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Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract
Ahmed Abulfotooh Eid1, Haytham Badawy1, Mostafa Elmissiry1
1Department of Urology, Faculty of medicine, University of Alexandria, Egypt.
Insights
Effective bowel management significantly improves bladder dynamics in children with neuropathic lower urinary tract dysfunction. This approach reduces urinary tract infections and enhances bladder capacity, leading to better overall outcomes.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder
- Bowel Management
Background:
- Children with neuropathic lower urinary tract dysfunction often experience concurrent bowel dysfunction, urinary tract infections (UTIs), and vesicoureteral reflux (VUR).
- Addressing bowel issues is crucial for managing these complex pediatric urological conditions.
Purpose of the Study:
- To investigate the impact of comprehensive bowel management strategies on bladder dynamics in children with neuropathic lower urinary tract dysfunction.
- To evaluate the effect of improved bowel function on associated urological complications.
Main Methods:
- A prospective study of 30 children (21 girls, 9 boys) with neuropathic lower urinary tract dysfunction and bowel dysfunction.
- Bowel management included psychological support, dietary changes, enemas, and maintenance therapy.
- Patients were assessed using history, physical examination, ultrasound, urodynamics, Wexener score, and bowel control charts.
Main Results:
- Significant improvements were observed in bowel dysfunction (Wexener score) and rectal diameter.
- The frequency of urinary tract infections (UTIs) decreased significantly.
- Cystometric bladder capacity increased significantly, while detrusor leak point pressure showed a non-significant decrease.
Conclusions:
- Bowel management is a critical component in treating children with neuropathic bladder dysfunction.
- Effective bowel management positively influences lower urinary tract function and reduces complication incidence.
- This study supports the importance of a multidisciplinary approach to managing pediatric neurogenic bladder.
Introduction And Aim:
Children with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics.
Patients And Methods:
In the period from January 2011 to January 2013, 30 patients, 21 girls and 9 boys with neuropathic lower urinary tract dysfunction were studied. All suffered from urinary tract and bowel dysfunctions. All children were on urological treatment. They had their bowel managed by assurance and psychological support, dietary modification, retrograde or antegrade enemas and maintenance therapy. They were evaluated initially and on follow up by history, physical examination, ultrasound, urodynamics, Wexener score and bowel control chart.
Results:
Mean age was 8.3 ± 3.47 years (range from 4 to 18). There was a significant decrease in bowel dysfunction (Wexener score decreased from 12.67 ± 1.54 to 10.17 ± 1.76, p = 0.00), rectal diameter (decreased from 34.83 ± 5.91 to 27.90 ± 5.32 mm, p = 0.00), and frequency of UTI (p = 0.00). Detrusor leak point pressure decreased from 37.33 ± 24.95 to 30 ± 17.35 cmH2O, (p = 0.42). The cystometric capacity increased from 136.63 ± 45.69 to 155.17 ± 39.29 ml. (p = 0.001). Reflux and kidney function improved but was not statistically significant (p = 0.25 and p = 0.066 respectively).
Conclusion:
Management of bowel dysfunction is of utmost importance in the treatment of children with neuropathic bladder dysfunction. It has a positive effect on lower urinary tract function and decreasing the incidence of complications. This is a LEVEL III prospective study.
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