Sonographically Determined Fecal Width: An Objective Indicator of Management of Bladder and Bowel Dysfunction in Children

Abstract

ObjectivesTo test whether sonographically determined fecal width (SDFW) correlates with symptom improvement in a population of children with Bladder and Bowel Dysfunction (BBD) managed with Standard Urotherapy, even for those patients lacking initial bowel complaints, MethodsWe retrospectively analyzed 200 pediatric BBD patients managed with SU for at least 3 months. Self-reported symptom improvement (complete, partial, no response) following International Children’s Continence Society (ICCS) guidelines was tabulated. Patients with complex urologic diagnoses other than VUR were excluded. Pharmacotherapy choice, physical therapy (PT), UTI occurrence, and VUR status were tabulated. SDFW was recorded. Non-parametric ANOVA and parametric/non-parametric T-testing were used for analysis. ResultsPatients had a mean age of 9.5 years (4-12). 48 patients had no GI complaints at presentation. Urotherapy yielded complete, partial, and no responses in 14% (n=27), 33% (n=67), and 53% (n=106) of patients, respectively. The average SDFW for those patients with complete response (2.6cm) was smaller than the SDFW of those with a partial response (3.1cm) or no response (3.3cm) (p=0.0001). Non-compliance led to greater SDFW compared to compliant patients (3.7cm and 3.1cm respectively, p=0.0001). FW was unaffected by VUR, UTI, PT, or pharmacotherapy. ConclusionsSDFW correlates well with symptom improvement in pediatric patients managed for BBD, confirming our hypothesis. SDFW is reasonable as single objective parameter to identify successful management in patients with BBD, extending to those without bowel complaints at presentation.