Preexisting neurogenic voiding dysfunction in children with imperforate anus: problems in management

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.