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Vesicoamniotic shunting using a double-basket catheter appears effective in treating fetal bladder outlet obstruction
Hye-Sung Won1, Sun-Kwon Kim, Jae-Yoon Shim
1Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
Background:
To estimate the effect of vesicoamniotic shunting using a double-basket catheter on treating fetal bladder outlet obstruction.
Methods:
A retrospective study involving 8 prenatally diagnosed bladder outlet obstruction cases that underwent vesicoamniotic shunt placement using a double-basket catheter from 1998 to 2004. Patients were followed-up for prenatal and neonatal outcome analyses.
Results:
Vesicoamniotic shunting was performed in 8 fetuses aged between 13.7 and 25.4 weeks' gestation (mean+/-SD, 19.7+/-3.5 weeks). Final diagnoses included 5 posterior urethral valves, 1 cloacal anomaly, 1 urethral stenosis, and 1 unknown. There were no maternal complications associated with the procedures. One woman diagnosed as having a fetus with posterior urethral valves decided to terminate her pregnancy and one fetus died in uterus spontaneously. Six women delivered live babies, and one baby required postnatal ventilatory support. Postnatal follow-up ranged from 3 to 60 months. Of the 6 newborns, 4 survived with normal renal function, 1 had renal insufficiency, and 1 died of renal failure at 3 months of age.
Conclusions:
Vesicoamniotic shunt placement using a double-basket catheter may be effective in improving perinatal and neonatal outcomes through long-term decompression of the fetal urinary tract in carefully selected cases.
