Urological outcomes of 5-year-old patients after open prenatal spina bifida aperta repair.

Authors

Luca Mazzone, Antonin Prouza, Timothy Mueller, SPINA BIFIDA STUDY GROUP ZURICH, Maya Horst

Published in

Journal of pediatric urology. Pages 106279. Sep 15, 2026. Epub Sep 15, 2026.

Abstract

Neurogenic lower urinary tract dysfunction (NLUTD) in patients with spina bifida aperta (SBA) is a severe burden. Furthermore, spinal inclusion cysts (IC) are recognized as contributors to the decline of lower urinary tract (LUT) function in SBA, primarily through mass effect and nerve root tethering. Considering the rationale for open prenatal SBA repair (PSBAR), we hypothesized a positive effect of PSBAR on urological outcome. The primary aim of this study was to assess LUT function in five-year-old patients after PSBAR. The secondary aim was to determine whether urological outcomes have changed since the start of the PSBAR program.
All patients undergoing open PSBAR at our institution have been enrolled in a prospective standardized follow-up protocol since 2010, with data recorded using a RedCap® registry. We retrospectively analyzed these data (Dec. 2010 to August 2025), focusing on bladder diary, urodynamic and ultrasound findings, clean intermittent catheterization (CIC) and anticholinergic use, and need for urological surgeries to answer the primary research question. For the secondary research question, a subgroup analysis of patients with PSBAR before 2018 and from 2018 onward was conducted to account for the surgical refinements during 2017-2018. Patients aged five years or older were included.
104 patients were included. 24 (23%) showed normal LUT function and were capable of volitional voiding. 80 (77%) showed NLUTD. CIC was performed by 72 (70%), and 58 (56%) required anticholinergics. Ultrasound of the urinary tract showed no abnormalities in patients with normal LUT function. 22 (28%) patients with NLUTD underwent one or more urological surgeries. The subgroup analysis of patients with PSBAR before 2018 and from 2018 onwards (55 vs 49 patients) demonstrated a statistically significantly higher percentage of normal LUT function in the later group (35% vs. 13%, p < 0.05). This correlates to a significant reduction in both IC formation and need for IC-related surgery, ultimately decreasing the number of patients with secondary deterioration of LUT function (41% vs 20%), p < 0.05).
23% of patients with open PSBAR exhibit normal LUT function by the age of five, increasing to 35% among those who underwent surgery from 2018 onward. This suggests improvement in urological outcome compared to the incidence of normal LUT function after postnatal repair (∼5%). IC occurrence represents a key determinant of urological outcome. Refinement of PSBAR surgical technique appears to exert a decisive influence on the urological outcome, primarily by preventing the formation of IC.

PMID:
42816301
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.

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