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Fetal Cystoscopy and Vesicoamniotic Shunting in Lower Urinary Tract Obstruction: Long-Term Outcome and Current Technical Limitations

Authors
  • Vinit, Nicolas
  • Gueneuc, Alexandra
  • Bessières, Bettina
  • Dreux, Sophie
  • Heidet, Laurence
  • Salomon, Rémi
  • Lapillonne, Alexandre
  • De Bernardis, Gaston
  • Salomon, Laurent J.
  • Stirnemann, Julien J.
  • Blanc, Thomas
  • Ville, Yves
Type
Published Article
Journal
Fetal Diagnosis and Therapy
Publisher
S. Karger AG
Publication Date
Aug 09, 2019
Volume
47
Issue
1
Pages
74–83
Identifiers
DOI: 10.1159/000500569
PMID: 31401627
Source
Karger
Keywords
License
Green
External links

Abstract

Background: In utero therapeutic approaches for lower urinary tract obstruction (LUTO) have been developed to salvage the fetal kidney function. Objective: The aim of this work was to report the long-term survival, nephrological, and urological outcome of children treated prenatally for LUTO using operative fetal cystoscopy (FC) and vesicoamniotic shunting (VAS) or both. Methods: A retrospective study of 48 procedures (23 FC, 25 VAS) was performed on 33 patients (between 2008 and 2018). Reviewed data included prenatal management and clinical follow-up by a pediatric nephrologist and a pediatric urologist. Both intention-to-treat and per-protocol analyses were conducted. Results: The median follow-up was 3.6 years (0.5–7) for FC and 2.5 years (1.1–5.1) for VAS. There was no difference between FC and VAS in terms of survival (92 vs. 83%, p = 1), complication rate (74 vs. 92%, p = 0.88), or chronic kidney disease (58 vs. 50%, p = 1). The number of procedures was higher in the VAS group: 1.7 (1–3) versus 1.1 (1–2), p = 0.01. With a 30% rate of technical failure, FC added diagnostic value in 3 out of 21 cases. Conclusions: No difference was found between FC and VAS regarding survival, long-term kidney function, or urological outcome. Despite overly optimistic reports on FC, it lacks reproducibility due to posterior-urethra inadequate visualization and inappropriate instrumentation.

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