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The correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and
Sasa Milivojevic1, Aleksandra Zelenovic2, Jelena Milin-Lazovic3
1Department of Urology, University Children's Hospital, Belgrade, Serbia.
Insights
A larger transverse rectal diameter in children with neurogenic bowel and bladder dysfunction correlates with poorer bladder function and increased risk of urinary tract issues. This measurement can aid in early risk assessment.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Radiology
Background:
- Neurogenic bowel and bladder dysfunction (NBBD) significantly impacts children's health.
- Spina bifida is a common cause of NBBD, necessitating effective diagnostic tools.
- Understanding correlations between rectal size and bladder function is crucial for management.
Purpose of the Study:
- To investigate the relationship between transverse rectal diameter and urodynamic parameters in children with NBBD.
- To determine if rectal diameter can predict adverse urodynamic findings and upper urinary tract deterioration.
Main Methods:
- Prospective evaluation of 81 children with spina bifida and NBBD.
- Echosonographic measurement of transverse rectal diameter.
- Comprehensive urodynamic studies to assess bladder function.
Main Results:
- Strong negative correlations found between rectal diameter and maximum bladder capacity and compliance.
- Strong positive correlations observed with maximal detrusor pressure, leak point pressure, and post-void residual (PVR).
- Transverse rectal diameter ≥40 mm showed high sensitivity and specificity for unfavorable urodynamic patterns, predicting upper urinary tract deterioration (AUC 0.857).
Conclusions:
- Transverse rectal diameter is significantly correlated with urodynamic findings in children with NBBD.
- A rectal diameter ≥40 mm serves as a risk factor for upper urinary tract deterioration.
- Echosonographic measurement of transverse rectal diameter should be integrated into the diagnostic approach for children with NBBD to aid clinical decision-making.
Background:
The aim of this study was to examine the correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction.
Methods:
Between 2014 and 2022, we prospectively evaluated 81 consecutive spina bifida children with neurogenic bowel and bladder dysfunction (35 boys and 46 girls, mean age 9.5 ± 3.4 years). All patients underwent echosonographic measurement of transverse rectal diameter and urodynamic studies.
Results:
We found a strong negative correlation between transverse rectal diameter and maximum bladder capacity (r = -0.682, p < 0.001) and compliance (r = -0.690, p < 0.001). There was also a strong positive correlation between transverse rectal diameter and maximal detrusor pressure (r = 0.650, p < 0.001), leak point pressure (r = 0.793, p < 0.001), and PVR (r = 0.762, p < 0.001). In ROC analysis, transverse rectal diameter demonstrated good performance for distinguishing children with upper urinary tract deterioration, with an AUC of 0.857 (95% CI 0.761-0.953). A transverse rectal diameter ≥40 mm was 83.3% sensitive and 100% specific for the diagnosis of unfavorable urodynamic patterns.
Conclusion:
There is a correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. Ultrasonographically assessed transverse rectal diameter of ≥40 mm may be used as a risk factor for upper urinary tract deterioration (unfavorable urodynamic findings). We suggest the transverse rectal diameter echosonographic measurement use as an integral part of the diagnostic approach in children with neurogenic bowel and bladder dysfunction, as it can help decision-making while waiting for urodynamic testing.
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