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A systematic review and meta-analysis of the effectiveness of fetal cystoscopy as an intervention for congenital bladder neck obstruction
  1. R K Morris1,2,
  2. R Ruano3,4,
  3. M D Kilby1,2
  1. 1University of Birmingham, Birmingham, UK
  2. 2Fetal Medicine Centre, Birmingham Women's Hospital, Birmingham, UK
  3. 3Sao Paulo University, Sao Paulo, Brazil
  4. 4Texas Children's Center and Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, USA

Abstract

Objective To determine the effectiveness of fetal cystoscopy as an intervention for congenital bladder neck obstruction.

Methods Systematic searches in 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. No language restrictions. Independent selection of studies, data extraction and quality assessment. Meta-analysis of Peto odds ratios was conducted.

Results A total of 2071 citation were identified and 66 papers selected for detailed evaluation. Four papers were selected for inclusion in the review including a total of 63 patients. 37 patients underwent fetal cystoscopy, of which 25 had posterior urethral valves and 7 urethral atresia. Eight fetuses were treated with laser ablation of valves and four had hydroablation. Compared to no treatment/vesicocentesis alone, fetal cystoscopy showed an odds ratio for improved perinatal survival of 20.51 (95% CI 3.87 to 108.69). Compared to vesicoamniotic shunting cystoscopy the odds ratio for perinatal survival was 1.49 (95% CI 0.13 to 16.97). There was no statistically significant heterogeneity but for cystoscopy versus vesicoamniotic shunting all results crossed the line of no effect. No long-term paediatric follow-up studies exist for fetal cystoscopy.

Conclusion There is little published evidence for the effectiveness of fetal cystoscopy as an intervention for lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an experimental intervention. This study was funded via the HTA.

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