# Bladder Outlet Obstruction — GCMD Library living collection

Everything in the library about bladder outlet obstruction — built automatically from dossiers that name it.

Updated: n/a · 5 episodes · 96 cited statements

## Episodes
### Fundamentals
- [Fetal Genitourinary Diseases and Bladder Outlet Obstruction: Fetal...](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920) — video · 3:45 · [machine version](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920.md)

### Diagnosis & Workup
- [Fetal Diagnostic Imaging: Cincinnati Fetal Center](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744) — video · 10:34 · [machine version](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744.md)
- [Fetal Diagnosis Imaging: Fetal Genitourinary Disease 2015](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918) — video · 10:31 · [machine version](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918.md)

### Surgical Management
- [Renal transplantation: Cincinnati Fetal Center](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623) — video · 13:51 · [machine version](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623.md)

### Long-Term Care
- [Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622) — video · 35:10 · [machine version](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=0) Pulmonary Survival in Neonates with Bladder Outlet Obstruction (Ep 1)
- [7:31](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=451) Managing Advanced Chronic Kidney Disease in Fetal Center Graduates (Ep 1)
- [26:41](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1601) Clinical Decision-Making and Nutritional Management (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=0) Early surgical interventions: gastrostomy tubes and peritoneal dialysis catheters (Ep 2)
- [3:35](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=215) Timing and approach for renal transplantation in infants (Ep 2)
- [5:45](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=345) Technical discussion: gastrostomy tube placement considerations (Ep 2)
- [11:50](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=710) Anatomical observations: small stomach phenomenon in bladder outlet obstruction (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0) Amnioinfusion technique for fetal bladder outlet obstruction evaluation (Ep 3)
- [3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180) Ultrasound imaging findings in genitourinary abnormalities (Ep 3)
- [8:38](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=518) Kidney size, diaphragmatic excursion, and role of MRI (Ep 3)
- [0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0) Amnioinfusion technique for fetal bladder outlet obstruction evaluation (Ep 4)
- [2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177) Imaging findings in fetal genitourinary abnormalities (Ep 4)
- [8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515) Role of kidney size and MRI in diagnosis (Ep 4)
- [0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0) Introduction to Fetal Bladder Outlet Obstruction: Historical Paradigm and Management Pathways (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Infants with renal failure are often called for gastrostomy tube and peritoneal dialysis catheter placement within the first few days of life. — Alonso (clinical) [Ep 2 · 0:13](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=13)
- Babies that make urine are not likely to need peritoneal dialysis immediately but are likely to need it in the future. — Alonso (clinical) [Ep 2 · 0:31](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=31)
- Peritoneal dialysis catheters should ideally be left alone for a couple of weeks after placement if possible. — Alonso (clinical) [Ep 2 · 0:49](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- Gastrostomy tube placement is focused along the lesser curvature or close to it to preserve stomach tissue for potential future bladder augmentation by Doctor Reddy. — Alonso (clinical) [Ep 2 · 0:49](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- Gastrostomy tube placement is performed laparoscopic-assisted to visualize exact stomach location, then the camera is turned into the pelvis to position the PD catheter. — Alonso (clinical) [Ep 2 · 1:21](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=81)
- The nephrology team is generally good at predicting which babies will need a peritoneal dialysis catheter. — Alonso (opinion) [Ep 2 · 1:42](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=102)
- Hemodialysis catheters need to be fairly large caliber and are preferentially placed in the right internal jugular site because it provides a straight shot into the atrium. — Alonso (clinical) [Ep 2 · 2:04](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=124)
- Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis. — Alonso (clinical) [Ep 2 · 3:03](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- Hernias in dialysis patients are generally left alone if they are not affecting dialysis mechanics or causing symptoms. — Alonso (clinical) [Ep 2 · 3:03](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- The ideal weight for infant renal transplantation is around 10 kg if the patient is not on peritoneal dialysis. — Alonso (clinical) [Ep 2 · 3:46](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=226)
- Infants on peritoneal dialysis have a more accommodating abdominal cavity and laxity in the abdominal wall, allowing transplantation at weights closer to 8 kg. — Alonso (clinical) [Ep 2 · 4:08](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=248)
- All infant renal transplant recipients at this center have been transplanted with adult donor kidneys. — Alonso (clinical) [Ep 2 · 4:24](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=264)
- An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin. — Alonso (clinical) [Ep 2 · 4:39](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=279)
- Wound complications are the biggest complication from a general surgical perspective in infant renal transplantation, surprisingly more common than vascular complications. — Alonso (clinical) [Ep 2 · 5:06](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=306)
- Some infant transplant patients can only be closed at the skin level initially and develop leaks or dehiscence requiring biologic mesh (such as derma matrix) for closure. — Alonso (clinical) [Ep 2 · 5:15](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=315)
- In a 13-year follow-up study of gastrostomy tubes in babies, all G-tubes migrated superiorly onto the chest wall. (clinical) [Ep 2 · 7:21](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=441)
- Placing gastrostomy tubes too close to peritoneal dialysis catheters creates infection risk early on because drainage can get underneath the PD catheter dressing when there is insufficient space between sites. — Alonso (clinical) [Ep 2 · 7:54](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=474)
- The standard gastrostomy tube insertion site is 2 finger breadths below the costal margin. — Alonso (clinical) [Ep 2 · 8:31](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=511)
- For patients with posterior urethral valves, gastrostomy tube location is placed high on the stomach toward the lesser curvature to preserve the ability to use a gastric segment for gastric augmentation later in life. (clinical) [Ep 2 · 8:48](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=528)
- Some infants with posterior urethral valves will need urinary diversion with a vesicostomy placed about 1-2 finger breadths below the umbilicus, requiring mitigation of infection risks by spacing catheter sites appropriately. (clinical) [Ep 2 · 9:13](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=553)
- Peritoneal dialysis catheters can be placed in a way that allows immediate use with lower volumes, though waiting for healing is preferable. — Alonso (clinical) [Ep 2 · 11:27](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=687)
- Amnioinfusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills. (clinical) [Ep 2 · 12:30](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=750)
- Early onset large bladders that extend upward and push the diaphragm and stomach back may cause anatomical distortion that results in stomachs ending up higher long-term. (opinion) [Ep 2 · 13:23](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=803)
- If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%. — Paul Kingma (clinical) [Ep 1 · 2:42](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=162)
- If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor. — Paul Kingma (clinical) [Ep 1 · 3:08](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=188)
- Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured. — Paul Kingma (clinical) [Ep 1 · 5:33](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=333)
- Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint. — Paul Kingma (clinical) [Ep 1 · 6:00](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=360)
- Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites. — Jan Scober (clinical) [Ep 1 · 10:32](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=632)
- Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine. — Jan Scober (clinical) [Ep 1 · 11:03](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=663)
- Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction. — Jan Scober (clinical) [Ep 1 · 15:37](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=937)
- Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100. — Jan Scober (clinical) [Ep 1 · 19:48](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1188)
- Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function. — Jan Scober (clinical) [Ep 1 · 20:14](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1214)
- The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR. — Jan Scober (guideline) [Ep 1 · 20:42](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1242)
- Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed. — Jan Scober (clinical) [Ep 1 · 22:42](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1362)
- Peritoneal dialysis is the technically least difficult way to provide dialysis in small children. — Jan Scober (clinical) [Ep 1 · 23:27](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1407)
- Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis. — Jan Scober (clinical) [Ep 1 · 25:17](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1517)
- At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life. — Jan Scober (clinical) [Ep 1 · 13:24](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=804)
- Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies. — Jan Scober (clinical) [Ep 1 · 13:53](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=833)
- Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies. — Jan Scober (clinical) [Ep 1 · 14:52](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=892)
- If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period. — Paul Kingma (clinical) [Ep 1 · 27:46](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1666)
- If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents. — Paul Kingma (clinical) [Ep 1 · 28:15](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1695)
- The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis. — Paul Kingma (clinical) [Ep 1 · 28:44](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1724)
- When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels. — Jan Scober (clinical) [Ep 1 · 30:04](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1804)
- Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems. — Jan Scober (clinical) [Ep 1 · 30:22](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1822)
- Temporary hemodialysis catheters in newborns are difficult to maintain because there is not much catheter design for small children, resulting in excess extravascular catheter that moves despite securing, and the 8 French catheter is limited to jugular veins. — Maria Alonso (clinical) [Ep 1 · 31:27](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1887)
- Tunneled hemodialysis catheters are easier to maintain from a movement standpoint but are still very large and likely to cause local thrombosis or stenosis in the central circulation. — Maria Alonso (clinical) [Ep 1 · 31:53](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1913)
- Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated. — Jan Scober (clinical) [Ep 1 · 32:34](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1954)
- High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients. — Jan Scober (clinical) [Ep 1 · 32:49](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1969)
- The density of formula is essentially an inverse function of urine output. — Jan Scober (clinical) [Ep 1 · 33:12](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=1992)
- The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise. — Jan Scober (clinical) [Ep 1 · 33:50](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2030)
- It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition. — Jan Scober (clinical) [Ep 1 · 34:15](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2055)
- Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it. — Jan Scober (clinical) [Ep 1 · 34:31](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2071)
- The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration. — Jan Scober (clinical) [Ep 1 · 34:45](https://origin-library.globalcastmd.com/watch/managing-advanced-chronic-kidney-disease-cincinnati-fetal-center-622?t=2085)
- Fetuses with bladder outlet obstruction and oligohydramnios present with posterior placentas, hands and feet up in front of the face, compressed chest, difficult-to-visualize stomach, and bladder visible at the base with umbilical cord and hypogastric arteries bifurcating around it. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Amnioinfusion is needed if the patient is a candidate for shunt placement and is performed as the first step in evaluation at Cincinnati Fetal Center. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Karyotype can usually be obtained from a washing of the amniotic sac during amnioinfusion. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Amnioinfusion allows visualization of the uncompressed chest for size measurement and comparison to norms, which helps predict pulmonary hypoplasia. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Heart size ratios are very critical in prognosis for fetuses with bladder outlet obstruction. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Associated cardiac anomalies are not common in fetal genitourinary disease. — Bill (epidemiological) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Posturing of hands and feet can be part of the diagnosis when looking for complex genetic syndromes. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Velamentous cord insertions could complicate shunt placement. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- After intervention, if fluid volume drops off again due to end-stage fetal renal disease, repeat amnioinfusions can be performed through several different techniques. — Bill (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=0)
- Profound oligohydramnios makes diagnosis difficult in bladder outlet obstruction cases. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Fairly dilated and tortuous ureters can be confused with a big bladder by referring physicians. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Bladder outlet obstruction diagnosis has shifted from mid-trimester to early third trimester detection in the past to now being diagnosed just outside of the first trimester. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- A keyhole configuration of the bladder is commonly seen with posterior urethral valves or other obstructive neuropathies. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- When assessing kidneys for renal function prediction, echogenicity of the parenchyma and orientation of renal cysts should be evaluated. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Tortuous structures extending below the lower pole of the kidney are more likely dilated ureters than dilated kidneys. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Irregular configuration, inconsistent echogenicity, and wide distribution of cyst size are concerning findings in renal imaging. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Early in the disease process, renal cysts can be distributed around the outer pole of the kidney, then become more disoriented and distorted as the process progresses. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- It is important to confirm the presence of two kidneys, as multicystic dysplastic kidney can be associated with absence of the contralateral kidney. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- Bladder outlet obstruction is not just isolated to the genitourinary system; evaluation must include looking for a variety of other abnormalities. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- With oligohydramnios, the problem comes back to pulmonary hypoplasia, and if pulmonary hypoplasia is in place, it is very difficult to correct. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- A bell-shaped thorax with lower ribs being pushed out indicates the pulmonary circuit is not developing normally. — Jaco (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=180)
- If kidneys are high enough or big enough to impair diaphragmatic excursion, there is a bigger problem and more likely diagnosis of pulmonary hypoplasia. — Jaco (clinical) [Ep 3 · 8:54](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=534)
- Loss of diaphragmatic movement from phrenic nerve dissection is a primary reason for pulmonary hypoplasia, and big kidneys can cause the diaphragm to stop moving and create the same crisis for pulmonary development. — Jaco (clinical) [Ep 3 · 8:54](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=534)
- MRI provides a visual image that parents can better understand and gives a big picture of the baby with clear images for parents to see when dealing with a renal abnormality. — Jaco (opinion) [Ep 3 · 9:43](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=583)
- For bladder outlet obstruction, ultrasound alone is not sufficient; MRI is a very important discriminator for comprehensive evaluation. — Jaco (opinion) [Ep 3 · 9:43](https://origin-library.globalcastmd.com/watch/fetal-diagnostic-imaging-cincinnati-fetal-center-744?t=583)
- Amnioinfusion is needed if the patient is a candidate for a shunt in order to place the shunt properly — Bill (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- A karyotype can usually be obtained from a washing of the amniotic sac by doing amnioinfusion — Bill (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- Amnioinfusion allows visualization of the uncompressed chest to look at chest size and compare it to norms, which can help predict pulmonary hypoplasia — Bill (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- Heart size ratios are very critical in prognosis for fetal bladder outlet obstruction — Bill (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- Associated anomalies of the heart are not common in fetal genitourinary disease — Bill (epidemiological) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- After intervention, if fluid volume drops off again because of end-stage fetal renal disease, amnioinfusions can be repeated through several different techniques — Bill (clinical) [Ep 4 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=0)
- Bladder outlet obstruction diagnosis was made in the mid-trimester to early 3rd trimester in the past, but is now diagnosed just outside of the first trimester — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- The keyhole configuration of the bladder is seen commonly with posterior urethral valves or other obstructive neuropathies — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- When evaluating kidneys, echogenicity of the parenchyma and orientation of renal cysts allow better assessment of postnatal renal function — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- Early in the disease process, renal cysts can be distributed around the outer pole of the kidney, and as the process progresses, things become more disoriented and distorted — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- With oligohydramnios, the problem really comes back to pulmonary hypoplasia — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- If pulmonary hypoplasia is in place, it is very difficult to correct — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- A bell-shaped thorax with lower ribs being pushed out indicates the pulmonary circuit is not developing normally — Jacob (clinical) [Ep 4 · 2:57](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=177)
- If kidneys are high enough or big enough that they are impairing diaphragmatic excursion, there is a bigger problem and more likely diagnosis of pulmonary hypoplasia — Jacob (clinical) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515)
- Big kidneys can cause the diaphragm to stop moving and create the same crisis for pulmonary development as phrenic nerve dissection — Jacob (clinical) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515)
- MRI provides a visual image that parents can better get a handle on the diagnosis compared to ultrasound alone — Jacob (opinion) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515)
- For renal abnormalities, MRI is a very important discriminator because it gives a big picture of the baby and the images are clear for parents to see — Jacob (opinion) [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515)
- Bladder outlet obstruction provides a language and framework for coaching conversations about other genitourinary diseases such as cloaca in the female (opinion) [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Many infants with bladder outlet obstruction have unusually small stomachs, potentially related to minimal amniotic fluid during development. — The host summarizing the discussion [Ep 2 · 11:50](https://origin-library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=710)
- Loss of diaphragmatic movement from phrenic nerve dissection is a primary reason for pulmonary hypoplasia — Jacob summarizing the discussion [Ep 4 · 8:35](https://origin-library.globalcastmd.com/watch/fetal-diagnosis-imaging-fetal-genitourinary-disease-2015-918?t=515)
- 50% of fetuses with bladder outlet obstruction will survive to birth with therapy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- 50% of fetuses with bladder outlet obstruction that survive to live birth will survive infancy and childhood — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- There are no good predictors of survival for fetuses with bladder outlet obstruction — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Many predictive methods have been tried but work with limited ability to predict which fetuses will survive into childhood — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Prior to current options, neonates that survived birth and early infancy had no opportunity for additional treatment beyond that period — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Many children with bladder outlet obstruction that made it through fetal life would die of end-stage renal disease in infancy — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- For bladder outlet obstruction patients with normal fluid at evaluation, historical management has been observation regarding treatment — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Patients with bladder outlet obstruction and normal fluid are delivered close to term because complicating prematurity would be an additional challenge for the child to make it out of the nursery — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- For bladder outlet obstruction patients with abnormal fluid at evaluation, management includes evaluating renal fluid production and quality of the fluid — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Restoring fluid to normal levels is an intervention option chosen by the family for bladder outlet obstruction cases with abnormal fluid — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- A multidisciplinary team including neonatologists, urologists, transplant surgeons, and nephrologists is needed for bladder outlet obstruction care — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Preparation for chronic medical care of bladder outlet obstruction patients now includes preparing the mother, father, and rest of the family — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- There is a growing population of adult survivors of bladder outlet obstruction requiring continuity of care — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)
- Survivors of bladder outlet obstruction have diseases of the lungs, kidneys, and bladders requiring a multidisciplinary team of neonatologists, pulmonologists, urologists, nephrologists, and transplant surgeons — The host summarizing a resource [Ep 5 · 0:00](https://origin-library.globalcastmd.com/watch/fetal-genitourinary-diseases-and-bladder-outlet-obstruction-fetal-920?t=0)

## Changelog
- Sep 16: 2 items added automatically
- Sep 15: 3 items added automatically

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