Supplementary Material for: Fetal cystoscopy (FC) and vesicoamniotic shunting (VAS) in lower urinary tract obstruction (LUTO): a meta-analysis of long-term outcome and current technical limitations

Purpose: To compare obstetrical, survival, and nephro-urological outcomes of fetuses diagnosed with lower urinary tract obstruction (LUTO) undergoing antenatal procedures by vesicoamniotic shunting (VAS) or fetal cystoscopy (FC).
Methods: This study was a literature search using MEDLINE, Scopus, Embase, and Cochrane reference lists. All studies reporting VAS and FC's effectiveness, complications, and technical issues in the prenatal treatment of LUTO were selected for a single-proportion meta-analysis. Two reviewers independently selected studies, extracted data, and assessed quality. We computed and declared effect sizes for estimating a single proportion using the Freeman-Turkey transformed proportion.
Results: out of a total of 467 citations identified, 49 studies were included for a detailed evaluation of VAS and FC perinatal outcomes. Overall, VAS and FC were burdened by a similar incidence of intrauterine fetal demise [VAS: 0.51 (0.42-0.61) versus FC: 0.47 (0.28-0.67); p=0.73], postnatal death [VAS: 0.87 (0.75-0.99) versus FC: 0.86 (0.62-1.09); p-value: 0.87], and postnatal renal impairment [VAS: 1.22 (1.06-1.39) versus FC: 0.96 (0.67-1.25); p-value: 0.12]. Likewise, the two procedures were complicated by a similar rate of chorioamnionitis [VAS: 0.38 (0.28-0.47) versus FC: 0.39 (0.12-0.66); p-value: 0.92], premature rupture of membranes/preterm premature rupture of membranes (PROM/PPROM) [VAS: 0.77 (0.60-0.94) versus FC: 0.84 (0.60-1.07); p-value: 0.65], premature birth [VAS: 1.83 (1.55-2.10) versus FC: 1.56 (0.92-2.21): p-value: 0.46], and fetal abdominal wall/intestinal problems [VAS: 0.43 (0.29-0.57) versus FC: 0.50 (0.19-0.81); p-value: 0.69]. Termination of pregnancy (TOP) was chosen significantly more often after FC than VAS [VAS: 0.65 (0.53-0.77) versus FC: 1.18 (1.03-1.33); p-value: < 0.001].
Conclusion: Our meta-analysis yields similar results in terms of obstetric, survival, and nephro-urological outcomes between VAS and FC. The higher incidence of TOP in FC over the VAS group may be associated with the fact that FC is also considered a diagnostic tool and can guide for TOP for those with more complex diseases.