Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Pediatr Surg Int. 2021 Apr;37(4):461-468. doi: 10.1007/s00383-020-04835-5. Epub 2021 Jan 23.
Association of spinal or vertebral anomalies and the iatrogenic denervation during surgical correction of anorectal malformation patients especially in boys can lead to neurogenic bladder inthese subset of patients. The paucity of literature with regard to urodynamic studies focusing exclusively in male children with high-anorectal malformations (HARM) lead us to analyze the urodynamic changes. The objective was to study urodynamic profile in male patients who have undergone surgery for anorectal malformation.
Male high-anorectal malformation patients who had completed all the stages of repair were prospective studied. Following the basic work up, all patients based on the urodynamics were categorized into 2 groups as safe or unsafe bladders. Unsafe bladder was defined as detrusor pressure > 40 cm (high detrusor pressure) or pressure variability of 15 cm of water (detrusor overactivity) or significant post-void residue. MRI was limited to patients with only abnormal urodynamics to rule out spinal causes of neurogenic bladder and due to financial constraints, it could not be offered to all patients.
41 HARM meet the exclusion criteria. All patients were asymptomatic with none having history of urinary tract infections. Ultrasound showed bladder wall thickening in 31.7% patients. UDS revealed reduction in bladder capacity and compliance was noted in 31.7% and 30% patients, respectively. Elevated detrusor pressures (> 40 cm of water) were noted in 10% (4/41), detrusor overactivity with concomitant elevated detrusor pressures in 19.5% (8/41) and normal UDS in 70% (29/41). 13 patients (31.7%) had abnormal cystometric parameters with 12(30%) having unsafe bladders. MRI confirmed sacral agenesis in 1 patient with unsafe bladder.
Urodynamics can demonstrate occult neurovesical dysfunction in patients with HARM. This would help in early renal protective therapy and prevent the burden of long-term sequelae of neurovesical dysfunction in HARM patients.
在肛门直肠畸形患者（尤其是男孩）的手术矫正过程中，脊柱或椎体异常以及医源性去神经支配与这些患者的神经源性膀胱有关。由于缺乏专门针对高肛门直肠畸形（HARM）男性儿童的尿动力学研究文献，我们进行了这项分析以研究尿动力学变化。目的是研究接受肛门直肠畸形手术的男性患者的尿动力学特征。
前瞻性研究已完成所有修复阶段的男性高肛门直肠畸形患者。在基本检查后，根据尿动力学将所有患者分为 2 组，即安全或不安全膀胱。不安全膀胱定义为逼尿肌压力>40cm（高逼尿肌压力）或压力变化 15cm 水柱（逼尿肌过度活动）或有明显的残余尿量。由于财务限制，仅对尿动力学异常的患者进行 MRI 检查以排除神经源性膀胱的脊髓原因，并且由于财务限制，无法将其提供给所有患者。
41 例 HARM 符合排除标准。所有患者均无症状，无尿路感染史。超声显示 31.7%的患者膀胱壁增厚。尿动力学显示膀胱容量减少，顺应性分别为 31.7%和 30%的患者。10%（4/41）的患者出现逼尿肌压力升高（>40cm 水柱），19.5%（8/41）的患者逼尿肌过度活动伴有逼尿肌压力升高，70%（29/41）的患者尿动力学正常。13 例（31.7%）患者存在膀胱测压参数异常，其中 12 例（30%）膀胱不安全。MRI 证实 1 例逼尿肌不安全的患者存在骶骨发育不全。
尿动力学可显示 HARM 患者隐匿性神经膀胱功能障碍。这有助于早期进行肾脏保护治疗，防止 HARM 患者神经膀胱功能障碍的长期后遗症。
