A survival curve for bladder function without lower urinary tract reconstruction associated with in-utero myelomeningocele repair: Results from a prospective one-institution analysis since 2011.

PURPOSE: Our institution has prospectively studied outcomes from standardized follow-up algorithms for patients with myelomeningocele (MMC). This study conducts a cohort analysis of patients who underwent in-utero MMC closure, constructing a Kaplan-Meier survival curve to address a common question from families: "What is the chance my child will need bladder augmentation at 4, 10, and 15 years?" The Kaplan-Meier curve estimates the probability of survival under varying conditions and time intervals, adjusted to express "bladder intactness" compared to augmented bladder over time since birth.

MATERIAL AND

METHODS

We evaluated our database and selected patients with MMC operated in utero and treated at our institution between 2011 and May 2024. All patients were treated by the same examiner, with the information recorded in a specific electronic medical record, adopting the same follow-up protocol for neurogenic bladder, implemented at our institution. We have included only patients that started follow-up with us before 1 year of age. Incidence of lower urinary tract surgery was used for creating a Kaplan-Meyer survival curve.

RESULTS

From a total of 168 cases, we have found 103 patients that filled our inclusion criteria for the study. Urological surgery was performed in 13 patients (12.6 %): (10 augmentations and 3 vesicostomies). The mean age at the time of surgery was 5.2 years (median 4.8 years) and follow-up time until surgery was 59.8 months (median 54). The first urodynamic study showed bladder categorization as follows: high-risk in 49.5 % (n: 51), incontinent in 22.3 % (n: 23), underactive bladder in 7.8 % (n: 8), and normal pattern in 20.4 % (n: 21). At 110 months (∼9 years), surgery-free survival was 54.4 %. Our overall follow-up in the series was 46 months.

CONCLUSION

This analysis confirms the limited data available in the literature regarding the evolution of bladder function in patients with MMC corrected in utero and attempts to estimate the probability of experimental evolution over the observation period. At 110 months (∼9 years), surgery-free survival was 54.4 %.