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Fetal Closure of Myelomeningocele Does Not Improve Lower Urinary Tract Function
Vikrant Uberoi1, Nora G. Lee1, Pablo Gomez2, Paul J. Kokorowski2, Shahram Khoshbin3, Stuart B. Bauer2, Carlos R. Estrada2
1Boston University, Boston, MA;2Children's Hospital Boston, Boston, MA;3Brigham and Women's Hospital, Boston, MA
Recent data comparing prenatal to postnatal closure of myelomeningocele showed decreased need for ventriculoperitoneal shunting (VPS) and improved motor outcomes in patients closed prenatally. Ten patients closed in-utero are followed in our Spina Bifida program. We hypothesized that fetal repair of myelomeningocele would improve lower urinary tract (LUT) function.
Ten prenatally closed patients were matched (age, gender and spinal defect level) with 10 patients closed postnatally. Urologic outcomes were retrospectively reviewed including urodynamic (UDS) data, need for intermittent catheterization, and use of anti-cholinergics and prophylactic antibiotics.
Mean patient ages at UDS for the prenatally versus postnatally closed groups were 6.3 years (range 7 months-12 years) and 6.6 years (range 5 months-13 years) respectively (p=0.87) with mean follow-up being 7.9 years (range 9 days-12 years) and 7.8 years (range 3 months-11 years) respectively. Each group had 5 lumbar and 5 sacral level defects. Urodynamic findings including bladder capacity, detrusor overactivity, detrusor pressure at capacity, and presence of sphincter dyssynergia were not significantly different between the groups. 7 patients in the prenatal group require intermittent catheterization compared with 9 patients in the postnatal group (p=0.58). There was no difference in rates of anti-cholinergic or antibiotic use between the two groups. Interestingly, there was no difference of VPS between the groups in our study.
While fetal closure of myelomeningocele has been shown to decrease rates of VPS and improve motor function, it is not associated with any significant improvement in LUT function when compared to matched patients closed postnatally.
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