{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:58:33Z","timestamp":1790823513224,"version":"4.1.0"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>A substudy of the Management of Myelomeningocele Study evaluating urological outcomes was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Pregnant women diagnosed with fetal myelomeningocele were randomly assigned to either prenatal or standard postnatal surgical repair. The substudy included patients randomly assigned after April 18, 2005. The primary outcome was defined in their children as death or the need for clean intermittent catheterization (CIC) by 30 months of age characterized by prespecified criteria. Secondary outcomes included bladder and kidney abnormalities observed by urodynamics and renal\/bladder ultrasound at 12 and 30 months, which were analyzed as repeated measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Of the 115 women enrolled in the substudy, the primary outcome occurred in 52% of children in the prenatal surgery group and 66% in the postnatal surgery group (relative risk [RR]: 0.78; 95% confidence interval [CI]: 0.57\u20131.07). Actual rates of CIC use were 38% and 51% in the prenatal and postnatal surgery groups, respectively (RR: 0.74; 95% CI: 0.48\u20131.12). Prenatal surgery resulted in less trabeculation (RR: 0.39; 95% CI: 0.19\u20130.79) and fewer cases of open bladder neck on urodynamics (RR: 0.61; 95% CI: 0.40\u20130.92) after adjustment by child\u2019s gender and lesion level. The difference in trabeculation was confirmed by ultrasound.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Prenatal surgery did not significantly reduce the need for CIC by 30 months of age but was associated with less bladder trabeculation and open bladder neck. The implications of these findings are unclear now, but support the need for long-term urologic follow-up of patients with myelomeningocele regardless of type of surgical repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2015-2114","type":"journal-article","created":{"date-parts":[[2015,9,28]],"date-time":"2015-09-28T20:34:55Z","timestamp":1443472495000},"page":"e906-e913","source":"Crossref","is-referenced-by-count":110,"title":["Bladder Function After Fetal Surgery for Myelomeningocele"],"prefix":"10.1542","volume":"136","author":[{"suffix":"III","given":"John W.","family":"Brock","sequence":"first","affiliation":[{"name":"Departments of Urology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Carr","sequence":"additional","affiliation":[{"name":"Division of Pediatric Urology, and"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. Scott","family":"Adzick","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela K.","family":"Burrows","sequence":"additional","affiliation":[{"name":"The Biostatistics Center, George Washington University, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Departments of Urology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Thom","sequence":"additional","affiliation":[{"name":"The Biostatistics Center, George Washington University, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori J.","family":"Howell","sequence":"additional","affiliation":[{"name":"Center for Fetal Diagnosis and Treatment, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jody A.","family":"Farrell","sequence":"additional","affiliation":[{"name":"Department of Surgery, Benioff Children\u2019s Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Dabrowiak","sequence":"additional","affiliation":[{"name":"Pediatric Surgery\/Fetal Center, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana L.","family":"Farmer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Benioff Children\u2019s Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Earl Y.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Lurie Children\u2019s Hospital and Northwestern University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley P.","family":"Kropp","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony A.","family":"Caldamone","sequence":"additional","affiliation":[{"name":"Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy I.","family":"Bulas","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Radiology, Children\u2019s National Medical Center, Washington, District of Columbia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Tolivaisa","sequence":"additional","affiliation":[{"name":"Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence S.","family":"Baskin","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California, San Francisco, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the MOMS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,10,1]]},"reference":[{"issue":"252","key":"2021120908455542900_B1","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1001\/jama.1984.03350050038023","article-title":"Predictive value of urodynamic evaluation in newborns with myelodysplasia.","volume":"5","author":"Bauer","year":"1984","journal-title":"JAMA"},{"issue":"10","key":"2021120908455542900_B2","doi-asserted-by":"crossref","first-page":"e48399","DOI":"10.1371\/journal.pone.0048399","article-title":"Upper and lower urinary tract outcomes in adult myelomeningocele patients: a systematic review.","volume":"7","author":"Veenboer","year":"2012","journal-title":"PLoS One"},{"issue":"6","key":"2021120908455542900_B3","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1016\/S0022-5347(01)64766-9","article-title":"Neurogenic bladder dysfunction due to myelomeningocele: neonatal versus childhood treatment.","volume":"157","author":"Wu","year":"1997","journal-title":"J Urol"},{"issue":"3 pt 2","key":"2021120908455542900_B4","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1097\/00005392-199909000-00031","article-title":"Improved bladder function after prophylactic treatment of the high risk neurogenic bladder in newborns with myelomentingocele.","volume":"162","author":"Kaefer","year":"1999","journal-title":"J Urol"},{"issue":"19","key":"2021120908455542900_B5","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1001\/jama.282.19.1826","article-title":"Improvement in hindbrain herniation demonstrated by serial fetal magnetic resonance imaging following fetal surgery for myelomeningocele.","volume":"282","author":"Sutton","year":"1999","journal-title":"JAMA"},{"key":"2021120908455542900_B6","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.juro.2011.04.005","article-title":"Long-term urological impact of fetal myelomeningocele closure.","volume":"186","author":"Clayton","year":"2011","journal-title":"J Urol"},{"issue":"6","key":"2021120908455542900_B7","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/S0022-5347(05)65596-6","article-title":"Fetal intervention for myelomeningocele: effect on postnatal bladder function.","volume":"166","author":"Holmes","year":"2001","journal-title":"J Urol"},{"key":"2021120908455542900_B8","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/j.juro.2012.06.034","article-title":"In utero closure of myelomeningocele does not improve lower urinary tract function.","volume":"188","author":"Lee","year":"2012","journal-title":"J Urol"},{"issue":"3","key":"2021120908455542900_B9","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.juro.2006.04.042","article-title":"The timing of primary neurosurgical repair significantly affects neurogenic bladder prognosis in children with myelomeningocele.","volume":"176","author":"Tarcan","year":"2006","journal-title":"J Urol"},{"issue":"5","key":"2021120908455542900_B10","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1002\/nau.22576","article-title":"Urological evaluation of patients that had undergone in utero myelomeningocele closure: A prospective assessment at first presentation and early follow-up. 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