Clark T Justin, Martin William L, Divakaran T G, Whittle Martin J, Kilby Mark D, Khan Khalid S
Division of Reproductive and Child Health, Birmingham Women's Hospital, University of Birmingham, Birmingham, United Kingdom.
Obstet Gynecol. 2003 Aug;102(2):367-82. doi: 10.1016/s0029-7844(03)00577-5.
To estimate the effect of prenatal bladder drainage on perinatal survival in fetuses with lower urinary tract obstruction.
Relevant articles were identified by searching the databases MEDLINE (1966-2002), EMBASE (1988-2002), and the Cochrane library (2000;4).
Studies were selected if the effect of prenatal bladder drainage (vesicocentesis, vesicoamniotic shunt, or open fetal bladder surgery) on perinatal survival was reported in fetuses with ultrasonic evidence of lower urinary tract obstruction. Study selection, quality assessment, and data abstraction were performed independently and in duplicate.
TABULATION, INTEGRATION, AND RESULTS: Sixteen observational studies that included nine case series (147 fetuses) and seven controlled series (195 fetuses) were identified. Study characteristics and quality were recorded for each study. Data on the effect of bladder drainage on perinatal survival were abstracted. Where controlled data were available, 2 x 2 tables were generated to compare the effects of bladder drainage versus no bladder drainage on perinatal survival. Pooled odds ratios (ORs) were used as summary measures of effect, and the results were stratified according to predicted fetal prognoses (based on ultrasound features and fetal urinary electrolytes). Among controlled studies, bladder drainage appeared to improve perinatal survival relative to no drainage (OR 2.5; 95% confidence interval [CI] 1.1, 5.9; P =.03). However, this observation was largely because among the subgroup of fetuses with a poor prognosis there was a marked improvement (OR 8.1; 95% CI 1.2, 52.9; P =.03). Improved perinatal outcome was also suggested in those fetuses considered to have a good prognosis (OR 2.8; 95% CI 0.7, 10.8; P =.13).
There is a lack of high quality evidence to reliably inform clinical practice regarding prenatal bladder drainage in fetuses with ultrasonic evidence of lower urinary tract obstruction. The limited available evidence suggests that prenatal bladder drainage may improve perinatal survival in these fetuses, particularly those with poor predicted prognoses. Further research in the form of a multicenter randomized controlled trial is required to assess the short- and long-term effects of this intervention.
评估产前膀胱引流对下尿路梗阻胎儿围产期存活率的影响。
通过检索MEDLINE（1966 - 2002年）、EMBASE（1988 - 2002年）和Cochrane图书馆（2000年第4期）数据库确定相关文章。
若有研究报告了产前膀胱引流（膀胱穿刺术、膀胱羊膜分流术或开放性胎儿膀胱手术）对超声检查有下尿路梗阻证据的胎儿围产期存活率的影响，则纳入该研究。研究选择、质量评估和数据提取由两人独立进行且重复操作。
制表、整合与结果：共确定了16项观察性研究，其中包括9个病例系列（147例胎儿）和7个对照系列（195例胎儿）。记录每项研究的特征和质量。提取膀胱引流对围产期存活率影响的数据。若有对照数据，生成2×2表格以比较膀胱引流与不进行膀胱引流对围产期存活率的影响。合并比值比（OR）用作效应的汇总指标，并根据预测的胎儿预后（基于超声特征和胎儿尿液电解质）进行分层。在对照研究中，与不引流相比，膀胱引流似乎可提高围产期存活率（OR 2.5；95%置信区间[CI] 1.1，5.9；P = 0.03）。然而，这一观察结果主要是因为在预后不良的胎儿亚组中有显著改善（OR 8.1；95% CI 1.2，52.9；P = 0.03）。在那些被认为预后良好的胎儿中也提示围产期结局有所改善（OR 2.8；95% CI 0.7，10.8；P = 0.13）。
缺乏高质量证据来可靠地指导关于超声检查有下尿路梗阻证据的胎儿产前膀胱引流的临床实践。有限的现有证据表明，产前膀胱引流可能会提高这些胎儿的围产期存活率，尤其是那些预测预后不良的胎儿。需要开展多中心随机对照试验形式的进一步研究，以评估这种干预措施的短期和长期效果。
