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Sonographically Determined Fecal Width: An Objective Indicator of Management of Bladder and Bowel Dysfunction in
Tanner Hoppman1, Takahiro Ouchi2, Yiqing Dong3
1Vanderbilt University, Nashville, TN.
Insights
Sonographically determined fecal width (SDFW) effectively predicts symptom improvement in children with bladder and bowel dysfunction (BBD) treated with standard urotherapy (SU). This objective measure aids in assessing treatment success, even in patients without initial bowel issues.
Area of Science:
- Pediatric Urology
- Gastroenterology
- Diagnostic Imaging
Background:
- Bladder and bowel dysfunction (BBD) is common in children, often managed with standard urotherapy (SU).
- Assessing treatment response in BBD can be subjective, necessitating objective markers.
- Sonographically determined fecal width (SDFW) has emerged as a potential objective indicator.
Purpose of the Study:
- To evaluate the correlation between SDFW and symptom improvement in pediatric BBD patients undergoing SU.
- To determine if SDFW can serve as an objective measure of treatment success in BBD, including cases without initial bowel complaints.
Main Methods:
- Retrospective analysis of 200 pediatric BBD patients treated with SU for at least 3 months.
- Symptom improvement categorized as complete, partial, or no response based on International Children's Continence Society guidelines.
- Statistical analysis including non-parametric ANOVA and t-tests to compare SDFW across response groups and with other clinical factors.
Main Results:
- A statistically significant correlation was found between smaller SDFW and better symptom improvement (P=.0001).
- Patients with complete response had an average SDFW of 2.6 cm, compared to 3.1 cm (partial) and 3.3 cm (no response).
- Non-compliance was associated with larger SDFW (3.7 cm vs. 3.1 cm, P=.0001), while VUR, UTI, PT, and pharmacotherapy did not significantly affect fecal width.
Conclusions:
- SDFW is a reliable objective parameter for assessing treatment success in pediatric BBD patients managed with SU.
- SDFW can be utilized to monitor treatment outcomes, even in children presenting without initial gastrointestinal symptoms.
Objective:
To test whether sonographically determined fecal width (SDFW) correlates with symptom improvement in a population of children with bladder and bowel dysfunction (BBD) managed with standard urotherapy (SU), even for those patients lacking initial bowel complaints.
Methods:
We retrospectively analyzed 200 pediatric BBD patients managed with SU for at least 3 months. Self-reported symptom improvement (complete, partial, no response) following International Children's Continence Society guidelines was tabulated. Patients with complex urologic diagnoses other than vesicoureteral reflux (VUR) were excluded. Pharmacotherapy choice, physical therapy (PT), urinary tract infection (UTI) occurrence, and VUR status were tabulated. SDFW was recorded. Non-parametric analysis of variants (ANOVA) and parametric/non-parametric t testing were used for analysis.
Results:
Patients had a mean age of 9.5 years (4-12). Forty-eight patients had no gastrointestinal complaints at presentation. Urotherapy yielded complete, partial, and no responses in 14% (n = 27), 33% (n = 67), and 53% (n = 106) of patients, respectively. The average SDFW for those patients with complete response (2.6 cm) was smaller than the SDFW of those with a partial response (3.1 cm) or no response (3.3 cm) (P = .0001). Non-compliance led to greater SDFW compared to compliant patients (3.7 cm and 3.1 cm, respectively, P = .0001). Fecal width was unaffected by VUR, UTI, PT, or pharmacotherapy.
Conclusion:
SDFW correlates well with symptom improvement in pediatric patients managed for BBD, confirming our hypothesis. SDFW is reasonable as single objective parameter to identify successful management in patients with BBD, extending to those without bowel complaints at presentation.
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