Abstract：
The purpose of this retrospective cohort study was to compare the outcome of human fetuses with isolated severe lower urinary tract obstructions (LUTO) that were first treated before the completion of 16 weeks of gestation to fetuses first treated later in gestation.
Vesicoamniotic shunt insertion (VAS) was performed in 63 subsequent fetuses with LUTO between 12 + 5 and 30 + 3 weeks. The fetuses were analyzed in three groups: Group-I-fetuses underwent their first intervention until the completion of 16 weeks, Group-II-fetuses were first treated between 16 + 1 and 24 + 0 weeks and Group-III-fetuses beyond 24 + 1 weeks. Renal and pulmonary outcome parameters and complicating factors were assessed.
- All mothers tolerated the procedures well. Overall fetal survival was 47 of 63 (75%). The mean age at delivery of survivors was 35 weeks. 68% of Group-I-fetuses, 77% of group-II-fetuses, and 100% of group-III-fetuses survived beyond postnatal hospital discharge. Amongst the survivors the chance for normal renal function was higher for group I with 79% (15/19) compared to first fetal intervention after the completion of 16 weeks with 32% (9/28, p = 0.003, OR = 7.9 [2.0, 30.8] 95% CI). Clinically relevant pulmonary hypoplasia was observed in 11% of Group-I-, 27% of Group-II-, and 20% of Group-III-fetuses.
Early intervention in fetal LUTO before the completion of 16 weeks may achieve a higher rate of normal renal and pulmonary function in survivors than treatment beyond that point in time. This observation is important for the future management of this challenging patient population.
Vesicoamniotic shunt insertion (VAS) was performed in 63 subsequent fetuses with LUTO between 12 + 5 and 30 + 3 weeks. The fetuses were analyzed in three groups: Group-I-fetuses underwent their first intervention until the completion of 16 weeks, Group-II-fetuses were first treated between 16 + 1 and 24 + 0 weeks and Group-III-fetuses beyond 24 + 1 weeks. Renal and pulmonary outcome parameters and complicating factors were assessed.
- All mothers tolerated the procedures well. Overall fetal survival was 47 of 63 (75%). The mean age at delivery of survivors was 35 weeks. 68% of Group-I-fetuses, 77% of group-II-fetuses, and 100% of group-III-fetuses survived beyond postnatal hospital discharge. Amongst the survivors the chance for normal renal function was higher for group I with 79% (15/19) compared to first fetal intervention after the completion of 16 weeks with 32% (9/28, p = 0.003, OR = 7.9 [2.0, 30.8] 95% CI). Clinically relevant pulmonary hypoplasia was observed in 11% of Group-I-, 27% of Group-II-, and 20% of Group-III-fetuses.
Early intervention in fetal LUTO before the completion of 16 weeks may achieve a higher rate of normal renal and pulmonary function in survivors than treatment beyond that point in time. This observation is important for the future management of this challenging patient population.
摘要：
这项回顾性队列研究的目的是比较妊娠16周前首次治疗的患有孤立性严重下尿路梗阻（LUTO）的人类胎儿与妊娠后期首次治疗的胎儿的结局。
在12+5和30+3周之间，对63例随后的LUTO胎儿进行了Vesicoamiotic分流插入术（VAS）。将胎儿分为三组进行分析：I组胎儿进行首次干预，直到16周完成，II组胎儿首先在16+1和24+0周之间治疗,III组胎儿超过24+1周。评估了肾脏和肺部预后参数以及复杂因素。
-所有母亲都能很好地接受这种手术。胎儿总生存率为63例中的47例（75％）。生还者分娩时的平均年龄为35周。68%的I组胎儿，77%的II组胎儿，III组胎儿100%存活超过产后出院.在存活者中，与完成16周后的首次胎儿介入治疗32％（9/28，p=0.003，OR=7.9[2.0，30.8]95％CI）相比，I组的肾功能正常的机会更高，为79％（15/19）。在I组的11％中观察到临床相关的肺发育不全，第二类的27%，和20%的III组胎儿。
在16周结束前对胎儿LUTO进行早期干预可能比超过该时间点的治疗更高的幸存者肾脏和肺功能正常率。这一观察结果对于这一具有挑战性的患者群体的未来管理是重要的。
在12+5和30+3周之间，对63例随后的LUTO胎儿进行了Vesicoamiotic分流插入术（VAS）。将胎儿分为三组进行分析：I组胎儿进行首次干预，直到16周完成，II组胎儿首先在16+1和24+0周之间治疗,III组胎儿超过24+1周。评估了肾脏和肺部预后参数以及复杂因素。
-所有母亲都能很好地接受这种手术。胎儿总生存率为63例中的47例（75％）。生还者分娩时的平均年龄为35周。68%的I组胎儿，77%的II组胎儿，III组胎儿100%存活超过产后出院.在存活者中，与完成16周后的首次胎儿介入治疗32％（9/28，p=0.003，OR=7.9[2.0，30.8]95％CI）相比，I组的肾功能正常的机会更高，为79％（15/19）。在I组的11％中观察到临床相关的肺发育不全，第二类的27%，和20%的III组胎儿。
在16周结束前对胎儿LUTO进行早期干预可能比超过该时间点的治疗更高的幸存者肾脏和肺功能正常率。这一观察结果对于这一具有挑战性的患者群体的未来管理是重要的。
