Bladder Function After Fetal Surgery for Myelomeningocele

被引:77
|
作者
Brock, John W., III [1 ]
Carr, Michael C. [3 ,5 ]
Adzick, N. Scott [4 ]
Burrows, Pamela K. [6 ]
Thomas, John C. [1 ]
Thom, Elizabeth A. [6 ]
Howell, Lori J. [4 ]
Farrell, Jody A. [7 ]
Dabrowiak, Mary E. [2 ]
Farmer, Diana L. [7 ]
Cheng, Earl Y. [9 ,10 ]
Kropp, Bradley P. [11 ]
Caldamone, Anthony A. [12 ]
Bulas, Dorothy I. [13 ]
Tolivaisa, Susan [14 ]
Baskin, Laurence S. [8 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Urol, Nashville, TN USA
[2] Vanderbilt Univ, Med Ctr, Fetal Ctr, Dept Pediat, Nashville, TN USA
[3] Childrens Hosp Philadelphia, Div Pediat Urol, Philadelphia, PA 19104 USA
[4] Childrens Hosp Philadelphia, Ctr Fetal Diag & Treatment, Philadelphia, PA 19104 USA
[5] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA
[6] George Washington Univ, Biostat Ctr, Washington, DC USA
[7] Univ Calif San Francisco, Benioff Childrens Hosp, Dept Surg, San Francisco, CA 94143 USA
[8] Univ Calif San Francisco, Dept Urol, San Francisco, CA USA
[9] Lurie Childrens Hosp, Chicago, IL USA
[10] Northwestern Univ, Chicago, IL 60611 USA
[11] Univ Oklahoma, Hlth Sci Ctr, Dept Urol, Oklahoma City, OK USA
[12] Brown Univ, Warren Alpert Med Sch, Div Urol, Providence, RI 02912 USA
[13] Childrens Natl Med Ctr, Dept Diagnost Imaging & Radiol, Washington, DC 20010 USA
[14] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pregnancy & Perinatol Branch, Bethesda, MD USA
基金
美国国家卫生研究院;
关键词
NEUROGENIC BLADDER; WALL THICKNESS; CHILDREN; CLOSURE; MYELODYSPLASIA; DYSFUNCTION; NEWBORNS;
D O I
10.1542/peds.2015-2114
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND: A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted. METHODS: Pregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (GIG) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures. RESULTS Of the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57-1.07). Actual rates of GIG use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74; 95% CI: 0.48-1.12). Prenatal surgery resulted in less trabeculation (RR: 0.39; 95% CI: 0.19-0.79) and fewer cases of open bladder neck on urodynamics (RR: 0.61; 95% CI: 0.40-0.92) after adjustment by child's gender and lesion level. The difference in trabeculation was confirmed by ultrasound. CONCLUSIONS: Prenatal surgery did not significantly reduce the need for GIG by 30 months of age but was associated with less bladder trabeculation and open bladder neck. The implications of these findings are unclear now, but support the need for long-term urologic follow-up of patients with myelomeningocele regardless of type of surgical repair.
引用
收藏
页码:E906 / E913
页数:8
相关论文
共 50 条
  • [1] Bladder function and fetal treatment of myelomeningocele
    Baskin, Laurence S.
    [J]. BJU INTERNATIONAL, 2019, 123 (04) : 560 - 561
  • [2] Fetal surgery for myelomeningocele: After the Management of Myelomeningocele Study (MOMS)
    Moldenhauer, Julie S.
    Adzick, N. Scott
    [J]. SEMINARS IN FETAL & NEONATAL MEDICINE, 2017, 22 (06): : 360 - 366
  • [3] Fetal intervention for myelomeningocele: Effect on postnatal bladder function
    Holmes, NM
    Nguyen, HT
    Harrison, MR
    Farmer, DL
    Baskin, LS
    [J]. JOURNAL OF UROLOGY, 2001, 166 (06): : 2383 - 2386
  • [4] Systematic sonographic bladder volume measurements at evaluation and directly after fetal myelomeningocele repair - is bladder function predictable?
    Vonzun, L.
    Mazzone, L.
    Moehrlen, U.
    Meuli, M.
    Krahenmann, F.
    Zimmermann, R.
    Ochsenbein-Kolble, N.
    Horst, M.
    [J]. GEBURTSHILFE UND FRAUENHEILKUNDE, 2020, 80 (10) : E142 - E142
  • [6] Fetal surgery for myelomeningocele
    Hirose, S
    Farmer, DL
    Albanese, CT
    [J]. CURRENT OPINION IN OBSTETRICS & GYNECOLOGY, 2001, 13 (02) : 215 - 222
  • [7] Fetal Surgery for Myelomeningocele
    Hirose, Shinjiro
    Farmer, Diana L.
    [J]. CLINICS IN PERINATOLOGY, 2009, 36 (02) : 431 - +
  • [8] Fetal surgery for myelomeningocele
    不详
    [J]. EUROPEAN JOURNAL OF PEDIATRICS, 2000, 159 (09) : 710 - 711
  • [9] Fetal surgery for myelomeningocele
    Leslie N. Sutton
    N. Scott Adzick
    Mark P. Johnson
    [J]. Child's Nervous System, 2003, 19 : 587 - 591
  • [10] Fetal Surgery for Myelomeningocele?
    Simpson, Joe Leigh
    Greene, Michael F.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2011, 364 (11): : 1076 - 1077