Some studies underway start as early as the newborn period as seen in fetal surgery trials with the most notable being a prospective trial known as the "MOMS Trial". This study by Tarcana et al retrospectively investigated the impact of primary repair timing on neuropathic bladder prognosis in children with myelomeningocele.

They reviewed the records of 401 children with myelomeningocele between 1996 and 2005. There were 129 patients included in the study based on the availability of urological follow-up data at age 3 years. This age was chosen by the investigators as an ideal point for the standardization of urological findings. Children were assigned to 1 of 2 groups-those who underwent primary neurosurgical repair within 72 hours of delivery (group 1) and those undergoing repair after 72 hours (group 2). They compared the incidence of febrile urinary tract infections, hydronephrosis, vesicoureteral reflux and secondary tethering of the spinal cord at the age of 3 years, as well as bladder capacity and detrusor leak point pressure between the 2 groups on urodynamic studies.

They found that there was a significantly increased incidence of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering of the spinal cord in children in group 2 compared to group 1. Urodynamic evaluation also showed a significantly lower bladder capacity and a substantially higher detrusor leak point pressure in children who received primary repair after 72 hours of life (t test, p less than 0.05). A subgroup analysis of group 1 comparing children who underwent repair before and after 24 hours following delivery failed to demonstrate any significant difference in terms of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering. They also found that average bladder capacity was significantly higher and mean detrusor leak point pressure was lower in children undergoing repair within 24 hours of delivery.

The group concluded that the timing of primary neurosurgical repair has a significant impact on neuropathic bladder prognosis in children with myelomeningocele. Closure of the spinal lesion on the first day of life seems to provide the best chance for favorable lower urinary tract function in this retrospective series.

Tarcan T, Önol FF, I?lker Y, Alpay H, ?im?e?k F, Özek M

Journal of Urology 176(3): 1161-1165, September 2006.

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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