Association Between Rectal Diameter and Response to Treatment in Children with Bladder and Bowel Dysfunction: Could it be a Good Predictor?
Noel Charlles, Medical Student, Glicia Estevam de Abreu, Coloproctologist, Eneida Regis Dourado, Radiologist, Maria Luiza Veiga, Physiotherapist, Ananda Baião Nacif, Physiotherapist, Maria Thaís de Andrade Calasans, Nurse, Ana Aparecida Nascimento Martinelli Braga, Psychologist, Ubirajara de Oliveira Barroso Júnior, Pediatric Urologyst.
Bahiana School of Medicine and Public Health, Salvador, Brazil.
BACKGROUND: Lower Urinary Tract Symptoms (LUTS) are associated with Functional Constipation (FC) in 47% of children, characterizing the Bladder and Bowel Dysfunction (BBD). Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children refractory to Urotheraphy. One pilot study showed that 85% of children with BBD had urinary and intestinal symptoms cured with TENS and other studies showed that children with increased Rectal Diameter (RD) have more FC. However, RD prediction in maintenance of BBD after treatment was never evaluated. Our air was to evaluate the association between RD and response to treatment in Children with BBD. METHODS: This prospective cohort study evaluated patients from 5 to 17 years old with BBD. Data of LUTS and FC were evaluated using the Dysfunctional Voiding Scoring System (DVSS), the Rome IV criteria and Constipation Score. Rectal Diameter was measured using abdominal ultrasound before and after treatment according to the technique established by Klijn et al and was considered enlarged when >3 cm. Descriptive analysis, binary regression was performed and the area under the receiver operating characteristic (ROC) curve was calculated. RESULTS: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, rectal diameter was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6 cm), with FC persisting post-treatment in 11/15 (73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment rectal diameter to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI: 2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI: 0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI: 2.40-8.0) for the persistence of BBD following treatment. CONCLUSIONS: Rectal diameter appers to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.
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