Preoperative occupational therapy in children with neurogenic bladder: improving independence with bladder management and self-catheterization

Kane, Morgan

doi:10.1007/s11884-021-00643-2

Cited by 1 publication

(1 citation statement)

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“…Many patients who are continent may still be dependent on caregivers for completion of CIC routines, limiting their functional self-care outcomes. 45 For the purposes of this study, we elected to use a composite endpoint of gastrointestinal surgery or enema dependence for bowel dysfunction, and genitourinary surgery or CIC dependence for urinary dysfunction. The decision between surgical management and enema/CIC dependence can be physician and patient dependent; therefore, we selected these composite endpoints to best capture the need for definitive bowel and/or bladder support.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine closure of myelomeningocele defects with primary linear repair versus bipedicle fasciocutaneous flaps: a post-MOMS cohort study with long-term follow-up

Pontell¹,

Yengo‐Kahn

Taylor

et al. 2023

Journal of Neurosurgery: Pediatrics

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OBJECTIVE The objective of this study was to determine the effects of in utero bipedicle flaps on maternal-fetal morbidity/mortality, the need for CSF diversion, and long-term functional outcomes. METHODS Eighty-six patients who underwent fetal myelomeningocele repair from 2011 to 2021 at a single institution were reviewed. Primary outcomes included intrauterine fetal demise, postnatal death, postnatal myelomeningocele repair dehiscence, and CSF diversion by final follow-up. RESULTS The cohorts were no different with regard to race, ethnicity, maternal age at fetal surgery, body mass index, gravidity, parity, gestational age at fetal surgery, estimated fetal weight at fetal surgery, or fetal lesion level. Of the 86 patients, 64 underwent primary linear repair and 22 underwent bipedicle flap repair. There were no significant differences in rates of intrauterine fetal demise, postnatal mortality, midline repair site dehiscence, or the need for CSF diversion by final follow-up. Operative times were longer (32.5 vs 18.7 minutes, p < 0.001) and gestational age at delivery was lower (232 vs 241 days, p = 0.01) in the bipedicle flap cohort, but long-term functional outcomes were not different. CONCLUSIONS Analysis of the total cohort affirms the long-term benefits of fetal myelomeningocele repair. In utero bipedicle flaps are safe and can be used for high-tension lesions without increasing perioperative risks to the mother or fetus. In utero flaps preserve the long-term benefits seen with primary linear repair and may expand inclusion criteria for fetal repair, providing life-changing care for more patients.

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Section: Discussionmentioning

confidence: 99%