Original articleImpact of spinal cord malformation on bladder function in children with anorectal malformations
Section snippets
Patients
This material was based on a prospective study of patients with ARM referred to the Department of Pediatric Surgery, the Queen Silvia Children's Hospital Gothenburg, Sweden, from 1995 to 2005. The department is a regional referral center in the southwestern part of Sweden, serving a population of approximately 2.5 million.
During this period, 105 patients with ARM, representing virtually all patients with anal anomalies in the region, were treated. Forty-five cases were categorized as high
Methods
Investigations in the neonatal period included plain abdominal film, colostogram via a transperineal punction through the fistula or the distal colostomy, spinal and sacral radiograph, ultrasound of urinary tract, and voiding cystourethrography. Spinal ultrasound was routinely performed in the neonatal period in 24 patients. The limited number of patients investigated is because the method was only available from 1999. Magnetic resonance imaging (MRI) of the spine was added in 14 patients owing
Statistical methods
For comparison between groups, Mann-Whitney U test was used for continuous variables and Fisher's Exact test for dichotomous variables. For analyses of difference of before and after, Wilcoxon's signed rank test was used. All tests were 2-tailed and conducted at 5% significance level.
Anorectal malformation in boys (n = 21)
Sixteen (8 prostatic, 5 bulbar, and 3 no fistula) of 21 boys with ARM were considered to have normal urodynamics both before and after surgical reconstruction. Seven of these boys were found to have mild detrusor overactivity (4 before and 6 after surgery), which was considered to be of nonneurogenic origin.
Five boys with fistulas (1 bladder neck, 4 prostatic) were considered to have NBD both before and after reconstructive surgery. The urodynamic pattern was characterized by neurogenic
Discussion
In this prospective study of children with ARM, 25% of the children were found to have NBD. There is wide variation reported in the prevalence of neurogenic bladder dysfunction in children with ARM, from 17% to 50% [2], [3], [4], [5]. The variation seems to depend on factors such as small material, selection of patients, retrospective studies, differences in investigation techniques, and inconsistency in classification and follow-up program.
Regarding NBD in the present study, the problem was
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Reoperative Anorectal Procedures in Patients with Anorectal Malformations – Is Bladder Function Affected?
2023, Journal of Pediatric SurgeryThe Importance of Screening for Additional Anomalies in Patients with Anorectal Malformations: A Retrospective Cohort Study
2023, Journal of Pediatric SurgeryA prospective cohort study of assisted bladder emptying following primary cloacal repair: The Children's National experience
2023, Journal of Pediatric UrologyFour-hour voiding observations detect neurogenic lower urinary tract dysfunction in neonates with anorectal malformation
2021, Journal of Pediatric UrologyCitation Excerpt :Since bladder capacity is age dependent, we also gave bladder capacity as a percentage of the capacity expected for age, using the formula [30 + 2.5 × age in months] recommended by the ICCS standardisation document [11]. Pressure measurement (MMS, UDS 0075-Solar) was performed according to a routine method described previously [3]. To calculate reference values for normal/abnormal urodynamic findings, results from earlier studies in infants of comparable age were used [11,14].
Predictors of upper tract damage in pediatric neurogenic bladder
2017, Journal of Pediatric UrologyCitation Excerpt :The reported incidence of NVD in ARM varies from 17% to 50% and occurs more commonly with supralevator anomalies as was also noticed in this study [3,12]. Underlying intraspinal abnormality (18–50%), sacral agenesis, and damage to the afferent pelvic nerve during reconstructive procedures contribute to NVD in ARM [12]. The peculiar sex predilection of detrusor overactivity with failure of storage in boys and incomplete evacuation in girls was not seen in this study [12].
Manometric findings in relation to functional outcomes in different types of anorectal malformations
2017, Journal of Pediatric Surgery