In:
Fetal Diagnosis and Therapy, S. Karger AG, Vol. 47, No. 1 ( 2020), p. 74-83
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In utero therapeutic approaches for lower urinary tract obstruction (LUTO) have been developed to salvage the fetal kidney function. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 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. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 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%, 〈 i 〉 p 〈 /i 〉 = 1), complication rate (74 vs. 92%, 〈 i 〉 p 〈 /i 〉 = 0.88), or chronic kidney disease (58 vs. 50%, 〈 i 〉 p 〈 /i 〉 = 1). The number of procedures was higher in the VAS group: 1.7 (1–3) versus 1.1 (1–2), 〈 i 〉 p 〈 /i 〉 = 0.01. With a 30% rate of technical failure, FC added diagnostic value in 3 out of 21 cases. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 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.
Type of Medium:
Online Resource
ISSN:
1015-3837
,
1421-9964
Language:
English
Publisher:
S. Karger AG
Publication Date:
2020
detail.hit.zdb_id:
1482292-1
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