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- Title
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; De Bernardis, Gaston; Salomon, Laurent J; Stirnemann, Julien J
- Abstract
<bold>Background: </bold>In utero therapeutic approaches for lower urinary tract obstruction (LUTO) have been developed to salvage the fetal kidney function.<bold>Objective: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
URINARY organs; CHRONIC kidney failure; CYSTOSCOPY; UROLOGICAL surgery; DUODENUM abnormalities; BLADDER abnormalities; RETROSPECTIVE studies; FETAL diseases; TREATMENT effectiveness
- Publication
Fetal Diagnosis & Therapy, 2020, Vol 47, Issue 1, p74
- ISSN
1015-3837
- Publication type
journal article
- DOI
10.1159/000500569