In utero myelomeningocele (MMC) closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared the bladder status in patients that underwent fetal MMC surgery and postnatal repair.
We retrospectively reviewed our database: Group 1 consisted of in utero surgery and group 2 consisted of postnatal repair. Group 3 was a subgroup of 2, including patients presenting initially with age below 12 months. We recorded medical history, radiological investigation renal ultrasonography, voiding cystourethrography (VCUG), urodynamic evaluation (UE) and clinical outcome of the bladder pattern after treatment.
We identified 88 patients in Group 1, 86 in Group 2, and 38 patients in Group 3. The incidence of UTI was higher in the postnatal period (45% versus 20%). Hydronephrosis occurred in 20.7%, 22.6%, and 28.9% in Groups 1, 2 and 3, respectively. VUR was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in Group 1, no difference in others urodynamic parameters. The high-risk bladder pattern at initial evaluation occurred in 56%, 50%, and 46% of groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after the treatment in all groups.
In utero repair did not improve urological parameters when compared to patients operated in the postnatal period.
The Journal of urology. 2019 Sep 03 [Epub ahead of print]
João Luiz Gomes Parizi, Marcela Leal da Cruz, Maria Cristina Andrade, Gilmar Garrone, Sérgio Leite Ottoni, Sérgio Cavalheiro, Antonio Moron, Antonio Macedo
Department of Urology, CACAU-NUPEP, São Paulo, Brazil., Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil., Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil., Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil.