title: Long-term urological impact of fetal myelomeningocele closure.
abstract: OBJECTIVE
  Between 1997 and 2002 a large number of fetal myelomeningocele closures were performed at our institution. Previously early reports showed little improvement in neonatal bladder function after fetal back closure. We evaluated the long-term urological impact of this procedure.
  
  
  METHODS
  Using a combination of retrospective review and survey questionnaire we reviewed the records of 28 patients in whom fetal myelomeningocele closure was done at our institution between 1997 and 2002. The areas addressed included medical management for neurogenic bladder and bowel, need for lower urinary tract reconstruction and functional bladder assessment by videourodynamics. Parameters after fetal myelomeningocele closure were compared to those of 33 age and sex matched patients with myelomeningocele who underwent standard postnatal closure.
  
  
  RESULTS
  We reviewed the records of 28 patients after fetal myelomeningocele closure. At a mean age of 9.6 years 23 used clean intermittent catheterization to manage the bladder, 24 required a bowel regimen to manage constipation and 6 underwent lower urinary tract reconstruction with enterocystoplasty and a catheterizable bladder channel. Videourodynamics performed in 14 patients at a mean age of 7.4 years revealed decreased bladder capacity in 71%, detrusor overactivity in 35% and increased detrusor pressure in 25%. Compared to age and sex matched children who underwent postnatal closure we noted no significant differences in bladder management, urinary tract surgery or urodynamics.
  
  
  CONCLUSIONS
  Neurogenic bowel and bladder management continues to be a significant issue for patients after fetal myelomeningocele closure. After fetal surgery patients should be followed closely, similar to patients who undergo postnatal closure.
authors.affiliation: Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee 37232, USA. douglas.b.clayton@vanderbilt.edu
authors.forename: Douglass B
authors.initials: DB
authors.lastname: Clayton
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Tanaka
authors.forename: Lisa
authors.initials: L
authors.lastname: Trusler
authors.forename: John C
authors.initials: JC
authors.lastname: Thomas
authors.forename: John C
authors.initials: JC
authors.lastname: Pope
authors.forename: Mark C
authors.initials: MC
authors.lastname: Adams
authors.forename: John W
authors.initials: JW
authors.lastname: Brock
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008161:Lumbosacral Region / Q000196:embryology / Q000601:surgery*; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000196:embryology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*