Urinary and Fecal Continence in 5-Year-Old Patients Who Underwent in utero Myelomeningocele Repair: A Prospective Study

After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological...

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Bibliographic Details
Published in:	Fetal diagnosis and therapy Vol. 46; no. 5; p. 319
Main Authors:	Macedo, Jr, Antonio, Cavalheiro, Sérgio, Moron, Antonio, Lobountchenko, Tássia, Dini, Felipe Silveira, Ottoni, Sergio Leite, Garrone, Gilmar, Ligori, Riberto, Leal da Cruz, Marcela
Format:	Journal Article
Language:	English
Published:	Switzerland 01-11-2019
Subjects:	Age Factors Child, Preschool Databases, Factual Defecation Fecal Incontinence - etiology Fecal Incontinence - physiopathology Fecal Incontinence - therapy Female Fetal Therapies - adverse effects Fetal Therapies - methods Gestational Age Humans Male Meningomyelocele - complications Meningomyelocele - diagnostic imaging Meningomyelocele - physiopathology Meningomyelocele - surgery Prospective Studies Risk Factors Treatment Outcome Ultrasonography, Prenatal Urinary Incontinence - etiology Urinary Incontinence - physiopathology Urinary Incontinence - therapy Urodynamics Urogenital Surgical Procedures - adverse effects Fetal surgery Myelomeningocele Fecal continence Urinary continence
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Summary:	After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological care. In the present study, we were interested in estimating urinary and fecal continence in this new subset of patients. We selected from our database patients aged 5 years or older for evaluation of urinary and fecal continence. We reviewed all charts and completed a questionnaire to study aspects of urinary and fecal continence. We identified 14 patients, i.e., 4 (28.6%) males and 10 (71.4%) females. The mean age at MMC surgery was 25.6 gestational weeks. The uro-dynamic class was high-risk in 6 (42.9%), incontinent in 4 (28.6%), hypocontractile in 1 (7.1%), and normal in 3 (21.4%) patients. Three patients had undergone surgery (2 augmentations, i.e., 1 in association with a left colon ACE Macedo-Malone procedure and 1 mini-sling urethroplasty). Twelve patients underwent clean intermittent catheterization (CIC) (85.7%). Only 3 (21.4%) patients had no urinary leakage. Eleven patients (78.6%) used diapers. Eight patients (57.2%) underwent retrograde rectal irrigation and 11 (78.6%) complained of fecal loss. Eleven patients (78.6%) did not report an impact on their self-esteem. Despite the use of CIC in 85.7% of the cases, the continence rate in MMC patients operated on in utero was low and 78.6% of the patients used diapers. This data can be used to educate parents about future conditions of their 5-year-old children and may stimulate the debate regarding further attempts (surgical or not) to improve fecal and urinary continence.
ISSN:	1421-9964
DOI:	10.1159/000496791