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S22-17
(P)
FETAL MYELOMENINGOCELE REPAIR: THREE YEARS OF ACTIVE UROLOGICAL
FOLLOW UP. CAN WE PREDICT BLADDER FUNCTION?
Antonio Macedo Jr1 MACEDO JR1, Marcela LEAL DA CRUZ, Gustavo MARCONI CAETANO MARTINS,, João PARIZI, Bruno
LESLIE, Riberto Liguori LIGUORI, Gilmar GARRONE and Sérgio LEITE OTTONI
Universidade Federal de São Paulo, Pediatric Urology, São Paulo, BRAZIL
PURPOSE
The MOMS study (2011) reported benefits of neurological and orthopedic aspects of patients undergoing fetal
myelomeningocele repair. However, urological aspects were not evaluated in this study. A prospective study of urologic
evaluation was initiated in November 2011 at our institution. The aim of this study is to describe the urological
scenarium of 16 patients who had completed three years old.
MATERIAL AND METHODS
Since November 2011, 60 patients started urological evaluation and 16 of these had completed three years old. We
performed clinical evaluation, ultrasound of the urinary tract, voiding cystourethrogram and urodynamic study. Patients
were categorized into 4 groups: normal, high risk (overactive bladder with detrusor leak point pressure grater than 40
cmH2O or high filling pressure also greater than 40 cmH2O), incontinent and underactive bladder.
RESULTS
One patient was initially classified as underactive bladder, six patients as incontinent and nine as high risk. By 5 of the
high risk group patients, hydronephrosis or VUR were present, as well as, febrile UTI (one of this without hydroneprhosis
or VUR). Patients classified as incontinent pattern were only kept in surveillance, while those classified with underactive
bladder and righ risk initiated clean intermittent catheterization (CIC) without and with anticolinergic respectively. After
the initial treatment, two patients changed the high risk bladder pattern to normal one and one shifted into incontinent
pattern. Three patients remained at righ risk pattern, but without UTI. One patient underwent vesicostomy and two
patients haven't got the second urodynamic study. One patient presented initially an incontinent pattern but changed
into high risk.
CONCLUSIONS
We confirmed the need of active surveillance by this group, in order to categorize bladder patterns and evaluate
response. As shown in the initial set of exams, bladder pattern remains unpredictable.