title: A 4-Year Prospective Urological Assessment of In Utero Myelomeningocele Repair-Does Gestational Age at Birth Have a Role in Later Neurogenic Bladder Pattern?
abstract: Premature delivery is a major complication of in utero myelomeningocele repair. The prematurity rate in MOMS (Management of Myelomeningocele Study) was 79%, with a mean gestational age at birth of 34 weeks. We speculated that prematurity could also influence urological outcome in patients operated on prenatally for myelomeningocele.
  
  
  
  Beginning in November 2011, we prospectively followed a population of patients with myelomeningocele who had undergone in utero repair.
  
  
  
  We compared patients based on gestational age at birth, ie younger than 34 weeks (group 1, 42 patients) and 34 weeks or older (group 2, 37 patients). Mean gestational age at birth was 28.3 weeks (range 25 to 33) in group 1 and 35.2 weeks (34 to 38) in group 2. Of the cases 47.5% in group 1 were classified as high risk, 35% as incontinent, 10% as hypocontractile and 7.5% as normal. By comparison, 54.5% of cases in group 2 were classified as high risk, 33.3% as incontinent and 12.1% as normal. Differences between the groups were not statistically significant. Mean followup was 27.9 months in group 1 and 24.3 months in group 2.
  
  
  
  Our results show that gestational age at birth has little impact on bladder pattern. These data reinforce the need to follow this population closely.
authors.affiliation: Department of Urology, Division of Pediatric Urology-Center for Supporting Children with Urological Anomalies, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.
authors.forename: Marcela
authors.initials: M
authors.lastname: Leal da Cruz
authors.affiliation: Department of Urology, Division of Pediatric Urology-Center for Supporting Children with Urological Anomalies, São Paulo, Brazil.
authors.forename: Riberto
authors.initials: R
authors.lastname: Liguori
authors.affiliation: Department of Urology, Division of Pediatric Urology-Center for Supporting Children with Urological Anomalies, São Paulo, Brazil.
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.affiliation: Department of Urology, Division of Pediatric Urology-Center for Supporting Children with Urological Anomalies, São Paulo, Brazil.
authors.forename: Sérgio Leite
authors.initials: SL
authors.lastname: Ottoni
authors.affiliation: Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Cavalheiro
authors.affiliation: Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil; Santa Joana Maternity Hospital, São Paulo, Brazil.
authors.forename: Antonio Fernandes
authors.initials: AF
authors.lastname: Moron
authors.affiliation: Department of Urology, Division of Pediatric Urology-Center for Supporting Children with Urological Anomalies, São Paulo, Brazil; Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
mesh_terms: D002675:Child, Preschool; D005260:Female; D005333:Fetus / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008591:Meningomyelocele / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology* / Q000209:etiology*
keywords: fetal therapies; meningomyelocele; prenatal diagnosis; urodynamics