Table 2 Study characteristics and outcomes of antenatal intervention for fetal lower urinary tract obstruction
From: Antenatal and postnatal management of posterior urethral valves: where do we stand?
Study | Study design | Patient characteristics | Survival outcome | Renal function outcome |
|---|---|---|---|---|
Crombleholme 1990 [9] | Retrospective | 40 fetuses: 16 good prognosis group (9 treated) 24 poor prognosis group (10 treated) | OS: 38% After exclusion of elective terminations: 58% OS Good prognosis group: 81% OS Poor prognosis group: 13% OS | Good prognosis group: none of 9 treated survivors had ESRD Poor prognosis group: 2/3 treated survivors had ESRD |
Nicolini 1991 [12] | Retrospective | 17 fetuses (8 had VAS) | Only 2 fetuses with VAS survived (25%) The remaining patients were terminated, aborted or died in the neonatal period | The two survivors had normal RF at follow-up |
Lipitz 1993 [10] | Retrospective | 25 fetuses (14 had VAS) | VAS: 6/14 (43%) survived the neonatal period No treatment: 3/11 (27%) survived the neonatal period | 5/6 survivors after VAS had RI 2/3 survivors without VAS had RI |
Freedman 1999 [13] | Retrospective | 34 patients had VAS 17 survived > 2 years 14 studied (4 had PUV) | 2-year OS: 50% | 36% (5/14) had kidney transplant 21% (3/14) had RI Of 4 PUV patients: one had normal RF, 2 had RI and one had ESRD 3 required bladder augmentation |
Morris 2013 [6] | Randomized controlled trial | 31 fetuses (16 VAS, 15 no treatment) | VAS: 8/16 (50%) survived the neonatal period No treatment: 4/15 (27%) survived the neonatal period | VAS: 2/16 patients had normal RF at 2 years No treatment: none had normal RF at 2 years |
Holmes 2001 [11] | Retrospective | 14 fetuses with PUV (9 VAS, 2 FVA, 2 bladder marsupialization, 1 cutaneous ureterostomy) | 8/14 (57%) survived (12 months-19 years) | 5/8 (63%) survivors had RI, 2 of them had kidney transplant |
Quintero 1995 [25] | Cohort | 13 fetuses (4 standard VAS, 2 urethral stents, 1 PUV permeation, 4 diagnostic fetal cystoscopy only) | Standard VAS: 3/4 survived Urethral stents: 2/2 survived One patient had PUV permeation was terminated | VAS: 1/3 survivors had normal RF 2 had ESRD Urethral stents: no data on RF |
Welsh 2003 [26] | Cohort, retrospective | 10 fetuses had intervention: 1 HA 2 HA + guidewire passage 4 guidewire only 1 HA + guidewire passage + VAS 2. guidewire + VAS 3. Only diagnostic cystoscopy | OS: 50% (5/10) in those who had intervention (16–34 months) | Overall, 3/5 survivors had normal RF 2/3 PUV survivors had normal RF |
Ruano 2015 [23] | Case–control, prospectively collected data | 111 fetuses (34 FVA, 16 VAS, 61 no intervention) | Intervention group: 40% 6-month OS FVA: 38% 6-month OS VAS: 44% 6-month OS No intervention: 6-month 20% OS | FVA: better RF than no intervention (75% had normal RF vs. 39%) VAS: similar RF to no intervention group (60% had normal RF vs. 39%) |