The assessment of lower urinary tract function in children with anorectal malformations before and after PSARP.
BACKGROUND
Lower urinary tract dysfunction (LUTD) with anorectal malformations (ARM) is usually associated with sacral and spinal abnormalities and less commonly due to iatrogenic pelvic nerve damage during surgery. Posterior sagittal anorectoplasty (PSARP) is believed to have a minimal deleterious effect on lower urinary tract function.


OBJECTIVE
The aim of this study was to assess the effects of PSARP on lower urinary tract function by means of urodynamic studies (UDS) performed before and after the definitive surgery in patients with ARM.


METHODS
The study was conducted between January 2003 and July 2005, in 17 cases of ARM (high/supralevator, n = 13 and low/infralevator, n = 4). All patients were subjected to preoperative UDS and then again 6 weeks after the PSARP. The parameters observed were maximum cystometric capacity (MCC), leak point pressure or end filling pressure (LPP/EFP), uninhibited detrusor contractions (UDCs) and compliance.


RESULTS
Associated vertebral anomalies were present in 38.5 % (5 of 13) in high ARM compared with 25 % in low ARM. The incidence of preoperative lower urinary tract dysfunction in various forms was found to be 70.5 % (12 of 17 patients) and postoperatively the incidence was found to be 76.4 % (13 of 17 patients). The pre- and postoperative mean MCC, volume at P (det) < 20 cm, volume at P (det) < 30 cm and LPP were compared and found to be statistically not significant (p = 0.578, p = 0.551, p = 0.875 and p = 0.863, respectively). UDCs were present in 29.4 % patients (5 of 17) preoperatively and 35.3 % (6 of 17) patients postoperatively; however, only 16.6 % (2 of 12) developed fresh UDCs. The incidence of LUTD did not differ if the patient had undergone PSARP or required abdominal dissection with PSARP. All 6 patients with vertebral or sacral anomaly had LUTD.


CONCLUSIONS
There seems to be a high incidence of LUTD in ARM even in the absence of clinical and radiological evidence of lower urinary tract abnormalities. In addition, it was noted that there are changes, although statistically insignificant, in the neurovesical function of these patients following PSARP.
Jindal
B
B
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Grover
V P
VP
Bhatnagar
V
V
D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D011184:Postoperative Period; D011300:Preoperative Care; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D012447:Sacrum / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods