title: Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. Do their bladder benefit from it?
abstract: OBJECTIVE
  To report our data on initial urological presentation after in utero myelomeningocele (MMC) closure.
  
  
  METHODS
  A prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, voiding cystourethrogram, and urodynamic evaluation.
  
  
  RESULTS
  In utero MMC closure was performed in 19 patients at gestational age of 25.6 weeks 25-27. Birth occurred at a mean gestational age of 31.8 weeks 26-36. Hyperactive bladder was observed in 89.5% 17/19. Bladder compliance was normal in two cases (10.5%), was markedly reduced in 10 patients (52.6%) and not possible to be determined due to urinary leakage in 7 patients (36.8%). We observed normal bladder capacity in 8 patients (42.1%), reduced in 11 (57.9%), and detrusor-sphincter dyssynergia in 9 patients (47.4%). Underactive bladder was diagnosed in one case. Clean Intermittent Catheterization was initiated by 11 patients (57.9%) mostly in association with anticholinergics 10/11. Vesicoureteral reflux was found in 5 patients (26.3%) and 9 had pyelonephritis at a mean follow-up of 5.4 months 2-17.
  
  
  CONCLUSIONS
  Our data suggested that despite in utero MMC surgery, patients are at risk for bladder abnormal function and renal deterioration and should be aggressively treated, not differently from those operated in the post-natal term. This study has the merit of being a prospectively set evaluation performed by one investigator, including the urodynamic study. We acknowledge the need of long-term follow up.
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marcela
authors.initials: M
authors.lastname: Leal
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Atila
authors.identifier: http://orcid.org/0000-0002-4134-936X
authors.initials: A
authors.lastname: Rondon
authors.affiliation: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
authors.affiliation: Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil.|Santa Joana Maternity and Hospital, São Paulo, Brazil.
authors.forename: Antonio Fernandes
authors.initials: AF
authors.lastname: Moron
authors.affiliation: Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Cavalheiro
mesh_terms: D003187:Compliance; D005260:Female; D046128:Fetal Therapies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008591:Meningomyelocele / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D011704:Pyelonephritis / Q000150:complications / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000503:physiopathology*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000503:physiopathology*
keywords: fetal surgery; myelomeningocele; spina bifida; urodynamics