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Impact of spinal cord malformation on bladder function in children with anorectal malformations
Helena Borg1, Gundela Holmdahl, Ingrid Olsson
1Department of Pediatric Surgery, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at University of Gothenburg, 416 85 Gothenburg, Sweden. helena.borg@vgregion.se
Insights
Neurogenic bladder dysfunction (NBD) in children with anorectal malformations (ARMs) is linked to spinal cord issues. Spinal ultrasound and perineal inspection can screen for NBD, with urodynamics reserved for suspicious cases.
Area of Science:
- Pediatric Urology
- Neuro-urology
- Congenital Malformations
Background:
- Anorectal malformations (ARMs) can be associated with neurogenic bladder dysfunction (NBD).
- Identifying risk factors for NBD is crucial for appropriate management in pediatric patients with ARMs.
Purpose of the Study:
- To investigate risk factors for neurogenic bladder dysfunction (NBD) in children with high anorectal malformations (ARMs).
- To determine the necessity of urodynamic studies in pediatric patients diagnosed with ARMs.
Main Methods:
- Urodynamic evaluation of bladder function was performed before and after posterior sagittal anorectoplasty (PSARP) in 37 patients with high ARMs.
- Spinal imaging, including radiography, ultrasound, and MRI when indicated, was utilized to assess spinal anomalies.
Main Results:
- Neurogenic bladder dysfunction (NBD) was identified in 25% of ARM patients, primarily associated with spinal cord malformations like regression or tethering.
- Partial sacral agenesis and abnormal perineal appearance in boys were correlated with NBD.
- Iatrogenic denervation risk appears minimal with the PSARP technique.
Conclusions:
- Spinal ultrasound and perineal inspection are recommended screening tools for NBD in children with ARMs.
- Urodynamic investigation should be reserved for patients with suspected spinal cord anomalies or other NBD indicators.
- Children with spinal cord malformations require regular urodynamic follow-up due to the risk of tethered cord syndrome.
Purpose:
Risk factors for the presence of neurogenic bladder dysfunction (NBD) in children born with high anorectal malformations (ARMs), were investigated, to identify the need for urodynamics in these patients.
Material And Methods:
The study included 37 patients with high ARMs (21 boys and 16 girls). Bladder function was evaluated with urodynamics both before and after anorectoplasty (posterior sagittal anorectoplasty [PSARP]). All patients were investigated with spinal radiograph. Spinal ultrasound was performed in the neonatal period, and magnetic resonance imaging was added in case of abnormal ultrasound or urodynamics and in case of cloacal malformation.
Results:
In ARM patients with rectourethral and vestibular fistulas and cloacas, NBD was identified in 9 children (25%). The bladder dysfunction was innate in all cases except in one girl with cloaca, indicating that the risk of iatrogenic denervation seems minimal using the PSARP technique. All children with innate NBD had a spinal cord malformation either as spinal cord regression or tethering with or without a lipoma. Concerning vertebral status, almost all children with NBD had partial sacral agenesis. Abnormal perineal appearance was highly correlated to NBD in boys, especially in those with a spinal cord regression malformation. Innate NBD was not found in any child with normal spinal cord.
Conclusion:
From these results, we suggest that spinal ultrasound and perineal inspection are used as screening procedures for NBD in children with ARM. Urodynamic investigation is recommended only when spinal cord anomalies or other signs indicative of NBD are present. In case of spinal cord malformation, repeated urodynamics during follow-up is mandatory because of the risk for developing tethered cord syndrome.
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