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Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve

Noel Charlles Nunes1, Glicia Estevam de Abreu1, Eneida Regis Dourado1

  • 1Centro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.

International Braz J Urol : Official Journal of the Brazilian Society of Urology
|October 30, 2023
PubMed

Insights

Increased rectal diameter (RD) in children with bladder and bowel dysfunction (BBD) predicts persistent functional constipation (FC) after treatment. This finding highlights RD as a key factor in evaluating BBD treatment outcomes.

Area of Science:

  • Pediatric Gastroenterology
  • Urology
  • Medical Imaging

Background:

  • Bladder and Bowel Dysfunction (BBD) affects many children, with treatments like Parasacral Transcutaneous Electrical Stimulation (TENS) being common.
  • Functional Constipation (FC) is frequently associated with BBD, and increased Rectal Diameter (RD) has been linked to FC.
  • The predictive value of RD for treatment outcomes in pediatric BBD remains largely unevaluated.

Purpose of the Study:

  • To investigate the association between pre-treatment Rectal Diameter (RD) and treatment response in children and adolescents diagnosed with Bladder and Bowel Dysfunction (BBD).
  • To determine if RD can serve as a predictor for the persistence of Functional Constipation (FC) following BBD treatment.

Main Methods:

  • A cohort of pediatric patients (5-17 years) with BBD was assessed using the Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and Constipation Score.
  • Rectal Diameter (RD) was measured via abdominal ultrasound before treatment, with an enlarged diameter defined as >3 cm.
  • Statistical analyses included descriptive statistics, binary regression, and Receiver Operating Characteristic (ROC) curve analysis to evaluate RD's predictive capability.

Main Results:

  • Out of 40 children, 37.5% presented with enlarged RD (>3 cm).
  • Children with enlarged RD were significantly more likely to experience persistent FC post-treatment (73.3%), requiring more laxatives and reporting more severe constipation.
  • Pre-treatment RD was identified as an independent predictor of persistent FC (OR=9.56), with ROC analysis indicating high sensitivity (100%) and specificity (77.14%) for RD >3 cm.

Conclusions:

  • Pre-treatment Rectal Diameter (RD) is a significant predictor of treatment outcomes in pediatric Bladder and Bowel Dysfunction (BBD), particularly for the persistence of Functional Constipation (FC).
  • Measuring RD using abdominal ultrasound can aid in identifying children at higher risk for treatment non-response.
  • RD measurement should be considered a valuable tool in the comprehensive evaluation and management of pediatric BBD.
Abstract

Keywords:
Lower Urinary Tract SymptomsPediatricsUltrasonography

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