Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract dysfunction and its effect on bladder dynamics
| Autor: | Ashraf Koraitim, Ahmed Foad, Ahmed Eid, Mostafa Elmissiry, Mohammed Ebada, Haytham Badawy |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Urinary system Urinary Bladder Urology Bowel management Physical examination Vesicoureteral reflux Maintenance therapy medicine Humans Prospective Studies Urinary Bladder Neurogenic Prospective cohort study Child medicine.diagnostic_test business.industry Incidence (epidemiology) Reflux General Medicine medicine.disease Intestinal Diseases Urodynamics Child Preschool Pediatrics Perinatology and Child Health Surgery Female business |
| Zdroj: | Journal of pediatric surgery. 54(4) |
| ISSN: | 1531-5037 |
| Popis: | Introduction and Aim Children with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics. Patients and methods In the period from January 2011 to January 2013, 30 patients, 21 girls and 9 boys with neuropathic lower urinary tract dysfunction were studied. All suffered from urinary tract and bowel dysfunctions. All children were on urological treatment. They had their bowel managed by assurance and psychological support, dietary modification, retrograde or antegrade enemas and maintenance therapy. They were evaluated initially and on follow up by history, physical examination, ultrasound, urodynamics, Wexener score and bowel control chart. Results Mean age was 8.3 ± 3.47 years (range from 4 to 18). There was a significant decrease in bowel dysfunction (Wexener score decreased from 12.67 ± 1.54 to 10.17 ± 1.76, p = 0.00), rectal diameter (decreased from 34.83 ± 5.91 to 27.90 ± 5.32 mm, p = 0.00), and frequency of UTI (p = 0.00). Detrusor leak point pressure decreased from 37.33 ± 24.95 to 30 ± 17.35 cmH2O, (p = 0.42). The cystometric capacity increased from 136.63 ± 45.69 to 155.17 ± 39.29 ml. (p = 0.001). Reflux and kidney function improved but was not statistically significant (p = 0.25 and p = 0.066 respectively). Conclusion Management of bowel dysfunction is of utmost importance in the treatment of children with neuropathic bladder dysfunction. It has a positive effect on lower urinary tract function and decreasing the incidence of complications. This is a LEVEL III prospective study. |
| Databáze: | OpenAIRE |
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