Saccone Gabriele, D'Alessandro Pietro, Escolino Maria, Esposito Rosanna, Arduino Bruno, Vitagliano Amerigo, Quist-Nelson Johanna, Berghella Vincenzo, Esposito Ciro, Zullo Fulvio
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy.
Department of Tanslational Medical Sciences (DISMET), Pediatric Surgery Unit, School of Medicine, University of Naples Federico II, Naples, Italy.
J Matern Fetal Neonatal Med. 2020 Aug;33(15):2664-2670. doi: 10.1080/14767058.2018.1555704. Epub 2019 Jan 4.
To evaluate the effectiveness of antenatal intervention for the treatment of congenital lower urinary tract obstruction (LUTO) in improving perinatal survival and postnatal renal function. Electronic databases were searched from their inception until May 2018. Selection criteria included randomized controlled trials and nonrandomized studies including fetuses with ultrasound evidence of LUTO evaluating antenatal intervention for improving perinatal outcomes. Any type of antenatal bladder drainage technique was analyzed. The primary outcome was perinatal survival. The secondary outcome was postnatal survival with normal renal function. The summary measures were reported as summary odds ratio (OR) with 95% of confidence interval (CI). Ten articles with a total of 355 fetuses were included in the meta-analysis. Inclusion criteria of the selected studies were singleton pregnancy with severe LUTO confirmed on detailed fetal ultrasound examination. Nine studies analyzed the efficacy of vesico-amniotic shunt performed in the second trimester. The overall estimate survival was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.54, 95% CI: 1.14-5.67). 64/112 fetuses (57.1%) survived in the vesico-amniotic shunt group compared to 52/134 (38.8%) in the control group. Five studies reported on postnatal renal function between 6 months and 2 years. Rate of good postnatal renal function was higher in the vesico-amniotic shunt group compared to the conservative group (OR: 2.09, 95% CI: 0.74-5.9). Fetal cystoscopy was performed in only two included studies. Overall, 45 fetuses underwent fetal cystoscopy. The perinatal survival was higher in the cystoscopy group compared to the conservative management group (OR: 2.63, 95% CI: 1.07-6.47). Normal renal function was noted in 13/34 fetuses in the cystoscopy group versus 12/61 in the conservative management group at 6 months follow-up (OR: 1.75, 95% CI: 1.05-2.92) Antenatal bladder drainage appears to improve perinatal survival in cases of LUTO.
评估产前干预治疗先天性下尿路梗阻（LUTO）对改善围产期生存率和出生后肾功能的有效性。检索电子数据库自建库至2018年5月。选择标准包括随机对照试验和非随机研究，纳入有超声证据显示LUTO的胎儿，评估产前干预对改善围产期结局的效果。分析任何类型的产前膀胱引流技术。主要结局是围产期生存率。次要结局是出生后肾功能正常的生存率。汇总测量结果报告为汇总比值比（OR）及95%置信区间（CI）。荟萃分析纳入了10篇文章，共355例胎儿。所选研究的纳入标准为单胎妊娠且经详细胎儿超声检查确诊为重度LUTO。9项研究分析了孕中期进行羊膜腔分流术的疗效。与保守治疗组相比，羊膜腔分流术组的总体估计生存率更高（OR：2.54，95%CI：1.14 - 5.67）。羊膜腔分流术组112例胎儿中有64例（57.1%）存活，而对照组134例中有52例（38.8%）存活。5项研究报告了出生后6个月至2年的肾功能情况。与保守治疗组相比，羊膜腔分流术组出生后肾功能良好的比例更高（OR：2.09，95%CI：0.74 - 5.9）。仅2项纳入研究进行了胎儿膀胱镜检查。总体而言，45例胎儿接受了胎儿膀胱镜检查。与保守治疗组相比，膀胱镜检查组的围产期生存率更高（OR：2.63，95%CI：1.07 - 6.47）。在6个月随访时，膀胱镜检查组34例胎儿中有13例肾功能正常，而保守治疗组61例中有12例（OR：1.75，95%CI：1.05 - 2.92）。产前膀胱引流似乎可改善LUTO病例的围产期生存率。
