Journal of pediatric urology · 2026
An age-matched comparison of early urological outcomes in patients who underwent antenatal versus postnatal myelomeningocele repair: A prospective single centre experience.
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Pickett Lianne, Jayasimha Sudhindra, Maestri Susan, Cao Kevin, Thompson Dominic, De Coppi Paolo, Desai Divyesh, Kumar Neetu, Vythilingam Ganesh, Johal Nav
Аннотация
BACKGROUND: Antenatal myelomeningocele (MMC) repair improves neurosurgical outcomes, but its impact on early renal and bladder outcomes remains uncertain.
OBJECTIVE: To test the hypothesis that antenatal myelomeningocele repair is associated with fewer symptomatic febrile urinary tract infections during early follow-up than postnatal repair, and to compare secondary upper urinary tract, bladder management and non-invasive bladder function outcomes within a single-centre risk-stratified pathway.
METHODS: We reviewed a prospectively maintained MMC database (2018-2025). All antenatally repaired children were included; postnatal repairs were restricted to children meeting Management of Myelomeningocele Study eligibility criteria. Outcomes included symptomatic febrile UTI, upper urinary tract findings, bladder emptying management, post-void residual urine on non-invasive bladder function assessment, selective uroflowmetry and invasive urodynamics, and symptomatic oxybutynin use. UTI was defined as a febrile episode with UTI-compatible symptoms and urinary leucocytes or pyuria; asymptomatic bacteriuria was not counted.
RESULTS: Sixty-six children were managed; Nineteen underwent antenatal repair and 14 formed the MOMS-eligible postnatal comparator group. Prematurity was more frequent after antenatal repair (79% vs 0%, p < 0.001) and ventriculoperitoneal shunt requirement was lower (26% vs 79%, p = 0.005). Symptomatic UTI occurred less often in the antenatal group (21% vs 79%, p = 0.002). Hydronephrosis, VUR, DMSA scarring and overnight drainage all favoured the antenatal group but did not reach statistical significance.
CONCLUSIONS: Within this small single-centre cohort managed by a consistent risk-stratified pathway, antenatal MMC repair was associated with fewer documented symptomatic febrile UTIs during early follow-up. Differences in upper tract outcomes, bladder emptying management and selectively measured functional outcomes remained uncertain.
OBJECTIVE: To test the hypothesis that antenatal myelomeningocele repair is associated with fewer symptomatic febrile urinary tract infections during early follow-up than postnatal repair, and to compare secondary upper urinary tract, bladder management and non-invasive bladder function outcomes within a single-centre risk-stratified pathway.
METHODS: We reviewed a prospectively maintained MMC database (2018-2025). All antenatally repaired children were included; postnatal repairs were restricted to children meeting Management of Myelomeningocele Study eligibility criteria. Outcomes included symptomatic febrile UTI, upper urinary tract findings, bladder emptying management, post-void residual urine on non-invasive bladder function assessment, selective uroflowmetry and invasive urodynamics, and symptomatic oxybutynin use. UTI was defined as a febrile episode with UTI-compatible symptoms and urinary leucocytes or pyuria; asymptomatic bacteriuria was not counted.
RESULTS: Sixty-six children were managed; Nineteen underwent antenatal repair and 14 formed the MOMS-eligible postnatal comparator group. Prematurity was more frequent after antenatal repair (79% vs 0%, p < 0.001) and ventriculoperitoneal shunt requirement was lower (26% vs 79%, p = 0.005). Symptomatic UTI occurred less often in the antenatal group (21% vs 79%, p = 0.002). Hydronephrosis, VUR, DMSA scarring and overnight drainage all favoured the antenatal group but did not reach statistical significance.
CONCLUSIONS: Within this small single-centre cohort managed by a consistent risk-stratified pathway, antenatal MMC repair was associated with fewer documented symptomatic febrile UTIs during early follow-up. Differences in upper tract outcomes, bladder emptying management and selectively measured functional outcomes remained uncertain.