Department of Urology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
College of Public Health, University of Iowa, Iowa City, IA, USA.
J Pediatr Urol. 2023 Oct;19(5):625.e1-625.e6. doi: 10.1016/j.jpurol.2023.07.005. Epub 2023 Jul 18.
In neurologically intact children with constipation and lower urinary tract symptoms, treatment of constipation frequently results in improved or resolved lower urinary tract symptoms. The impact of treatment of constipation on bladder function in children with a neurogenic bowel and bladder is not well studied. The objective of this study was to evaluate the impact of antegrade continence enemas (ACE) via Chait tube on urodynamic study (UDS) parameters and urinary continence in patients with neurogenic bowel and bladder (NGB). We hypothesized that following ACE some patients would demonstrate improved UDS parameters and improved urinary continence.
A review of patients with NGB who underwent a cecostomy was performed. Inclusion criteria required UDS within 12 months before and after Chait tube placement and no change in clean intermittent catheterization or anticholinergic medications. UDS parameters assessed included bladder capacity, bladder compliance, and bladder stability. In addition, the frequency of antegrade continence enemas and encopresis were reviewed as was the frequency of UTIs before and after the surgery.
8 children met inclusion criteria, including 5 girls and 3 boys, with a mean (range) age of 8.5 years (5-13). All children were on clean intermittent catheterization and 7 were on anticholinergic medications. The patients demonstrated a significant improvement in constipation and encopresis (p < 0.05). All but 1 patient had resolution of encopresis, and 6 of 7 patients who had constipation before ACE management had a resolution of constipation. 2 patients (25%) developed urinary continence (i.e., dry between CIC), and 2 others had improvement in continence. 3, 2, and 2 patients had urodynamic improvement in bladder capacity, compliance, or stability, respectively. However, no significant improvement in urinary incontinence or UDS parameters was demonstrated for the group overall.
Our data demonstrate that some children with neurogenic bowel and bladder will have improvement in continence and UDS parameters following the initiation of ACE. Despite significant improvement in constipation and encopresis, the frequency of bladder improvement in this population appears less than that reported in neurologically intact children following treatment of constipation. Confirmatory studies with a larger number of children are needed. However, since constipation appears to negatively impact bladder function in some children with neurogenic bowel and bladder, it is reasonable to try to eliminate significant constipation in these patients before increasing pharmaceutical management of their neurogenic bladder.
在神经功能正常的便秘伴下尿路症状的儿童中，治疗便秘常可改善或消除下尿路症状。神经源性肠道和膀胱患儿治疗便秘对膀胱功能的影响尚未得到很好的研究。本研究的目的是评估通过 Chait 管行顺行清洁灌肠（ACE）对神经源性肠道和膀胱（NGB）患者尿动力学研究（UDS）参数和尿控的影响。我们假设，在 ACE 后，一些患者将表现出 UDS 参数的改善和尿控的改善。
对接受乙状结肠造口术的 NGB 患者进行了回顾性研究。纳入标准要求在 Chait 管放置前后 12 个月内行 UDS，且清洁间歇导尿或抗胆碱能药物无变化。评估的 UDS 参数包括膀胱容量、膀胱顺应性和膀胱稳定性。此外，还回顾了 ACE 的频率和便秘情况，以及手术前后尿路感染的频率。
8 名儿童符合纳入标准，包括 5 名女孩和 3 名男孩，平均（范围）年龄为 8.5 岁（5-13 岁）。所有儿童均行清洁间歇导尿，7 名儿童行抗胆碱能药物治疗。便秘和便秘的发生率均有显著改善（p<0.05）。所有患者除 1 例外均解决了便秘，7 名接受 ACE 治疗前有便秘的患者中有 6 名解决了便秘。2 名患者（25%）出现尿控（即，CIC 之间无尿失禁），2 名患者尿控改善。3 名、2 名和 2 名患者分别在膀胱容量、顺应性或稳定性方面有 UDS 改善。然而，总体上，该组患者的尿失禁或 UDS 参数无显著改善。
我们的数据表明，一些神经源性肠道和膀胱患儿在开始 ACE 治疗后，尿控和 UDS 参数会有所改善。尽管便秘和便秘明显改善，但在该人群中，膀胱改善的频率似乎低于神经功能正常的儿童在治疗便秘后的频率。需要进行更多儿童的证实性研究。然而，由于便秘似乎会对一些神经源性肠道和膀胱患儿的膀胱功能产生负面影响，因此在增加对这些患者神经源性膀胱的药物治疗之前，合理的做法是努力消除严重的便秘。
