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Bladder Function After Fetal Surgery for Myelomeningocele

Brock, 3rd, John W ; Carr, Michael C ; 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

Pediatrics (Evanston), 2015-10, Vol.136 (4), p.e906-e913 [Periódico revisado por pares]

United States: American Academy of Pediatrics

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Título:
Bladder Function After Fetal Surgery for Myelomeningocele
Autor: Brock, 3rd, John W ; Carr, Michael C ; 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
Assuntos: Adult ; Care and treatment ; Children ; Children & youth ; Female ; Fetal surgery ; Fetus ; Health aspects ; Humans ; Intubation ; Kidney - diagnostic imaging ; Male ; Meningomyelocele ; Meningomyelocele - surgery ; Myelomeningocele ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Pediatrics ; Postoperative Complications ; Pregnancy ; Surgery ; Time Factors ; Treatment Outcome ; Ultrasonic imaging ; Ultrasonic waves ; Ultrasonography ; Ultrasound ; Urinary Bladder - diagnostic imaging ; Urinary Bladder - physiopathology ; Urinary Catheterization ; Urodynamics ; Urology
É parte de: Pediatrics (Evanston), 2015-10, Vol.136 (4), p.e906-e913
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-News-1
ObjectType-Feature-3
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Descrição: A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted. 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. 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. 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.
Editor: United States: American Academy of Pediatrics
Idioma: Inglês

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Bladder Function After Fetal Surgery for Myelomeningocele

United States: American Academy of Pediatrics

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