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Published on: August 28, 2020
In utero closure of myelomeningocele does not improve lower urinary tract function
Nora G Lee1, Pablo Gomez, Vikrant Uberoi
1Department of Urology, Children's Hospital Boston, Boston, Massachusetts, USA.
Insights
Prenatal myelomeningocele repair did not improve lower urinary tract function compared to postnatal repair. While fetal surgery shows benefits in shunting and motor outcomes, bladder function remains similar between groups.
Area of Science:
- Pediatric Surgery
- Urology
- Neuroscience
Background:
- Myelomeningocele is a severe birth defect affecting the spinal cord.
- Prenatal closure of myelomeningocele has shown promise in reducing shunt dependency and improving motor function.
- The impact of prenatal repair on lower urinary tract function requires further investigation.
Purpose of the Study:
- To evaluate the effect of in utero myelomeningocele repair on lower urinary tract function.
- To compare urological outcomes in patients who underwent prenatal versus postnatal myelomeningocele closure.
Main Methods:
- Retrospective review of 11 patients with in utero repair matched to 22 controls with postnatal repair.
- Urological outcomes assessed included urodynamic studies, catheterization needs, and medication use.
- Comparison of rates for ventriculoperitoneal shunting and spinal cord untethering surgery.
Main Results:
- No significant differences were observed in the need for clean intermittent catheterization, incontinence, or use of anticholinergic/antibiotic agents.
- Urodynamic parameters such as bladder capacity and detrusor pressure showed no significant group differences.
- Rates of ventriculoperitoneal shunting and spinal cord untethering surgery were comparable between prenatal and postnatal repair groups.
Conclusions:
- In utero closure of myelomeningocele does not significantly improve lower urinary tract function compared to postnatal repair.
- While prenatal repair offers benefits in other areas, its effect on bladder function requires continued study.
- Further research is needed to fully understand the long-term urological implications of fetal myelomeningocele surgery.
Purpose:
Recent data comparing prenatal to postnatal closure of myelomeningocele showed a decreased need for ventriculoperitoneal shunting and improved lower extremity motor outcomes in patients who underwent closure prenatally. A total of 11 children whose spinal defect was closed in utero were followed at our spina bifida center. We hypothesized that in utero repair of myelomeningocele improves lower urinary tract function compared to postnatal repair.
Materials And Methods:
Eleven patients who underwent in utero repair were matched to 22 control patients who underwent postnatal repair according to age, gender and level of spinal defect. Urological outcomes were retrospectively reviewed including urodynamic study data, need for clean intermittent catheterization, use of anticholinergic agents and prophylactic antibiotics, and surgical history. The need for ventriculoperitoneal shunting or spinal cord untethering surgery was also reviewed.
Results:
Mean followup was 7.2 years for patients who underwent in utero repair and 7.3 years for those who underwent postnatal repair. Mean patient age at compared urodynamic studies was 5.9 years for in utero repair and 6.0 years for postnatal repair. The in utero repair group was comprised of 5 lumbar and 6 sacral level defects with equal matching (1:2) in the postnatal repair cohort. There were no differences between the groups in terms of need for clean intermittent catheterization, incontinence between catheterizations or anticholinergic/antibiotic use. Urodynamic parameters including bladder capacity, detrusor pressure at capacity, detrusor overactivity and the presence of detrusor sphincter dyssynergia were not significantly different between the groups. There was no difference in the rate of ventriculoperitoneal shunting (p = 0.14) or untethering surgery (p = 0.99).
Conclusions:
While in utero closure of myelomeningocele has been shown to decrease rates of ventriculoperitoneal shunting and improve motor function, it is not associated with any significant improvement in lower urinary tract function compared to repair after birth.
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