Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review

• Published in: Ultrasound in obstetrics & gynecology 2011-06, Vol.37 (6), p.629-637
• Main Authors: Morris, R. K., Ruano, R., Kilby, M. D.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cystoscopes; Cystoscopy - methods; Data processing; Endoscopy; Female; fetal cystoscopy; Fetal Diseases - diagnosis; Fetal Diseases - therapy; Fetuses; Gynecology; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Language; lower urinary tract obstruction; Medical sciences; Nephrology. Urinary tract diseases; Obstetrics; Pregnancy; Prenatal diagnosis; Prenatal Diagnosis - methods; Quality control; Shunts; Survival; systematic review; Therapeutic applications; Ultrasound; Urethral Obstruction - congenital; Urethral Obstruction - diagnosis; Urethral Obstruction - embryology; Urethral Obstruction - therapy; Urinary Bladder - abnormalities; Urinary Bladder - embryology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract; Urinary tract. Prostate gland; vesicoamniotic shunt; vesicocentesis
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.8981

Objective To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis of and intervention for congenital lower urinary tract obstruction. Methods 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. Results 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. Conclusion 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. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.