Postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX® intrauterine shunt. A single center experience

J Kohaut; J Fischer-Mertens; G Cernaianu; D Schulten; G Holtkamp; S Kohl; S Habbig; R Klein; A Kribs; I Gottschalk; C Berg; M Dübbers

doi:10.1016/j.jpurol.2023.06.027

Postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX® intrauterine shunt. A single center experience

J Pediatr Urol. 2023 Oct;19(5):567.e1-567.e6. doi: 10.1016/j.jpurol.2023.06.027. Epub 2023 Jul 4.

Authors

J Kohaut¹, J Fischer-Mertens², G Cernaianu², D Schulten², G Holtkamp², S Kohl³, S Habbig³, R Klein³, A Kribs³, I Gottschalk⁴, C Berg⁴, M Dübbers²

Affiliations

¹ Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany. Electronic address: jules.kohaut@uk-koeln.de.
² Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
³ Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁴ Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

PMID: 37451915
DOI: 10.1016/j.jpurol.2023.06.027

Abstract

Introduction: 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.

Study design: 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.

Conclusion: 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.

Keywords: Lower urinary tract obstruction; Megacystis; Urethral atresia; Vesicoamniotic shunt.