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>> IT'S IMPORTANT TO WORK CLOSELY WITH THE REFERRING
PHYSICIAN GROUP PARTICULARLY IF THE FAMILY COMES FROM FAR
AWAY AND MANY OF OUR PATIENTS COME FROM AROUND
THE U.S. OR ACTUALLY, AROUND THE WORLD.
>> THEY RETURN HOME TO THEIR REFERRING PHYSICIANS.
WE USUALLY GIVE THEM A PHONE CALL AND TALK ABOUT ANY
ISSUES OR CONCERNS WE HAVE AS WELL AS SEND THEM
A DETAILED LETTER OF THINGS THAT WE WOULD RECOMMEND THEY
LOOK FOR.
>> AS WELL AS A REFERRAL TO A PEDIATRIC UROLOGIST WHO
WOULD BE ABLE TO EVALUATE THAT PARTICULAR CHILD
POST-NATALLY.
>> SUBSEQUENT ULTRASOUND SURVEILLANCE IS REALLY UP TO
THE DISCRETION OF THE OBSTETRICIAN, WHETHER IT'S
WEEKLY OR EVERY OTHER WEEK, JUST TO MAKE SURE THE SHUNT
IS IN PLACE, IT'S FUNCTIONING APPROPRIATELY
AND THE BABY IS MAINTAINING AMNIOTIC FLUID VOLUME.
>> LOTS OF THINGS CAN OCCUR, PRINCIPALLY,
TECHNICALLY, TO THE SHUNT.
>> THAT SHUNT CAN MIGRATE.
IT CAN MIGRATE INTO THE ABDOMEN IN WHICH CASE NOW
THE URINE EMPTIES INTO THE ABDOMEN,
OR IT CAN MIGRATE OUT INTO THE AMNIOTIC SPACE,
OR OUT OF THE BLADDER INTO THE ABDOMEN AND IT WOULD NO
LONGER WORK.
>> SO THE REASON THAT YOU WANT TO PLACE THAT SHUNT AS
LOW IN THE BLADDER AS YOU CAN,
IS BECAUSE AS THAT BLADDER COLLAPSES DOWN WITH
SUCCESSFUL DRAINAGE, THE SHUNT WILL STAY IN PLACE AND
HAS A MUCH, MUCH LOWER RISK FOR BEING DISPLACED OR
BECOMING OBSTRUCTED.
>> IN SOME SITUATIONS, YOU KNOW,
THE FETUS MAY GRAB THE SHUNT AND LITERALLY PULL IT OUT.
>> WE FOUND THAT SHUNT DISPLACEMENT OCCURS IN ABOUT
40 PERCENT OF CASES.
>> AND SO COMMUNICATION BETWEEN OUR GROUP AND THAT
REFERRING PHYSICIAN GROUP IS EXTREMELY IMPORTANT.