How to Investigate Neurovesical Dysfunction in Children With Anorectal Malformations

Mosiello, Giovanni; Capitanucci, Maria Luisa; Gatti, Claudia; Adorisio, Ottavio; Lucchetti, Maria Chiara; Silveri, Massimiliano; Schingo, Paolo; Gennaro, M. De

doi:10.1097/01.ju.0000083883.16836.91

Cited by 57 publications

(43 citation statements)

References 16 publications

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“…Conflicting reports exist when using these radiographic characteristics to predict lower urinary tract dysfunction in ARM (21)(22)(23)(24). In our select series of males with epididymitis we did not see an association between the existence of neurogenic bladder and either sacral or spinal cord radiographic abnormality.…”

Section: Discussioncontrasting

confidence: 62%

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

et al. 2014

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ARTICLE INfO ______________________________________________________________ ______________________Introduction: Epididymitis in patients with anorectal malformation (ARM) represents a unique problem because unlike the general population, an underlying urinary tract problem is frequently identified. We review our experience with epididymitis in ARM population with an emphasis on examining urologic outcomes. Materials and Methods:We performed a retrospective review of male patients with ARM cared for from 1980 to 2010. Clinical and pathologic variables recorded included age at presentation, recurrence, associated urologic anomalies, incidence of ureteral fusion with mesonephric ductal structures, glomerular filtration rate and urodynamic parameters.Results: Twenty-six patients were identified with documented episodes of epididymitis.Renal injury was noted in five patients (19%), all of whom were diagnosed with neurogenic bladder (NGB) several years after anorectoplasty. NGB was found in ten patients (38%) in our series. Ectopic insertion of ureter into a mesonephric ductal structure was discovered in five patients (19%). Twelve patients (46%) had recurrent episodes of epididymitis, with seven of these patients (58%) being diagnosed with NGB. Two patients in the pubertal group presented with a history of epididymitis and complained of ejaculatory pain. Conclusion: Epididymitis in a patient with ARM warrants a comprehensive urologic investigation, particularly in recurrent episodes. Attempts at surgical intervention (e.g. vasectomy) should be avoided until functional assessment of the urinary tract has occurred. Failure to recognize this association may lead to potentially avoidable complications and morbidity. Long term urological follow up of these patients is warranted to identify at risk patients and minimize renal deterioration

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Section: Discussioncontrasting

confidence: 62%

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

et al. 2014

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“…11 Neurovesical dysfunction is primarily related to tethered cord or to an iatrogenic nerve injury. 16 Once symptoms appear, they are often irreversible despite surgical intervention and may have a significant impact on the continence of patients with imperforate anus. Surgical release of a tethered cord before the onset of neurological problems may prevent the onset of these symptoms.…”

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confidence: 99%

“…However, Golonka et al 23 reported that a tethered cord in children with a low lesion is as common as in those with a high lesion. Mosiello et al 16 reported that the incidence of spinal cord anomalies is 60% in those with a low lesion and 66% in those with a high lesion. In the present study, spinal cord anomalies were identified in 30% (15 of 50 patients) and vertebral column anomalies in 40% (20 of 50 patients).…”

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confidence: 99%

“…13 However, with USG it is often difficult to evaluate spinal cord anomalies in patients with vertebral anomalies and in older children. 16 Our study did not include USG to evaluate lumbosacral spine because all our patients were older than 3 months. Mosiello et al 16 recommended that MRI screening at the age of 6-12 months for all patients with an imperforate anus.…”

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Role of magnetic resonance imaging to detect occult spinal anomalies in anorectal malformations

Gupta

Ray

et al. 2016

Int J Contemp Pediatr

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“…Occult spinal dysraphism was suspected when the spinal cord resided below the level of the second lumbar vertebra on spinal ultrasound, if the filum terminale was diffusely thickened or if the cord appeared to be fixed to a spinal lipoma. 7 Early in our series, 4 patients underwent a 2-stage procedure in which the rectal component was repaired first, leaving the urogenital sinus for a secondary operation. In the remaining 8 girls, a 1-stage abdomino-perineal pull-through was performed.…”

Section: Resultsmentioning

confidence: 99%

Long-term renal function and continence status in patients with

Braga

Lorenzo

Davé

et al. 2013

CUAJ

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*Voiding cystouretrogram of patients with vesicoureteral reflux (VUR) demonstrated that 2 patients had grade II VUR, 2 patients had grade III VUR and 1 patient had grade IV VUR. a reduced GFR. Overall, 9 of 12 (75%) girls had some degree of renal function impairment (Table 3).We attempted to compare the length of cloacal defect (common channel ≥ 3 cm or not) with incidence of renal anomalies, presence of impaired renal function, need for bladder augmentation and urinary continence (Table 4). Renal anomalies were present in 2 of 7 patients with common channels ≥ 3 cm, compared with 1 of 5 with common channels < 3 cm (22.8% v. 20%, p = 0.73). Impaired renal function (GFR < 80mL/min) occurred in 5 of 7 children who had long common channels, compared with 3 of 5 who had short common channels (71.4% v. 60%, p = 0.24). We found a statistically significant difference between long and short common channels with regard to the patient's need for bladder augmentation. Four of 7 (57.1%) patients who had a common channel ≥ 3 cm ended up with an augmentation cystoplasty, compared with none of the patients who had a common channel < 3 cm (57.1% v. 0%, p = 0.038). Finally, we found a difference in urinary dryness when comparing long and short common channels (85.7% v. 40%, p = 0.30). Girls with longer common channels had a higher rate of urinary dryness at the expense of a higher percentage of bladder augmentation and bladder neck closure. DiscussionUrological problems after definitive repair of cloacal malformations in children include urinary incontinence, poor renal function and recurrent urinary tract infections. Urinary continence was achieved in 67% of the patients in this study, a rate comparable with other reports (60%-83%). 4,9 Despite this apparently high rate of urinary continence in complex cases, dryness was achieved at the expense of major reconstructive surgery, such as bladder augmentation with or without bladder neck closure and clean intermittent catheterization through a Mitrofanoff conduit. In the present study, 63% of children who had dry intervals > 4 hours were on clean intermittent catheterization and 50% of them had an augmentation cystoplasty with bladder outlet closure and creation of a catheterizable conduit. Only 17% of girls who achieved dryness were voiding through the urethra. These results are far from ideal, but they are similar to those published in another series that reported that 46% of continent patients required major surgery and that no more than 22% voided spontaneously and were dry. 4 Conversely, in Hendren 10 and Pena's 11 series, 60% and 54% of children, respectively, voided spontaneously and were dry, but neither author mentioned the need for additional surgery at the level of the bladder neck.Recently, Pena reported a continence rate of 28% in girls with common channels > 3 cm and showed that these patients had a high likelihood of needing clean intermittent catheterization, compared with those with short common channels. 6 With that in mind, we attempted to compare dryness with le...

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How to Investigate Neurovesical Dysfunction in Children With Anorectal Malformations

Cited by 57 publications

References 16 publications

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Epididymitis in Patients with Anorectal Malformations: A Cause for Urologic Concern

Role of magnetic resonance imaging to detect occult spinal anomalies in anorectal malformations

Long-term renal function and continence status in patients with

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