Early postnatal bladder function in fetoscopic myelomeningocele repair patients

Issue title: Spina Bifida

Guest editors: Timothy Brei and Amy Houtrow

Article type: Research Article

Authors: Huang, Gene O.^a | Belfort, Michael A.^b | Whitehead, William E.^c | Olutoye, Oluyinka O.^d | Castillo, Jonathan^e | Castillo, Heidi^e | Ostermaier, Kathryn K.^e | Koh, Chester J.^a | Tu, Duong D.^{a; *}

Affiliations: [a] Division of Urology, Department of Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA | [b] Department of Obstetrics and Gynecology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA | [c] Department of Neurosurgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA | [d] Division of Pediatric Surgery, Department of Surgery, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA | [e] Division of Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA

Correspondence: [*] Corresponding author: Duong D. Tu, Department of Pediatric Urology, Texas Children’s Hospital, 6701 Fannin Street, Suite 620, Houston, TX 77030, USA. Tel.: +1 832 822 3160; E-mail: dxtu@texaschildrens.org.

Abstract: PURPOSE: Prenatal repair of myelomeningocele (MMC) via hysterotomy has demonstrated neurosurgical and motor benefits, when compared to postnatal repairs. Urologic benefits, however, remain to be seen. The purpose of this study was to review early postnatal bladder function in patients undergoing a novel endoscopic approach for MMC repair using an exteriorized uterus. METHODS: A prospective urologic assessment of patients undergoing fetoscopic MMC repair and receiving subsequent care at our facility, was performed. Patients were managed and urodynamic studies risk-stratified according to the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida. RESULTS: Fetoscopic MMC repair was performed in 14 patients. No patients had hydronephrosis or bladder thickening at birth. Detrusor overactivity was observed in nine (64.3%) patients. Impaired compliance was seen in eight (57.1%) patients. No patients had a detrusor leak point pressure of > 40 cm H2O or evidence of detrusor sphincter dyssynergia. Three (21.4%) patients had vesicoureteral reflux, seven (50.0%) had an open bladder neck, and none had trabeculated bladders. CONCLUSION: In this early experience with fetoscopic MMC repair, postnatal bladder function does not appear to be any worse than that of previously reported prenatal or postnatal closures.

Keywords: Neural tube defects, spinal dysraphism, neurogenic urinary bladder, urodynamics

DOI: 10.3233/PRM-170465

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 10, no. 3-4, pp. 327-333, 2017