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

Objective Assessing the presence of pelvic dyssynergia on high-resolution anorectal manometry (HR-ARM) in children with lower urinary tract symptoms (LUTS).

Methods 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.

Results Forty children with a mean age of 9.33 ± 2.66 years, 22 (55%) were male, underwent HR-ARM. Twenty (50%) patients suffered from constipation. Twenty-eight children (70%) had pelvic dyssynergia, with Type I dyssynergia being the most common. Among children with pelvic dyssynergia, seventeen (60,7%) had non-monosymptomatic enuresis (p=0.04). Patients with dyssynergia had a higher intrarectal expulsion pressure, with a median 54.15(IC 45.88 – 66.23) × 28.05 (IC 25.98 – 36.53); p< 0.001. In addition, they had a lesser anal relaxation during straining, with a median -10.35 (IC -28.82 – 9,15) × 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 more severe cases of LUTS.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025