Bowel Control, Bladder Function, and Quality of Life in Children with Cloacal Malformations.

INTRODUCTION: Long-term outcomes of cloacal malformations remain unclear. We evaluated postoperative bowel control, bladder function and quality of life in patients under 18 years of age with cloaca. MATERIALS AND METHODS: This was a multi-center cross-sectional observational study accomplished by the Nordic Pediatric Surgery Research Consortium. Patients with a cloacal malformation, 4-17 years of age, were eligible. Data including patient characteristics, surgical procedures, and complications were retrieved from case records. Established questionnaires with normative control values evaluating bowel function, bladder function, and health-related quality of life (HRQoL) were sent to the patients and their caregivers. The study was approved by the participating center's Ethics Review Authorities. RESULTS: Twenty-six (67%) of 39 eligible patients with median age 9.5 (range, 4-17) years responded. Twenty-one (81%) patients had a common channel ≤3 cm. Imaging confirmed sacral anomalies in 11 patients and spinal cord abnormalities in nine. Excluding patients with stoma (n = 5), median bowel function score was 12 [7-19], and 5 patients (20%) reported a bowel function score ≥17, approaching normal bowel control level. Bowel management increased proportion of socially continent school-aged children to 52%. Six (23%) patients had a permanent urinary diversion or used clean intermittent catheterization (CIC), while majority (70%) of the remaining patients were urinary continent. The reported HRQoL was comparable to healthy Swedish children. CONCLUSION: Whilst well-preserved spontaneous bowel control was rare, a majority of patients were dry for urine without any additional procedures. Few patients experienced social problems or negative impact on HRQoL due to bladder or bowel dysfunction. LEVEL OF EVIDENCE: Level IV.

Surgical treatment for urinary incontinence in children. / Kirurgisk behandling ved urininkontinens hos barn.

Only a small proportion of children with urinary tract malformations are incontinent, but it is important to identify those children for whom surgical treatment can eliminate or reduce urinary leakage.

[Endoscopic treatment of vesicoureteral reflux in children]. / Endoskopisk behandling av vesikoureteral refluks hos barn.

BACKGROUND: At Rikshospitalet, Norway, vesicoureteral reflux (VUR) in children has been treated with subureteric teflon (polytetrafluoroethylen) injection (STING) since 1994. After a biological injection substance became commercially available, we changed to Deflux (dextranomer/hyaluronic acid) in 2000. The aim of this study was to assess whether the VUR results following use of the new injection substance are comparable to those for the previously used substance. MATERIAL AND METHODS: 202 ureters with VUR grade II-V in 132 patients (91 girls) were treated for the first time with subureteric injections of teflon (n = 77) or Deflux (n = 125) during the 5-year period November 1998-2003. The charts were retrospectively reviewed. RESULTS: 201 ureters (131 patients) were followed up with urinary tract ultrasound and voiding cystogram 1-34 months after the last injection. After the first teflon injection 43% of the ureters had no reflux and an additional 9% were improved. After the first Deflux injection 48 % of the ureters had no reflux and 10% were improved. After 1-3 injections 78% (teflon 71%, Deflux 81%) were without or had reduced VUR. Three ureters showed terminal stenosis after the first Deflux injection. Statistically, the results were independent of VUR grade, injection substance and surgeon experience, and similar for duplex and single ureters. INTERPRETATION: Endoscopic treatment of VUR in children is safe and simple. The results after Deflux and teflon were similar. Urinary tract ultrasound and voiding cystogram should be used for follow-up of all patients some months after injection.