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Reduction of transverse rectal diameter and its effect on bladder dynamics in children with spinal dysraphism
Zoran Radojicic1, Sasa Milivojevic2, Jelena Milin Lazovic3
1University Children's Hospital, Belgrade, Serbia. drzoranradojicic@gmail.com.
Insights
Bowel management significantly reduced rectal diameter in children with spinal dysraphism, improving bladder function and urodynamic parameters. This approach should complement standard urotherapy for better outcomes.
Area of Science:
- Pediatric Urology
- Neurogenic Bladder Management
- Spinal Dysraphism Research
Background:
- Spinal dysraphism frequently leads to bladder dysfunction and bowel management challenges.
- Transverse rectal diameter is a potential indicator of bowel dysfunction in these patients.
Purpose of the Study:
- To investigate the impact of bowel management on reducing transverse rectal diameter.
- To assess the subsequent effects on bladder dynamics and urodynamic parameters in children with spinal dysraphism.
Main Methods:
- Prospective evaluation of 61 children with spinal dysraphism undergoing bowel management.
- Echosonographic measurement of transverse rectal diameter before and after intervention.
- Urodynamic studies conducted pre- and post-bowel management without altering urological treatment.
Main Results:
- Bowel management decreased transverse rectal diameter by 56% (p < 0.001).
- Significant improvements observed in bladder capacity (39.4%), detrusor compliance (89.2%), and reductions in maximal detrusor pressure (27.8%), leak point pressure (37.2%), and post-void residual (PVR) volume (36.7%).
- Female gender and % change in maximal detrusor pressure predicted rectal diameter changes.
Conclusions:
- Reduced transverse rectal diameter through bowel management positively impacts bladder function and urodynamics in children with spinal dysraphism.
- This reduction serves as a valuable adjunct to standard urotherapy in managing these complex cases.
Introduction:
To examine the reduction of transverse rectal diameter and its effect on bladder dynamics in children with spinal dysraphism.
Methods:
We prospectively evaluated 61 consecutive children with spinal dysraphism, 25 (41%) boys and 36 (59%) girls, aged 4 to 16 years; mean age 9.3 ± 3.8 years, who received bowel management. All children underwent echosonographic measurement of transverse rectal diameter before and after starting bowel management. Also, all the patients had undergone urodynamic studies before and after starting bowel management, with no changes in their urological treatment.
Results:
Bowel management caused an decrease in transverse rectal diameter by 56 ± 7.2% (p < 0.001). In addition, a decrease was observed for maximal detrusor pressure by 27.8 ± 7.8% (p < 0.001), leak point pressure by 37.2 ± 4.4% (p < 0.001), and PVR by 36.7 ± 8.0 (p < 0.001). Maximum bladder capacity was significantly increased after bowel management in both non-adjusted (36.4 ± 14.8%; p < 0.001) and adjusted analysis for age (39.4 ± 14.3%, p < 0.001). Detrusor compliance was also increased by 89.2 ± 24.8% (p < 0.001). Female gender and % change of maximal detrusor pressure were significant predictors of transversal rectal diameter change in univariate as well as in multivariate analysis (OR = 10.548, 95% CI 2.309-48.180; p = 0.002 and OR = 1.121, 95% CI 1.009-1.245; p = 0.034).
Conclusions:
Decrease in transverse rectal diameter may be useful for bladder function and urodynamic findings in children with spinal dysraphism. Therefore, decrease in transverse rectal diameter should be a supplement to standard urotherapy.
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