Postnatal surgical complications in lower urinary tract obstruction following fetal vesico- amniotic shunting

Fetal lower urinary tract obstruction (LUTO) is a rare congenital disease associated with high morbidity and mortality due to pulmonary hypoplasia and renal insufficiency. Fetal management includes early vesicoamniotic shunting (VAS), a technique that has evolved in recent years to preserve kidney function. Previous publications have focused on intrauterine shunt complications, such as dislocation and preterm premature rupture of membranes (PPROM). In our study we aimed to assess postnatal shunt related complications that became obvious after birth.

We describe our preliminary experience with 25 fetuses who underwent VAS with a Somatex^® shunt as well as postnatal shunt removal at two experienced centers for fetal medicine. The intrauterine course, underlying pathology, postnatal outcome and details on shunt explantation and related complications were assessed. The data were retrospectively analysed in relation to the intrauterine course, underlying pathology, further malformations, and perioperative characteristics with a focus on the complication spectrum and type of intervention.

Twenty-five fetuses underwent VAS at a median of 17 weeks. Two newborns were excluded because they died within the first 24 hours of life secondary to fulminant lung hypoplasia. In ten (43%) newborns, shunt removal was performed under local anaesthesia. In 13 (57%) neonates, the shunt was explanted surgically, and five (22%) of these operations were defined as complex.

Intrauterine VAS with a Somatex^® shunt is feasible, and in the majority of cases, shunt explantation can be easily performed after birth. However, the umbrellas may cause intraabdominal tissue damage, peritoneal adhesions or skin defects, and early surgical management of VAS associated complications might be necessary.