The Assessment of Lower Urinary Tract Function in Children with Anorectal Malformations before and after PSARP

Jindal, Bibekanand; Grover, V P; Bhatnagar, Veereshwar

doi:10.1055/s-2008-1039027

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…An abnormal sacrum with abnormal spinal cord can have prognostic information with respect to achieving fecal continence following PSARP (20). Conflicting reports exist when using these radiographic characteristics to predict lower urinary tract dysfunction in ARM (21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Many patients with ARM have lower urinary tract dysfunction that causes clinically important urological problems such as incontinence and upper urinary tract deterioration [1, 12, 13, 15]. Lower urinary tract dysfunction is defined as any functional anomaly of the bladder and/or urethra that has negative influence on voiding function.…”

Section: Discussionmentioning

confidence: 99%

“…Lower urinary tract dysfunction is defined as any functional anomaly of the bladder and/or urethra that has negative influence on voiding function. In patients with ARM, voiding dysfunction usually is neuropathic in origin and is commonly caused by associated defects of the lumbosacral spinal column (e.g., sacral agenesis) or abnormalities in the spinal cord (e.g., tethered spinal cord) [13, 15, 23]. Less commonly, iatrogenic pelvic nerve damage acquired during reconstruction of the ARM causes voiding dysfunction [2, 15, 24, 25].…”

Section: Discussionmentioning

confidence: 99%

“…To detect vesico-ureteral reflux, all patients with a dilatation of the upper urinary tract should undergo a voiding cysto-urethrography [8, 12]. Furthermore, sacral X-ray and an ultrasonography of the spinal cord should be made to detect lumbosacral anomalies or defects of the spinal cord [13, 15]. Patients with ARM and a coexisting anomaly of the lumbosacral spinal column or spinal cord are more likely to have lower urinary tract dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Urological anomalies in anorectal malformations in The Netherlands: effects of screening all patients on long-term outcome

et al. 2011

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IntroductionUrological anomalies are frequently seen in patients with anorectal malformations (ARM) and can result in upper urinary tract deterioration. Whether the current method of screening is valid, adequate and needed for all patients is not clear. We, therefore, evaluated the urological screening methods in our ARM patients for changes in urological treatment, outcome and follow-up.MethodsThe medical records of 331 children born with an ARM in the period 1983–2003 were retrospectively studied. Documentation of diagnosis, screening method, urological anomalies, treatment, complications, follow-up and outcome were measured.ResultsThe overall incidence of urological anomalies was 52%. The incidence of urological anomalies and urological follow-up time decreased with diminishing complexity of the ARM. Hydronephrosis, vesico-urethral reflux, lower urinary tract dysfunction and urinary incontinence were encountered most. Treatment invasiveness increased with the increase of complexity of an ARM. Lower urinary tract dysfunction needing urological care occurred in 43% in combination with lumbosacral or spinal cord anomalies and in 8% with no abnormalities in the lumbosacral-/spinal region.ConclusionsUrological anomalies in patients with complex ARM are more severe than in patients with less complex ARM. Ultrasonography of the urinary tract should be performed in all patients. Voiding cysto-urethrography can be reserved for patients with dilated upper urinary tracts, urinary tract infections or lumbosacral and spinal abnormalities. All patients with complex ARM need urodynamic investigations. When using these indications, the screening for urological anomalies in ARM patients can be optimized with long-term follow-up in selected patients.

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“…Less commonly, iatrogenic pelvic nerve damage acquired during reconstruction of the ARM causes voiding dysfunction but posterior sagittal anorectoplasty (PSARP) causes minimal injury to nerve supply of genitourinary system as there is limited rectovesical dissection (3)(4)(5). Urological abnormalities can result in severe deterioration of the upper urinary tract when treated inadequately (6) or there is delay in identification of LUTD (7,8). LUTD are more common and severe in complex ARM but less complex ARM are also not free from risk to develop LUTD and therefore urodynamic study is recommended to diagnose LUTD in patients of ARM (9).…”

Section: Introductionmentioning

confidence: 99%

Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

Saxena

Sinha

Pathak

et al. 2020

ANAMS

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Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with anorectal malformation (ARM) which if left untreated leads to upper tract damage. Aim: To determine role of uroﬂowmetry in early diagnosis of LUTD in children with ARM. Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroﬂowmetry at-least 6 weeks after deﬁnitive procedure. Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroﬂowmetric abnormalities were present in 11/20 (55%) patients. Forty ﬁve percent (5/11) patients with abnormal uroﬂowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroﬂowmetry. The incidence of uroﬂowmetric abnormalities was signiﬁcantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1). Conclusion: Uroﬂowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroﬂowmetric abnormalities can be done for early deﬁnitive diagnosis and prevention of upper urinary tract damage.

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The Assessment of Lower Urinary Tract Function in Children with Anorectal Malformations before and after PSARP

Cited by 6 publications

References 19 publications

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

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

Urological anomalies in anorectal malformations in The Netherlands: effects of screening all patients on long-term outcome

Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

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