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A Comparative Analysis of Bladder Pattern of Patients who Underwent In Utero Versus Postnatal Myelomeningocele Repair

2019; Lippincott Williams & Wilkins; Volume: 203; Issue: 1 Linguagem: Inglês

10.1097/ju.0000000000000521

1527-3792

João Luiz Gomes Parizi, Marcela Leal da Cruz, Maria Cristina de Andrade, Gilmar Garrone, Sérgio Leite Ottoni, Sérgio Cavalheiro, Antônio Fernandes Moron, António Macedo,

Cerebrospinal fluid and hydrocephalus

No AccessJournal of UrologyPediatric Urology1 Jan 2020A Comparative Analysis of Bladder Pattern of Patients who Underwent In Utero Versus Postnatal Myelomeningocele RepairThis article is commented on by the following:Editorial Comment João Luiz Gomes Parizi, Marcela Leal da Cruz, Maria Cristina Andrade, Gilmar Garrone, Sérgio Leite Ottoni, Sérgio Cavalheiro, Antonio Moron, and Antonio Macedo, João Luiz Gomes PariziJoão Luiz Gomes Parizi Department of Urology, Federal University of São Paulo, São Paulo, Brazil Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil , Marcela Leal da CruzMarcela Leal da Cruz *Correspondence: Rua Maestro Cardim, 560/215, 01323-000, São Paulo, Brazil telephone: 55 11 32870639; FAX: 55 11 32873954; E-mail Address: [email protected] Department of Urology, Federal University of São Paulo, São Paulo, Brazil , Maria Cristina AndradeMaria Cristina Andrade Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil , Gilmar GarroneGilmar Garrone Department of Urology, Federal University of São Paulo, São Paulo, Brazil , Sérgio Leite OttoniSérgio Leite Ottoni Department of Urology, Federal University of São Paulo, São Paulo, Brazil , Sérgio CavalheiroSérgio Cavalheiro Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil Santa Joana Maternity Hospital, São Paulo, Brazil , Antonio MoronAntonio Moron Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil Santa Joana Maternity Hospital, São Paulo, Brazil , and Antonio Macedo,Antonio Macedo, Department of Urology, Federal University of São Paulo, São Paulo, Brazil Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil View All Author Informationhttps://doi.org/10.1097/JU.0000000000000521AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In utero myelomeningocele closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared bladder status in patients who underwent fetal myelomeningocele surgery versus postnatal repair. Materials and Methods: We retrospectively reviewed our database, with group 1 consisting of in utero surgery and group 2 consisting of postnatal repair. Group 3 was a subgroup of group 2, including patients initially presenting at age less than 12 months. We recorded medical history, radiological investigation with renal ultrasonography, voiding cystourethrography, urodynamic evaluation and clinical outcome of the bladder pattern after treatment. Results: We identified 88 patients in group 1, 86 in group 2 and 38 in group 3. The incidence of urinary tract infection was higher in the postnatal period (45% vs 20%). Hydronephrosis occurred in 20.7%, 22.6% and 28.9% of patients in groups 1, 2 and 3, respectively. Vesicoureteral reflux was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in group 1 and no difference in other urodynamic parameters. The high risk bladder pattern at initial evaluation occurred in 56%, 50% and 46% of patients in groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after treatment in all groups. Conclusions: In utero repair did not improve urological parameters compared to repair in the postnatal period. References 1. : Treatment of the neurogenic bladder in spina bifida. Pediatr Nephrol 2008; 23: 889. Google Scholar 2. : A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 2011; 364: 993. Google Scholar 3. : Bladder function after fetal surgery for myelomeningocele. Pediatrics 2015; 136: e906. Google Scholar 4. : Categorization of bladder dynamics and treatment after fetal myelomeningocele repair: first 50 cases prospectively assessed. J Urol 2015; 193: 1808. Link, Google Scholar 5. : A 4-year prospective urological assessment of in utero myelomeningocele repair--does gestational age at birth have a role in later neurogenic bladder pattern?J Urol 2017; 197: 1550. Link, Google Scholar 6. : In utero myelomeningocoele repair and urological outcomes: the first 100 cases of a prospective analysis. Is there an improvement in bladder function?BJU Int 2019; 123: 676. Google Scholar 7. : Campbell-Walsh Urology, 11th ed.Philadelphia: Elsevier/Saunders 2016. Google Scholar 8. : Ultrasonographic measurement of bladder wall thickness as a risk factor for upper urinary tract deterioration in children with myelodysplasia. J Urol 2008; 180: 312. Link, Google Scholar 9. : International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 1985; 15: 105. Google Scholar 10. : The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006; 176: 314. Link, Google Scholar 11. : Urodynamic testing in children: indications, technique, interpretation and significance. J Urol 2011; 186: 1190. Link, Google Scholar 12. : Four-hour voiding observation in healthy infants. J Urol 1996; 156: 1809. Link, Google Scholar 13. : Prognostic value of urodynamic testing in myelodysplastic patients. J Urol 1981; 126: 205. Link, Google Scholar 14. : Prenatal myelomeningocele repair: do bladders better?Neurourol Urodyn 2017; 36: 1651. Google Scholar 15. : Long-term urological impact of fetal myelomeningocele closure. J Urol 2011; 186: 1581. Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byWan J (2019) This Month in Pediatric UrologyJournal of Urology, VOL. 203, NO. 1, (4-4), Online publication date: 1-Jan-2020.Related articlesJournal of Urology23 Oct 2019Editorial Comment Volume 203Issue 1January 2020Page: 194-199 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsurodynamicsurinary bladderfetal therapiesneurogenicmeningomyeloceleMetricsAuthor Information João Luiz Gomes Parizi Department of Urology, Federal University of São Paulo, São Paulo, Brazil Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil More articles by this author Marcela Leal da Cruz Department of Urology, Federal University of São Paulo, São Paulo, Brazil *Correspondence: Rua Maestro Cardim, 560/215, 01323-000, São Paulo, Brazil telephone: 55 11 32870639; FAX: 55 11 32873954; E-mail Address: [email protected] More articles by this author Maria Cristina Andrade Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil More articles by this author Gilmar Garrone Department of Urology, Federal University of São Paulo, São Paulo, Brazil More articles by this author Sérgio Leite Ottoni Department of Urology, Federal University of São Paulo, São Paulo, Brazil More articles by this author Sérgio Cavalheiro Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil Santa Joana Maternity Hospital, São Paulo, Brazil More articles by this author Antonio Moron Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil Santa Joana Maternity Hospital, São Paulo, Brazil More articles by this author Antonio Macedo, Department of Urology, Federal University of São Paulo, São Paulo, Brazil Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. 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