title: Prenatal myelomeningocele repair: Do bladders better?
abstract: OBJECTIVE
  Prenatal myelomeningocele (MMC) repair has been proven to significantly reduce the need for hydrocephalus shunting and improve lower-extremity motor outcomes. The aim of this study was to evaluate the effect of prenatal MMC repair on the urological outcome.
  
  
  METHODS
  All patients who underwent fetal MMC repair at our institution are followed prospectively. Assessments include medical history, renal and bladder ultrasound, voiding cystourethrogram and urodynamic study, need for clean intermittent catheterization (CIC) and anticholinergics, and the occurrence of urinary tract infections (UTI).
  
  
  RESULTS
  Of the 30 patients who underwent prenatal MMC closure from December 2010 to December 2015, eight patients with a postnatal follow-up of at least 2 years were included in this study and compared with eight patients after postnatal MMC repair. The level of the bony spinal defect was similar in both groups. Urological evaluation at 2 years revealed normal bladder function in 50% after prenatal repair. Neurogenic bladder dysfunction requiring CIC and anticholinergic therapy was seen in 50% in the prenatal and in 100% in the postnatal group. Significant bladder wall thickening was found in 37.5% and 87.5%, respectively. Febrile UTIs occurred in 37.5% in the prenatal and 62.5% in the postnatal group during the observation period.
  
  
  CONCLUSIONS
  Our data suggest a positive effect of prenatal MMC closure on lower urinary tract function. The long-term significance of these results remains unclear. Therefore, continued close monitoring of renal and bladder function are mandatory.
authors.affiliation: Division of Pediatric Urology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Maya
authors.initials: M
authors.lastname: Horst
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Mazzone
authors.affiliation: Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schraner
authors.affiliation: Division of Pediatric Urology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Bodmer
authors.affiliation: The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.
authors.forename: Ueli
authors.initials: U
authors.lastname: Möhrlen
authors.affiliation: The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
authors.affiliation: Division of Pediatric Urology, University Children's Hospital, Zurich, Switzerland.
authors.forename: Rita
authors.initials: R
authors.lastname: Gobet
mesh_terms: D005260:Female; D005333:Fetus / Q000601:surgery*; D006801:Humans; D057928:Intermittent Urethral Catheterization; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008591:Meningomyelocele / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000503:physiopathology; D014563:Urodynamics
keywords: fetal surgery; myelomeningocele; neurogenic; spina bifida; urinary bladder; urodynamics