Your browser doesn't support javascript.
loading
The impact of antegrade continence enemas on bladder function in patients with neurogenic bladder and bowel.
Lorenger, Laura E; Albright, Ryan A; Storm, Douglas W; Bevill, Mark D; Reyes, Bella A; Cooper, Christopher S.
Afiliación
  • Lorenger LE; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
  • Albright RA; College of Public Health, University of Iowa, Iowa City, IA, USA.
  • Storm DW; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
  • Bevill MD; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
  • Reyes BA; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
  • Cooper CS; Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA. Electronic address: christopher-cooper@uiowa.edu.
J Pediatr Urol ; 19(5): 625.e1-625.e6, 2023 10.
Article en En | MEDLINE | ID: mdl-37516581
ABSTRACT

INTRODUCTION:

In neurologically intact children with constipation and lower urinary tract symptoms, treatment of constipation frequently results in improved or resolved lower urinary tract symptoms. The impact of treatment of constipation on bladder function in children with a neurogenic bowel and bladder is not well studied. The objective of this study was to evaluate the impact of antegrade continence enemas (ACE) via Chait tube on urodynamic study (UDS) parameters and urinary continence in patients with neurogenic bowel and bladder (NGB). We hypothesized that following ACE some patients would demonstrate improved UDS parameters and improved urinary continence. MATERIALS AND

METHODS:

A review of patients with NGB who underwent a cecostomy was performed. Inclusion criteria required UDS within 12 months before and after Chait tube placement and no change in clean intermittent catheterization or anticholinergic medications. UDS parameters assessed included bladder capacity, bladder compliance, and bladder stability. In addition, the frequency of antegrade continence enemas and encopresis were reviewed as was the frequency of UTIs before and after the surgery.

RESULTS:

8 children met inclusion criteria, including 5 girls and 3 boys, with a mean (range) age of 8.5 years (5-13). All children were on clean intermittent catheterization and 7 were on anticholinergic medications. The patients demonstrated a significant improvement in constipation and encopresis (p < 0.05). All but 1 patient had resolution of encopresis, and 6 of 7 patients who had constipation before ACE management had a resolution of constipation. 2 patients (25%) developed urinary continence (i.e., dry between CIC), and 2 others had improvement in continence. 3, 2, and 2 patients had urodynamic improvement in bladder capacity, compliance, or stability, respectively. However, no significant improvement in urinary incontinence or UDS parameters was demonstrated for the group overall.

DISCUSSION:

Our data demonstrate that some children with neurogenic bowel and bladder will have improvement in continence and UDS parameters following the initiation of ACE. Despite significant improvement in constipation and encopresis, the frequency of bladder improvement in this population appears less than that reported in neurologically intact children following treatment of constipation. Confirmatory studies with a larger number of children are needed. However, since constipation appears to negatively impact bladder function in some children with neurogenic bowel and bladder, it is reasonable to try to eliminate significant constipation in these patients before increasing pharmaceutical management of their neurogenic bladder.
Asunto(s)
Palabras clave

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Vejiga Urinaria Neurogénica / Encopresis / Intestino Neurogénico / Incontinencia Fecal / Síntomas del Sistema Urinario Inferior Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: J Pediatr Urol Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Vejiga Urinaria Neurogénica / Encopresis / Intestino Neurogénico / Incontinencia Fecal / Síntomas del Sistema Urinario Inferior Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Idioma: En Revista: J Pediatr Urol Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos