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Abstract：
BACKGROUND: The purpose of this study was to determine the incidence of lower urinary tract surgery in patients with myelomeningocele (MMC) operated in utero as well as in the subgroup of patients with a minimum age of 5 years.
METHODS: We use a previously published protocol to categorize bladder patterns and propose the treatment: high risk pattern-anticholinergics and clean intermittent catheterization (CIC); incontinent and normal patterns-clinical surveillance and underactivity pattern- CIC. Non-response to clinical treatment with maintenance of detrusor pressure higher than 40 cmH20 with worsening of hydronephrosis or recurrent urinary infection were imperative indications for surgery and urinary incontinence due to sphincter deficiency and leakage pressure below 40 cmH20 in patients aged 5 years and older were possible indications too. We identified the prevalence of urinary tract surgery and concomitant treatment of constipation and refractory fecal incontinence by convenience, the technique performed and surgery outcomes.
RESULTS: A total of 122 patients are part of the prospective protocol. The first UE was performed in 119 patients (median age of 4 months). The categorization of the bladder pattern was high risk in 52.1%, incontinent in 25.2%, hypocontractile 4.2% and normal in 18.5%. Current follow-up was 29.9 months (1-99 months). Surgery was performed on 10 patients (8.4%): 3 vesicostomies, 2 surgeries to treat vesicoureteral reflux, 6 bladder augmentations, 3 ACE and a sling surgery. Considering only patients older than 5 years, we identified 65 patients and seven surgeries performed (10.8%).
CONCLUSIONS: Most bladder reconstruction studies are case series of single institutions or cooperative services, most of which are retrospective. The prospective clinical interpretation and imaging and urodynamic exams over time allowed us prospectively to define the risk of surgery in patients with myelomeningocele operated in utero. It must be considered that the response to the initial urological treatment and even the failure that leads to the need for surgery have to be evaluated in a context of follow-up time. For this reason we have studied separately patients over 5 years-old and also the group considered to be at greatest risk for surgery, the high-risk group of the categorization already described.
CONCLUSIONS: We found an incidence of 10.8% of surgeries in patients over 5 years-old and 12.9% for the high-risk group. This information may be useful to educate parents when stating urological treatment.
METHODS: We use a previously published protocol to categorize bladder patterns and propose the treatment: high risk pattern-anticholinergics and clean intermittent catheterization (CIC); incontinent and normal patterns-clinical surveillance and underactivity pattern- CIC. Non-response to clinical treatment with maintenance of detrusor pressure higher than 40 cmH20 with worsening of hydronephrosis or recurrent urinary infection were imperative indications for surgery and urinary incontinence due to sphincter deficiency and leakage pressure below 40 cmH20 in patients aged 5 years and older were possible indications too. We identified the prevalence of urinary tract surgery and concomitant treatment of constipation and refractory fecal incontinence by convenience, the technique performed and surgery outcomes.
RESULTS: A total of 122 patients are part of the prospective protocol. The first UE was performed in 119 patients (median age of 4 months). The categorization of the bladder pattern was high risk in 52.1%, incontinent in 25.2%, hypocontractile 4.2% and normal in 18.5%. Current follow-up was 29.9 months (1-99 months). Surgery was performed on 10 patients (8.4%): 3 vesicostomies, 2 surgeries to treat vesicoureteral reflux, 6 bladder augmentations, 3 ACE and a sling surgery. Considering only patients older than 5 years, we identified 65 patients and seven surgeries performed (10.8%).
CONCLUSIONS: Most bladder reconstruction studies are case series of single institutions or cooperative services, most of which are retrospective. The prospective clinical interpretation and imaging and urodynamic exams over time allowed us prospectively to define the risk of surgery in patients with myelomeningocele operated in utero. It must be considered that the response to the initial urological treatment and even the failure that leads to the need for surgery have to be evaluated in a context of follow-up time. For this reason we have studied separately patients over 5 years-old and also the group considered to be at greatest risk for surgery, the high-risk group of the categorization already described.
CONCLUSIONS: We found an incidence of 10.8% of surgeries in patients over 5 years-old and 12.9% for the high-risk group. This information may be useful to educate parents when stating urological treatment.
摘要：
背景：本研究的目的是确定子宫内手术的脊髓膜膨出（MMC）患者以及最小年龄为5岁的患者亚组的下尿路手术发生率。
方法：我们使用以前发表的方案对膀胱模式进行分类，并提出治疗方法：高风险模式-抗胆碱能药物和清洁间歇性导管插入术（CIC）；失禁和正常模式-临床监测和活动不足模式-CIC。对维持逼尿肌压力高于40cmH20并伴有肾积水恶化或复发性尿路感染的临床治疗无反应是手术的必要指征，5岁及以上的患者由于括约肌缺乏和泄漏压力低于40cmH20也是可能的指征。我们确定了尿路手术的患病率和便秘和难治性大便失禁的伴随治疗方便，所执行的技术和手术结果。
结果：共有122名患者是前瞻性方案的一部分。首次UE在119名患者中进行(中位年龄4个月)。膀胱模式的分类是高风险的52.1％，失禁占25.2%，收缩不足4.2%和正常18.5%。当前随访时间为29.9个月（1-99个月）。对10例患者（8.4％）进行了手术：3例膀胱切开术，2例治疗膀胱输尿管反流的手术，6个膀胱扩大，3ACE和吊带手术。仅考虑5岁以上的患者，我们确定了65例患者和7例手术(10.8%).
结论：大多数膀胱重建研究是单一机构或合作服务的病例系列，其中大部分是回顾性的。随着时间的推移，前瞻性临床解释以及影像学和尿动力学检查使我们能够前瞻性地确定子宫内手术的脊髓膜膨出患者的手术风险。必须考虑到，必须在随访时间的背景下评估对初始泌尿外科治疗的反应，甚至导致手术需要的失败。出于这个原因，我们分别研究了5岁以上的患者以及被认为具有最大手术风险的组，已经描述的分类的高危人群。
结论：我们发现5岁以上患者的手术发生率为10.8%，高危人群为12.9%。这些信息可能有助于在说明泌尿外科治疗时教育父母。
方法：我们使用以前发表的方案对膀胱模式进行分类，并提出治疗方法：高风险模式-抗胆碱能药物和清洁间歇性导管插入术（CIC）；失禁和正常模式-临床监测和活动不足模式-CIC。对维持逼尿肌压力高于40cmH20并伴有肾积水恶化或复发性尿路感染的临床治疗无反应是手术的必要指征，5岁及以上的患者由于括约肌缺乏和泄漏压力低于40cmH20也是可能的指征。我们确定了尿路手术的患病率和便秘和难治性大便失禁的伴随治疗方便，所执行的技术和手术结果。
结果：共有122名患者是前瞻性方案的一部分。首次UE在119名患者中进行(中位年龄4个月)。膀胱模式的分类是高风险的52.1％，失禁占25.2%，收缩不足4.2%和正常18.5%。当前随访时间为29.9个月（1-99个月）。对10例患者（8.4％）进行了手术：3例膀胱切开术，2例治疗膀胱输尿管反流的手术，6个膀胱扩大，3ACE和吊带手术。仅考虑5岁以上的患者，我们确定了65例患者和7例手术(10.8%).
结论：大多数膀胱重建研究是单一机构或合作服务的病例系列，其中大部分是回顾性的。随着时间的推移，前瞻性临床解释以及影像学和尿动力学检查使我们能够前瞻性地确定子宫内手术的脊髓膜膨出患者的手术风险。必须考虑到，必须在随访时间的背景下评估对初始泌尿外科治疗的反应，甚至导致手术需要的失败。出于这个原因，我们分别研究了5岁以上的患者以及被认为具有最大手术风险的组，已经描述的分类的高危人群。
结论：我们发现5岁以上患者的手术发生率为10.8%，高危人群为12.9%。这些信息可能有助于在说明泌尿外科治疗时教育父母。
