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Disfunción de la vejiga en niños con malformaciones anorectales: identificación de factores de riesgo y desarrollo de
Arka Banerjee1, Sukanya Vinchurkar2, Adwait S Bendre3
1Wadia Hospital for Children, Mumbai, India.
Pediatric surgery international
|August 22, 2025
Resumen
Los niños con malformaciones anorectales (MRA) a menudo presentan síntomas del tracto urinario inferior (SUT) y disfunción neurogénica de la vejiga (DNB). Este estudio identificó los factores de riesgo clave y desarrolló un sistema de puntuación para predecir la DNB en estos pacientes.
Área de la Ciencia:
- Urología pediátrica
- Resultados de la cirugía
- Malformaciones congénitas
Sus antecedentes:
- Las malformaciones anorectales (MRA) son afecciones congénitas que pueden afectar significativamente la función del tracto urinario inferior.
- La disfunción neurogénica de la vejiga (DNB) es una complicación común en niños con MRA, que conduce a posibles problemas urológicos a largo plazo.
- La identificación temprana y el tratamiento de NBD son cruciales para optimizar los resultados en pacientes con MRA.
Objetivo del estudio:
- Evaluar la prevalencia de los síntomas del tracto urinario inferior (LUTS) en niños con MRA entrenados para ir al baño.
- Identificar los factores de riesgo específicos asociados con el desarrollo de la disfunción neurogénica de la vejiga (DNB) en esta población.
- Desarrollar y validar un sistema de puntuación para predecir resultados urológicos deficientes en niños con MRA.
Principales métodos:
- Revisión retrospectiva de los registros médicos y las entrevistas de pacientes de 166 pacientes con ARM tratados entre abril de 2014 y marzo de 2019.
- Se utilizó un análisis de regresión logística para identificar los factores de riesgo significativos para la DNB.
- Se desarrolló un sistema de puntuación predictiva utilizando métricas de Número Necesario para Tratar (NNT).
Principales resultados:
- El 32,5% de los pacientes con ARM presentaron LUTS.
- El ARM alto (RR: 2.43), las anomalías vertebrales (RR: 1.66), las cirugías de vejiga previas (RR: 2.68) y la reconstrucción abdomino-perineal (RR: 2.88) fueron factores de riesgo significativos para el NBD.
- El sistema de puntuación desarrollado (umbral ≥12) mostró una sensibilidad del 70,4% y una especificidad del 76,8% para predecir la DNB.
Conclusiones:
- NBD es frecuente en pacientes con ARM, con varios factores de riesgo identificables.
- El sistema de puntuación desarrollado proporciona una herramienta práctica para la estratificación temprana del riesgo de NBD en ARM.
- Se necesitan estudios prospectivos adicionales para validar el sistema de puntuación y refinar las estrategias de manejo para mejorar los resultados urológicos.
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