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In utero myelomeningocoele repair and urological outcomes: the first 100 cases of a prospective analysis. Is there an improvement in bladder function?
Author(s) -
Macedo Antonio,
Ottoni Sergio Leite,
Garrone Gilmar,
Liguori Riberto,
Cavalheiro Sergio,
Moron Antonio,
Leal Da Cruz Marcela
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14639
Subject(s) - medicine , urology , in utero , prospective cohort study , urinary system , reflux , cystourethrography , surgery , vesicoureteral reflux , pregnancy , disease , fetus , biology , genetics
Objectives To evaluate the first 100 cases of in utero myelomeningocoele (MMC) repair and urological outcomes in a prospective analysis aiming to define possible improvement in bladder function. Patients and methods We used a protocol consisting of a detailed medical history, urinary tract ultrasonography, voiding cystourethrography, and urodynamic evaluation. Patients were categorised into four groups: normal, high risk (overactive bladder with a detrusor leak‐point pressure >40 cm H 2 O and high filling pressures also >40 cm H 2 O), incontinent, and underactivity (underactive bladder with post‐void residual urine), and patients were treated accordingly. Results We evaluated 100 patients, at a mean age of 5.8 months (median 4 months), classified as high risk in 52.6%, incontinent in 27.4%, with underactive bladder in 4.2%, and only 14.7% had a normal bladder profile. Clean intermittent catheterisation was initiated in 57.3% of the patients and anticholinergics in 52.6%. Antibiotic prophylaxis was initiated in 19.1% of the patients presenting with vesico‐ureteric reflux. Conclusion The high incidence of abnormal bladder patterns suggests little benefit of in utero MMC surgery concerning the urinary tract.