Bladder function after fetal surgery for myelomeningocele

John W. Brock, N. Scott Carr, N. Scott Adzick, Pamela K. Burrows, John C. Thomas, Elizabeth A. Thom, Lori J. Howell, Jody A. Farrell, Mary E. Dabrowiak, Diana L Farmer, Earl Y. Cheng, Bradley P. Kropp, Anthony A. Caldamone, Dorothy I. Bulas, Susan Tolivaisa, Laurence S. Baskin

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

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 (CIC) 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 CIC 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 CIC 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.

Original languageEnglish (US)
Pages (from-to)e906-e913
JournalPediatrics
Volume136
Issue number4
DOIs
StatePublished - Oct 1 2015

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Meningomyelocele
Intermittent Urethral Catheterization
Urinary Bladder
Confidence Intervals
Urodynamics
Kidney
Pregnant Women

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Brock, J. W., Carr, N. S., Adzick, N. S., Burrows, P. K., Thomas, J. C., Thom, E. A., ... Baskin, L. S. (2015). Bladder function after fetal surgery for myelomeningocele. Pediatrics, 136(4), e906-e913. https://doi.org/10.1542/peds.2015-2114

Bladder function after fetal surgery for myelomeningocele. / Brock, John W.; Carr, N. Scott; Adzick, N. Scott; Burrows, Pamela K.; Thomas, John C.; Thom, Elizabeth A.; Howell, Lori J.; Farrell, Jody A.; Dabrowiak, Mary E.; Farmer, Diana L; Cheng, Earl Y.; Kropp, Bradley P.; Caldamone, Anthony A.; Bulas, Dorothy I.; Tolivaisa, Susan; Baskin, Laurence S.

In: Pediatrics, Vol. 136, No. 4, 01.10.2015, p. e906-e913.

Research output: Contribution to journalArticle

Brock, JW, Carr, NS, Adzick, NS, Burrows, PK, Thomas, JC, Thom, EA, Howell, LJ, Farrell, JA, Dabrowiak, ME, Farmer, DL, Cheng, EY, Kropp, BP, Caldamone, AA, Bulas, DI, Tolivaisa, S & Baskin, LS 2015, 'Bladder function after fetal surgery for myelomeningocele', Pediatrics, vol. 136, no. 4, pp. e906-e913. https://doi.org/10.1542/peds.2015-2114
Brock JW, Carr NS, Adzick NS, Burrows PK, Thomas JC, Thom EA et al. Bladder function after fetal surgery for myelomeningocele. Pediatrics. 2015 Oct 1;136(4):e906-e913. https://doi.org/10.1542/peds.2015-2114
Brock, John W. ; Carr, N. Scott ; Adzick, N. Scott ; Burrows, Pamela K. ; Thomas, John C. ; Thom, Elizabeth A. ; Howell, Lori J. ; Farrell, Jody A. ; Dabrowiak, Mary E. ; Farmer, Diana L ; Cheng, Earl Y. ; Kropp, Bradley P. ; Caldamone, Anthony A. ; Bulas, Dorothy I. ; Tolivaisa, Susan ; Baskin, Laurence S. / Bladder function after fetal surgery for myelomeningocele. In: Pediatrics. 2015 ; Vol. 136, No. 4. pp. e906-e913.
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abstract = "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 (CIC) 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 CIC 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 CIC 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.",
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T1 - Bladder function after fetal surgery for myelomeningocele

AU - Brock, John W.

AU - Carr, N. Scott

AU - Adzick, N. Scott

AU - Burrows, Pamela K.

AU - Thomas, John C.

AU - Thom, Elizabeth A.

AU - Howell, Lori J.

AU - Farrell, Jody A.

AU - Dabrowiak, Mary E.

AU - Farmer, Diana L

AU - Cheng, Earl Y.

AU - Kropp, Bradley P.

AU - Caldamone, Anthony A.

AU - Bulas, Dorothy I.

AU - Tolivaisa, Susan

AU - Baskin, Laurence S.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - 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 (CIC) 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 CIC 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 CIC 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.

AB - 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 (CIC) 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 CIC 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 CIC 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.

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