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A 5-YEAR PROSPECTIVE UROLOGICAL ASSESSMENT
OF IN UTERO MMC REPAIR: DOES GESTATIONAL AGE
AT BIRTH PLAY A ROLE AT LATER NEUROGENIC BLADDER
PATTERN?
Marcela LEAL DA CRUZ
1
, Antonio MACEDO JUNIOR
2
, Sergio LEITE
OTTONI
1
, Gilmar GARRONE
1
, Riberto LIGOURI
1
, Maria Isabel SILVA SILVA
1
and Jorge ANTONIO POMPERMAIER
1
1) CACAU - Centro de apoio a criança com anomalia urológica, NUPEP, Sao Paulo, BRAZIL - 2) Federal University
of Sao Paulo, Departament of pediatric, Sao Paulo, BRAZIL
PURPOSE
Amajor complication of in utero myelomeningocele (MMC) repair is premature delivery. The prema-
turity rate in Management of Myelomeningocele Study (MOMS) was 79%, with a mean gestational
age (GA) at birth of 34 weeks. Considering this particular aspect of prenatal surgery group, we
speculated if prematurity could also influence the urological outcome.
MATERIAL AND METHODS
Since November 2011, we prospectively follow a population of MMC patients that had undergonein
uterorepair. We compared the urological status of this population according to GA at birth: below
34weeks (group 1) and 34weeks or above (group 2). We reviewed clinical history, renal sonogram,
VCUG and urodynamics following a previously reported protocol.
RESULTS
We studied 79 patients,42 at group 1 and 37 at group 2. Mean GA at birth was 28.3 (25 -33) weeks
in group 1 and 35.2 (34-38) weeks in group 2. Patients were classified as high risk in 47.5% of group
1 and 54.5% of group 2, incontinent in 35% of group 1 and 33.3% of group 2, hypocontractile in
10% of group 1 and normal pattern in 7.5% of group 1 and 12.1% of group 2, none with statistical
significance. Mean follow up was 27,9 and 24,3months for groups 1 and 2, respectively.
CONCLUSIONS
Our data showed that GA at birth has little impact on bladder pattern so as to clinical outcome.
These data reinforce the need to follow these patients very closely irrespectively of earlier or later
age at birth.
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Discussion