The effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review.

OBJECTIVES: To determine the effectiveness of fetal cystoscopy in the prenatal diagnosis and intervention for congenital lower urinary tract obstruction. METHODS: Literature search using Medline, Embase, Cochrane Library, MEDION, Web of Science reference lists, and contact with experts. All studies reporting on fetal cystoscopy in lower urinary tract obstruction with data for a 2×2 table were selected for review. No language restrictions were applied. There was independent selection of studies, data extraction, and quality assessment by two reviewers. Peto odds ratios were calculated as a summary measure of effect. MAIN RESULTS: A total of 2071 citations were identified, 66 papers selected for detailed evaluation. Four papers were selected for inclusion including a total of 63 patients. Two papers had results for use of cytsoscopy for diagnosis. Fetal cystoscopy altered the ultrasound diagnosis of underlying pathology in 36.4% and 25% of fetuses in each paper. Compared to no treatment, fetal cystoscopic intervention demonstrated an odds ratio for improved perinatal survival of 20.51 (95% CI 3.87,106.89). However, comparing VAS to fetal cystoscopy there appeared to be no significant improvement in perinatal survival odds ratio 1.49 (0.13,16.97). These results had wide confidence intervals and for cystoscopy versus VAS, all results crossed the line of no effect. CONCLUSIONS: There is little published evidence for the effectiveness of therapeutic fetal cystoscopy as an intervention for congenital lower urinary tract obstruction and the quality of this evidence is poor. It should thus be considered to be an 'experimental intervention' and subject to further investigation. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.