Preexisting Neurogenic Voiding Dysfunction in Children with Imperforate Anus: Problems in Management

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.

Impact of spinal cord malformation on bladder function in children with anorectal malformations

“…Thus with meticulous anatomical reconstruction, using the PSARP, the risk of iatrogenic denervation seems to be minimal, as has also been shown in other studies [4,10,11].…”

“…There is wide variation reported in the prevalence of neurogenic bladder dysfunction in children with ARM, from 17% to 50% [2][3][4][5]. The variation seems to depend on factors such as small material, selection of patients, retrospective studies, differences in investigation techniques, and inconsistency in classification and follow-up program.…”

“…Neurogenic bladder dysfunction (NBD) has been shown to be common in children with ARM [2][3][4][5]. Theoretically, this could be an effect of pelvic nerve damage acquired during reconstruction of the ARM [6] or of congenital anomalies including other systems such as the vertebral, neurologic, urologic, and genital systems.…”

Diameter of the External Urethral Sphincter as a Predictor of Detrusor-Sphincter Incoordination in Children: Comparative Study of Voiding Cystourethrography

“…These urodynamic studies with the patients under general anesthesia correlate well with awake studies. 12 Detrusor-sphincter incoordination was defined as failure of EUS activity to decrease during bladder contraction or sustained increase in intravesical pressure. 4 The findings of EUS-EMG were analyzed by the investigators who were blinded to EUSD.…”

Investigation of daytime wetting: when is spinal cord imaging indicated?

“…This may be associated with a variety of developmental abnormalities of the spinal cord, 5 and indicated clinically by cutaneous abnormalities of the lower back overlying the lumbosacral spine, abnormal lower limb neurology, or orthopaedic abnormalities such as talipes and leg shortening. 8 Other factors associated with spinal cord abnormality include anorectal anomalies, 12 a family history of spina bifida, 5 and a maternal history of pregestational insulin dependent diabetes mellitus. 5 In addition, complex abnormalities of the lumbosacral spine may be detected on plain spinal x rays.…”