Abstract General Information

Title

INITIAL BLADDER CATEGORIZATION AFTER IN-UTERO MYELOMENINGOCELE CLOSURE: A PROSPECTIVE ANALYSIS OF 12 YEARS OF FOLLOW-UP

Introduction and objective

In-utero myelomeningocele is the gold standard treatment after the publication of the Management of Myelomeningocele Study. The benefits in regards to motor status and reduction of the need of Ventriculo Peritoneal Shunt have been confirmed and are reproducible. Differently, the urological outcome has been contradictory among institutions. We reviewed our database to evaluate the initial bladder categorization according to the Leal da Cruz categorization (J Urol. 2015) for patients treated from 2011-2023, reflecting 12 years of experience.

Method

Since 2011, all patients operated in-utero and referred to our institution undergo a prospective protocol consisting of initial clinical evaluation, radiological exams (sonogram, Voiding cystourethrography) and urodynamic evaluation. Patients were categorized in 4 patterns: High Risk (overactive pattern or higher filling pressures above 40 cmH2O); Incontinent (leakage below 40 cmH2O); Underactivity (underactive bladder with post-void residual urine) and Normal (normal bladder cystometry without leakage). Our protocol suggests Clean Intermittent Catheterization and anticholinergics for high risk, only clean intermittent catheterization for underactivity and surveillance for others, with yearly assessment. All urodynamic evaluations were performed using the same device and by the same investigators.

Results

A total of 129 patients with mean age at first urological evaluation at 6.4 months and a mean follow up of 28.6 months (1-99 months). Only 12 (10.34%) patients needed Ventriculo Peritoneal Shunt. At the first urological presentation, 19.35% had hydronephrosis and 21.74% vesicoureteral reflux. Mean age at the first urodynamic evaluation was 7,28 months. The urodynamic evaluation findings included 71.42% of detrusor overactivity, 41.46% reduced bladder compliance, 47.15% reduced bladder capacity and 55.74% urine leakage. Bladder pattern was 53.97% high risk, 25.21% incontinent, 3.97% underactivity and only 17.46% was normal. Clean Intermittent Catheterization was needed in 57.94% and use of anticholinergic in 53.97%.

Conclusion

In-utero myelomeningocele presented the high risk as a predominant bladder pattern.