Vesicoamniotic shunting versus conservative management in fetal lower urinary tract obstruction: a 10-year registry: a 10-year registry

Abstract

ObjectivesTo assess the perinatal mortality and the postnatal outcome in fetal lower urinary tract obstructions (LUTO) according to the prenatal management.MethodsThis was a retrospective study of all cases with suspected LUTO encountered in a ten-year period (2005 – 2014) in all 8 academic centres in the Netherlands and eventually treated at the Leiden University Medical Center. Antenatal management, sonographic findings and postnatal outcome were documented. The postnatal renal function (estimated Glomerular Filtration Rate or eGFR) was calculated using the Schwartz formula, considering the length of the infants and the nadir creatinine within one year of postnatal surgical intervention.Results341 fetuses were included: 275 cases with conservative management, 29 cases with vesico-amniotic shunting and 37 LUTO managed with vesicocentesis. The survival rate was respectively 76.7%, 82.6% and 60%. Oligohydramnios, abnormal karyotype and severe associated anomalies were significantly different comparing shunting to conservative management (respectively 100% vs 55%; 0% vs 15%; 24% vs 3%). Subgroup analysis was unable to show a significant difference in survival rate and postnatal renal function in vesico-amniotic shunt placement versus conservative management (survival rate: 68% vs 79%, p > 0.05; eGFR: 52 ml/min/1.73 m2 vs 61 ml/min/1.73 m2, p > 0.05).ConclusionsLUTO cases treated over the past ten years with vesico-amniotic shunt did not show any significant improvement in perinatal survival and postnatal renal function. The study suggests that prenatal selection of cases eligible for the treatment needs further refinement.