Avaliação inicial do trato urinário inferior de crianças com mielomeningocele submetidas à correção intrauterina e pós-natal

Abstract

Myelomeningocele is a birth defect of the central nervous system and most individuals with this condition develop a neurogenic bladder, which can result in chronic kidney disease. Traditionally, surgery to correct myelomeningocele is performed in the first few hours after birth. A few years ago, the intrauterine repair of myelomeningocele was created, with encouraging results in relation to hydrocephalus and motor function, but with still not so clear benefits in urinary tract function. The aim of this study was to evaluate the initial function of the lower urinary tract in children with myelomeningocele who underwent intrauterine surgical repair, compared with children with myelomeningocele who underwent postnatal repair. A cross-sectional study was carried out based on the medical records of children with myelomeningocele admitted from January 2017 to January 2022 and attended at the SARAH Network units in Rio de Janeiro and Brasília. The research included 147 children, separated into the intrauterine repair group, with 44 children, and postnatal repair, with 103 children. The following were described and analyzed: socio-demographic, functional and clinical characteristics; repercussions on the upper urinary tract; urodynamic parameters and risk classification for upper urinary tract deterioration after urological examinations, comparing data from both groups. Children in the intrauterine repair group were admitted earlier (between 1 to 27 months; median 3.50 [IIQ 2.00-6.00] in the intrauterine group and between 1 to 34 months; median 6.00 [IIQ 3.00-12.5] in the postnatal group) (p = 0.001) and performed urological examinations earlier (between 4 and 31 months; median 10.0 [IIQ 7.00-14.2] in the intrauterine group and between 4 and 36 months; median 15.0 [IQR 10.5-21.5] in the postnatal group) (p < .001). Regarding the urodynamic parameters, no significant differences were observed in the frequency of detrusor hyperactivity, with a high percentage in both groups (p = 0.532; 95%CI 0.88 to 1.28), in detrusor leak point pressures (p = 0.799; 95%CI -34.9 to 41.5) and at the end of filling pressures (p = 0.484; 95%CI -4.00 to 2.00) between patients undergoing intrauterine surgery and postnatal surgery, leading to a similar risk classification between groups. No differences were observed in the frequencies of outcomes considered unfavorable, such as changes in renal function in laboratory tests (p = 0.471; 95%CI 0.46 to 5.26), moderate to severe hydronephrosis (p = 0.897; 95%CI 0.12 to 5.72) and vesicoureteral reflux degrees III to V (p = 0.818; 95%CI 0.29 to 2.58). Our results, therefore, showed no difference in the initial assessment of lower urinary tract function in children who underwent intrauterine repair of myelomeningocele, when compared to children who underwent postnatal surgery.