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Related Experiment Videos

Intervention for fetal obstructive uropathy: has it been effective?

J S Elder1, J W Duckett, H M Snyder

  • 1Division of Urology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.

Lancet (London, England)
|October 31, 1987
PubMed
Summary
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Prenatal intervention for fetal hydronephrosis lacks evidence of improved outcomes. A review found high complication rates and poor survival, especially with oligohydramnios, necessitating a randomized trial for vesicoamniotic shunts.

Area of Science:

  • Perinatal medicine
  • Fetal surgery
  • Urology

Background:

  • Management of fetal hydronephrosis remains controversial.
  • Prenatal interventions lack robust evidence for improving renal function.
  • Percutaneous procedures on the fetal urinary tract are utilized despite limited data.

Purpose of the Study:

  • To evaluate the efficacy of interventions for suspected fetal obstructive uropathy.
  • To review published reports of fetal urinary tract drainage procedures.
  • To assess complication rates and survival outcomes associated with prenatal interventions.

Main Methods:

  • Systematic review of published reports of fetal urinary tract drainage up to December 1985.
  • Analysis of 57 reported cases.

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  • Identification of intervention types, complication rates, and survival data.

    • Main Results:

    • Vesicoamniotic shunt placement was the most common intervention (37%).
    • Complications occurred in 44% of cases, including shunt issues, premature labor, urinary ascites, and chorioamnionitis.
    • Survival rate was low (21%) among fetuses with oligohydramnios.

    Conclusions:

    • High complication rates and lack of demonstrated survival benefit question the efficacy of in-utero drainage.
    • Further research is needed to establish optimal management strategies.
    • A prospective, randomized trial comparing vesicoamniotic shunt placement with no intervention is warranted.