title: Prognostic evaluation of biofeedback response in patients treated for anorectal malformation.
abstract: OBJECTIVE
  Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB.
  
  
  METHODS
  25 children (median age of 6.5 years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favorables manometry and MRI); group 2 (favorable manometry and unfavorable MRI); group 3 (unfavorable manometry and favorable MRI); group 4 (unfavorables manometry and MRI). All groups started a cycle of BFB and six months after end of BFB, were reevaluated by clinical score and manometry.
  
  
  RESULTS
  The overall response to BFB was excellent in 44%, discrete in 40% and poor in 16%; a better response was found in groups 1 and 2 than groups 3 and 4. The differences between groups before BFB proportionally correlated with values after BFB; a correlation with genitourinary and spinal anomalies was found.
  
  
  CONCLUSIONS
  Our results showed that BFB is an effective for fecal incontinence when the assessment pretreatment (functional and morphologic) is favorable; the manometry can evaluate the potential sphincterial recovery after BFB with a further prognostic benefit if correlated to morphologic evaluation with MRI.
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy. Electronic address: annacaruso2@libero.it.
authors.forename: A M
authors.initials: AM
authors.lastname: Caruso
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Catalano
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Li Voti
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Salerno
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Casuccio
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Di Pace
authors.affiliation: Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cimador
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D001676:Biofeedback, Psychology / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008365:Manometry; D011379:Prognosis; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Anorectal malformation; Anorectal manometry; Biofeedback training; Fecal incontinence