IN-UTERO MYELOMENINGOCELE REPAIR: CLINICAL OUTCOME AFTER TREATMENT OF HIGH-RISK BLADDER PATTERN. A PROSPECTIVE STUDY.
Antonio Macedo, Jr., PhD1, Sergio Ottoni, M.D.2, Gilmar Garrone, PhD2, Antonio Moron, M.D.1, Sergio Cavalheiro, M.D.1, Marcela Leal da Cruz, PhD2.
1Federal University of Sao Paulo, São Paulo, Brazil, 2CACAU/NUPEP, São Paulo, Brazil.
BACKGROUND: To evaluate treatment response to myelomeningocele patients operated in-utero and categorized as high-risk bladder pattern.
METHODS: From our prospective cohort, clinical information, images and serial urodynamic evolution (UE) of high-risk group were collected. At every UE, patients were reclassified to maintain a high-risk or low-risk pattern, so we could serially define the percentage of response to the treatment. We also defined the incidence of lower urinary tract surgery in this group.
RESULTS: Between 2011 to 2020, we have been following 121 patients and 60 (49.6%) of them were initially categorized as high-risk and included in this study. The initial UE was performed at a mean age of 7.9 months and hyperactivity was found in 83.3%(mean maximum pressure of 76.5cmH20). When evaluating patients with 2 or more UE, we identified 44 patients (follow-up: 36.8months). The recategorization of the bladder pattern confirmed maintenance of high-risk in 61.4% and low-risk in 38.6% in the second exam. Patients who underwent 3, 4 and 5 UE had a response close to 60% of change in the bladder pattern to low-risk. The incidence of surgery was 13.3% (3 vesicostomy, 2 vesicoureteral reflux surgeries and 3 bladder augmentation).
CONCLUSIONS: Early urological treatment of high-risk bladder patterns was effective in approximately 60%. The incidence of surgery was 13.3%. We reinforce the need to correctly treat every patient with myelomeningocele, in accordance with objective parameters and based on UE, whether undergoing in utero or postnatal treatment.
Back to 2021 Posters