Postnatal Surgical Complications in Lower Urinary Tract Obstruction Following Fetal Vesico- Amniotic Shunting

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2025 Feb 24

PMID 39994551

Authors

Anna Messling

Anna-Maria Ziegler

Jochen Hubertus

Christoph Berg

Matthias Nissen

Andreas Heydweiller

Eva Weber

Affiliations

Soon will be listed here.

Abstract

Purpose: 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.

Materials And Methods: 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.

Results: 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.

Conclusion: 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.

References

Smith-Harrison L, Hougen H, Timberlake M, Corbett S . Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol. 2015; 11(6):341-7. DOI: 10.1016/j.jpurol.2015.07.012. View

FREEDMAN A, Johnson M, Smith C, Gonzalez R, Evans M . Long-term outcome in children after antenatal intervention for obstructive uropathies. Lancet. 1999; 354(9176):374-7. DOI: 10.1016/S0140-6736(98)11006-1. View

Strizek B, Gottschalk I, Recker F, Weber E, Flock A, Gembruch U . Vesicoamniotic shunting for fetal megacystis in the first trimester with a Somatex intrauterine shunt. Arch Gynecol Obstet. 2020; 302(1):133-140. PMC: 7266802. DOI: 10.1007/s00404-020-05598-z. View

FREEDMAN A, Johnson M, Gonzalez R . Fetal therapy for obstructive uropathy: past, present.future?. Pediatr Nephrol. 2000; 14(2):167-76. DOI: 10.1007/s004670050035. View

Malin G, Tonks A, Morris R, Gardosi J, Kilby M . Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG. 2012; 119(12):1455-64. DOI: 10.1111/j.1471-0528.2012.03476.x. View

Strizek B, Spicher T, Gottschalk I, Bockenhoff P, Simonini C, Berg C . Vesicoamniotic Shunting before 17 + 0 Weeks in Fetuses with Lower Urinary Tract Obstruction (LUTO): Comparison of Somatex vs. Harrison Shunt Systems. J Clin Med. 2022; 11(9). PMC: 9101314. DOI: 10.3390/jcm11092359. View

Glick P, Harrison M, Adzick N, Noall R, Villa R . Correction of congenital hydronephrosis in utero IV: in utero decompression prevents renal dysplasia. J Pediatr Surg. 1984; 19(6):649-57. DOI: 10.1016/s0022-3468(84)80348-6. View

Keil C, Bedei I, Sommer L, Koemhoff M, Axt-Fliedner R, Kohler S . Fetal therapy of LUTO (lower urinary tract obstruction) - a follow-up observational study. J Matern Fetal Neonatal Med. 2021; 35(25):8536-8543. DOI: 10.1080/14767058.2021.1988562. View

Bildau J, Enzensberger C, Degenhardt J, Kawecki A, Tenzer A, Kohl T . [Lower urinary tract obstruction (LUTO)--clinical picture, prenatal diagnostics and therapeutic options]. Z Geburtshilfe Neonatol. 2014; 218(1):18-26. DOI: 10.1055/s-0034-1367042. View

10.

Ruano R, Sananes N, Wilson C, Au J, Koh C, Gargollo P . Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol. 2015; 48(4):476-482. DOI: 10.1002/uog.15844. View

11.

Kohaut J, Fischer-Mertens J, Cernaianu G, Schulten D, Holtkamp G, Kohl S . Postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX® intrauterine shunt. A single center experience. J Pediatr Urol. 2023; 19(5):567.e1-567.e6. DOI: 10.1016/j.jpurol.2023.06.027. View

12.

Morris R, Khan K, Kilby M . Vesicoamniotic shunting for fetal lower urinary tract obstruction: an overview. Arch Dis Child Fetal Neonatal Ed. 2007; 92(3):F166-8. PMC: 2675321. DOI: 10.1136/adc.2006.099820. View

13.

Pringle K, Zuccollo J, Kitagawa H, Koike J, Delahunt B . Renal dysplasia produced by obstructive uropathy in the fetal lamb. Pathology. 2003; 35(6):518-21. DOI: 10.1080/00313020310001619145. View

14.

Lissauer D, Morris R, Kilby M . Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med. 2007; 12(6):464-70. DOI: 10.1016/j.siny.2007.06.005. View

15.

Schierbaum L, Schneider S, Herms S, Sivalingam S, Fabian J, Reutter H . Genome-Wide Survey for Microdeletions or -Duplications in 155 Patients with Lower Urinary Tract Obstructions (LUTO). Genes (Basel). 2021; 12(9). PMC: 8468665. DOI: 10.3390/genes12091449. View

16.

Morris R, Malin G, Quinlan-Jones E, Middleton L, Hemming K, Burke D . Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013; 382(9903):1496-506. PMC: 3898962. DOI: 10.1016/S0140-6736(13)60992-7. View

17.

Stadie R, Strizek B, Gottschalk I, Geipel A, Gembruch U, Berg C . Intrauterine vesicoamniotic shunting for fetal megacystis. Arch Gynecol Obstet. 2016; 294(6):1175-1182. DOI: 10.1007/s00404-016-4152-4. View

18.

Fievet L, Faure A, Coze S, Harper L, Panait N, Braunstein D . Fetal megacystis: etiologies, management, and outcome according to the trimester. Urology. 2014; 84(1):185-90. DOI: 10.1016/j.urology.2014.02.018. View

19.

Piscione T, Rosenblum N . The molecular control of renal branching morphogenesis: current knowledge and emerging insights. Differentiation. 2002; 70(6):227-46. DOI: 10.1046/j.1432-0436.2002.700602.x. View

20.

Osborne N, Bonilla-Musoles F, Machado L, Raga F, Bonilla Jr F, Ruiz F . Fetal megacystis: differential diagnosis. J Ultrasound Med. 2011; 30(6):833-41. DOI: 10.7863/jum.2011.30.6.833. View