What is the role of fetal surgery in the treatment of antenatal hydronephrosis and hydroureter?

Updated: Dec 16, 2020
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Although several prospective and retrospective studies have examined antenatal surgery in fetuses with sonographic findings consistent with lower urinary tract obstruction, no good evidence supports that this intervention improves renal outcome. [41] Although these procedures may increase the amount of amniotic fluid, thus potentially improving lung development and survival rate, the rate of chronic renal disease is high in survivors, necessitating renal replacement therapy in almost two thirds of the cases.

The benefit of vesicoamniotic shunting (VAS) proved inconclusive in the Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) trial, which compared VAS with conservative nonsurgical management in 31 singleton fetuses younger than 28 weeks’ gestation with isolated bladder outflow obstruction. Although survival to 28 days and 1 year appeared to be higher with VAS than with conservative management, the PLUTO investigators could not prove benefit beyond reasonable doubt, and VAS was substantially more costly. [42]

Newborns in the PLUTO trial had a very low chance of surviving with normal renal function, regardless of whether they underwent VAS. Short-term and long-term morbidity in both trial groups was substantial, and complications of VAS resulted in pregnancy loss in some cases. [42]


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