{"title":"胎儿膀胱镜检查（FC）和膀胱羊膜分流（VAS）治疗下尿路梗阻（LUTO）：一项长期结果和当前技术局限性的荟萃分析。","authors":"Irene Paraboschi, Ugo Maria Pierucci, Matthieu Peycelon, Gloria Pelizzo, Rodrigo Ruano","doi":"10.1159/000547182","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare obstetrical, survival, and nephro-urological outcomes of fetuses diagnosed with lower urinary tract obstruction (LUTO) undergoing antenatal procedures by vesicoamniotic shunting (VAS) or fetal cystoscopy (FC).</p><p><strong>Methods: </strong>This study was a literature search using MEDLINE, Scopus, Embase, and Cochrane reference lists. All studies reporting VAS and FC's effectiveness, complications, and technical issues in the prenatal treatment of LUTO were selected for a single-proportion meta-analysis. Two reviewers independently selected studies, extracted data, and assessed quality. We computed and declared effect sizes for estimating a single proportion using the Freeman-Turkey transformed proportion.</p><p><strong>Results: </strong>out of a total of 467 citations identified, 49 studies were included for a detailed evaluation of VAS and FC perinatal outcomes. Overall, VAS and FC were burdened by a similar incidence of intrauterine fetal demise [VAS: 0.51 (0.42-0.61) versus FC: 0.47 (0.28-0.67); p=0.73], postnatal death [VAS: 0.87 (0.75-0.99) versus FC: 0.86 (0.62-1.09); p-value: 0.87], and postnatal renal impairment [VAS: 1.22 (1.06-1.39) versus FC: 0.96 (0.67-1.25); p-value: 0.12]. Likewise, the two procedures were complicated by a similar rate of chorioamnionitis [VAS: 0.38 (0.28-0.47) versus FC: 0.39 (0.12-0.66); p-value: 0.92], premature rupture of membranes/preterm premature rupture of membranes (PROM/PPROM) [VAS: 0.77 (0.60-0.94) versus FC: 0.84 (0.60-1.07); p-value: 0.65], premature birth [VAS: 1.83 (1.55-2.10) versus FC: 1.56 (0.92-2.21): p-value: 0.46], and fetal abdominal wall/intestinal problems [VAS: 0.43 (0.29-0.57) versus FC: 0.50 (0.19-0.81); p-value: 0.69]. Termination of pregnancy (TOP) was chosen significantly more often after FC than VAS [VAS: 0.65 (0.53-0.77) versus FC: 1.18 (1.03-1.33); p-value: < 0.001].</p><p><strong>Conclusion: </strong>Our meta-analysis yields similar results in terms of obstetric, survival, and nephro-urological outcomes between VAS and FC. The higher incidence of TOP in FC over the VAS group may be associated with the fact that FC is also considered a diagnostic tool and can guide for TOP for those with more complex diseases.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-33"},"PeriodicalIF":1.6000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Fetal cystoscopy (FC) and vesicoamniotic shunting (VAS) in lower urinary tract obstruction (LUTO): a meta-analysis of long-term outcome and current technical limitations.\",\"authors\":\"Irene Paraboschi, Ugo Maria Pierucci, Matthieu Peycelon, Gloria Pelizzo, Rodrigo Ruano\",\"doi\":\"10.1159/000547182\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare obstetrical, survival, and nephro-urological outcomes of fetuses diagnosed with lower urinary tract obstruction (LUTO) undergoing antenatal procedures by vesicoamniotic shunting (VAS) or fetal cystoscopy (FC).</p><p><strong>Methods: </strong>This study was a literature search using MEDLINE, Scopus, Embase, and Cochrane reference lists. All studies reporting VAS and FC's effectiveness, complications, and technical issues in the prenatal treatment of LUTO were selected for a single-proportion meta-analysis. Two reviewers independently selected studies, extracted data, and assessed quality. We computed and declared effect sizes for estimating a single proportion using the Freeman-Turkey transformed proportion.</p><p><strong>Results: </strong>out of a total of 467 citations identified, 49 studies were included for a detailed evaluation of VAS and FC perinatal outcomes. Overall, VAS and FC were burdened by a similar incidence of intrauterine fetal demise [VAS: 0.51 (0.42-0.61) versus FC: 0.47 (0.28-0.67); p=0.73], postnatal death [VAS: 0.87 (0.75-0.99) versus FC: 0.86 (0.62-1.09); p-value: 0.87], and postnatal renal impairment [VAS: 1.22 (1.06-1.39) versus FC: 0.96 (0.67-1.25); p-value: 0.12]. Likewise, the two procedures were complicated by a similar rate of chorioamnionitis [VAS: 0.38 (0.28-0.47) versus FC: 0.39 (0.12-0.66); p-value: 0.92], premature rupture of membranes/preterm premature rupture of membranes (PROM/PPROM) [VAS: 0.77 (0.60-0.94) versus FC: 0.84 (0.60-1.07); p-value: 0.65], premature birth [VAS: 1.83 (1.55-2.10) versus FC: 1.56 (0.92-2.21): p-value: 0.46], and fetal abdominal wall/intestinal problems [VAS: 0.43 (0.29-0.57) versus FC: 0.50 (0.19-0.81); p-value: 0.69]. Termination of pregnancy (TOP) was chosen significantly more often after FC than VAS [VAS: 0.65 (0.53-0.77) versus FC: 1.18 (1.03-1.33); p-value: < 0.001].</p><p><strong>Conclusion: </strong>Our meta-analysis yields similar results in terms of obstetric, survival, and nephro-urological outcomes between VAS and FC. The higher incidence of TOP in FC over the VAS group may be associated with the fact that FC is also considered a diagnostic tool and can guide for TOP for those with more complex diseases.</p>\",\"PeriodicalId\":12189,\"journal\":{\"name\":\"Fetal Diagnosis and Therapy\",\"volume\":\" \",\"pages\":\"1-33\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Fetal Diagnosis and Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000547182\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Fetal Diagnosis and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000547182","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：比较经膀胱羊膜分流术（VAS）或胎儿膀胱镜检查（FC）诊断为下尿路梗阻（LUTO）的胎儿的产科、生存和肾泌尿学结局。方法：采用MEDLINE、Scopus、Embase和Cochrane文献检索方法进行文献检索。选择所有报告VAS和FC在LUTO产前治疗中的有效性、并发症和技术问题的研究进行单比例荟萃分析。两位审稿人独立选择研究、提取数据并评估质量。我们计算并声明了使用Freeman-Turkey转换比例估计单个比例的效应大小。结果：在确定的467个引用中，49个研究被纳入详细评估VAS和FC围产期结局。总体而言，VAS和FC的宫内死胎发生率相似[VAS: 0.51 (0.42-0.61) vs FC: 0.47 (0.28-0.67)；p=0.73]，产后死亡[VAS: 0.87 (0.75-0.99) vs FC: 0.86 (0.62-1.09)；p值：0.87]，产后肾功能损害[VAS: 1.22 (1.06-1.39) vs FC: 0.96 (0.67-1.25)；假定值:0.12)。同样，这两种手术的绒毛膜羊膜炎发生率相似[VAS: 0.38 (0.28-0.47) vs FC: 0.39 (0.12-0.66)；p值：0.92]，胎膜早破/早产胎膜早破（PROM/PPROM） [VAS: 0.77 (0.60-0.94) vs FC: 0.84 (0.60-1.07)；p值：0.65]，早产[VAS: 1.83 (1.55-2.10) vs FC: 1.56 (0.92-2.21): p值：0.46]，胎儿腹壁/肠道问题[VAS: 0.43 (0.29-0.57) vs FC: 0.50 (0.19-0.81)；假定值:0.69)。FC术后选择终止妊娠（TOP）的频率明显高于VAS [VAS: 0.65 (0.53-0.77) vs FC: 1.18 (1.03-1.33)；p值：< 0.001]。结论：我们的荟萃分析在VAS和FC之间的产科、生存和肾-泌尿预后方面得出了相似的结果。FC中TOP的发生率高于VAS组，这可能与FC也被认为是一种诊断工具，可以指导患有更复杂疾病的患者的TOP。
Fetal cystoscopy (FC) and vesicoamniotic shunting (VAS) in lower urinary tract obstruction (LUTO): a meta-analysis of long-term outcome and current technical limitations.
Purpose: To compare obstetrical, survival, and nephro-urological outcomes of fetuses diagnosed with lower urinary tract obstruction (LUTO) undergoing antenatal procedures by vesicoamniotic shunting (VAS) or fetal cystoscopy (FC).
Methods: This study was a literature search using MEDLINE, Scopus, Embase, and Cochrane reference lists. All studies reporting VAS and FC's effectiveness, complications, and technical issues in the prenatal treatment of LUTO were selected for a single-proportion meta-analysis. Two reviewers independently selected studies, extracted data, and assessed quality. We computed and declared effect sizes for estimating a single proportion using the Freeman-Turkey transformed proportion.
Results: out of a total of 467 citations identified, 49 studies were included for a detailed evaluation of VAS and FC perinatal outcomes. Overall, VAS and FC were burdened by a similar incidence of intrauterine fetal demise [VAS: 0.51 (0.42-0.61) versus FC: 0.47 (0.28-0.67); p=0.73], postnatal death [VAS: 0.87 (0.75-0.99) versus FC: 0.86 (0.62-1.09); p-value: 0.87], and postnatal renal impairment [VAS: 1.22 (1.06-1.39) versus FC: 0.96 (0.67-1.25); p-value: 0.12]. Likewise, the two procedures were complicated by a similar rate of chorioamnionitis [VAS: 0.38 (0.28-0.47) versus FC: 0.39 (0.12-0.66); p-value: 0.92], premature rupture of membranes/preterm premature rupture of membranes (PROM/PPROM) [VAS: 0.77 (0.60-0.94) versus FC: 0.84 (0.60-1.07); p-value: 0.65], premature birth [VAS: 1.83 (1.55-2.10) versus FC: 1.56 (0.92-2.21): p-value: 0.46], and fetal abdominal wall/intestinal problems [VAS: 0.43 (0.29-0.57) versus FC: 0.50 (0.19-0.81); p-value: 0.69]. Termination of pregnancy (TOP) was chosen significantly more often after FC than VAS [VAS: 0.65 (0.53-0.77) versus FC: 1.18 (1.03-1.33); p-value: < 0.001].
Conclusion: Our meta-analysis yields similar results in terms of obstetric, survival, and nephro-urological outcomes between VAS and FC. The higher incidence of TOP in FC over the VAS group may be associated with the fact that FC is also considered a diagnostic tool and can guide for TOP for those with more complex diseases.
期刊介绍：
The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
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