Frühes vesikoamniales Shunting bei subvesikaler Obstruktion

At the Center for Prenatal Medicine of the University Hospital Cologne vesicoamniotic shunting (VAS) with an intrauterine shunt (IUS) is offered for fetuses with a megacystis > 15 mm in the first trimester. The IUS can be placed through an 18 G cannula as early as the first trimester and has the potential to improve neonatal mortality and kidney function, although it has less impact on urological sequelae. The prognosis is worse for female fetuses or those with syndromic malformations. Minor complications, such as dislocation of the amniotic end of the shunt into the peritoneal cavity due to fetal growth can be effectively treated. After VAS the birth should be carefully planned and conducted in a center with neonatology, pediatric nephrology and pediatric surgery facilities. Postnatally, the “wet shunt” can be used for the placement of a suprapubic catheter. Alternatively, placement of a transurethral catheter or insertion of a new suprapubic catheter can be performed. A primary valve resection is less common in this cohort due to the higher incidence of a hypoplastic urethra compared to historical cohorts. The most important laboratory prognostic parameter for postnatal kidney function is the creatinine nadir. Interdisciplinary prenatal counselling before VAS is crucial and is the best possible preparation for expectant parents for the birth and medical care of their child.