Urinary and Fecal Continence in 5-Year-Old Patients Who Underwent in utero Myelomeningocele Repair: A Prospective Study

Macedo, António; Cavalheiro, Sérgio; Moron, Antônio Fernandes; Lobountchenko, Tassia; Dini, Felipe Silveira; Ottoni, Sérgio Leite; Garrone, Gilmar; Ligori, Riberto; Cruz, Marcela Leal da

doi:10.1159/000496791

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Patients may suffer from either fecal incontinence or constipation. One small study of fourteen patients who underwent prenatal MMC repair found that almost 80% continued to require diaper use by age five due to fecal incontinence [ 27 ]. A large proportion of patients require complex bowel regimens, including retrograde rectal irrigations (57%) or medications such as oral laxatives (79%) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…One small study of fourteen patients who underwent prenatal MMC repair found that almost 80% continued to require diaper use by age five due to fecal incontinence [ 27 ]. A large proportion of patients require complex bowel regimens, including retrograde rectal irrigations (57%) or medications such as oral laxatives (79%) [ 27 ]. In another long-term follow up of children with prenatally repaired MMC, only 26% reported continence all the time, and almost 60% were enrolled in a bowel management program at a median age of 10 years old [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Early investigations into improving bowel and bladder function in fetal ovine myelomeningocele repair

Theodorou

Jackson

Stokes

et al. 2022

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early investigations into improving bowel and bladder function in fetal ovine myelomeningocele repair

Theodorou

Jackson

Stokes

et al. 2022

Journal of Pediatric Surgery

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“…On the other hand, several studies suggested little benefit of prenatal OSB repair concerning the urinary tract. The group of Macedo published several studies [12, 14, 15, 28, 29] of prospectively followed up patients with prenatal OSB repair and a high incidence of abnormal bladder patterns. In an analysis of 100 patients [15], only 15% showed a normal bladder profile at a mean age of 5.8 months (median 4 months).…”

Section: Discussionmentioning

confidence: 99%

Urological Outcome after Fetal Spina Bifida Repair: Data from the Zurich Cohort

et al. 2020

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Introduction: Neurogenic lower urinary tract dysfunction (NLUTD) represents a severe burden for patients with open spina bifida (OSB). The effect of fetal OSB repair on the urological outcome remains unclear, as controversial data exist. The aim of this study was to further increment existing outcome data and to demonstrate that our earlier published positive preliminary results are not erratic. Methods: Data from standardized urological follow-up appointments of patients with fetal OSB repair operated at our center were analyzed. Data were obtained from urodynamic studies (UDSs) and radiologic exams performed in the newborn (gestational age 37-39 weeks), at ages of 6, 12, 18, and 24 months, and then at yearly intervals. Results: Of 82 patients (mean age 2.6 years, range 6 months to 7 years), 26 (32%) had a normal bladder function as demonstrated by UDSs. Of the 56 (68%) patients with NLUTD, 29 (51%) patients showed initially a normal UDS, but developed NLUTD in the follow-up, 19 (66%) of them spontaneously and another 10 (34%) in association with growth and development, or surgery of inclusion cysts. Radiologic abnormalities (upper tract dilatation and vesico-uretero-renal reflux) were seen in 15%, mainly patients with NLUTD. Conclusion: Our results add an important set of information to the existing body of evidence. The data reconfirm our earlier published favorable preliminary results and support other studies that show a possible benefit of prenatal OSB repair on the urological outcome, but they also demonstrate that the positive effect remains limited.

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“…The potential improvement in the bladder function is a controversial subject, as the different studies published in the post-MOMS era are conflicting. When analyzing prospective studies, the American groups involved in MOMS (2,3) and the Zurich group (4,5) suggest benefits of in utero MMC to the bladder function, while our studies in São Paulo go in the opposite direction and shows no improvements to bladder function, regardless if MMC closure had been in utero or postnatal (6)(7)(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 63%

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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Urinary and Fecal Continence in 5-Year-Old Patients Who Underwent in utero Myelomeningocele Repair: A Prospective Study

Cited by 7 publications

References 8 publications

Early investigations into improving bowel and bladder function in fetal ovine myelomeningocele repair

Early investigations into improving bowel and bladder function in fetal ovine myelomeningocele repair

Urological Outcome after Fetal Spina Bifida Repair: Data from the Zurich Cohort

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

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