In Utero Closure of Myelomeningocele Does Not Improve Lower Urinary Tract Function

Abstract

While in utero closure of myelomeningocele has been shown to decrease rates of ventriculoperitoneal shunting and improve motor function, it is not associated with any significant improvement in lower urinary tract function compared to repair after birth.

Prenatal myelomeningocele repair: Do bladders better?

“…The first five retrospective observational studies on the urological outcome in patients after prenatal MMC repair did not show significant improvements in lower urinary tract function. The urodynamic parameters were very similar to those usually found in patients who underwent postnatal repair . However, these data should be interpreted with caution because of their limitations, such as selection or treatment bias, the retrospective and non‐controlled nature of the studies, and disparate outcome measurements.…”

“…This milestone publication did not address urological outcomes; therefore, little is known about the effect of prenatal MMC closure on the neurogenic bladder dysfunction. There are only a few, mainly retrospective studies, focusing on urinary tract outcomes of prenatal MMC repair . Most of these studies did not demonstrate a positive effect of prenatal MMC repair on lower urinary tract function.…”

Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow‐up. Do their bladder benefit from it?

“…At a mean follow‐up of 7.2 years for patients who underwent in utero repair and 7.3 years for those who underwent post‐natal repair, no differences between the groups in terms of need for CIC, incontinence between catheterizations or anticholinergic/antibiotic use were found. Urodynamic parameters including bladder capacity, detrusor pressure at capacity, detrusor overactivity, and the presence of detrusor‐sphincter dyssynergia were not significantly different between the groups …”

Antenatal management of fetal neurosurgical diseases

“…Clayton et al [42] reported that 23 (82%) patients in a cohort of 28 used clean intermittent catheterization to manage the bladder at a mean age of 9.6 years, 24 (84%) required a bowel regimen to manage constipation, and 6 (21%) patients underwent lower urinary tract reconstruction. Lee et al [43] conducted a retrospective study to compare lower urinary tract function between the pre and postnatal MM repair groups and did not find differences between the two. Leal da Cruz et al [44] analyzed our cohort of the first 51 patients and found that 93.7% had significantly less urinary tract dysfunction of high bladder pressure or incontinence.…”