Fetal Cystoscopy and Vesicoamniotic Shunting in Lower Urinary Tract Obstruction: A Meta-Analysis of Long-Term Outcome and Current Technical Limitations.

INTRODUCTION

The aim of the study was to compare obstetrical, survival, and nephro-urological outcomes of fetuses diagnosed with lower urinary tract obstruction (LUTO) undergoing antenatal procedures by vesicoamniotic shunting (VAS) or fetal cystoscopy (FC).

METHODS

This study was a literature search using MEDLINE, Scopus, Embase, and Cochrane reference lists. All studies reporting VAS and FC's effectiveness, complications, and technical issues in the prenatal treatment of LUTO were selected for a single-proportion meta-analysis. Two reviewers independently selected studies, extracted data, and assessed quality. We computed and declared effect sizes for estimating a single proportion using the Freeman-Turkey transformed proportion.

RESULTS

Out of a total of 467 citations identified, 49 studies were included for a detailed evaluation of VAS and FC perinatal outcomes. Overall, VAS and FC were burdened by a similar incidence of intrauterine fetal demise (VAS: 0.51 [0.42-0.61] vs. FC: 0.47 [0.28-0.67]; p = 0.73), postnatal death (VAS: 0.87 [0.75-0.99] vs. FC: 0.86 [0.62-1.09]; p value: 0.87), and postnatal renal impairment (VAS: 1.22 [1.06-1.39] vs. FC: 0.96 [0.67-1.25]; p value: 0.12). Likewise, the two procedures were complicated by a similar rate of chorioamnionitis (VAS: 0.38 [0.28-0.47] vs. FC: 0.39 [0.12-0.66]; p value: 0.92), premature rupture of membranes/preterm premature rupture of membranes (VAS: 0.77 [0.60-0.94] vs. FC: 0.84 [0.60-1.07]; p value: 0.65), premature birth (VAS: 1.83 [1.55-2.10] vs. FC: 1.56 [0.92-2.21]: p value: 0.46), and fetal abdominal wall/intestinal problems (VAS: 0.43 [0.29-0.57] vs. FC: 0.50 [0.19-0.81]; p value: 0.69). Termination of pregnancy (TOP) was chosen significantly more often after FC than VAS (VAS: 0.65 [0.53-0.77] vs. FC: 1.18 [1.03-1.33]; p value: <0.001).

CONCLUSION

Our meta-analysis yields similar results in terms of obstetric, survival, and nephro-urological outcomes between VAS and FC. The higher incidence of TOP in FC over the VAS group may be associated with the fact that FC is also considered a diagnostic tool and can guide for TOP for those with more complex diseases.