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Neurovesical dysfunction in children after surgery for high or intermediate anorectal malformations
V Hulthén de Medina1, L Mellstam, P Amark
1Department of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Acta Paediatrica (Oslo, Norway : 1992)
|March 3, 2004
Summary
Neurovesical dysfunction (NVD) affects some patients after imperforate anus surgery, even without sacral anomalies. Early observation in newborns with anorectal malformations is recommended to detect NVD.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Imperforate anus is a congenital condition requiring surgical correction.
- Bladder dysfunction can be a complication following surgical repair of anorectal malformations.
- Neurovesical dysfunction (NVD) assessment is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the incidence and characteristics of bladder dysfunction in patients surgically treated for imperforate anus.
- To identify risk factors and associated anomalies in patients with NVD.
- To establish recommendations for early detection of NVD.
Main Methods:
- Retrospective review of 36 patients (11M, 25F) with high or intermediate imperforate anus treated between 1987 and 1997.
- Patients underwent posterior sagittal anorectoplasty.
- Micturition habits were assessed via structured interviews, flowmetry, residual urine measurements, and cystometry when indicated.
Main Results:
- 30 out of 36 patients had normal micturition habits.
- Six patients (16.7%) were diagnosed with neurovesical dysfunction (NVD), characterized by difficulty emptying the bladder and pathological residual volumes.
- NVD occurred in patients with various anorectal malformations, including rectourethral fistulae, cloacal malformations, and rectovestibular fistulae. Four of these six patients had sacral anomalies.
Conclusions:
- Neurovesical dysfunction (NVD) can occur in patients with imperforate anus, irrespective of sacral anomalies.
- Early detection of NVD is essential for appropriate management and improved outcomes.
- A 4-hour micturition observation in all newborns with intermediate or high anorectal anomalies is recommended to identify NVD promptly.