Dados do Trabalho

Título

PELVIC DYSSYNERGIA ON HIGH-RESOLUTION ANORECTAL MANOMETRY IN CHILDREN WITH LOWER URINARY TRACT SYMPTOMS

Introdução e Objetivo

High-resolution anorectal manometry (HR-AM) has been used in the evaluation of functional constipation (FC) in children, 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 and isolated symptoms with daytime urination. This study aims to assessing the presence of pelvic dyssynergia on high-resolution anorectal manometry in children with lower urinary tract symptoms.

Método

HR-ARM has been performed on children with LUTS aged ≥ 5 years. Children were categorized according to LUTS into non-monosymptomatic enuresis, monosymptomatic enuresis, 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.

Resultados

Twenty-nine children with a mean age of 9.07 ± 2.68 years, 15 (51,7%) were male, underwent HR-ARM. 13 (44,8%) had non-monosymptomatic enuresis, 10 (34.5%) had monosymptomatic enuresis, and 5 (17,2%) had isolated symptoms with daytime urination. Twelve (41,4%) patients suffered from constipation. Twenty children (69%) had pelvic dyssynergia, with Type I dyssynergia being the most common (12 children – 41,4%). Among children with pelvic dyssynergia, twelve (60%) had non-monosymptomatic enuresis (p=0.01). There was no association between pelvic dyssynergia and monosymptomatic enuresis / isolated symptoms with daytime urination. Pacients with dyssynergia had a higher intrarectal expulsion pressure, with a median 53.4 (IC 46.6-64.4) x 29.9 (IC 23.9 – 49.2); p=0.006.

Conclusão

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 more severe cases of LUTS.