Pressure-limited vesico-amniotic shunt tube for fetal obstructive uropathy

Nagae, Hideki; Kitagawa, Hiroaki; Pringle, Kevin C.; Koike, Junki; Zuccollo, Jane; Satō, Yoshihiro; Seki, Yasuji; Wakisaka, Munechika; Nakada, Koonosuke

doi:10.1016/j.jpedsurg.2006.08.012

Cited by 22 publications

(22 citation statements)

References 17 publications

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“…The procedure of vesicoamniotic shunts is far from ideal as it has many disadvantages, like erroneous placement, displacement, urinary ascites formation and affecting bladder function because presence of shunts preclude a normal urination cycle [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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Objectives: The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy. Material and methods:Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO.The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed. Results:In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5-6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed. Conclusions:Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

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Section: Discussionmentioning

confidence: 99%

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Dębska¹,

Kretowicz²,

Olędzka³

et al. 2017

Ginekol Pol

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“…Our findings after creating a V-A shunt in the fetal lamb after the creation of a bladder outlet obstruction suggested that although the shunt may salvage kidney function, it did not preserve bladder function [5]. The shunted bladder had marked thickening of the bladder wall with fibrosis extending from the submucosal layer into the intramuscular region.…”

Section: Discussionmentioning

confidence: 78%

“…Our shunt tube is designed to maintain a constant pressure in the bladder and allow the bladder to empty against a resistance, providing a continuous resistance of approximately 15 to 54 mm Hg. This shunt tube appears to preserve normal bladder development, reducing both muscle hypertrophy and interstitial fibrosis [5]. This suggests that in the shunted bladder, at least, the changes in the bladder wall (and in the bladder function or compliance) are at least partially iatrogenic and not strictly congenital.…”

Section: Discussionmentioning

confidence: 91%

“…We found that in utero placement of a V-A shunt after creating obstructive uropathy in fetal lambs produces a shrunken noncompliant bladder [2][3][4]. We also found that the placement of a valved shunt into an obstructed system resulted in a much more compliant bladder with reduced fibrosis in the bladder wall [5]. The question arose as to whether the shrunken fibrotic bladder is the result of the bladder outlet obstruction or a direct result of the shunt.…”

mentioning

confidence: 82%

“…The question arose as to whether the shrunken fibrotic bladder is the result of the bladder outlet obstruction or a direct result of the shunt. We hypothesized that the normal fetal bladder filling and emptying cycle is a critical part of the development of normal bladder function [5].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Is a vesicoamniotic shunt intrinsically bad? Shunting a normal fetal bladder

Kitagawa

Pringle

Koike

et al. 2007

Journal of Pediatric Surgery

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Non-operative management of acute cholecystitis in the elderly (Br J Surg 2012; 99: 1254–1261)

Bass

Walsh

2012

British Journal of Surgery

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The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (http://www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

show abstract

Pressure-limited vesico-amniotic shunt tube for fetal obstructive uropathy

Cited by 22 publications

References 17 publications

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Early vesico-amniotic shunting — does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

Is a vesicoamniotic shunt intrinsically bad? Shunting a normal fetal bladder

Non-operative management of acute cholecystitis in the elderly (Br J Surg 2012; 99: 1254–1261)

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