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Management of urodynamic outcomes and pelviperineal disorders in children with high anorectal malformation
Senda Houidi, Fatma Thamri, Hela Oueslati, Yasmine Karoui, Yosra Kerkeni, Riadh Jouini
children hospital Bechir Hamza, Pediatric surgery department A Tunis Tunisia
Introduction:
Anorectal malformation (ARM) is the most common congenital colorectal defect. In high ARM, associated genitourinary anomalies are frequent. But urinary and and perineal disorders could be related to the sequelae of surgery and spinal abnormalities. We report our experience to try to prevent urologic morbidity and fecal incontinence in children with high ARM.
Patients and Methods:
A retrospective study was performed and included children treated for high ARM from 2010 to 2020. They were repaired with the posterior sagittal approach in the Department of Pediatric Surgery in the Children’s Hospital of Tunis. Data was collected from patients’ files.
Results:
A total of 25 children with high ARM were included. There were 21 boys and 4 girls. Associated malformations were esophageal atresia (5 cases), Vescio uretral-reflux (8 patients) and solitary kidney (2 cases). Four patients had a low inserted spinal cord, sacral agenesis (2 cases). All patients have had a posterior sagittal approach. Surgery results’ evaluation time varied between 4 and 10 years. Total continence was achieved in 12 patients. Soiling was identified in 10 cases. Three patients had constipation. All patients had a satisfying urinary continence. Eleven patients had repeated urinary tract infections, so urodynamic study was performed in 10 patients. Urodynamic findings included detrusor overactivity (6 cases) and hypo compliant bladder with reduced capacity (1 case). Four patients were treated with intermittent self-catheterization(ISC) associated to posterior tibial nerve stimulation and intravesical injection of botulinum toxin with ISC (2cases) for overactive bladder. Six patients with VUR were treated endoscopically. Soiling was treated by biofeedback with good results.
Conclusion:
Fecal and urinary continence remains a challenge in children with a high ARM. It is mainly
dependent on sacral abnormalities and the quality of the initial surgery with an ability to improve after perineal rehabilitation.