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

Vinit, Nicolas; Gueneuc, Alexandra; Bessières, Bettina; Dreux, Sophie; Heidet, Laurence; Salomon, Rémi; Lapillonne, Alexandre; Bernardis, Gaston De; Salomon, Laurent; Stirnemann, J.; Blanc, Thomas; Ville, Y.

doi:10.1159/000500569

Cited by 36 publications

(30 citation statements)

References 31 publications

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“…They noted that the candidates for fetal intervention could be appropriately selected based on fetoscopic findings. 25 In contrast, a retrospective study of 48 procedures (FC, n = 23; VAS, n = 25) reported by Vinit et al 26 showed that there were no significant differences in the long-term outcomes (including survival, the renal function, and urological outcomes) of the two groups. Inadequate visualization of the posterior urethra by FC was thought to have contributed to these results.…”

Section: Discussionmentioning

confidence: 91%

Prenatally diagnosed lower urinary tract obstruction: A 15‐year experience at two tertiary centers in Japan

Sugibayashi

Wada

Ozawa

et al. 2021

J of Obstet and Gynaecol

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Aim: To examine the outcomes of prenatally diagnosed lower urinary tract obstruction (LUTO) with current management using vesicoamniotic shunting (VAS). Methods: A retrospective study of prenatally diagnosed LUTO before 26 weeks of gestation at two tertiary centers in Japan between March 2002 and September 2017. LUTO was diagnosed by ultrasound demonstration of an enlarged fetal bladder associated with hydronephrosis and/or hydroureters. VAS was offered for fetuses with LUTO at ≤26 weeks of gestational age, in the presence of oligohydramnios or decreasing amniotic fluid and a favorable fetal urinary analysis. Results: Among 87 fetuses with LUTO, 46 (53%) were terminated before 22 weeks of gestation. Eight cases (9%) underwent VAS and one underwent fetoscopic urethrotomy. The live birth rates in the VAS and expectant groups were 100% (8/8) and 56% (18/32), respectively (p = 0.034), and the survival rates at 6 months old with a normal renal function were 38% (3/8) and 16% (5/32), respectively (p = 0.608). The etiology varied with six cases of associated anomalies among 23 diagnosed cases. Among the nine cases of posterior urethral valve (PUV), only one fetus underwent VAS at 25 weeks of gestation, ultimately surviving with mild renal dysfunction. Among the other eight cases of PUV that were managed expectantly, two died, and only one of the six survivors showed a normal renal function. Conclusions: More than half of the prenatally diagnosed LUTO cases were terminated. VAS seemed effective for achieving a perinatal survival, regardless of etiology. The outcomes were poor in cases of expectantly managed PUV.

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Section: Discussionmentioning

confidence: 91%

Prenatally diagnosed lower urinary tract obstruction: A 15‐year experience at two tertiary centers in Japan

Sugibayashi

Wada

Ozawa

et al. 2021

J of Obstet and Gynaecol

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“…Fetal renal therapy options: • VAS is an ultrasound-guided procedure introducing a 1-way flow shunt/conduit between the obstructed fetal bladder and the amniotic cavity (Table 3, [15,[48][49][50][51][52][53]). • FC is ultrasound guided allowing direct vision of the urethralbladder floor with possible direct urethral-bladder floor therapy (Table 3, [15,[48][49][50][51][52][53]). • Fetal vesicostomy using open maternal-fetal or endoscopic approach with amnioinfusion (Table 3, [15,[48][49][50][51][52][53]).…”

Section: Results/interventions: Identification Of Potential Evidenced-based Protocol Elements For Development Of An Eras-luto Guidelinementioning

confidence: 99%

“…• FC is ultrasound guided allowing direct vision of the urethralbladder floor with possible direct urethral-bladder floor therapy (Table 3, [15,[48][49][50][51][52][53]). • Fetal vesicostomy using open maternal-fetal or endoscopic approach with amnioinfusion (Table 3, [15,[48][49][50][51][52][53]). • Amnioinfusion has been proposed for an improved ultrasound diagnostic opportunity with second trimester and/or oligohydramnios secondary to bladder neck obstruction and to allow fetal access for VAS or FC [54][55][56][57][58].…”

Section: Results/interventions: Identification Of Potential Evidenced-based Protocol Elements For Development Of An Eras-luto Guidelinementioning

confidence: 99%

“…For fetal LUTO, Vinit et al [52] compared FC and VAS procedure with no significant difference for survival (92 vs. 83%, p = 1), complication rate (74 vs. 92%, p = 0.88), and chronic kidney disease (58 vs. 50%, p = 1). The number of procedures needed for the VAS group was higher 1.7 (1-3) than FC 1.1 (1-2) p = 0.01 but FC, while adding certain diagnostic value, had a 30% technical failure rate.…”

Section: Results/interventions: Identification Of Potential Evidenced-based Protocol Elements For Development Of An Eras-luto Guidelinementioning

confidence: 99%

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Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Wilson¹,

Nelson²

2021

Fetal Diagn Ther

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Background: Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. Problem: The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. Methods: A quality improvement review Squire 2.0 (2000–2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. Interventions: Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. Results: A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. Conclusions: The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.

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“…Urological fistulas are usually caused by inadequate curvature of the instrument, fetal mobilization, and limited surgeon experience 147. The long term benefits of fetal cystoscopy over VAS remain undetermined and improvements of the instruments and techniques are warranted 149. Our group is currently investigating the benefits, safety, and risks related to fetal cystoscopy for stage II LUTO (ClinicalTrials.gov Identifier: NCT03281798).…”

Section: Fetal Endoscopic Surgeriesmentioning

confidence: 99%

Prenatal regenerative fetoscopic interventions for congenital anomalies

Ruano

2020

BMJ

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Abstract Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.

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

Cited by 36 publications

References 31 publications

Prenatally diagnosed lower urinary tract obstruction: A 15‐year experience at two tertiary centers in Japan

Prenatally diagnosed lower urinary tract obstruction: A 15‐year experience at two tertiary centers in Japan

Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Prenatal regenerative fetoscopic interventions for congenital anomalies

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