ReviewsPrenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis
Section snippets
Sources
Relevant literature was identified by searching general bibliographic databases, MEDLINE (1966–2002), and EMBASE (1988–2002) using a combination of the key words “congenital urinary obstruction,” “invasive procedure,” and “prenatal diagnosis”; their word variants; and MeSH. In addition, the Cochrane Library (2000, issue 4) was searched. Reference lists of all known reviews and primary studies were checked and the specialist journal Prenatal Diagnosis was manually searched. Unpublished data were
Study selection
Two reviewers (TJC and WLM) independently extracted data from all articles meeting the selection criteria, including data on features of methodological quality. Quality assessment involved scrutinizing study designs and the relevant features of population, intervention, and outcome17:
- 1.
Study design. Randomized controlled trials (RCTs) where intervention (vesicocentesis, vesicoamniotic shunt insertion, or open shunt insertion–corrective surgery) was compared with no intervention were considered
Results
As shown in Figure 1, the electronic search yielded 362 citations, of which 30 were considered potentially relevant. Examination of their full texts revealed that eight were duplicates and six did not meet the selection criteria (see Appendix). Thus, a total of 16 primary studies (all in English), including 342 fetuses were selected for review (Table 1). No randomized trials were identified. Nine studies were case series (147 fetuses) and seven were controlled studies (195 fetuses).
Details of
Conclusion
Our review shows that there is a lack of high-quality evidence to reliably inform clinical practice regarding prenatal bladder drainage in fetuses with ultrasonic evidence of lower urinary tract obstruction. The limited available evidence suggests that in utero fetal bladder drainage may improve perinatal survival in these fetuses, and this finding is consistent whether voluntary termination of pregnancies is included or excluded. Those fetuses with poor predicted prognoses, as determined by
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2018, Journal of Pediatric UrologyCitation Excerpt :In order to prevent such complications, research has been directed at circumventing the pathology by in utero vesicocentesis or vesicoamniotic shunting (VAS). It has been shown that VAS and other bladder drainage techniques for fetal LUTO will ameliorate pulmonary hypoplasia and will increase survival rates in patients with an initial poor prognosis [8]. However, it remains uncertain if these interventions have significant benefit for renal function in humans.