Advances in Fetal Surgery for Lower Urinary Tract Obstruction: From Prenatal Diagnosis to Long-Term Outcomes

Lower urinary tract obstruction (LUTO) represents one of the most severe congenital anomalies affecting fetal urinary outflow, often leading to renal dysplasia, pulmonary hypoplasia, and long-term kidney failure. Over the past two decades, major advances in prenatal imaging, biochemical staging, and minimally invasive techniques have transformed the management of affected fetuses. Among available interventions, vesicoamniotic shunting (VAS) and fetal cystoscopy (FC) have emerged as key procedures to decompress the obstructed bladder and preserve renal and pulmonary function. However, clinical variability, heterogeneous protocols, and limited long-term follow-up data, especially into adolescence, still hinder a clear consensus on patient selection and optimal management. This Research Topic will explore recent progress and persisting challenges in the prenatal and postnatal continuum of care for fetuses diagnosed with LUTO.

This Research Topic aims to provide a multidisciplinary overview of fetal interventions for LUTO, integrating insights from maternal–fetal medicine, pediatric urology, and nephrology. Despite growing evidence, the long-term efficacy of fetal therapy in preserving renal and bladder function remains unclear, with most studies focusing on short-term neonatal outcomes. Our goal is to consolidate current knowledge and encourage the development of standardized prenatal staging systems and postnatal follow-up protocols extending into adolescence. By comparing outcomes of VAS, FC, and conservative management, contributors will address how prenatal selection criteria, such as fetal urine biochemistry and ultrasound staging, affect renal prognosis, survival, and quality of life. This Topic seeks to bridge experimental, clinical, and ethical perspectives, ultimately promoting more evidence-based and patient-centered approaches to fetal therapy in obstructive uropathies.

We invite contributions focusing on prenatal diagnosis, staging, intervention techniques, and long-term outcomes in fetuses with LUTO. Themes may include:

· Prenatal predictors of postnatal outcome (survival and renal function);

· Advances in fetal therapy (cystoscopy and vesicoamniotic shunting);

· Perinatal genetic diseases and tests;

· Ethical considerations and parental counseling;

· Standardization of follow-up into childhood and adolescence;

· Emerging technologies such as 3D imaging, simulation, and robotics.

Manuscript types of interest include original research, systematic reviews, mini-reviews, clinical trials, meta-analyses, and technical reports. Contributions from multidisciplinary teams and multicenter collaborations are particularly encouraged to foster translational insight from prenatal management to postnatal care.