Studies on pudendal nerve terminal motor latency in patients after ileal J-pouch-anal anastomosis for ulcerative colitis and adenomatous coli in childhood.
OBJECTIVE
To clarify the neurological function with respect to external anal sphincter (EAS) muscles in child patients with or without soiling after ileal J pouch anal anastomosis (IPAA), we examined the terminal motor latency in the pudendal motor nerves (PNTML).


METHODS
A total of nine patients after IPAA for UC (7 cases) and AC (2 cases) were studied (6 males and 3 females, 10 to 15 with a mean age of 13.8 years). Patients one year after IPAA with soiling were also subdivided by the see page of mucous and/or stool group A (5 cases); rare soiling with loose stool, group B (4 cases); occasional soiling (1 time per 2 or 3 days). However, all patients showed continence 2 years after IPAA (Group C). Group D served as controls without gastrointestinal symptoms and digestive diseases and consisted of 12 subjects (8 males and 4 females aged 12 to 16 years old with a mean age of 14.8 years). Examinations were performed 1 and 2 years after ileostomy closure. Bilateral (left-sided and right-sided) PNTML tests were performed on all patients in order to measure the latency of the response in the bilateral EAS muscle following digitally directed transrectal pudendal nerve stimulation.


RESULTS
1) Values of the PNTML at the right-sided of the PN: The conduction delay in group B was the longest, followed by groups A, C, and D. Moreover, significant differences in PNTML were noted between groups A and B, between groups A and D, between groups B and C, and between groups B and D (p < 0.0001, p = 0.0316, p < 0.0001, p < 0.0001 respectively). There were no significance differences between group A and C or between groups C and D (p = 0.1733, p = 0.2957, respectively). 2) Values of the PNTML at the left-sided of the PN: The conduction delay in group B was the longest, followed by groups A, C, and D. Moreover, significant differences in PNTML were noted between groups A and B, between groups A and D, between groups B and C, and between groups B and D (p < 0.0001, p = 0.0584, p < 0.0001, p < 0.0001 respectively). There were no significance differences between groups A and C or between groups C and D (p = 0.3042, p = 0.2553, respectively).


CONCLUSIONS
These findings support the hypothesis that child patients' soiling after IPAA may be caused by damage to the bilateral pudendal motor nerves.
Tomita
Ryouichi
R
Department of Surgery, Nippon Dental University Hospital at Tokyo, 2-3-16 Fujimi Chiyoda-ku, Tokyo 102-8158, Japan. rtomita-ndus@mvg.biglobe.ne.jp
Igarashi
Seigo
S
Koshinaga
Tugumichi
T
Fujisaki
Shigeru
S
Kusafuka
Takeshi
T
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology* / Q000601:surgery*; D000293:Adolescent; D001003:Anal Canal / Q000294:innervation*; D000714:Anastomosis, Surgical; D002648:Child; D003093:Colitis, Ulcerative / Q000503:physiopathology* / Q000601:surgery*; D039021:Colonic Pouches; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D009431:Neural Conduction / Q000502:physiology*; D018709:Statistics, Nonparametric