Journal of pediatric urology · 2025
Evaluation of the impact of intrauterine myelomeningocele repair on urinary tract function.
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de Lima Fernanda Marinho, Barboza André Luís, Dias Bruno Leonardo Scofano, Duarte Lenamaris Mendes Rocha, Kuschnir Maria Cristina Caetano, da Fonseca Eliane Maria Garcez Oliveira
Аннотация
OBJECTIVE: To compare initial urological examinations and bladder risk categorization of children with myelomeningocele undergoing intrauterine and postnatal repair.
METHODS: Cross-sectional study, with data collection from children with myelomeningocele (MMC), aged 0-36 months, admitted between January/2017 and January/2022 and followed up in a network of rehabilitation hospitals in Brazil. Urodynamic Study (UDS) parameters; urinary tract ultrasonography (US) and voiding cystourethrography (VCUG) were analyzed. Bladder risk categorization was done according to the CDC UMPIRE protocol.
RESULTS: We analyzed 103 patients, 38 from intrauterine group and 65 from postnatal group. Age at admission ranged between 1 and 34 months (median 4 [IQR 3.00-7.50]) and the first urologic exams were performed between 4 and 36 months (median 12 [IQR 7.50-18.0]). None of the parameters analyzed in UDS, urinary tract US, VCUG and laboratory tests showed significant difference between groups. Moderate to severe hydronephrosis or vesicoureteral reflux grades III to V were observed in 7 children, 2 (5 %) from the intrauterine group and 6 (9 %) from the postnatal group (p = 0.46; RR: 0.66; 95 % CI 0.19-2.25). There was no statistical difference between groups (p = 0.45) for bladder categorization, with high risk being identified in 1 (3 %) child in intrauterine group and in 2 (3 %) children of postnatal group.
CONCLUSION: In this studied population, no significant differences were observed in the initial evaluation of the lower urinary tract, including urodynamics, imaging tests and in the bladder risk categorization between children with MMC who underwent fetal or postnatal surgery. Larger, multicentric, prospective studies are needed to further assess the benefits of MMC intrauterine repair on bladder function and long-term urological outcomes.
METHODS: Cross-sectional study, with data collection from children with myelomeningocele (MMC), aged 0-36 months, admitted between January/2017 and January/2022 and followed up in a network of rehabilitation hospitals in Brazil. Urodynamic Study (UDS) parameters; urinary tract ultrasonography (US) and voiding cystourethrography (VCUG) were analyzed. Bladder risk categorization was done according to the CDC UMPIRE protocol.
RESULTS: We analyzed 103 patients, 38 from intrauterine group and 65 from postnatal group. Age at admission ranged between 1 and 34 months (median 4 [IQR 3.00-7.50]) and the first urologic exams were performed between 4 and 36 months (median 12 [IQR 7.50-18.0]). None of the parameters analyzed in UDS, urinary tract US, VCUG and laboratory tests showed significant difference between groups. Moderate to severe hydronephrosis or vesicoureteral reflux grades III to V were observed in 7 children, 2 (5 %) from the intrauterine group and 6 (9 %) from the postnatal group (p = 0.46; RR: 0.66; 95 % CI 0.19-2.25). There was no statistical difference between groups (p = 0.45) for bladder categorization, with high risk being identified in 1 (3 %) child in intrauterine group and in 2 (3 %) children of postnatal group.
CONCLUSION: In this studied population, no significant differences were observed in the initial evaluation of the lower urinary tract, including urodynamics, imaging tests and in the bladder risk categorization between children with MMC who underwent fetal or postnatal surgery. Larger, multicentric, prospective studies are needed to further assess the benefits of MMC intrauterine repair on bladder function and long-term urological outcomes.