目的：为了达成Delphi产生的关于诊断的国际专家共识，预后，管理,和胎儿下尿路梗阻（LUTO）的核心结果集（COS）。
方法：在国际LUTO专家小组中进行了三轮Delphi程序。为小组提供了用于诊断的文献综述产生的参数列表，预后，管理,和结果。在COS的开发过程中，与患者组一起进行了平行程序。
结果：共接触了160名专家，其中99人完成了第一轮比赛，80人(80/99，80.8%)完成了所有三轮比赛。在头三个月，应客观测量膀胱的纵向直径(≥7mm为异常)以怀疑LUTO.在妊娠中期，LUTO的成像参数可能包括：a)膀胱增大，b)钥匙孔标志,c)膀胱壁增厚,d)双侧积水(输尿管)肾病,e）男性。目前的预后评分文献缺乏共识。然而,专家一致认为羊水量（<24周）对预测生存的价值，胎儿干预的价值是提高新生儿的生存。虽然专家认可超声参数对肾发育不良的作用，至少一次膀胱穿刺术,和尿液生化用于预后和咨询，这些项目在确定胎儿介入治疗候选资格方面未达成共识.另一方面,提示LUTO的成像参数，没有限制生命的结构或遗传异常，胎龄≥16周,根据专家共识,羊水过少定义为最深垂直口袋(DVP)<2cm,应作为胎儿干预的候选标准.如果评估了膀胱笔芯，应该主观评估。膀胱羊膜分流术应该是胎儿介入的第一线。在怀疑胎儿肾衰竭的情况下，连续羊膜输注只能作为研究方案下的实验程序提供。商定了未来研究的核心结果集。
结论：关于诊断的国际共识，预后,和胎儿LUTO的管理，以及核心成果集，应告知临床护理和研究，以优化围产期结局。本文受版权保护。保留所有权利。
OBJECTIVE: To reach a Delphi-generated international expert
consensus on the diagnosis, prognostic, management, and core outcome set (COS) of fetal Lower Urinary Tract Obstruction (LUTO).
METHODS: A three-round Delphi procedure was conducted among an international panel of LUTO experts. The panel was provided with a list of literature review-generated parameters for the diagnosis, prognostic, management, and outcomes. A parallel procedure was conducted along with patient groups during the development of COS.
RESULTS: A total of 160 experts were approached, of whom 99 completed the first round and 80 (80/99, 80.8%) completed all three rounds. In the first trimester, an objective measurement of longitudinal bladder diameter (with ≥7 mm being abnormal) should be used to suspect LUTO. In the second trimester, imaging parameters of LUTO could include: a) an enlarged bladder, b) a keyhole sign, c) bladder wall thickening, d) bilateral hydro (uretero) nephrosis, and e) male sex. There was a lack of
consensus on the current prognostic scoring literature. However, experts agreed on the value of amniotic fluid volume (< 24 weeks) to predict survival and that the value of fetal intervention is to improve neonatal survival. While experts endorsed the role of sonographic parameters of renal dysplasia, at least one vesicocentesis, and urine biochemistry for prognosis and counseling, these items did not reach a
consensus for determining fetal intervention candidacy. On the other hand, imaging parameters suggestive of LUTO, absence of life-limiting structural or genetic anomalies, gestational age of ≥16 weeks, and oligohydramnios defined as deepest vertical pocket (DVP) <2 cm should be used as candidacy criteria for fetal intervention based on experts\'
consensus. If a bladder refill was evaluated, it should be assessed subjectively. Vesicoamniotic shunt should be the first line of fetal intervention. In the presence of suspected fetal renal failure, serial amnioinfusion should only be offered as an experimental procedure under research protocols. The core outcome set for future studies was agreed upon.
CONCLUSIONS: International
consensus on the diagnosis, prognosis, and management of fetal LUTO, as well as the Core Outcome Set, should inform clinical care and research to optimize perinatal outcomes. This article is protected by copyright. All rights reserved.
