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.