ESPU Congress 2017 - Abstract book

271

19–22 APRIL, 2017, BARCELONA, SPAIN

13:06–13:09

S25-5 (PP)

★

EVOLUTION OF BLADDER FUNCTION DURING EARLY

CHILDHOOD AFTER IN UTERO MYELOMENINGOCELE

REPAIR

Maya HORST

, Luca MAZZONE

, Christine BODMER

, Martin MEULI

and Rita GOBET

1) Univ. Children’s Hospital Zurich, Pediatric Urology, Zurich, SWITZERLAND - 2) Univ. Children’s Hospital Zurich,

Pediatric Surgery, Zürich, SWITZERLAND - 3) Univ. Children’s Hospital Zurich, Center for Fetal Diagnosis and Therapy,

Zürich, SWITZERLAND - 4) Univ. Children’s Hospital, Pediatric Urology, Zürich, SWITZERLAND

PURPOSE

The urological outcome after prenatal myelomeningocele (MMC) repair is still controversial; how-

ever, recent data indicate a possible positive effect on postnatal bladder function. We aim to present

an update on the urologic outcome during early childhood after prenatal MMC repair.

MATERIAL AND METHODS

All patients operated prenatally for MMC at our institution are followed prospectively. Assessment

includes urinary ultrasound, VCUG and urodynamic study, need for clean intermittent catheteriza-

tion (CIC) and anticholinergics, and the occurrence of urinary tract infections (UTI).

RESULTS

Of the 40 patients who underwent prenatal MMC closure since 2010, one patient died after birth

due to respiratory failure. 39 patients were included in this study. Postnatal urodynamics revealed

neurogenic bladder dysfunction (NBD) in 46%. The percentage of NBD increased during the first

6 months to 76% and remaining stable during further follow-up at 65%. After 6 months none of

the patients with normal bladder function spontaneously developed bladder dysfunction; however

5 patients lost normal bladder function after removal of intradural dermoids. Vesico-ureteral reflux

was found in 6 (15%) patients. Three NBD-patients (11%) had at least one febrile UTI, patients with

normal bladder function were infect-free. CIC and anticholinergic therapy was initiated in all NBD

patients. Four patients additionally received intravesical botox injections, one patient developed

upper tract deterioration and underwent vesicostomy.

CONCLUSIONS

Our data suggest that prenatal MMC repair yields less bladder dysfunction than expected after

postnatal repair. However, further evolution of bladder function in these patients throughout child-

hood is indispensable.