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. 2020 Jul;302(1):133-140.
doi: 10.1007/s00404-020-05598-z. Epub 2020 May 24.

Vesicoamniotic shunting for fetal megacystis in the first trimester with a Somatex® intrauterine shunt

B Strizek  1 , I Gottschalk  2 , F Recker  3 , E Weber  3 , A Flöck  3 , U Gembruch  3 , A Geipel  3 , C Berg  3   2
Affiliations

Vesicoamniotic shunting for fetal megacystis in the first trimester with a Somatex® intrauterine shunt

B Strizek et al. Arch Gynecol Obstet. 2020 Jul.

Abstract

Purpose: The objective was to evaluate the feasibility of vesicoamniotic shunting (VAS) in the first trimester with the Somatex® intrauterine shunt and report on complications and neonatal outcome.

Methods: Retrospective cohort study of all VAS before 14 weeks at two tertiary fetal medicine centres from 2015 to 2018 using a Somatex® intrauterine shunt. All patients with a first trimester diagnosis of megacystis in male fetuses with a longitudinal bladder diameter of at least 15 mm were offered VAS. All patients that opted for VAS after counselling by prenatal medicine specialists, neonatologists and pediatric nephrologists were included in the study. Charts were reviewed for complications, obstetric and neonatal outcomes.

Results: Ten VAS were performed during the study period in male fetuses at a median GA of 13.3 (12.6-13.9) weeks. There were two terminations of pregnancy (TOP) due to additional malformations and one IUFD. Overall there were four shunt dislocations (40%); three of those between 25-30 weeks GA. Seven neonates were born alive at a median GA of 35.1 weeks (31.0-38.9). There was one neonatal death due to pulmonary hypoplasia. Neonatal kidney function was normal in the six neonates surviving the neonatal period. After exclusion of TOP, perinatal survival was 75%, and 85.7% if only live-born children were considered.

Conclusion: VAS in the first trimester is feasible with the Somatex® Intrauterine shunt with low fetal and maternal complication rates. Neonatal survival rates are high due to a reduction in pulmonary hypoplasia and the rate of renal failure at birth is very low. VAS can be safely offered from the late first trimester using the Somatex® intrauterine shunt.

Keywords: LUTO; Megacystis; Posterior urethral valve; Vesicoamniotic shunt.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Somatex® Intra Uterine Shunt. The shunt consisting of a nitinol wire mesh and impermeable silicone coating with silicone-free, self-deploying parasols at both ends of the shunt with two X-ray markers
Fig. 2
Fig. 2
Correct shunt position in a transverse view after vesicoamniotic shunting at 12 + 4 weeks. The shunt can be easily visualized due to its nitinol wire mesh. The fetal bladder is empty
Fig. 3
Fig. 3
Images illustrating shunt dislocations. a Intraabdominal shunt dislocation. The distal end of the shunt (on the right side of the image) is dislocated into the abdominal cavity leading to urinary ascites. b After placement of an abdomino-amniotic Harrison shunt the ascites has decreased. c The proximal end of the shunt is dislocated subcutaneously. The bladder is still enlarged. d A second Somatex® shunt (shunt 2) is correctly positioned in the fetal bladder, which is empty, shunt 1 can be seen next to shunt 2
Fig. 4
Fig. 4
Outcome in 10 fetuses after first trimester VAS. IUFD intrauterine fetal death, NND neonatal death, TOP termination of pregnancy, VAS vesicoamniotic shunt
See this image and copyright information in PMC

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