Abstract General Information

Title

COMPARATIVE EVALUATION OF TWO IN-UTERO OPEN TECHNIQUES TO REPAIR MYELOMENINGOCELE IN REGARDS TO MOTOR, VENTRICULAR PERITONEAL SHUNT AND BLADDER FUNCTION PARAMETERS

Introduction and objective

We want to compare the impact of two techniques of open fetal closure of myelomeningocele in bladder categorization parameters.

Method

We evaluated 128 patients that underwent fetal closure of myelomeningocele: 102 with the original technique (group 1) and 26 patients with the modified technique (group 2) that consists of more aggressive dissection of distal nerves of the aponeurosis and non hermetic closure of aponeurosis to avoid compression of neural canal.

Results

Patients operated in the group 1 presented with overall good lower limb mobility in 72.54%, regular in 12.2% and poor condition in 7.8, whereas patients operated with the group 2 presented 88.4%, 3.8%, 7.6% respectively. The incidence of ventriculo peritoneal shunt was 9.8% and 3.8% respectively. The onset of febrile urinary tract infection was 25.4% (group 1) and 3.8% (group 2). The incidence of hydronephrosis was 19.6%(group 1) and no patient reported using the modified technique. No difference was found in regards to bladder trabeculation: 22.5% (group 1) and 23.07% (group 2). Vesicoureteral reflux was present in 16.6% (group 1) and 23.07% (group 2). Mean age at urodynamic evaluation was 7.9 months (group 1) and 6.8 months (group 2) and patients as high risk in 51.9% (group 1) and 38.4% (group 2), incontinent in 25.4% (group 1) and 23.07%(group 2), with underactive bladder in 2.9% (group 1), 1.9% (group 2) and normal bladder profile 15.6%(group 1) and 26.9%(group 2) respectively.

Conclusion

We found a trend of improvement of normal bladder profile and reduction of high-risk patterns with the modification in the technique of fetal myelomeningocele closure.