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Fetal intervention for myelomeningocele: effect on postnatal bladder function.
N M Holmes1, H T Nguyen, M R Harrison
1Department of Urology, University of California San Francisco, San Francisco, California, USA.
The Journal of Urology
|November 7, 2001
Summary
In utero repair of myelomeningocele (spina bifida) in newborns showed similar bladder issues as postnatal care. Prematurity is a risk, and long-term effects require further study.
Area of Science:
- Fetal surgery
- Neonatal urology
- Neural tube defects
Background:
- Myelomeningocele is a common congenital central nervous system malformation.
- Prenatal diagnosis is typically via ultrasound.
- Significant postnatal sequelae necessitate exploring early interventions.
Purpose of the Study:
- To evaluate urodynamic findings in newborns following in utero repair of myelomeningocele.
- To characterize postnatal bladder function after fetal surgery for spina bifida.
Main Methods:
- Retrospective review of a fetal surgery database.
- Inclusion criteria: myelomeningocele diagnosis, normal karyotype, no other anomalies, gestational age < 24 weeks.
- Surgical repair performed before 24 weeks gestation.
Main Results:
- Six patients underwent fetal surgery for myelomeningocele.
- All were born prematurely (≤ 32 weeks gestation).
- Videourodynamics at 1 month showed decreased bladder capacity, increased detrusor storage pressures, and significant post-void residual in 4 patients. Hydronephrosis and vesicoureteral reflux were also observed.
Conclusions:
- In utero repair of myelomeningocele did not prevent urodynamic changes or urinary tract abnormalities seen in standard postnatal care.
- Prematurity is a potential complication of in utero treatment.
- Long-term bladder function outcomes remain unknown; a randomized controlled trial is needed.