Clinical results of fetal obstructive uropathy treated by vesicoamniotic shunting

Objectives. To report the clinical results of 5 fetuses after a vesicoamnio tic shunting procedure (VASP). Methods. Between 1995 and 1998, 5 patients (two with prune belly syndrome, one with a cloacal anomaly, one with urethral stenosis, and one with a sacr ococcygeal teratoma) underwent VASP using a double-basket catheter. We used the following selection criteria: a fetus without chromosomal defects, wit h oligohydramnios, and with a predicted good renal function from, sequentia l or single fetal urinalysis (sodium concentration, chloride concentration, and osmolarity at: less than 100 mEq/L, less than 90 mEq/L, and less than 210 mOsm, respectively). Results. The mean gestational age was 20.8 +/- 6.9 weeks at diagnosis, 24.2 +/- 6.0 weeks at VASP, and 30.6 +/- 6.2 weeks at delivery. In our study, 2 of 5 patients survived. One of the patients with prune belly syndrome was 18 months old at last follow-up, with hydrocephalus and a creatinine level of 0.2 mg/dL. The patient with the cloacal anomaly was 4 years old at last follow-up and had signs of clonic convulsion, However, psychomotor developm ent was delayed in both. Of the 3 patients who died, 2 died after birth, an d the autopsy determined death was due to pulmonary insufficiency. The pati ent with urethral stenosis died in utero. Conclusions. Although the principal purpose of VASP is to prevent pulmonary hypoplasia and dysfunctional kidneys, VASP was not always effective, as th e outcomes were poor in most of our patients. A greater standardization of patient selection and a large cohort study in the future should be consider ed to assess VASP. (C) 2000, Elsevier Science Inc.