Vesico-amniotic shunt insertion prior to the completion of 16 weeks results in improved preservation of renal function in surviving fetuses with isolated severe lower urinary tract obstruction (LUTO)

Abstract

This retrospective study by Kohl et al. highlights the feasibility of vesico-amniotic shunting (VAS) before 16 weeks gestation using a Cook pigtail catheter, or the Somatex® nitinol wire mesh shunt. The authors report a technical success rate of 80% before 16 weeks, which they state is similar to the success rates of VAS later in pregnancy. Fetal intervention before 16 weeks is known to be hazardous due to an increased risk of chorioamniotic separation or shunt dislodgement into the fetal abdominal cavity, that can occur with fetal growth, resulting in fetal ascites and requiring further urgent intervention.