ABSTRACT
PLUTO was an international, multicentre randomized control trial that aimed at testing improved survival and renal outcomes in infant with lower urinary tract obstruction (LUTO) that had undergone fetal vesicoamniotic shunt (VAS) in comparison to expectant management. Thirty-one (22%) were recruited from 7 (33%) of the 21 participating centres; 16 were randomized to the VAS arm and 15 to the conservative management arm. Three of the 16 pregnancies in the intervention arm did not receive a VAS, and two of the 15 in the conservative management arm had shunting. Renal impairment at 28 days was observed in 6/8 in the intervention group and 4/4 in the conservative management group. The PLUTO trial, conceived and led from Birmingham, UK, was unique in the sense that it was the very first randomized trial of fetal intervention for a urological disease. Yet, there is an argument nowadays that VAS performed early in the second trimester for LUTO provides better outcomes.
