Department of Urology, Children's Hospital Boston, Boston, Massachusetts, USA.
J Urol. 2012 Oct;188(4 Suppl):1567-71. doi: 10.1016/j.juro.2012.06.034. Epub 2012 Aug 20.
Recent data comparing prenatal to postnatal closure of myelomeningocele showed a decreased need for ventriculoperitoneal shunting and improved lower extremity motor outcomes in patients who underwent closure prenatally. A total of 11 children whose spinal defect was closed in utero were followed at our spina bifida center. We hypothesized that in utero repair of myelomeningocele improves lower urinary tract function compared to postnatal repair.
Eleven patients who underwent in utero repair were matched to 22 control patients who underwent postnatal repair according to age, gender and level of spinal defect. Urological outcomes were retrospectively reviewed including urodynamic study data, need for clean intermittent catheterization, use of anticholinergic agents and prophylactic antibiotics, and surgical history. The need for ventriculoperitoneal shunting or spinal cord untethering surgery was also reviewed.
Mean followup was 7.2 years for patients who underwent in utero repair and 7.3 years for those who underwent postnatal repair. Mean patient age at compared urodynamic studies was 5.9 years for in utero repair and 6.0 years for postnatal repair. The in utero repair group was comprised of 5 lumbar and 6 sacral level defects with equal matching (1:2) in the postnatal repair cohort. There were no differences between the groups in terms of need for clean intermittent catheterization, incontinence between catheterizations or anticholinergic/antibiotic use. Urodynamic parameters including bladder capacity, detrusor pressure at capacity, detrusor overactivity and the presence of detrusor sphincter dyssynergia were not significantly different between the groups. There was no difference in the rate of ventriculoperitoneal shunting (p = 0.14) or untethering surgery (p = 0.99).
While in utero closure of myelomeningocele has been shown to decrease rates of ventriculoperitoneal shunting and improve motor function, it is not associated with any significant improvement in lower urinary tract function compared to repair after birth.
最近比较胎儿期和产后闭合脊髓脊膜膨出的数据表明，在接受产前闭合的患者中，需要进行脑室-腹腔分流术的比例降低，下肢运动功能得到改善。我们的脊柱裂中心共随访了 11 例在子宫内闭合脊柱缺陷的患儿。我们假设与产后修复相比，胎儿期修复脊髓脊膜膨出可改善下尿路功能。
根据年龄、性别和脊柱缺陷水平，将 11 例接受宫内修复的患者与 22 例接受产后修复的对照患者相匹配。回顾性分析尿动力学研究数据、清洁间歇性导尿需求、抗胆碱能药物和预防性抗生素使用以及手术史。还回顾了脑室-腹腔分流或脊髓松解手术的需求。
接受宫内修复的患者平均随访 7.2 年，接受产后修复的患者平均随访 7.3 年。接受比较性尿动力学研究的患者平均年龄为 5.9 岁，接受宫内修复的患者为 6.0 岁。宫内修复组包括 5 例腰椎和 6 例骶骨水平缺陷，产后修复组 1:2 配对。两组在清洁间歇性导尿需求、导尿间失禁或抗胆碱能/抗生素使用方面无差异。膀胱容量、容量时逼尿肌压力、逼尿肌过度活动和逼尿肌括约肌协同失调的存在等尿动力学参数在两组间无显著差异。脑室-腹腔分流术（p=0.14）或松解术（p=0.99）的发生率无差异。
虽然胎儿期闭合脊髓脊膜膨出已被证明可降低脑室-腹腔分流术的发生率并改善运动功能，但与出生后修复相比，其对下尿路功能并无显著改善。
