 10.1016/j.bpobgyn.2019.01.003. PMID: 30819578
Winyard P, Chitty LS
Semin Fetal Neonatal Med 2008 Jun;13(3):142-51. Epub 2007 Dec 11 doi: 10.1016/j.siny.2007.10.009. PMID: 18065301

Diagnosis

Flores-Torres J, Sanchez-Valle A, Duncan JR, Panzarino V, Rodriguez JM, Kirby RS
Adv Pediatr 2023 Aug;70(1):131-144. Epub 2023 May 15 doi: 10.1016/j.yapd.2023.03.001. PMID: 37422291
Expert Panel on Urological Imaging, Smith AD, Nikolaidis P, Khatri G, Chong ST, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Kwun R, Lyshchik A, Nicola R, Purysko AS, Savage SJ, Taffel MT, Yoo DC, Delaney EW, Lockhart ME
J Am Coll Radiol 2022 Nov;19(11S):S224-S239. doi: 10.1016/j.jacr.2022.09.017. PMID: 36436954
Syngelaki A, Hammami A, Bower S, Zidere V, Akolekar R, Nicolaides KH
Ultrasound Obstet Gynecol 2019 Oct;54(4):468-476. doi: 10.1002/uog.20844. PMID: 31408229
Cheung KW, Morris RK, Kilby MD
Best Pract Res Clin Obstet Gynaecol 2019 Jul;58:78-92. Epub 2019 Jan 11 doi: 10.1016/j.bpobgyn.2019.01.003. PMID: 30819578
Clayton DB, Brock JW 3rd
Clin Perinatol 2014 Sep;41(3):643-59. Epub 2014 Jul 19 doi: 10.1016/j.clp.2014.05.012. PMID: 25155733

Therapy

Nelson O, Simpao AF, Tran KM, Lin EE
Curr Opin Anaesthesiol 2020 Jun;33(3):368-373. doi: 10.1097/ACO.0000000000000862. PMID: 32324666
Cheung KW, Morris RK, Kilby MD
Best Pract Res Clin Obstet Gynaecol 2019 Jul;58:78-92. Epub 2019 Jan 11 doi: 10.1016/j.bpobgyn.2019.01.003. PMID: 30819578
Clayton DB, Brock JW
Curr Urol Rep 2018 Feb 22;19(1):12. doi: 10.1007/s11934-018-0760-9. PMID: 29468448
Wenstrom KD, Carr SR
Obstet Gynecol 2014 Oct;124(4):817-835. doi: 10.1097/AOG.0000000000000476. PMID: 25198256
Mishra OP, Abhinay A, Prasad R
Indian J Pediatr 2013 Oct;80(10):838-43. Epub 2013 Jul 24 doi: 10.1007/s12098-013-1118-4. PMID: 23881478

Prognosis

Cheung KW, Morris RK, Kilby MD
Best Pract Res Clin Obstet Gynaecol 2019 Jul;58:78-92. Epub 2019 Jan 11 doi: 10.1016/j.bpobgyn.2019.01.003. PMID: 30819578
Clayton DB, Brock JW 3rd
Clin Perinatol 2014 Sep;41(3):643-59. Epub 2014 Jul 19 doi: 10.1016/j.clp.2014.05.012. PMID: 25155733
Tonni G, Vito I, Ventura A, Grisolia G, De Felice C
Arch Gynecol Obstet 2013 Feb;287(2):187-94. Epub 2012 Nov 9 doi: 10.1007/s00404-012-2615-9. PMID: 23138754
Hodges SJ, Patel B, McLorie G, Atala A
ScientificWorldJournal 2009 Oct 14;9:1119-26. doi: 10.1100/tsw.2009.127. PMID: 19838598Free PMC Article
Winyard P, Chitty LS
Semin Fetal Neonatal Med 2008 Jun;13(3):142-51. Epub 2007 Dec 11 doi: 10.1016/j.siny.2007.10.009. PMID: 18065301

Clinical prediction guides

Safdar A, Singh K, Sun RC, Nassr AA
Curr Opin Pediatr 2021 Apr 1;33(2):220-226. doi: 10.1097/MOP.0000000000001001. PMID: 33651757
Katsoufis CP
Pediatr Nephrol 2020 Jul;35(7):1193-1201. Epub 2019 Jun 13 doi: 10.1007/s00467-019-04280-0. PMID: 31197474
Cheung KW, Morris RK, Kilby MD
Best Pract Res Clin Obstet Gynaecol 2019 Jul;58:78-92. Epub 2019 Jan 11 doi: 10.1016/j.bpobgyn.2019.01.003. PMID: 30819578
Winyard P, Chitty LS
Semin Fetal Neonatal Med 2008 Jun;13(3):142-51. Epub 2007 Dec 11 doi: 10.1016/j.siny.2007.10.009. PMID: 18065301
Johnson HW, Gleave M, Coleman GU, Nadel HR, Raffel J, Weckworth PF
J Urol 1987 Oct;138(4 Pt 2):1023-7. doi: 10.1016/s0022-5347(17)43488-4. PMID: 3309371

Recent systematic reviews

Saccone G, D'Alessandro P, Escolino M, Esposito R, Arduino B, Vitagliano A, Quist-Nelson J, Berghella V, Esposito C, Zullo F
J Matern Fetal Neonatal Med 2020 Aug;33(15):2664-2670. Epub 2019 Jan 4 doi: 10.1080/14767058.2018.1555704. PMID: 30501534
Nassr AA, Shazly SAM, Abdelmagied AM, Araujo Júnior E, Tonni G, Kilby MD, Ruano R
Ultrasound Obstet Gynecol 2017 Jun;49(6):696-703. doi: 10.1002/uog.15988. PMID: 27270578
Moaddab A, Sananes N, Hernandez-Ruano S, Werneck Britto IS, Blumenfeld Y, Stoll F, Favre R, Ruano R
J Ultrasound Med 2015 Nov;34(11):2057-64. Epub 2015 Oct 7 doi: 10.7863/ultra.14.12064. PMID: 26446816
Tonni G, Vito I, Ventura A, Grisolia G, De Felice C
Arch Gynecol Obstet 2013 Feb;287(2):187-94. Epub 2012 Nov 9 doi: 10.1007/s00404-012-2615-9. PMID: 23138754
Morris RK, Malin GL, Khan KS, Kilby MD
BJOG 2009 Sep;116(10):1290-9. Epub 2009 May 8 doi: 10.1111/j.1471-0528.2009.02194.x. PMID: 19438489

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