Bladder Function After Fetal Surgery for Myelomeningocele.

Area of Science:

• Urology
• Pediatric Surgery
• Maternal-Fetal Medicine

Background:

• A substudy of the Management of Myelomeningocele Study focused on urological outcomes.
• Evaluated the impact of surgical timing on bladder function in children with fetal myelomeningocele.

Purpose of the Study:

• To compare urological outcomes between prenatal and postnatal surgical repair of fetal myelomeningocele.
• Assessed the need for clean intermittent catheterization (CIC) and bladder/kidney abnormalities.

Main Methods:

• Pregnant women with fetal myelomeningocele were randomized to prenatal or postnatal surgical repair.
• Primary outcome: death or CIC by 30 months. Secondary outcomes: bladder/kidney abnormalities via urodynamics and ultrasound at 12 and 30 months.

Main Results:

• The primary outcome (death or CIC) occurred in 52% of the prenatal group vs. 66% of the postnatal group (RR: 0.78; 95% CI: 0.57-1.07).
• Actual CIC rates were 38% (prenatal) vs. 51% (postnatal) (RR: 0.74; 95% CI: 0.48-1.12).
• Prenatal surgery showed significantly less bladder trabeculation (RR: 0.39) and fewer cases of open bladder neck (RR: 0.61) on urodynamics, confirmed by ultrasound.

Conclusions:

• Prenatal surgery did not significantly decrease the need for CIC by 30 months of age.
• Prenatal repair was associated with reduced bladder trabeculation and open bladder neck.
• Long-term urologic follow-up is essential for all myelomeningocele patients, irrespective of surgical timing.