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Initial urological assessment of patients that have undergone in utero myelomeningocele closure: a prospective follow-up study.
Antonio Macedo, MD, Bruno Leslie, MD, Marcela Leal, MD, Atila V. Rondon, MD, Valdermar Ortiz, MD, Antonio Moron, MD, Sergio Cavalheiro, MD.
Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Objective: To present our data on initial urological presentation after in utero MMC
closure assessed in a prospective follow-up protocol.
Patients and Methods: A prospective urological workup was designed for patients that underwent in utero MMC closure and referred to our urological facility. The protocol consisted of detailed anamneses, renal sonography, voiding cystourethrogram and urodynamic evaluation.
Results: In utero MMC closure was performed in 22 patients at 25.5 weeks of
gestational age (25-27). Birth occurred at a mean gestational age of 28.7 weeks (26-
36). Overactive bladder was observed in 94.4%. Bladder compliance was normal in only one case (5.6%) and was markedly reduced in 10 patients (55.5%) or not possible to be determined due to urinary leakage in 7 patients (38.9%). We observed normal bladder capacity in 4 patients (22.2%), reduced in 13 (72.2%) and detrusor sphincter dyssynergia in 8 patients (44.4%). Hypocontractile bladder was diagnosed in one case.
Conclusion: Our data are comparable to the literature reports and has the merit of being a prospective evaluation performed by one investigator, including the urodynamic study. Presently no definite conclusion can be made and patients have to be followed with great care, not differently to those operated in the post-natal term.
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