title: Bladder Function After Fetal Surgery for Myelomeningocele.
abstract: BACKGROUND
  A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted.
  
  
  METHODS
  Pregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (CIC) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures.
  
  
  RESULTS
  Of the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57-1.07). Actual rates of CIC use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74; 95% CI: 0.48-1.12). Prenatal surgery resulted in less trabeculation (RR: 0.39; 95% CI: 0.19-0.79) and fewer cases of open bladder neck on urodynamics (RR: 0.61; 95% CI: 0.40-0.92) after adjustment by child's gender and lesion level. The difference in trabeculation was confirmed by ultrasound.
  
  
  CONCLUSIONS
  Prenatal surgery did not significantly reduce the need for CIC by 30 months of age but was associated with less bladder trabeculation and open bladder neck. The implications of these findings are unclear now, but support the need for long-term urologic follow-up of patients with myelomeningocele regardless of type of surgical repair.
authors.affiliation: Departments of Urology, and john.brock@vanderbilt.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Brock
authors.affiliation: Division of Pediatric Urology, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Michael C
authors.initials: MC
authors.lastname: Carr
authors.affiliation: Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.affiliation: The Biostatistics Center, George Washington University, Washington, District of Columbia;
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Burrows
authors.affiliation: Departments of Urology, and.
authors.forename: John C
authors.initials: JC
authors.lastname: Thomas
authors.affiliation: The Biostatistics Center, George Washington University, Washington, District of Columbia;
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thom
authors.affiliation: Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Howell
authors.affiliation: Department of Surgery, Benioff Children's Hospital, and.
authors.forename: Jody A
authors.initials: JA
authors.lastname: Farrell
authors.affiliation: Pediatric Surgery/Fetal Center, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Mary E
authors.initials: ME
authors.lastname: Dabrowiak
authors.affiliation: Department of Surgery, Benioff Children's Hospital, and.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Farmer
authors.affiliation: Lurie Children's Hospital and Northwestern University, Chicago, Illinois;
authors.forename: Earl Y
authors.initials: EY
authors.lastname: Cheng
authors.affiliation: Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Kropp
authors.affiliation: Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island;
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Caldamone
authors.affiliation: Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, District of Columbia; and.
authors.forename: Dorothy I
authors.initials: DI
authors.lastname: Bulas
authors.affiliation: Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Tolivaisa
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California;
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Baskin
mesh_terms: D000328:Adult; D005260:Female; D005333:Fetus; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011247:Pregnancy; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014546:Urinary Catheterization; D014563:Urodynamics