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Bladder Function After Fetal Surgery for Myelomeningocele.

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Prenatal surgery for fetal myelomeningocele did not significantly lower the need for clean intermittent catheterization (CIC) by age 30 months. However, it was linked to fewer bladder abnormalities, suggesting careful urologic monitoring is crucial.

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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.