Conversion of vesicostomy into continent catheterizable reservoirs in myelomeningocele

Macedo, António; Ottoni, Sérgio Leite; Garrone, Gilmar; Mattos, Ricardo Marcondes; Cruz, Marcela Leal da

doi:10.1590/s1677-5538.ibju.2020.0385

Cited by 1 publication

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“…Reconstructive surgery (such as enterocystoplasty) was indicated for patients who were refractory to clinical treatment. For those who were at an early age, vesicostomy should be regarded as an alternative in order to postpone definitive surgery (15).…”

Section: Introductionmentioning

confidence: 99%

In utero myelomeningocele repair and high-risk bladder pattern. a prospective study

Macedo

Ottoni²,

Moron

et al. 2022

Int. braz j urol.

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Objectives: High-risk bladder pattern can be defined by Urodynamic Evaluation (UE) as overactive bladder with detrusor leak point pressure higher than 40 cmH2O and/ or higher filling pressures also above 40 cmH2O. We wanted to evaluate response to treatment in myelomeningocele patients operated in utero in this subgroup. Patients and Methods: From our prospective cohort of in utero MMC we have identified patients in the high-risk group. Treatment consisted of anticholinergics (Oxybutynin 0.2 mg/Kg) 2 or 3 times daily in association with CIC. At every UE, patients were reclassified in high-risk or low-risk patterns. Patients not responding were proposed bladder reconstruction or diversion according to age. Results: Between 2011 to 2020, we have been following 121 patients and 60 (49.6%) of them were initially categorized as high-risk. The initial UE was performed at a mean age of 7.9 months and detrusor overactivity was found in 83.3% (mean maximum pressure of 76.5cmH20). When evaluating patients with 2 or more UE, we identified 44 patients (follow-up: 36.8months). It was observed in the group of patients who underwent 2 to 5 UE, that response to treatment was validated by the finding of 40% of low-risk bladder patterns in the second UE and between 62% to 64% in the third to the fifth UE. The incidence of surgery was 13.3%. Conclusions: Early urological treatment of high-risk bladder pattern was effective in approximately 60%. We reinforce the need to correctly treat every patient with myelomeningocele, in accordance with UE, whether undergoing in utero or postnatal treatment.

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Section: Introductionmentioning

confidence: 99%