At present, I have one patient under my care who underwent prenatal closure of his spina bifida defect. Only with time, will we be able to determine whether this intervention has been of benefit for him from a urological standpoint. MOMS (Management of Myelomeningocele Study) is, as yet, the only prospective randomised trial to compare the effects of prenatal to postnatal surgical closure of the spinal defect. At 30 months of age, less bladder trabeculation and a more normal bladder shape were noted in those undergoing prenatal surgery. In this recent study, Brock et al. present longer-term outcomes of the MOMS trial (MOMS 2). Mean age of follow-up was 7.4 years in both the prenatal and postnatal surgical groups. Less patients (62% in the prenatal vs. 87% in the postnatal surgical group) had been placed on clean intermittent catheterisation (CIC). Volitional voiding was better in the prenatal group (24% vs. 4%). However, there were similar numbers of patients who had undergone augmentation cystoplasty and vesicostomy formation. Apart from higher post-void residuals in the postnatal surgery group, there were no differences in video urodynamic data or findings on ultrasound of the renal tract. Improved long-term lower urinary tract function would be of great benefit to both patient and parents and provide further support to parents facing the decision whether to undergo prenatal intervention. Some of the differences noted may have been secondary to variability in interventions provided by their local treating urologist (rather than care being provided solely by trial sites or protocol). Similarly, definitions such as ‘volitional voiding’ are not well defined (e.g. a patient who is not on routine CIC or in nappies is a volitional voider in this study). Lastly, parents may have a bias towards presenting more normal outcomes if they have undergone prenatal intervention. Overall, an excellent study and well worth reading.
