Related Experiment Videos
Preexisting neurogenic voiding dysfunction in children with imperforate anus: problems in management
H Kakizaki1, K Nonomura, Y Asano
1Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
Insights
Evaluating lower urinary tract function before anorectoplasty in children with imperforate anus is crucial. Early detection and management of neurogenic voiding dysfunction can prevent serious renal damage.
Area of Science:
- Pediatric Urology
- Neuro-urology
- Congenital Anomalies
Background:
- Imperforate anus is often associated with congenital anomalies.
- Neurogenic voiding dysfunction can lead to significant urinary tract complications.
- Sacral and spinal cord anomalies are frequently linked to voiding dysfunction.
Purpose of the Study:
- To investigate the relationship between imperforate anus and neurogenic voiding dysfunction.
- To determine the association between bony sacral or spinal cord anomalies and lower urinary tract function.
- To assess the impact of pre-anorectoplasty voiding function on upper urinary tract status.
Main Methods:
- Retrospective evaluation of 24 children with imperforate anus.
- Assessment of lower urinary tract function (urodynamics) before anorectoplasty.
- Correlation with bony sacral anomalies (plain radiography) and spinal cord anomalies (MRI).
Main Results:
- 100% of patients with high imperforate anus lesions exhibited abnormal voiding (detrusor-sphincter dyssynergia).
- Sacral agenesis and occult spinal dysraphism were more prevalent in patients with abnormal voiding.
- Seven patients had vesicoureteral reflux; 3 experienced renal damage due to high-grade reflux or non-compliance with management.
Conclusions:
- Pre-anorectoplasty evaluation of lower urinary tract function is essential in children with imperforate anus.
- High incidence of congenital neurogenic voiding dysfunction necessitates early intervention.
- Clean intermittent catheterization is vital for managing neurogenic voiding dysfunction and preventing renal deterioration.
Abstract:
We evaluated 22 boys and 2 girls 1 month to 8 years old with imperforate anus to determine the relationship between neurogenic voiding dysfunction and bony sacral or spinal cord anomalies. Lower urinary tract function before anorectoplasty was normal in 12 children (group 1), abnormal (detrusor-sphincter dyssynergia) in 9 (group 2) and not evaluated in 3 (group 3). High lesions of imperforate anus were present in 22% of the patients in group 1 and in 100% of those in group 2. Plain radiography revealed partial sacral agenesis in 1 child in group 1 and 4 in group 2. Magnetic resonance imaging detected occult spinal dysraphism in 1 patient in group 1 and 2 in group 2. (Occult spinal dysraphism included sacral lipoma, tethered cord, syringomyelia and thick filum terminale.) Seven children in group 2 had vesicoureteral reflux before anorectoplasty. All children in group 2 were placed on clean intermittent catheterization for the management of neurogenic voiding dysfunction. Normal upper urinary tract function was maintained in all patients in group 1 and 6 in group 2. The remaining 3 children in group 2 had high grade reflux at presentation associated with severe renal damage or noncompliance with clean intermittent catheterization. These findings indicate that in children with imperforate anus lower urinary tract function should be evaluated before anorectoplasty because of the high incidence of associated congenital neurogenic voiding dysfunction and the potential risk for renal deterioration. When possible, neurogenic voiding dysfunction should be managed with clean intermittent catheterization to prevent renal damage.