Abstract General Information


Title

LONG TERM FOLLOW-UP OF PATIENTS WITH MYELOMENINGOCELE AFTER IN-UTERO REPAIR: WHAT IS THE FATE OF THE BLADDER?

Introduction and objective

The benefits of in-utero myelomeningocele repair to bladder function is still a topic of debate in pediatric urology. Since 2011 we prospectively follow myelomeningocele patients operated in utero. We decided to review all patients born between 2011 and 2013, projecting a follow-up of 10 to almost 12 years.

Method

We selected patients born between 2011 to 2013. We categorize patients according to the Leal da Cruz categorization (J Urol 2015) classification under 4 bladder patterns: high risk, underactive bladder, incontinent and normal to define the treatment. We reviewed clinical information and defined follow-up as the interval between first and last visit in the clinic. We excluded patients from the analysis who did not return for at least a second year evaluation. We registered the number of visits and urodynamic evaluation/per patients to outline the relevance of the follow-up.

Results

A total of 40 patients (aged 9 to 12 years, mean age: 10) were selected. Mean follow up was 49.68 months with 6.2 (median:10) urological visits and 3.46 urodynamic evaluations per patient. First urological evaluation was at 5.5 months. At first urodynamic evaluation (6.5 months) 82.5% had detrusor overactivity. We found 62.5% of high risk, 32.5% of incontinence, 2.5% of underactive bladder and 2.5% of normal pattern. Clean Intermittent Catheterization was needed in 65% and anticholinergics in 62.5%. 32.5% of the patients had at least 1 febrile urinary tract infection, and in 12.85% hospitalization was required. From these, 80% belonged to the high-risk group. Surgery was performed in 6 patients (15%) : 3 enterocystoplasty (Macedo Technique), 1 enterocystoplasty and Left Antegrade Continent Enema,1 vesicostomy and 1 sling. After the 5th and 6th urodynamic evaluation (under treatment) high risk pattern prevalence was 46.15% and 45.45% respectively.

Conclusion

This analysis confirms our statements that fetal myelomenigocele surgery offers limited improvement in bladder function compared to postnatal surgery.

Area

Neurogenic Bladder

Category

Original studies

Authors

TAIANE ROCHA CAMPELO, HUGO SANTIAGO CRESPO, RAUL GARCIA ARAGON, RENATA ALVES CORREA, RAFAEL JORDAN BALLADARES, MARCELA LEAL DA CRUZ, ANTONIO MACEDO JR, EMANUELLE LIMA MACEDO