School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Ultrasound Obstet Gynecol. 2011 Jun;37(6):629-37. doi: 10.1002/uog.8981. Epub 2011 May 16.
To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis of and intervention for congenital lower urinary tract obstruction.
This study was a literature search using MEDLINE, Embase, Cochrane Library, MEDION, Web of Science reference lists and contact with experts. All studies reporting on fetal cystoscopy in lower urinary tract obstruction with data for a 2 × 2 table were selected for review. No language restrictions were applied. There was independent selection of studies, data extraction and quality assessment by two reviewers. Peto odds ratios were calculated as a summary measure of effect.
A total of 2071 citations were identified and 66 papers selected for detailed evaluation, from which four papers with a total of 63 patients were selected for inclusion. Two papers had results for the use of cystoscopy in diagnosis, showing that fetal cystoscopy altered the ultrasound diagnosis of the underlying pathology in 36.4 and 25.0% of fetuses, respectively. Compared to no treatment, fetal cystoscopic intervention demonstrated an odds ratio for improved perinatal survival of 20.51 (95% CI, 3.87-108.69). However, comparing vesicoamniotic shunt (VAS) with fetal cystoscopy there appeared to be no significant improvement in the perinatal survival odds ratio of 1.49 (95% CI, 0.13-16.97). These results had wide CIs and for cystoscopy vs. VAS, all results crossed the line of no effect.
There is little published evidence for the effectiveness of therapeutic fetal cystoscopy as an intervention for congenital lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an 'experimental intervention' and subjected to further investigation.
确定胎儿膀胱镜检查在先天性下尿路梗阻的产前诊断和干预中的有效性。
本研究通过 MEDLINE、Embase、Cochrane 图书馆、MEDION、Web of Science 参考文献列表和与专家联系进行文献检索。选择所有报告下尿路梗阻胎儿膀胱镜检查并具有 2×2 表格数据的研究进行综述。未应用语言限制。两位评审员独立选择研究、提取数据和评估质量。计算 Peto 优势比作为效应的综合度量。
共确定了 2071 条引文，并对 66 篇论文进行了详细评估，其中 4 篇论文共 63 例患者被纳入研究。两篇论文的研究结果表明膀胱镜检查在诊断中的应用，胎儿膀胱镜检查分别改变了基础病理的超声诊断，分别为 36.4%和 25.0%的胎儿。与不治疗相比，胎儿膀胱镜检查干预可使围产儿生存率提高的优势比为 20.51（95%CI，3.87-108.69）。然而，与膀胱阴道分流术（VAS）相比，膀胱镜检查并未显著改善围产儿生存率优势比为 1.49（95%CI，0.13-16.97）。这些结果的置信区间较宽，对于膀胱镜检查与 VAS 相比，所有结果都跨越了无效应线。
治疗性胎儿膀胱镜检查作为先天性下尿路梗阻的干预措施的有效性证据很少，且该证据质量较差。因此，应将其视为一种“实验性干预措施”，并进行进一步研究。
