Abstract：
BACKGROUND: Intrauterine vesicoamniotic shunting (VAS) using a Somatex® shunt was shown to significantly affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO) [Figure 1]. Data on postnatal surgical management and complications are largely lacking.
OBJECTIVE: To describe the postnatal management of patients with prenatal VAS for megacystitis in suspected severe LUTO.
METHODS: All male newborns with previous intrauterine VAS using a Somatex® shunt treated in our institution were retrospectively analyzed. We evaluated the spectrum of urethral pathologies and postnatal surgical management, especially focusing on shunt removal.
RESULTS: Between 2016 and 2022, 17 patients (all male) were treated postnatally in our institution after VAS for suspected severe LUTO. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in eight patients (8/17). Seven shunts could be removed without further anesthesia as a bedside procedure. Ten patients required surgical shunt removal under general anesthesia due to migration (59%). Laparoscopic shunt extraction was performed in 8/10 cases. Most frequently, dislocated shunts were located incorporated in the detrusor in eight cases and the removal required a bladder suture in 2/8 patients. In one case, the shunt was removed from the abdominal wall and in one case from the intestine wall [Figure 2]. Posterior urethral valves were found in 8/17 patients, 6/17 patients showed a urethral atresia and one patient had urethral duplication. In two patients, we identified a high grade bilateral vesicoureteral reflux without LUTO.
CONCLUSIONS: In our observation, more than half of the newborns with megacystis in suspected LUTO require a shunt removal surgery after early VAS using a Somatex® shunt. Urethral atresia may be found more frequently in these patients. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.
OBJECTIVE: To describe the postnatal management of patients with prenatal VAS for megacystitis in suspected severe LUTO.
METHODS: All male newborns with previous intrauterine VAS using a Somatex® shunt treated in our institution were retrospectively analyzed. We evaluated the spectrum of urethral pathologies and postnatal surgical management, especially focusing on shunt removal.
RESULTS: Between 2016 and 2022, 17 patients (all male) were treated postnatally in our institution after VAS for suspected severe LUTO. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in eight patients (8/17). Seven shunts could be removed without further anesthesia as a bedside procedure. Ten patients required surgical shunt removal under general anesthesia due to migration (59%). Laparoscopic shunt extraction was performed in 8/10 cases. Most frequently, dislocated shunts were located incorporated in the detrusor in eight cases and the removal required a bladder suture in 2/8 patients. In one case, the shunt was removed from the abdominal wall and in one case from the intestine wall [Figure 2]. Posterior urethral valves were found in 8/17 patients, 6/17 patients showed a urethral atresia and one patient had urethral duplication. In two patients, we identified a high grade bilateral vesicoureteral reflux without LUTO.
CONCLUSIONS: In our observation, more than half of the newborns with megacystis in suspected LUTO require a shunt removal surgery after early VAS using a Somatex® shunt. Urethral atresia may be found more frequently in these patients. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.
摘要：
背景：使用Somatex®分流术的宫内膀胱羊膜分流术(VAS)被证明显著影响疑似下尿路梗阻(LUTO)中患有巨大膀胱的男性胎儿的存活[图1]。缺乏有关产后手术管理和并发症的数据。
目的：描述疑似严重LUTO的巨细胞炎患者产前VAS的产后处理。
方法：回顾性分析在我们机构接受Somatex®分流术治疗的所有患有宫内VAS的男性新生儿。我们评估了尿道病理和产后手术治疗的范围，特别是专注于分流去除。
结果：在2016年至2022年之间，有17名患者（均为男性）在VAS后在我们机构接受了疑似严重LUTO的产后治疗。五个患有脱位分流的胎儿在子宫内进行了重新植入。总的来说,8例患者在妊娠38周前早产(8/17)。作为床边程序，无需进一步麻醉即可移除七个分流器。十名患者由于迁移而需要在全身麻醉下进行手术分流术（59％）。8/10例进行腹腔镜分流术。大多数情况下,8例脱位分流位于逼尿肌中，2/8例患者需要进行膀胱缝合。在一个案例中,分流从腹壁和1例的肠壁中取出[图2].在8/17患者中发现了后尿道瓣膜，6/17例患者出现尿道闭锁，1例患者出现尿道重复。在两个病人中，我们发现无LUTO的双侧膀胱输尿管高度反流.
结论：在我们的观察中，在疑似LUTO中,超过一半的患有巨乳的新生儿需要在使用Somatex®分流管进行早期VAS后进行分流管切除手术.在这些患者中，尿道闭锁可能更常见。在父母的产前咨询和产后管理计划中应考虑这些数据。
目的：描述疑似严重LUTO的巨细胞炎患者产前VAS的产后处理。
方法：回顾性分析在我们机构接受Somatex®分流术治疗的所有患有宫内VAS的男性新生儿。我们评估了尿道病理和产后手术治疗的范围，特别是专注于分流去除。
结果：在2016年至2022年之间，有17名患者（均为男性）在VAS后在我们机构接受了疑似严重LUTO的产后治疗。五个患有脱位分流的胎儿在子宫内进行了重新植入。总的来说,8例患者在妊娠38周前早产(8/17)。作为床边程序，无需进一步麻醉即可移除七个分流器。十名患者由于迁移而需要在全身麻醉下进行手术分流术（59％）。8/10例进行腹腔镜分流术。大多数情况下,8例脱位分流位于逼尿肌中，2/8例患者需要进行膀胱缝合。在一个案例中,分流从腹壁和1例的肠壁中取出[图2].在8/17患者中发现了后尿道瓣膜，6/17例患者出现尿道闭锁，1例患者出现尿道重复。在两个病人中，我们发现无LUTO的双侧膀胱输尿管高度反流.
结论：在我们的观察中，在疑似LUTO中,超过一半的患有巨乳的新生儿需要在使用Somatex®分流管进行早期VAS后进行分流管切除手术.在这些患者中，尿道闭锁可能更常见。在父母的产前咨询和产后管理计划中应考虑这些数据。
