Assessment of lower urinary tract function in children before and after transanal endorectal pull through for Hirschsprung's disease

Abstract

Usually in Hirschsprung's disease (HD), long-term sequelae in children are related to abnormalities in defecation. However, some of these patients also develop lower urinary tract problems. The aim of this study is to assess and define the effects of transanal endorectal pull through procedure in patients with HD on lower urinary tract function by means of urodynamic studies (UDS) performed before and after surgery. The study was conducted at Ibn Rochd University Hospitals from 2007 to 2016. Twenty-eight patients with HD were subjected to urodynamic studies before and after the different definitive surgical procedures. They were all males with a mean age of 3 years. The main outcome measurements were maximum cystometric capacity, compliance, unstable detrusor contraction and residual urinary volume. Urodynamic findings were normal in 23 (82%) children, and abnormal in 5 (18%) children. In uroflowmetric study, dysuria with detrusor sphincter dyssynergia and significant post-void urine residual (more than 20 mL) were found in the 3 symptomatic children. In cystometric study, five children had unstable detrusor contraction, low bladder compliance and small-capacity bladder. In HD, neurovesical dysfunction may exist preoperatively and though the incidence of postoperative changes in neurovesical function may appear high. Children who present with urinary problems after surgery should be assessed urodynamically.