Clinical results of fetal obstructive uropathy treated by vesicoamniotic shunting.

Abstract

OBJECTIVES:

To report the clinical results of 5 fetuses after a vesicoamniotic shunting procedure (VASP).

METHODS:

Between 1995 and 1998, 5 patients (two with prune belly syndrome, one with a cloacal anomaly, one with urethral stenosis, and one with a sacrococcygeal teratoma) underwent VASP using a double-basket catheter. We used the following selection criteria: a fetus without chromosomal defects, with oligohydramnios, and with a predicted good renal function from sequential or single fetal urinalysis (sodium concentration, chloride concentration, and osmolarity at less than 100 mEq/L, less than 90 mEq/L, and less than 210 mOsm, respectively).

RESULTS:

The mean gestational age was 20.8 +/- 6.9 weeks at diagnosis, 24.2 +/- 6.0 weeks at VASP, and 30.6 +/- 6.2 weeks at delivery. In our study, 2 of 5 patients survived. One of the patients with prune belly syndrome was 18 months old at last follow-up, with hydrocephalus and a creatinine level of 0.2 mg/dL. The patient with the cloacal anomaly was 4 years old at last follow-up and had signs of clonic convulsion. However, psychomotor development was delayed in both. Of the 3 patients who died, 2 died after birth, and the autopsy determined death was due to pulmonary insufficiency. The patient with urethral stenosis died in utero.

CONCLUSIONS:

Although the principal purpose of VASP is to prevent pulmonary hypoplasia and dysfunctional kidneys, VASP was not always effective, as the outcomes were poor in most of our patients. A greater standardization of patient selection and a large cohort study in the future should be considered to assess VASP.

• Authors: Y Makino, H Kobayashi, K Kyono, K Oshima, T Kawarabayashi
• Journal: Urology (Urology) Vol. 55 Issue 1 Pg. 118-22 (Jan 2000) ISSN: 1527-9995 [Electronic] United States
• PMID: 10654907 (Publication Type: Clinical Trial, Journal Article)

Topics

• Amnion (surgery)
• Anastomosis, Surgical
• Cloaca (abnormalities)
• Fetal Diseases (surgery)
• Humans
• Prune Belly Syndrome
• Treatment Outcome
• Ureteral Obstruction (surgery)
• Urethral Obstruction (surgery)
• Urinary Bladder (surgery)
• Urinary Bladder Neck Obstruction (surgery)