Abstract General Information

Title

PELVIC DYSSYNERGIA ON HIGH-RESOLUTION ANORECTAL MANOMETRY (HR-ARM) IN CHILDREN WITH LOWER URINARY TRACT SYMPTOMS (LUTS)

Introduction and objective

High-resolution anorectal manometry (HR-AM) has been used to assisting the identification and discrimination of the 4 types of pelvic dyssynergia. From the data of HR-AM, it is possible to identify similarities and differences between the groups with monosymptomatic enuresis (MNE), non- monosymptomatic enuresis (NMNE) and isolated symptoms with daytime urination. The purpose of this study was to assessing the presence of pelvic dyssynergia on high-resolution HR-ARM in children with lower urinary tract symptoms (LUTS).

Method

HR-ARM has been performed on children with LUTS aged ≥ 5 years. Children were categorized according to LUTS into NMNE, MNE, and isolated urinary with daytime urination. The evaluation of the urinary symptoms was carried out with the help of a structured questionnaire and a voiding diary. HR-ARM was performed according to the London protocol. According to Rao´s classification, pelvic dyssynergia was classified as Type I dyssynergia, II, III, and IV. Functional constipation (FC) was assessed using the Rome IV criteria.

Results

Thirty-two children with a mean age of 9.06 ± 2.63 years, 17 (53,1%) were male, underwent HR-ARM. 14 (43,8%) had NMNE, 11 (34.4%) had MNE, and 6 (18,8%) had isolated symptoms with daytime urination. Fourteen (43,8%) patients suffered from constipation. Twenty-one children (65,6%) had pelvic dyssynergia, with Type I dyssynergia being the most common (13 children – 40,6%). Among children with pelvic dyssynergia, twelve (57,1%) had NMNE (p=0.03). There was no association between pelvic dyssynergia and MNE / isolated symptoms with daytime urination. Pacients with dyssynergia had a higher intrarectal expulsion pressure, with a median 53.8 (IC 47.55 – 63.75) x 28.5 (IC 25.85 – 40.35); p=0.001. In addition, they had a lesser anal relaxation during straining, with a median -10.35 (IC -28.82 – 9,15) x 36.6 (IC 22.85 – 50); p<0,001.

Conclusion

The presence of pelvic dyssynergia is associated with the simultaneous presence of daytime and nocturnal symptoms, hence non-monosymptomatic enuresis. This could indicate that the presence of pelvic incoordination is more common in patients with daytime symptoms and enuresis concurrent.