Milivojevic Sasa, Milic Natasa, Lazovic Jelena Milin, Radojicic Zoran
University Children's Hospital Belgrade, Serbia.
Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Internal Medicine, Mayo Clinic, Rochester, USA.
J Pediatr Urol. 2020 Oct;16(5):556.e1-556.e7. doi: 10.1016/j.jpurol.2020.04.013. Epub 2020 Apr 21.
To examine the effects of bowel management on urodynamic findings in spina bifida children with detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD).
Between 2014 and 2019 we prospectively evaluated 39 consecutive spina bifida children with DO and DSD (18 (46.2%) boys and 21 (53.8%) girls, aged 4-16 years; mean age 9.5 ± 3.7 years) who received bowel management and we treated their bowel dysfunction with an aim of alleviating the symptoms of constipation, preventing constant overdistension of the rectosigmoid, providing regular emptying of the colon and faecal continence. Bowel management included daily enema, laxative application and a special diet who was performed during 12 months. All children had undergone urodynamic studies before and after starting bowel management, with no changes in their urological treatment.
Bowel management caused an increase in maximum bladder capacity from 183.0 (112.0-234.0) to 237.0 (165.0-298.0) (p < 0.001). When maximal bladder capacity adjusted for age there was also significant increment (adjusted before 0.54 (0.47-0.64), adjusted after 0.75 (0.70-0.82), p < 0.001). In addition, we observed a decrease in maximal detrusor pressure from 64.3 (49.0-77.0) to 46.4 (32.0-59.0) cm H2O (p < 0.001) and an increase in bladder compliance from 3.0 (2.0-3.3) to 5.6 (3.9-6.6) ml/cm H2O (p < 0.001). There was also significant reductions in leak point pressure from 62.0 (48.0-69.0) to 39.0 (30.0-43.0) cm H2O (p = 0.001), and significant reductions in post-void residual volume (PVR) from 165.0 (128.0-187.0) to 98.0 (68.0-136.0) ml in our 13 patients who could achieve spontaneous voiding (p = 0.001).
Administering bowel management may be useful for bladder function and urodynamic findings in spina bifida children with DO and DSD. Therefore, bowel management should form an integral part of the treatment in spina bifida children with DO and DSD.
探讨肠道管理对患有逼尿肌过度活动（DO）和逼尿肌括约肌协同失调（DSD）的脊柱裂儿童尿动力学检查结果的影响。
2014年至2019年期间，我们前瞻性评估了39例连续患有DO和DSD的脊柱裂儿童（18例（46.2%）男孩和21例（53.8%）女孩，年龄4 - 16岁；平均年龄9.5 ± 3.7岁），这些儿童接受了肠道管理，我们对其肠道功能障碍进行治疗，目的是缓解便秘症状，防止直肠乙状结肠持续过度扩张，实现结肠定期排空和粪便节制。肠道管理包括每日灌肠、使用泻药和特殊饮食，持续12个月。所有儿童在开始肠道管理前后均接受了尿动力学检查，其泌尿外科治疗无变化。
肠道管理使最大膀胱容量从183.0（112.0 - 234.0）增加到237.0（165.0 - 298.0）（p < 0.001）。在根据年龄调整最大膀胱容量后，也有显著增加（调整前0.54（0.47 - 0.64），调整后0.75（0.70 - 0.82），p < 0.001）。此外，我们观察到最大逼尿肌压力从64.3（49.0 - 77.0）降至46.4（32.0 - 59.0）cm H₂O（p < 0.001），膀胱顺应性从3.0（2.0 - 3.3）增加到5.6（3.9 - 6.6）ml/cm H₂O（p < 0.001）。漏点压力也从62.0（48.0 - 69.0）显著降至39.0（30.0 - 43.0）cm H₂O（p = 0.001），在我们13例能够自主排尿的患者中，排尿后残余尿量（PVR）从165.0（128.0 - 187.0）显著降至98.0（68.0 - 136.0）ml（p = 0.001）。
对患有DO和DSD的脊柱裂儿童进行肠道管理可能对膀胱功能和尿动力学检查结果有益。因此，肠道管理应成为患有DO和DSD的脊柱裂儿童治疗的一个组成部分。
