Marcela Leal da Cruz1, Riberto Liguori2, Gilmar Garrone2, Bruno Leslie2, Sérgio Leite Ottoni2, Sérgio Carvalheiro3, Antonio Fernandes Moron4, Valdemar Ortiz2, Antonio Macedo2. 1. Department of Urology, Federal University of São Paulo, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br. 2. Department of Urology, Federal University of São Paulo, São Paulo, Brazil. 3. Department of Neurosurgery, Federal University of São Paulo, São Paulo, Brazil. 4. Department of Obstetrics-Fetal Medicine, Federal University of São Paulo, São Paulo, Brazil; Santa Joana Maternity and Hospital, São Paulo, Brazil.
Abstract
PURPOSE: We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment. MATERIALS AND 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.
PURPOSE: We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment. MATERIALS AND 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: Cássia Maria Carvalho Abrantes do Amaral; Dulce Elena Casarini; Maria Cristina Andrade; Marcela Leal da Cruz; Antônio Macedo Journal: Int Braz J Urol Date: 2020 Sep-Oct Impact factor: 3.050