title: The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele.
abstract: OBJECTIVE
  The correlation between timing of the primary neurosurgical repair and urological prognosis in infants with open spinal dysraphism remains unknown. We investigated the impact of primary repair timing on neurogenic bladder prognosis in children with myelomeningocele.
  
  
  METHODS
  We retrospectively reviewed the records of 401 children with myelomeningocele followed at our multidisciplinary clinic between 1996 and 2005. Among these patients 129 were included in the study based on the availability of urological followup data at age 3 years, which was chosen as an ideal point for the standardization of urological findings. Children were assigned to 1 of 2 groups-those who underwent primary neurosurgical repair within 72 hours of delivery (group 1) and those undergoing repair after 72 hours (group 2). We compared the incidence of febrile urinary tract infections, hydronephrosis, vesicoureteral reflux and secondary tethering of the spinal cord at age 3 years, as well as cystometric bladder capacity and detrusor leak point pressure between the 2 groups.
  
  
  RESULTS
  Urological followup data at age 3 years revealed significantly increased incidence of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering of the spinal cord in children in group 2 compared to group 1 (chi-square, p < or =0.05 for all comparisons). Urodynamic assessment also showed a significantly lower bladder capacity and a substantially higher detrusor leak point pressure in children who received primary repair at later than 72 hours (t test, p <0.05). A subgroup analysis of group 1 comparing children who underwent repair before and after 24 hours following delivery failed to demonstrate any significant difference in terms of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering (chi-square, p >0.05 for all comparisons), whereas mean bladder capacity was significantly higher (t test, p <0.05) and mean detrusor leak point pressure was lower (t test, p = 0.08) in children undergoing repair within 24 hours of delivery.
  
  
  CONCLUSIONS
  The timing of primary neurosurgical repair has a significant impact on neurogenic bladder prognosis in children with myelomeningocele. Closure of the spinal lesion on the first day of life seems to provide the best chance for favorable lower urinary tract function.
authors.affiliation: Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, University Hospital, Tophanelioglu cd. 13-15, Altunizade 34662, Istanbul, Turkey. tufan@marmara.edu.tr
authors.forename: Tufan
authors.initials: T
authors.lastname: Tarcan
authors.forename: Fikret Fatih
authors.initials: FF
authors.lastname: Onol
authors.forename: Yalçin
authors.initials: Y
authors.lastname: Ilker
authors.forename: Harika
authors.initials: H
authors.lastname: Alpay
authors.forename: Ferruh
authors.initials: F
authors.lastname: Simşek
authors.forename: Memet
authors.initials: M
authors.lastname: Ozek
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000150:complications*; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*