Faculty Collaboration Database

The impact of antegrade continence enemas on bladder function in patients with neurogenic bladder and bowel. J Pediatr Urol 2023 Oct;19(5):625.e1-625.e6

Date

07/30/2023

Pubmed ID

37516581

DOI

10.1016/j.jpurol.2023.07.005

Scopus ID

2-s2.0-85166272113 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

INTRODUCTION: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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.

DISCUSSION: 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.

Author List

Lorenger LE, Albright RA, Storm DW, Bevill MD, Reyes BA, Cooper CS

Author

Douglas W. Storm MD Chief, Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cholinergic Antagonists
Constipation
Encopresis
Enema
Fecal Incontinence
Female
Humans
Lower Urinary Tract Symptoms
Male
Neurogenic Bowel
Retrospective Studies
Treatment Outcome
Urinary Bladder
Urinary Bladder, Neurogenic