Intrauterine Surgery in Infravesical Obstruction
Regarding the subject of infravesical obstruction I would like to mention that the PLUTO study by Morris and Kilby cited by the authors (1) was stopped early: parents of affected unborn babies were given hope that intrauterine shunting of the bladder would result in improved fetal outcomes (lower mortality) because of prevention of pulmonary hypoplasia and not of improved renal function (morbidity).
The infants in whom shunts were placed using intrauterine surgery did not die from pulmonary hypoplasia any more but survived with very poor renal function, which means dialysis from an early age and transplantation later on. The fact that such critical nuances are explained to parents in the counseling has led to a situation in which increasing numbers of parents decide on a termination or non-intervention, not in favor of this randomized study. Due to the small number of cases the study was stopped before completion. All preceding studies on this subject showed that in this heterogeneous condition, patient selection is the decisive factor in order to reach a valid conclusion about which group might benefit from fetal surgery. Poor renal function has been described in the outcomes of all of these studies.
Parents and treating doctors should not be given false hopes. There is no proof that intrauterine shunting saves or preserves renal function.
The PLUTO study showed that the only sensible intervention in fetal infravesical obstruction is termination of the pregnancy.
Dr. med. Annette Reuss
Praxis Central Essen, firstname.lastname@example.org
|2.||Diemert A, Diehl W, Glosemeyer P, Deprest J, Hecher K: Intrauterine Surgery—Choices and Limitations. Dtsch Arztebl Int 2012; 109(38): 603–8 VOLLTEXT|