Evaluations and managements of urination disorders after anorectoplasty

Abstract

Objective To explore the causes and managements of urination disorders after anorectoplasty. Methods There were 7 males and 3 females with an age range of 1-12 years. There were rectourethrobulbar fistula (n=4), rectourethroprostatic fistula (n=3), cloaca (n=1) (common channel <3 cm), pouch colon (n=1) and rectovestibular fistula (n=1). All manifested dysuria and 3 had concurrent urinary incontinence. Spinal tetherd cord (n=2) (rectovestibular fistula & rectourethroprostatic) and sacral dysplasia (n=2) were visualized on magnetic resonance imaging (MRI). Voiding vesicourethrography revealed left vesicourethal reflux (n=3). Urodynamic study indicated that both bladder volume and residual urine increased. However, detrusor pressor during storage was normal without detrusor overactivity and urine flow rate decreased (n=9). Detrusor contractility decreased (n=8) and showed no change (n=1). Bladder volume and urine flow rate decreased. However, detrusor pressor overacted during storage and residual urine increased in 1 case of rectovesitibular fistula with concurrent tethered spinal cord. One child of rectourethral fistula with complicated posterior urethral diverticulum underwent excision of diverticulum. Another two children of complicated vesicourethal reflux (VUR) underwent ureteral implantation. Clean intermittent catheterization (CIC) was maintained in 8 cases. Results The follow-up period was 6 months to 5 years. VUR persisted with cloaca at 1 year. And VUR disappeared and there was no dysuria or residual urine in children of rectourethral fistula with complicated posterior urethral diverticulum. VUR disappeared in children with rectourethrobulbar fistula, but CIC was still required. Another 7 cases had no impairment of upper urinary tract. Conclusions Sacral vertebrae, spinal cord dysplasia and surgical injury may result in neurogenic bladder. Inappropriate management of rectourethral fistula can cause urethral diverticulum or urethral stricture. CIC is a primary option for neurogenic bladder. Urethral diverticulum should be resected if dysuria occurs. Key words: Congenital ano-rectal malformation; Urination disorder; Urodynamics