Huang Gene O, Belfort Michael A, Whitehead William E, Olutoye Oluyinka O, Castillo Jonathan, Castillo Heidi, Ostermaier Kathryn K, Koh Chester J, Tu Duong D
Division of Urology, Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Department of Obstetrics and Gynecology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
J Pediatr Rehabil Med. 2017 Dec 11;10(3-4):327-333. doi: 10.3233/PRM-170465.
Prenatal repair of myelomeningocele (MMC) via hysterotomy has demonstrated neurosurgical and motor benefits, when compared to postnatal repairs. Urologic benefits, however, remain to be seen. The purpose of this study was to review early postnatal bladder function in patients undergoing a novel endoscopic approach for MMC repair using an exteriorized uterus.
A prospective urologic assessment of patients undergoing fetoscopic MMC repair and receiving subsequent care at our facility, was performed. Patients were managed and urodynamic studies risk-stratified according to the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida.
Fetoscopic MMC repair was performed in 14 patients. No patients had hydronephrosis or bladder thickening at birth. Detrusor overactivity was observed in nine (64.3%) patients. Impaired compliance was seen in eight (57.1%) patients. No patients had a detrusor leak point pressure of > 40 cm H2O or evidence of detrusor sphincter dyssynergia. Three (21.4%) patients had vesicoureteral reflux, seven (50.0%) had an open bladder neck, and none had trabeculated bladders.
In this early experience with fetoscopic MMC repair, postnatal bladder function does not appear to be any worse than that of previously reported prenatal or postnatal closures.
与出生后修复相比，经子宫切开术对脊髓脊膜膨出（MMC）进行产前修复已显示出神经外科和运动方面的益处。然而，泌尿系统方面的益处仍有待观察。本研究的目的是回顾采用子宫外置的新型内镜方法进行MMC修复的患者出生后的早期膀胱功能。
对在我们机构接受胎儿镜下MMC修复并接受后续护理的患者进行前瞻性泌尿系统评估。根据疾病控制与预防中心针对患有脊柱裂的新生儿和幼儿的泌尿系统和肾脏治疗方案，对患者进行管理并对尿动力学研究进行风险分层。
14例患者接受了胎儿镜下MMC修复。出生时没有患者出现肾积水或膀胱增厚。9例（64.3%）患者观察到逼尿肌过度活动。8例（57.1%）患者出现顺应性受损。没有患者的逼尿肌漏点压>40 cm H2O或存在逼尿肌括约肌协同失调的证据。3例（21.4%）患者有膀胱输尿管反流，7例（50.0%）患者膀胱颈开放，没有患者出现膀胱小梁形成。
在这项胎儿镜下MMC修复的早期经验中，出生后的膀胱功能似乎并不比先前报道的产前或产后闭合情况更差。
