title: Categorization of bladder dynamics and treatment after fetal myelomeningocele repair: first 50 cases prospectively assessed.
abstract: OBJECTIVE
  We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment.
  
  
  METHODS
  We performed urinary tract ultrasound, voiding cystourethrogram and urodynamic evaluation. We then categorized patients into 4 patterns, including normal, high risk (overactive bladder with detrusor leak point pressure greater than 40 cm H2O and high filling pressure also greater than 40 cm H2O), incontinent and underactive bladder.
  
  
  RESULTS
  A total of 51 patients were enrolled in study at the first medical appointment. Urodynamic evaluation was done in 48 of these patients as the initial investigation, enabling attribution of a bladder pattern. The high risk pattern was found in 27 patients (56.2%), 18 were incontinent and 1 had an underactive bladder. Only 2 patients (4.2%) in this series had a normal bladder.
  
  
  CONCLUSIONS
  Of patients who underwent myelomeningocele closure during gestation 93.7% had significant lower urinary tract dysfunction consisting of high bladder pressure or incontinence. These data reinforce the absolute need to follow these patients closely. The potential benefits of fetal surgery in the urinary tract remain to be proved.
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.
authors: Marcela
authors: M
authors: Leal da Cruz
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Riberto
authors: R
authors: Liguori
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Gilmar
authors: G
authors: Garrone
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Bruno
authors: B
authors: Leslie
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Sérgio Leite
authors: SL
authors: Ottoni
authors: Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
authors: Sérgio
authors: S
authors: Carvalheiro
authors: Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil; Santa Joana Maternity and Hospital, São Paulo, Brazil.
authors: Antonio Fernandes
authors: AF
authors: Moron
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Valdemar
authors: V
authors: Ortiz
authors: Department of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors: Antonio
authors: A
authors: Macedo
mesh_terms: D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008591:Meningomyelocele / Q000503:physiopathology* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D001743:Urinary Bladder / Q000503:physiopathology*; D014551:Urinary Tract / Q000503:physiopathology; D014563:Urodynamics
keywords: fetal therapies; meningomyelocele; neurogenic; risk; urinary bladder; urodynamics