Anorectal manometry and urodynamics in children with spina bifida: can we predict the colonic dysmotility from bladder dysfunction?

Abstract

Introduction Spina bifida is a condition that impacts the development of the neural tube leading to urological and gastrointestinal symptoms. Both systems are influenced together due to their shared innervation and embryological origin. Despite its impact on health and well-being there has been limited research on the relationship between manometry results and urodynamic tests, in this patient population. The aim of this study was to delineate the association of neurogenic bladder/bowel dysfunction with anorectal manometry and urodynamics. Materials and methods Urodynamics and anorectal manometry were used to analyse the neurogenic bowel and bladder dysfunctions in 29 paediatric patients with spina bifida. Those children who had previous anorectal surgical interventions were excluded from the study. Patients were grouped according to the level of spinal defect to lower or upper defect. In this study, parameters such as bladder compliance, postvoid residual volume, detrusor activity, anorectal pressures, and rectal compliance were considered. Group comparison tests were performed using standardized paediatric protocols for data analysis as well as correlation tests. A p-value less than 0.05 was considered significant at all levels. Results A total of 29 patients with spina bifida were identified. Of these, 14 were male and 15 were female. Bladder function differed among the patients in the lower defect (LD, n:18) and upper defect (UD, n:11) groups. LD group exhibited lower bladder volumes (175.45 +/- 106.19 mL) compared to the UD group (266.83 +/- 102.54 mL, p < 0.05). All LD and 72.7% of UD had detrusor sphincter dyssynergia. There was positive correlation between functional bladder parameters and bowel dysfunction, such as rectoanal inhibitory reflex (RAIR) and maximum filling pressures of the bladder (rho = 0.569, p < 0.05). There was also a significant correlation between rectal compliance and bladder volumes. Conclusions Association of neurogenic bowel and bladder dysfunction is a complex issue which requires personalized approach for managing the consequences. In children with neurogenic bladder dysfunction increased RAIR activity may be a sign for colonic dysmotility of neurogenic origin. This study may also pave the way for delineation of the mechanism under the generation of RAIR which is thought to be only intrinsic in origin. To optimize treatment modalities, full assessment with anorectal manometry and urodynamic studies should be done in patients with spina bifida.