Skip to main content

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%)
  1. FVA: fetoscopic valve ablation, ESRD: end-stage renal disease, HA: hydroablation, OS: overall survival, PUV: posterior urethral valve, RF: renal function, RI: renal impairment, VAS: vesicoamniotic shunt