Related Experiment Videos
The effect of rectosigmoidectomy and Duhamel-type pull-through procedure on lower urinary tract function in children
T M Boemers1, N M Bax, J D van Gool
1Department of Pediatric Surgery and Pediatric Nephrology, University Medical Center Utrecht, The Netherlands.
Insights
Rectosigmoidectomy in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Hirschsprung's disease is a congenital condition affecting the large intestine.
- Surgical correction often involves rectosigmoidectomy and a Duhamel-type pull-through procedure.
Purpose of the Study:
- To evaluate the impact of rectosigmoidectomy and Duhamel-type pull-through on lower urinary tract function in pediatric patients with Hirschsprung's disease.
- To assess changes in urodynamic parameters before and after surgical intervention.
Main Methods:
- Prospective study of 11 children with Hirschsprung's disease.
- Standard urodynamic investigations including simultaneous measurement of abdominal pressure, bladder pressure, detrusor pressure, and pelvic floor electromyography.
- Laparoscopic resection of the aganglionic bowel segment and Duhamel-type pull-through procedure.
Main Results:
- Postoperatively, 7 out of 11 children showed abnormally large cystometric bladder capacity (87% increase) and significant residuals (156% increase).
- Despite urodynamic alterations, all children maintained detrusor contractility and voided spontaneously, with no clinical urologic problems reported.
- One child exhibited low bladder compliance postoperatively.
Conclusions:
- Rectosigmoidectomy in Hirschsprung's disease patients can lead to bladder function alterations, possibly due to partial detrusor denervation.
- Routine preoperative urodynamic screening is not indicated, but postoperative evaluation is recommended for children with voiding issues.
- Informed consent regarding potential urologic problems is crucial, especially with subtotal resection of the aganglionic segment.
Background/Purpose:
The aim of this study was to investigate the effect of rectosigmoidectomy and Duhamel-type pull-through procedure on lower urinary tract function in children with Hirschsprungs disease.
Methods:
During a 3-year period the authors assessed 11 consecutive children with Hirschsprung's disease prospectively by standard urodynamic investigations, before and after surgery. Urodynamics included simultaneous measurement of abdominal pressure, bladder pressure, detrusor pressure, and pelvic floor electromyography during filling and voiding. All children were submitted to laparoscopic resection of the aganglionic bowel segment below the cul de sac and a Duhamel-type pull-through procedure. Postoperatively, the children were assessed urodynamically and evaluated every 3 months for urologic problems.
Results:
Mean age at first urodynamic study was 5 months (range, 2 to 10). Postoperative urodynamics were performed at a mean age of 10 months (range, 5 to 159). The mean interval between operation and postoperative urodynamic study was 6 months (range, 2 to 10). No child had structural urologic anomalies or urologic problems before surgery, and all had normal preoperative urodynamic findings. After surgery, urodynamics were considered normal in 3 children. In 7 children cystometric bladder capacity (CBC) was abnormally large, and 6 of these children had significant residuals. However, all had detrusor contractility and were able to void spontaneously. One child had low bladder compliance postoperatively. Despite the urodynamic changes, no child had clinical urologic problems at further follow-up. Mean follow-up after surgery was 24 months.
Conclusions:
This study found that after rectosigmoidectomy below the cul de sac alterations of bladder function can be observed. In 7 of the 11 patients studied, mean cystometric bladder capacity was 87% higher than capacity estimated for age. Moreover, postoperative residuals were 156% higher than the preoperative values. These findings suggest that partial detrusor denervation is likely in these patients. However, because detrusor contractility was present, and none of the children had retention or any urologic problems, the findings must be interpreted carefully. Because children with Hirschsprung's disease generally do not have preexisting urologic problems, routine preoperative urodynamic screening is not necessary. However, children with voiding problems after operation should be investigated urodynamically. For legal reasons parents should be informed of possible urologic problems, especially if subtotal resection of the aganglionic bowel segment is planned.