The Influence of Bowel Management on the Frequency of Urinary Infections in Spina Bifida Patients
Zoran I. Radojicic, MD, PhD1, Sasa Milivojevic, MD1, Jelena Milin Lazovic, MD2.
1University Childrens Hospital, Belgrade, Serbia, 2Institute of Medical Statistics and Information Science, Belgrade School of Medicine, Belgrade, Serbia.
BACKGROUND: To examine the effects of bowel management on the frequency of urinary infections in Spina Bifida patients. METHODS: The research was carried out over the 2014-2017 period, during which 70 Spina Bifida patients aged 4 to 22 were observed. The first group consisted of 35 patients on average 10.2 years old ± 4.0 SD, of whom 48.6% were males and 51.4% females, who were administered bowel management combined with anticholinergic medication therapy and CIC. The second group consisted of 35 patients on average 9.8 years old ± 5.2 SD, of whom 37.1% were males and 62.9% females, who were treated only with anticholinergic medication therapy and CIC. There is no statistic difference between the two examined groups regarding age and sex (p> 0.05). Bowel management included daily enema, laxative application and a special diet, with a view of treating constipation and fecal incontinence that was estimated on the basis of Roma III criteria and encopresis frequency. The effects of the treatment were estimated on the basis of the number of urinary infections before and after the administered therapy, i.e. by comparing the group with administered bowel management to the group whose patients were treated exclusively with anticholinergics and CIC regarding the number of urinary infections. The follow-up period of every patient was 2 years.RESULTS: In the group in which bowel management combined with anticholinergic medication therapy and CIC was administered, the average number of urinary infections before treatment was 3.2 ± 1.2 SD, whereas the average number of urinary infections after treatment was 0.3 ± 0.5 SD. In the group treated exclusively with anticholinergic medication therapy and CIC the average number of urinary infections before treatment was 3.1 ± 1.1 SD, whereas the average number of urinary infections after treatment was 1.1 ± 1.0 SD. After the application of the Wilcoxon rank sum test, it was proved that both groups demonstrated a considerable decrease in number of urinary infections after treatment, i.e. a highly significant statistical difference in relation to the number of urinary infections before and after treatment (p< 0.001). The repeated measures ANOVA data analysis ascertained that there occurs a statistically highly important interaction between the groups (p< 0.001), i.e. the number of urinary infections decreases noticeably more in the group of patients who were administered bowel management combined with CIC and anticholinergic medication therapy. CONCLUSIONS: Administering bowel management considerably decreases the frequency of urinary infections, because of which it should form an integral part of treatment of Spina Bifida patients.
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