Bladder Function After Fetal Surgery for Myelomeningocele
| Autor: | Brock, John W, Carr, Michael C, Adzick, N Scott, Burrows, Pamela K, Thomas, John C, Thom, Elizabeth A, Howell, Lori J, Farrell, Jody A, Dabrowiak, Mary E, Farmer, Diana L, Cheng, Earl Y, Kropp, Bradley P, Caldamone, Anthony A, Bulas, Dorothy I, Tolivaisa, Susan, Baskin, Laurence S, MOMS Investigators |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Urologic Diseases Meningomyelocele Time Factors Urinary Bladder Renal and urogenital Reproductive health and childbirth Kidney Medical and Health Sciences Pediatrics Neurosurgical Procedures Fetus Postoperative Complications Pregnancy Clinical Research Humans Conditions Affecting the Embryonic and Fetal Periods Ultrasonography Pediatric MOMS Investigators Psychology and Cognitive Sciences Evaluation of treatments and therapeutic interventions Urodynamics Treatment Outcome Biomedical Imaging Female Urinary Catheterization 6.4 Surgery |
| Zdroj: | Pediatrics, vol 136, iss 4 |
| Popis: | BackgroundA substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted.MethodsPregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (CIC) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures.ResultsOf the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57-1.07). Actual rates of CIC use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74; 95% CI: 0.48-1.12). Prenatal surgery resulted in less trabeculation (RR: 0.39; 95% CI: 0.19-0.79) and fewer cases of open bladder neck on urodynamics (RR: 0.61; 95% CI: 0.40-0.92) after adjustment by child's gender and lesion level. The difference in trabeculation was confirmed by ultrasound.ConclusionsPrenatal surgery did not significantly reduce the need for CIC by 30 months of age but was associated with less bladder trabeculation and open bladder neck. The implications of these findings are unclear now, but support the need for long-term urologic follow-up of patients with myelomeningocele regardless of type of surgical repair. |
| Databáze: | OpenAIRE |
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