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19–22 APRIL, 2017, BARCELONA, SPAIN
12:46–12:51
S25-3 (LO)
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DOES IN-UTERO MMC SURGERY IMPACT
ON BLADDER FUNCTION AND UROLOGICAL OUTCOME?
A COMPARATIVE STUDY OF FETAL VERSUS POSTNATAL
MMC REPAIR
Marcela LEAL DA CRUZ
1
, João PARIZI
2
, Antonio MACEDO JR
3
, Sérgio OTTONI
1
,
Gilmar GARRONE
4
, Maria Isabel SILVA SILVA
5
, Jorge Antonio POMPERMAIER
5
and Riberto LIGUORI
6
1) Cacau- Centro de apoio a criança com anomalia urológica, Nupep, São Paulo, BRAZIL - 2) Cacau - centro de
apoio da criança com anomalia urológica, Nupep, São Paulo, BRAZIL - 3) Federal University of são paulo, Pediatric
departament, São Paulo, BRAZIL - 4) Cacau- centro de apoio da criança com anomalia urologica, Nupep, São Paulo,
BRAZIL - 5) CACAU - Centro de apoio a criança com anomalia urológica, NUPEP, Sao Paulo, BRAZIL - 6) Cacau-
centro de paoio a criança com anomalia urológica, Nupep, São Paulo, BRAZIL
PURPOSE
The advantages of in utero myelomeningocele (MMC) repair towards the conventional postnatal
consists of less VP-shunts and better motor status. Since November 2011, we prospectively follow
a in utero MMC repair series. We compared this population with a subset of patients before the
onset of fetal surgery, but followed according the same protocol.
MATERIAL AND METHODS
We evaluated two groups: A (postnatal repair) and B (in utero repair). We compared demographic
data, gestational age at diagnosis and birth, age at first urological evaluation in our clinic, incidence
of febrile urinary tract infection (UTI) and findings at renal ultrasound (US), voiding cystourethro-
gramVCUG and urodynamic exam (UE). All data was collected from initial urological set.
RESULTS
A total of 165 patients were studied: 86 at group A and 79 at group B. Mean prenatal diagnosis of
MMC was 27.4 weeks of gestational age to group A and 20.5 to group B and mean gestational age
at birth was 37.2 weeks and 33 weeks to groups Aand B, respectively. The first urological evaluation
occurred at a mean age of 27.9 months and 5.4 months in group B. UTI ratio was 40.7% in group
A and 22.8% in group B (p: 0,014). US found 22.9% and 19.2% of hydronephrosis in groups A and
B, respectively. There was a higher incidence of overactive bladder (p: 0.002) and urinary leakage
in group B but with comparable bladder capacity.
CONCLUSIONS
Our data showed that MMC patients operated in utero presented earlier to urologist, had higher
incidence of overactive pattern but less febrile UTI episodes. Group A had higher incidence of blad-
der thickness 40.9% vs 19.2% but comparable incidence of vesicoureteral reflux 15.6% vs 16.7%.
It is unclear if some of the different characteristics were linked to type of neurosurgical treatment or
to later initial presentation.