An age-matched comparison of early urological outcomes in patients who underwent antenatal versus postnatal myelomeningocele repair: A prospective single centre experience.

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.