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Kawahara T, Yamazaki A. Changes in Correlates of Health-Related Quality of Life Between Children with Spina Bifida and Their Parents as Influenced by Their Level of Independence in Toileting Self-Management: A Cross-Sectional Study. Cureus 2024; 16:e60526. [PMID: 38887360 PMCID: PMC11180625 DOI: 10.7759/cureus.60526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
Background Spina bifida (SB) leads to various complications, such as bladder and bowel disorders, which can significantly impact quality of life (QOL). Parents of children with SB are often heavily involved in bladder and bowel management, which can affect their own QOL. Therefore, transitioning to independent bladder and bowel management is pivotal because it influences the QOL of both children with SB and their parents. In this study, we investigated changes in health-related quality of life (HRQOL) among children with SB and their parents in the process of attaining independence in bladder and bowel self-management. Methods Children with SB aged 8-17 years and their parents completed the Japanese version of the QOL assessment in SB for children/teenagers (QUALAS-C/T-J) and the Short Form-8 (SF-8). Independence in bladder and bowel management was assessed using a visual analogue scale (VAS). We calculated the correlation between children's or parents' HRQOL and the children's level of independence in bladder and bowel management. Additionally, we conducted a Mann-Whitney U test on the scores of the higher and lower independence groups. The correlation between parent and child HRQOL was analyzed by dividing children's independence into two groups. Results This study consisted of 83 parent-child pairs. Parents' and children's HRQOL and levels of self-management independence were not significantly correlated, either overall or by level of independence. The parent-child group with less independence, especially in bowel management, showed moderate to strong HRQOL correlations, whereas the group with more independence showed weaker correlations. Conclusions The strength of the correlation for parent-child HRQOL was found to change based on the level of independence in bladder and bowel self-management. These results suggest that the strength of parent-child cohesion tends to be pronounced in regard to the children's degree of independence in bowel management.
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Affiliation(s)
- Tae Kawahara
- Pediatric and Family Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, JPN
| | - Akemi Yamazaki
- Pediatric and Family Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, JPN
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Valeska Halstead N, Hirsch J, Rosoklija I, Rague JT, Kim S, Meyer T, Larson JE, Swaroop VT, Bowman RM, Bowen DK, Kielb S, Cheng EY, Yerkes EB, Chu DI. Association Between Quality of Life and Neurogenic Bowel Symptoms by Bowel Management Program in Spina Bifida. Urology 2024; 184:228-234. [PMID: 38159612 PMCID: PMC10922677 DOI: 10.1016/j.urology.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To compare differences in bowel-specific quality of life (QOL), overall qQOL, and neurogenic bowel dysfunction (NBD) severity by bowel management program in patients with spina bifida (SB). METHODS We performed a retrospective cross-sectional study of patients ≥12 years old at our multidisciplinary SB center who completed both a modified Peristeen NBD questionnaire (assessing bowel symptom severity and bowel-specific QOL) and the Patient-Reported Outcomes Measurement Information System Pediatric Global Health questionnaire (assessing overall QOL). Nested, multivariable models were fit for associations between outcomes and bowel management program (enemas, conservative management, and none). RESULTS A total of 173 patients, 56.1% female and 64.6% with myelomeningocele, were included in our analysis. Median age was 18.2 years old. Patients reported using enemas (n = 42), conservative management (n = 63), and no bowel program (n = 68). When adjusting for covariates, there was no significant association between bowel-specific QOL nor overall QOL across bowel management programs. However, the use of conservative management compared to enemas was associated with worse bowel symptoms severity (adjusted beta=2.58, 95%CI=[0.09,5.06]). Additionally, greater bowel symptom severity was significantly associated with lower overall QOL (adjusted beta=-0.33, 95%CI=[-0.57,-0.10]). CONCLUSION NBD symptom severity in SB is more strongly associated with QOL than the individual bowel program being utilized. Our findings suggest that different degrees of NBD require different invasiveness of bowel programs, but it is the outcome of the bowel management program and not the specific program itself that is most associated with QOL.
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Affiliation(s)
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Soojin Kim
- Department of Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jill E Larson
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Vineeta T Swaroop
- Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Bokova E, Prasade N, Rosen JM, Lim IIP, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1558. [PMID: 37761519 PMCID: PMC10529947 DOI: 10.3390/children10091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. METHODS To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. RESULTS Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion. CONCLUSION Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient's age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - John M. Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Irene Isabel P. Lim
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20010, USA
| | - Rebecca M. Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Gandy K, Castillo H, Kelly M, Bradko V, MacDonald B, Thibadeau J, Queally J, Castillo J. Neurodevelopmental Implications on Urological Self-management Among People Living With Spina Bifida: A Practical Guide for Urology Providers. Urology 2023; 173:17-25. [PMID: 36473589 DOI: 10.1016/j.urology.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
Although folic acid fortification and advances in prenatal repair have reduced Spina Bifida (SB) prevalence and the severity of comorbidities, individuals with SB remain at elevated risk for neurocognitive impairments that studies have shown can negatively impact, among other things, urological self-care. Identifying and addressing these impairments with practical interventions can meaningfully improve long-term outcomes for individuals with SB. We review neurocognitive impairments associated with SB and provide practical solutions to support improvement of long-term urological outcomes.
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Affiliation(s)
- Kellen Gandy
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Heidi Castillo
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX
| | - Maryellen Kelly
- Department of Urology, Duke University Medical Center, Durham, NC
| | - Viachaslau Bradko
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX
| | - Beatriz MacDonald
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX
| | | | - Jennifer Queally
- Department of Psychiatry, Children's Hospital Boston, Boston, MA
| | - Jonathan Castillo
- Department of Pediatrics, Meyer Center for Developmental Pediatrics, Baylor College of Medicine, Houston, TX.
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Pediatric neurogenic bowel dysfunction: ICCS review document. J Pediatr Urol 2023:S1477-5131(23)00024-4. [PMID: 36828731 DOI: 10.1016/j.jpurol.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The International Children's Continence Society (ICCS) aims to improve the quality of life in children with lower urinary tract dysfunction. A substantial portion of children also have problems with bowel dysfunction. There is a lack of evidence-based information on managing neurogenic bowel dysfunction (NBD) in children. OBJECTIVE/METHODS The ICCS aimed to provide an up-to-date, selective, non-systematic review of NBD's definitions, assessment, and treatment. RESULTS Specific definitions and terminology are defined within the document. Recommendations and considerations for physical assessment, history taking, and diagnostic studies are made. Management updates, both surgical and non-surgical, are provided as well as recommendations for follow-up and monitoring of individuals with NBD. CONCLUSION This review of the current literature will help guide NBD management and research to improve NBD care.
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Kelly MS, Sherburne E, Kerr J, Payne C, Dorries H, Beierwaltes P, Guerro A, Thibadeau J. Release and highlights of the Lifespan Bowel Management Protocol produced for clinicians who manage neurogenic bowel dysfunction in individuals with spina bifida. J Pediatr Rehabil Med 2023; 16:675-677. [PMID: 38160374 PMCID: PMC10789357 DOI: 10.3233/prm-230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Maryellen S. Kelly
- Department of Urology, Duke University, Durham, NC, USA
- Healthcare of Women and Children’s Division, School of Nursing, Duke University, Durham, NC, USA
| | - Eileen Sherburne
- Department of Nursing Research, Children’s Wisconsin, Milwaukee, WI, USA
| | - Joy Kerr
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Patricia Beierwaltes
- College of Allied Health and Nursing, Minnesota State University, Mankato, Mankato, MN, USA
| | - Adam Guerro
- Spina Bifida Association, Arlington, VA, USA
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Baaleman DF, Wegh CAM, Hoogveld MTA, Benninga MA, Koppen IJN. Transanal Irrigation in Children: Treatment Success, Quality of Life, Adherence, Patient Experience, and Independence. J Pediatr Gastroenterol Nutr 2022; 75:166-172. [PMID: 35675698 PMCID: PMC9278699 DOI: 10.1097/mpg.0000000000003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/08/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To investigate the clinical effectiveness and patient experience of transanal irrigation (TAI) in children with constipation or fecal incontinence. METHODS Combined retrospective and cross-sectional study including pediatric patients who used a Navina TAI system. We retrospectively collected baseline characteristics and data on treatment success at 1- and 6-month follow-up (FU). Treatment success was defined as defecating at least 3 times per week and having less than 1 episode of fecal incontinence per week. We cross-sectionally assessed health-related quality of life (HRQoL), treatment adherence, treatment satisfaction (Treatment Satisfaction Questionnaire for Medication [TSQM]), illness perceptions, medication beliefs, and patient empowerment with validated questionnaires. RESULTS Thirty-four patients were included (median age at start TAI: 11 years old [range, 6-18]), 32 in the retrospective review, and 26 in the cross-sectional survey (median of 3 years after initiation). Most patients were diagnosed with functional constipation (n = 26; 76%) or a neurogenic bowel disorder (n = 6; 18%). Treatment success rates significantly improved at each FU compared with baseline (baseline: 4/25 [16%]; 1-month FU: 12/16 [75%], P = 0.008; 6-month FU: 11/18 [61%], P = 0.016; cross-sectional FU: 13/26 [50%], P = 0.008). HRQoL scores were high (PedsQL median, 73 [IQR, 54-85]). Adherence (defined as Medication Adherence Report Scale [MARS] ≥ 23) was low (36%), whereas TSQM effectiveness scores were high (median, 69 [IQR, 47-86]). The majority of children (61%) reported an increase in independence since TAI treatment. Patient empowerment (GYPES) levels were similar to those reported in children with other chronic conditions. CONCLUSIONS TAI with a Navina system is an effective bowel management system for children with intractable constipation or fecal incontinence.
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Affiliation(s)
- Desiree F. Baaleman
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Carrie A. M. Wegh
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- the Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Maxime T. A. Hoogveld
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A. Benninga
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilan J. N. Koppen
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Boman E, Nylander M, Oja J, Olofsson B. Transanal Irrigation for People With Neurogenic Bowel Dysfunction: An Integrative Literature Review. Gastroenterol Nurs 2022; 45:211-230. [PMID: 35833736 DOI: 10.1097/sga.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
Transanal irrigation has been introduced as a complement to standard bowel care for people with neurogenic bowel dysfunction. There is no contemporary integrative review of the effectiveness and feasibility of transanal irrigation from a holistic nursing perspective, only fragments of evidence to date. The aim was to investigate the effectiveness and feasibility of transanal irrigation for people with neurogenic bowel dysfunction. An integrative literature review was conducted. Nineteen studies were included. According to the results, transanal irrigation can reduce difficulties associated with defecation, episodes of incontinence, and the time needed for evacuation and bowel care. Transanal irrigation can increase general satisfaction with bowel habits and quality of life and decrease level of dependency. However, there are practical problems to overcome and adverse effects to manage. Discontinuation is relatively common. The results support the effectiveness of transanal irrigation, but feasibility is inconclusive. Users, including caregivers, report practical problems, and compliance was not always easy to achieve. It is important that users, including caregivers, are well informed and supported during transanal irrigation treatment, especially during introduction. The quality of the studies found was generally weak; therefore, high-quality quantitative and qualitative studies are needed on the topic.
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Affiliation(s)
- Erika Boman
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Malin Nylander
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Josefine Oja
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Erika Boman, PhD, RNT, is Lecturer, Department of Nursing, Umeå University, Umeå, Sweden; Department of Nursing, Åland University of Applied Sciences, Mariehamn, Finland
- Malin Nylander, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Josefine Oja, BSc, RN, is a former RN student at Umeå University, Umeå, Sweden
- Birgitta Olofsson, PhD, RN, is Professor, Department of Nursing, Umeå University, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Stevens J, de La Torre L, Hall J, Simmons H, Krause A, Ketzer J, Schletker J, Judd-Glossy L, Trainor S, Wilson P, Peña A, Bischoff A. The importance of dedicated colorectal team participation in the management of spina bifida and spinal cord injury patients. Pediatr Surg Int 2022; 38:69-74. [PMID: 34647156 DOI: 10.1007/s00383-021-05019-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In September 2020, the colorectal team of the International Center for Colorectal and Urogenital Care joined the spina bifida and spinal cord injury multidisciplinary clinic at Children's Hospital Colorado. Many important lessons were learned. METHODS A retrospective review of patients seen in the spina bifida and spinal cord injury multidisciplinary clinic from September 2020 to May 2021 was conducted. Data collected included demographics, diagnosis, pre or post-natal repair for those with myelomeningocele, whether the patient was previously seen by the colorectal team, wheelchair usage, voluntary bowel control vs. fecal incontinence, urinary control vs. clean intermittent catheterization, characteristics of contrast enema, and our proposed intervention. RESULTS Overall, 189 children were seen during the study period, ranging from 3 months to 20 years of age (average = 9.5 years). One hundred and two were males and 87 were females. Diagnosis included myelomeningocele (n = 153), spinal cord injury (n = 18), transverse myelitis (n = 7), sacral agenesis (n = 5), diastematomyelia (n = 2), spinal stenosis (n = 2), and tethered cord with lipoma (n = 2). Fifteen patients with myelomeningocele were repaired in-utero. One hundred and sixty patients were new to the colorectal team. Eighty-one patients were wheelchair users. One hundred and twenty-three patients suffered from fecal incontinence and needed enemas to be artificially clean for stool and thirty-eight patients had voluntary bowel movements and were clean with laxatives, suppository, or rectal stimulations. Twenty-eight patients were younger than three years of age and still in diapers. Despite a non-dilated colon on contrast enema, this population has a hypomotile colon. One hundred and twenty-eight patients required clean intermittent catheterization. CONCLUSION Joining the spina bifida and spinal cord injury multidisciplinary clinic allowed us to better serve this population and gave us enormous satisfaction to contribute to improve the quality of life of the patients and their parents. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jenny Stevens
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Luis de La Torre
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jennifer Hall
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Hope Simmons
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Amy Krause
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Jill Ketzer
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Julie Schletker
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Judd-Glossy
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Sarah Trainor
- Department of Pediatric Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
| | - Pamela Wilson
- Department of Pediatric Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
| | - Alberto Peña
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery Children's Hospital, Department of Surgery, Division of Pediatric Surgery, School of Medicine, University of Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA.
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Kelly MS, Wiener JS, Liu T, Patel P, Castillo H, Castillo J, Dicianno BE, Jasien J, Peterson P, Routh JC, Sawin K, Sherburne E, Smith K, Taha A, Worley G. Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele. J Pediatr Rehabil Med 2021; 13:685-693. [PMID: 33325404 PMCID: PMC8776357 DOI: 10.3233/prm-190667] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics. METHODS Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age ⩾ 5 years (n= 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status. RESULTS At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40-69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged ⩾ 12 years, female, non-Hispanic white, and with private insurance.
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Affiliation(s)
- Maryellen S. Kelly
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - John S. Wiener
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - Tiebin Liu
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Priya Patel
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Heidi Castillo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Brad E. Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joan Jasien
- Division of Pediatric Neurology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Paula Peterson
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jonathan C. Routh
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - Kathleen Sawin
- Department of Nursing Research, Children's Hospital of Wisconsin, USA and Self-management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Eileen Sherburne
- Department of Nursing Research, Children's Hospital of Wisconsin, USA and Self-management Science Center, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kathryn Smith
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA
| | - Asma Taha
- Doernbecher Children's Hospital and School of Nursing, Oregon Health Sciences University, Portland, OR, USA
| | - Gordon Worley
- Division of Pediatric Neurology, Department of Pediatrics, Duke University, Durham, NC, USA
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Abildgaaard HA, Ellebæk MB, Rawashdeh YF, Qvist N. Ileal Neoappendicostomy in the Treatment of Fecal Incontinence in Children. Eur J Pediatr Surg 2021; 31:427-431. [PMID: 32932538 DOI: 10.1055/s-0040-1716835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION An antegrade colonic enema (ACE) via an appendicostomy has been shown to be effective in the management of functional bowel problems. In cases with a missing appendix, a neoappendicostomy may be considered. MATERIALS AND METHODS A retrospective review of clinical outcomes in children who underwent ileal neoappendicostomy for ACE. Medical records were reviewed for data on demography, intra- and postoperative complications. A follow-up questionnaire on stoma problems, ACE-related problems, bowel function, patient satisfaction, well-being, and effect on daily activities was performed. RESULTS Ten patients were included at an average age of 10.6 years at surgery. In half of the patients, minor postoperative complications (Clavien-Dindo grade 2 or less) were found. Nine patients answered the questionnaire with a mean follow-up of 57 months. Despite complaints of stomal leakage, difficulties with catheterization, and pain during irrigation, they reported a high grade of satisfaction, improvements in well-being, and bowel function and the achievement of continence. CONCLUSION Ileal neoappendicostomy may be an alternative to ACE in children with severe and medically intractable constipation and or/and fecal incontinence where the appendix is missing or not available.
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Affiliation(s)
- Helle Attermann Abildgaaard
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense C, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | | | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Nahal MSH, Wigert H, Imam A, Axelsson ÅB. Assessment of health status in adolescents with spina bifida in the West Bank, Palestine: sense of coherence and self-perceived health. Disabil Rehabil 2021; 44:5479-5486. [PMID: 34106796 DOI: 10.1080/09638288.2021.1936660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess self-perceived health and sense of coherence (SOC) in adolescents with spina bifida (SB) in the West Bank, Palestine, compared to a healthy reference group. Further, to assess the association between impairment levels in the adolescents with SB and their self-perceived health and SOC. METHODS Fifty adolescents with SB and 150 healthy adolescents completed measures of self-perceived health - the Pediatric Quality of Life Inventory (PedsQLTM 4.0) - and SOC. The rehabilitation center nurses identified the physical impairments of the adolescents with SB from their medical records, and classified them by impairment severity. RESULTS Adolescents with SB reported lower self-perceived health (PedsQL median 55, IQR 42-67), than the reference group (median 85, IQR 74-90), p < 0.001, and lower SOC (median 47, IQR 44-50) than the reference group (median 55, IQR 44-61), p < 0.001. Impairment level was inversely associated with both self-perceived health and SOC. CONCLUSIONS The low self-perceived health and SOC among adolescents with SB in Palestine indicate the need for collaboration between policy makers and providers to improve these adolescents' physical and social environment and to promote the rehabilitation services provided for them.Implications for rehabilitationThe low self-perceived health and SOC among adolescents with SB in Palestine highlight the need to develop appropriate interventions to promote their health, independency, and self-care management.Collaboration of the caregivers and health care providers is required to develop, implement, and evaluate intervention programs that might promote coping abilities of the adolescents with SB.A multidisciplinary approach is needed to set goals that have a meaningful impact on social, emotional, behavioral, and educational conditions of the adolescents with SB and in different settings, for example, home, school, and community.The environment in Palestine presents barriers to the social engagement of adolescents with SB, and new ways are needed to enhance their participation in the society to promote their self-concept and wellbeing.
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Affiliation(s)
- Maha Sudki Hmeidan Nahal
- Faculty of Nursing, College of Health Professions, Al-Quds University, Abu Dies Campus, Jerusalem, Palestine
| | - Helena Wigert
- Faculty of Nursing, Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University and Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Asma Imam
- Health and Community Studies, School of Public Health at Al-Quds University, Abu Dies Campus, Jerusalem, Palestine
| | - Åsa B Axelsson
- Nursing, Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University and Division of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Utility estimation for neurogenic bowel dysfunction in the general population. J Pediatr Urol 2021; 17:395.e1-395.e9. [PMID: 33612400 PMCID: PMC8217085 DOI: 10.1016/j.jpurol.2021.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/11/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurogenic bowel dysfunction (NBD) affects over 80% of individuals with spina bifida causing bowel incontinence and/or constipation. NBD is also associated with decreased quality of life, depression, anxiety, and decreased employment/educational attainment. Because NBD is a life-altering condition without a cure, understanding the utility of different health states related to NBD would aid clinicians as they try to counsel families regarding management options and to better understand the quality of life associated with disease management. OBJECTIVE To elicit utility scores for NBD using an online community sample. STUDY DESIGN A cross-sectional anonymous survey was completed by 1534 voluntary participants via an online platform (Amazon Mechanical Turk (MTurk, http://www.mturk.com/)), representing an 87% response rate. The survey presented hypothetical scenarios that asked respondents to imagine themselves as an individual living with NBD or as the caretaker of a child with NBD. The time trade-off (TTO) method was used to estimate a utility score, and outcomes for each scenario were calculated using median and IQR. Univariate comparisons of distributions of TTO for demographic data were made using Kruskal-Wallis tests. RESULTS The median utility score for NBD was 0.84 [0.70-0.92]. Participants reported that they would give up a median of 5 years of their own life, to prevent NBD in themselves of their child. Utility values for child scenarios were significantly different when stratified by age, gender, race, parental status, marital status, and income. Stratification by current health status did not yield significantly different utility values. DISCUSSION Study findings are comparable with other TTO-determined utility values of moderately severe disease states, including severe persistent asthma (0.83), moderate seizure disorder (0.84) and mild mental retardation (0.84). The significant variations in utility values based on age, gender, race, parent status, partner/marital status and income variables existed in our study, which is similar to findings in other health fields. Study limitations include lack of unanimous agreement about TTO's validity in measuring utility values, and MTurk participant reports can be generalized to greater population. CONCLUSION NBD is perceived by the community as having a substantial impact on the lives of children with spina bifida, representing a 16% reduction from perfect health. In general, health state utilities have been increasingly used in healthcare systems to understand how burdensome a population perceives a disease is and to evaluate whether interventions improve quality of life years.
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Mosiello G, Safder S, Marshall D, Rolle U, Benninga MA. Neurogenic Bowel Dysfunction in Children and Adolescents. J Clin Med 2021; 10:1669. [PMID: 33924675 PMCID: PMC8069792 DOI: 10.3390/jcm10081669] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023] Open
Abstract
Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.
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Affiliation(s)
- Giovanni Mosiello
- Department of Surgery, Division of Urology, Bambino Gesù Pediatric and Research Hospital, 00165 Rome, Italy
| | - Shaista Safder
- College of Medicine, Center for Digestive, Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL 32806, USA;
| | - David Marshall
- Department of Pediatric Surgery and Pediatric Urology, Royal Belfast Hospital for Sick Children, Belfast BT97AB, UK;
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, Goethe-University Frankfurt, 60596 Frankfurt, Germany;
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
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15
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Prospective switch study comparing two irrigation systems for transanal irrigation in children. Acta Gastroenterol Belg 2021; 84:295-298. [PMID: 34217178 DOI: 10.51821/84.2.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. PATIENTS AND METHODS This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. RESULTS Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). CONCLUSIONS In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.
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16
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Faleiros F, Santos LM, Bimbatti K, Käppler C. Bowel Emptying Methods Used by German Residents Living With Spina Bifida. J Wound Ostomy Continence Nurs 2021; 48:149-152. [PMID: 33605711 DOI: 10.1097/won.0000000000000741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The purpose of this study was to describe and analyze methods of bowel emptying among Germans living with spina bifida. We also analyzed relationships between age, sex, level of spinal bifida anomaly, and methods of bowel elimination. DESIGN A quantitative, descriptive study. SUBJECTS AND SETTING The sample comprised 88 persons (56 women and 32 men) residing anywhere in the Federal Republic of Germany. Their mean age was 17.5 years (SD 13.64 years), range 0 to 55 years. METHODS Data were collected through an online survey questionnaire developed for the urological follow-up protocol for patients with spina bifida. Parents completed the questionnaire for participants younger than 18 years. RESULTS Twenty participants (22.7%) reported normal defecation and 68 (77.3%) reported neurogenic bowel dysfunction requiring regular bowel management. Participants requiring bowel management predominately used rectal irrigation (40.9%) and digital rectal stimulation (27.3%) to enhance bowel evacuation. Age emerged as the only factor related to the bowel management techniques. Younger participants (≤20 years) were more likely to use rectal irrigation for bowel evacuation (P = .001, Fisher's exact test), whereas older respondents (≥21 years) were more likely to use digital rectal stimulation (P = .015, Fisher's exact test). Analysis revealed no differences in methods of bowel evacuation based on sex or level of spina bifida anomaly (cervical, thoracic, lumbar, or sacral). CONCLUSIONS Rectal irrigation was the most common method for bowel evacuation. Participants were less likely to employ potentially effective and more conservative measures for intestinal emptying, such as toilet training/timed evacuation associated with Valsalva maneuvers, abdominal press, abdominal massage, and digital rectal stimulation. Additional comparative studies with more participants and other countries with intestinal emptying methods are needed to better understand the needs of individuals with spina bifida and their families and to improve the health-related quality of life of these people.
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Affiliation(s)
- Fabiana Faleiros
- Fabiana Faleiros, PhD, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Lilka Marques Santos, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Karina Bimbatti, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Christoph Käppler , PhD, Faculty of Rehabilitation Sciences, University of Dortmund, Germany
| | - Lilka Marques Santos
- Fabiana Faleiros, PhD, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Lilka Marques Santos, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Karina Bimbatti, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Christoph Käppler , PhD, Faculty of Rehabilitation Sciences, University of Dortmund, Germany
| | - Karina Bimbatti
- Fabiana Faleiros, PhD, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Lilka Marques Santos, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Karina Bimbatti, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Christoph Käppler , PhD, Faculty of Rehabilitation Sciences, University of Dortmund, Germany
| | - Christoph Käppler
- Fabiana Faleiros, PhD, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Lilka Marques Santos, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Karina Bimbatti, Nursing School of Ribeirão Preto, University of São Paulo, Ribeirão Preto (SP), Brazil
- Christoph Käppler , PhD, Faculty of Rehabilitation Sciences, University of Dortmund, Germany
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Kelly MS, Stout J, Wiener JS. Who is managing the bowels? A survey of clinical practice patterns in spina bifida clinics. J Pediatr Rehabil Med 2021; 14:675-679. [PMID: 34864702 DOI: 10.3233/prm-201512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Neurogenic bowel dysfunction (NBD) affects 80% of individuals with spina bifida. Performing and disseminating research on NBD to reach the appropriate audience is difficult given the variability among medical specialties managing NBD. This study aimed to identify which medical specialties and types of providers are currently managing NBD in the United States. METHODS A survey was developed and sent to 75 spina bifida clinics. Surveys queried which specialty was primarily responsible for medical and surgical management of NBD and any others that assist in NBD care. The license and certification level of the providers were collected. Descriptive statistics were performed to describe the results. RESULTS Response rate was 68%. Urology was the leading specialty primarily responsible for NBD management (39%) followed by rehabilitation medicine and developmental pediatrics (22% and 20%, respectively). Physicians were the primary providers of care followed by nurse practitioners (54% vs 31%). Urology performs 65% of NBD surgeries. CONCLUSION Multiple specialties and providers are involved in NBD management with variation among clinics. Development of improved NBD care should include a spectrum of specialties and providers. Dissemination of research should be aimed at multiple specialty groups.
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Affiliation(s)
- Maryellen S Kelly
- Healthcare of Women and Children, School of Nursing, Duke University, Durham, NC, USA.,Department of Surgery, Division of Urology, Duke University, Durham, NC, USA
| | - Jennifer Stout
- Department of Surgery, Division of Urology, Duke University, Durham, NC, USA
| | - John S Wiener
- Department of Surgery, Division of Urology, Duke University, Durham, NC, USA
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Pediatric Neurogenic Bladder and Bowel Dysfunction: Will My Child Ever Be out of Diapers? Eur Urol Focus 2020; 6:838-867. [PMID: 31982364 DOI: 10.1016/j.euf.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/02/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Managing patient and parent expectations regarding urinary and fecal continence is important with congenital conditions that produce neurogenic bladder and bowel dysfunction. Physicians need to be aware of common treatment algorithms and expected outcomes to best counsel these families. OBJECTIVE To systematically evaluate evidence regarding the utilization and success of various modalities in achieving continence, as well as related outcomes, in children with neurogenic bladder and bowel dysfunction. EVIDENCE ACQUISITION We performed a systematic review of the literature in PubMed/Medline in August 2019. A total of 114 publications were included in the analysis, including 49 for bladder management and 65 for bowel management. EVIDENCE SYNTHESIS Children with neurogenic bladder conditions achieved urinary continence 50% of the time, including 44% of children treated with nonsurgical methods and 64% with surgical interventions. Patients with neurogenic bowel problems achieved fecal continence 75% of the time, including 78% of patients treated with nonsurgical methods and 73% with surgical treatment. Surgical complications and need for revisions were high in both categories. CONCLUSIONS Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Surgical intervention can be successful in patients refractory to nonsurgical management, but the high complication and revision rates support their use as second-line therapy. This is consistent with guidelines issued by the International Children's Continence Society. PATIENT SUMMARY Approximately half of children with neurogenic bladder dysfunction will achieve urinary continence, and about three-quarters of children with neurogenic bowel dysfunction will become fecally continent. Most children can be managed without surgery. Patients who do not achieve continence with nonsurgical methods frequently have success with operative procedures, but complications and requirements for additional procedures must be expected.
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Beierwaltes P, Church P, Gordon T, Ambartsumyan L. Bowel function and care: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:491-498. [PMID: 33252093 PMCID: PMC7838963 DOI: 10.3233/prm-200724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Bowel dysfunction, such as constipation and fecal incontinence, has a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Secondary complications may result from bowel dysfunction and include urologic dysfunction, loss of skin integrity, shunt (hydrocephalus) function, as well as loss of social opportunities and employability. METHODS Using a consensus building methodology, the guidelines for management of bowel dysfunction in spina bifida were written by experts in the field of spina bifida and bowel function and care. RESULTS The evidence-based guidelines are presented in table format and provide age-specific recommendations to achieve fecal continence without constipation. Recommended treatments are presented from least to most invasive options. Literature supporting the recommendations and the interval research published to date is also presented. CONCLUSION These guidelines present a standardized approach to management of bowel dysfunction in spina bifida. Bowel management in children and young adults with spina bifida is limited by variability in clinical practice and paucity of robust research in neurogenic bowel. Collaborative multi-institutional efforts are needed to overcome research barriers and provide innovative solutions.
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Affiliation(s)
| | - Paige Church
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tiffany Gordon
- Workforce Professional Development and Family Nurse Practitioner Clinical Experiences, Minnesota State University Mankato, Mankato, MN, USA
| | - Lusine Ambartsumyan
- University of Washington, Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, WA, USA
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20
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Mummareddy N, Dewan MC, Huang A, Basem J, Bennett KA, Shannon CN, Wellons JC. Intrauterine closure of myelomeningocele is associated with superior long-term quality of life than postnatal closure: a single-center study. J Neurosurg Pediatr 2019; 24:115-119. [PMID: 31100721 DOI: 10.3171/2019.4.peds18770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Management of Myelomeningocele Study (MOMS) established several important benefits of myelomeningocele fetal closure, including decreased need for shunting at 30 months. However, the effects of fetal closure on long-term quality of life (QOL) have not been studied. In this study, the authors aimed to analyze the differences in long-term QOL between children treated with intrauterine repair and those treated with postnatal repair. METHODS Caregivers of children treated with either intrauterine or postnatal closure at a tertiary acute care hospital between 1997 and 2003 were contacted to participate. The Pediatric Quality of Life Inventory (PedsQL 4.0) and a surgical history questionnaire were administered over the phone. Responses to the QOL survey were reverse scored and linearly transformed to a 0-100 scale, with a higher score indicating better QOL. The Mann-Whitney U-test was used to analyze differences in means. RESULTS Seventy-four children had MMC repair between 1997 and 2003. Twenty-three (31%) of the patients' families responded to the PedsQL 4.0 questionnaire. Of these 23 children, 11 had intrauterine closure and 12 had postnatal closure. The intrauterine group did not differ in age (median [IQR] 17 years [14-17 years] vs 15 years [14-19 years], p = 0.926), sex (27.3% vs 41.7% male, p = 0.469), or lesion level (p = 0.199) from the postnatal group. Fewer patients in the intrauterine group underwent neurosurgical procedures than those in the postnatal group (55.6% vs 100%, p = 0.018). However, of the children receiving neurosurgical procedures, there was no difference in the number of procedures between the intrauterine and postnatal groups (median [IQR] 4 [2-10.5] vs 2.5 [1.75-6.25], p = 0.458). There was no difference in the percentage of children receiving nonneurosurgical procedures between the two groups (100% vs 100%, p > 0.99). Children who underwent intrauterine closure had significantly higher psychosocial health (median [IQR] 70.0 [56.7-83.3] vs 55.0 [42.1-60.0], p = 0.015) as well as total QOL (median [IQR] 56.5 [55.4-81.5] vs 49.5 [32.9-59.0], p = 0.019) than children with postnatal closure. Physical health was not significantly different between the two groups (median [IQR] 62.5 [37.5-78.1] vs 39.1 [18.8-59.4], p = 0.108). CONCLUSIONS Relative to postnatal closure, children who underwent intrauterine closure of MMC demonstrated better long-term QOL as measured by psychosocial and overall QOL metrics. Given that not all medical and socioeconomic confounders were adjusted for due to the low sample size, validation of these results in a larger population and across multiple centers is needed.
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Affiliation(s)
| | - Michael C Dewan
- 1Surgical Outcomes Center for Kids and
- Departments of2Neurological Surgery and
| | | | | | - Kelly A Bennett
- 3Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids and
- 4Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt; and
| | - John C Wellons
- 1Surgical Outcomes Center for Kids and
- 4Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt; and
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Kelly MS. Malone Antegrade Continence Enemas vs. Cecostomy vs. Transanal Irrigation-What Is New and How Do We Counsel Our Patients? Curr Urol Rep 2019; 20:41. [PMID: 31183573 DOI: 10.1007/s11934-019-0909-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW No gold standard exists for managing neurogenic bowel dysfunction, specifically in individuals with spina bifida. Since the International Children's Continence Society published its consensus document on neurogenic bowel treatment in 2012, an increased focus on why we must manage bowels and how to improve our management has occurred. This review provides updated information for clinicians. RECENT FINDINGS A surge in research, mostly retrospective, has been conducted on the success and satisfaction of three types of management for neurogenic bowel. All three management techniques have relatively high success rates for fecal continence and satisfaction rates. Selection of which treatment to carry out still is debated among clinicians. Transanal irrigation is a safe and effective management option for neurogenic bowel that does not require surgery. Antegrade enemas can be carried out via cecostomy tube or Malone antegrade continence enema with similar fecal continence outcomes.
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Affiliation(s)
- Maryellen S Kelly
- Division of Urology, Department of Surgery, Duke University Medical Center, Box 3831, Durham, NC, 27710, USA.
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22
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Vu Minh Arnell M, Abrahamsson K. Urinary continence appears to enhance social participation and intimate relations in adolescents with myelomeningocele. J Pediatr Urol 2019; 15:33.e1-33.e6. [PMID: 30228091 DOI: 10.1016/j.jpurol.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The majority of adults with myelomeningocele (MMC) in Western Sweden use incontinence pads. There is an ongoing discussion as to whether continence improves the quality of life (QoL) in individuals with MMC as it has been hard to establish that an increase in QoL measured by generic health-related quality of life (HRQoL) instruments is achieved by continence surgery. OBJECTIVE The hypotheses are that patients who are actively involved in a urotherapy/urology program are more continent than patients who are not and that urinary continence is one of the conditions required to enable social participation and physical intimacy. STUDY DESIGN All 25 individuals in Western Sweden with MMC (15 males) aged 16-18 years were involved in this cross-sectional, prospectively designed study of urinary and fecal continence. During interviews, questions were asked about the following: clean intermittent catheterization (CIC) and bowel regimens, the need for reminders or help from an assistant, social participation, and physical intimacy with a partner. RESULTS In the group, overall 17 of 25 (68%) had achieved urinary continence, 19 of 25 (76%) had a medical history of fecal continence, and 14 of 25 (56%) had no prescription for incontinence pads. Those who were urinary continent (17) included all nine patients who had received continence surgery in addition to six patients taking anticholinergics and two following the CIC procedure only. Urinary incontinence due to sphincter insufficiency was found in eight individuals, all of whom declined surgical treatment. All individuals (25/25) physically catheterized themselves, and 15/25 (60%) performed the fecal elimination regimen independently. Twelve individuals participated actively in social life, and eight of them had, or had had, a partner. All these 12 were urinary continent, and all but one were able to follow a fecal elimination regimen independently. Three of the 12 said they were fecal incontinent but knew how to become continent by following the prescribed fecal elimination regimen. DISCUSSION Studies in this patient group have shown that incontinence means that it's harder to live a healthy adult life. Children too worry about incontinence episodes at school, and 70% consider urinary incontinence a problem. A limitation in the study is the small population, something often seen in rare diseases. CONCLUSIONS With standardized follow-up, active treatment strategy and uro/bowel therapy, the urinary continence rate in adolescents with MMC at the study center is high compared with adults with MMC in Sweden. It appears that urinary continence is important in enabling successful participation in social life and in intimate physical relations with others.
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Affiliation(s)
- M Vu Minh Arnell
- The Pediatric Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - K Abrahamsson
- The Pediatric Surgery Department, Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
Spina bifida is a birth defect that commonly causes bowel and bladder dysfunction in children with a significant negative impact on quality of life and emotional wellbeing. Fecal continence improves satisfaction and the quality of life of both children and their caretakers. Bowel management in children with spina bifida is hampered by limited controlled studies and variable practice within different institutions and subspecialists. The goals of a successful bowel management program in children with spina bifida consist of predictable bowel movements, social continence, and eventual independence. Treatment options range from conservative interventions such as diets and oral laxatives that modify stool consistency and transit, to trans-anal irrigations and antegrade continence enemas that facilitate predictable recto-sigmoid emptying and provide a greater degree of independence. In children, the treatment approach should be implemented in the context of the child's developmental age in order to allow for optimum social integration with their age-appropriate peers. We present a review of a stepwise approach to bowel management in children with spina bifida and the challenges related to the proposed treatment options.
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Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Leonel Rodriguez
- Colorectal and Pelvic Malformations Center, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Bakanienė I, Prasauskienė A. Clinical and Environmental Predictors of Health-Related Quality of Life in Lithuanian Children and Adolescents with Spina Bifida: A Cross-Sectional Analysis of a Nationally Represented Sample. ACTA ACUST UNITED AC 2018; 54:medicina54040059. [PMID: 30344290 PMCID: PMC6174335 DOI: 10.3390/medicina54040059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 11/16/2022]
Abstract
Background and objectives: In pediatric chronic health conditions, health-related quality of life (HRQOL) is a useful indicator of health, development, and well-being. The purpose of the study was to assess the effect of clinical and environmental factors on the HRQOL of children and adolescents with spina bifida (SB). Materials and methods: A cross-sectional study of the sample of 99 children and adolescents with SB aged 5 to 17 years. The questionnaires used in the study were the Spina Bifida Health-Related Quality of Life instrument (HRQOL-SB), and the Participation and Environment Measure for Children and Youth. Medical data were obtained from the medical records and the clinical examination. Results: A multivariate linear regression revealed that the most potent predictors of the HRQOL in children with SB were the community overall environmental supports (β = 0.504; p = 0.0001), a number of health conditions (β = -0.395; p = 0.0001), access to personal transportation (β = 0.236; p = 0.023), and supplies (β = 0.181; p = 0.031), explaining 80.3% of the variance in the SB-HRQOL scores. The most significant predictors of the HRQOL in adolescents were a number of health conditions (β = -0.387; p = 0.0001), cognitive demands of activities at home (β = 0.345; p = 0.0001), supplies (β = 0.267; p = 0.0001), money (β = 0.303; p = 0.0001), physical layout at school (β = 0.188; p = 0.008), and access to public transportation (β = 0.206; p = 0.019), explaining 89.5% of the variance in the SB-HRQOL scores. Conclusions: Both clinical and environmental factors determined the HRQOL of children and adolescents with SB. Environmental supports and resources contributed to HRQOL more than medical problems, especially in adolescents. The number of associated medical problems, reflecting disease severity, was the more potent clinical predictor compared to an individual health problem.
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Affiliation(s)
- Indrė Bakanienė
- Department of Children's Rehabilitation, Lithuanian University of Health Sciences, LT-4717910 Kaunas, Lithuania.
| | - Audronė Prasauskienė
- Department of Children's Rehabilitation, Lithuanian University of Health Sciences, LT-4717910 Kaunas, Lithuania.
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25
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Abstract
Spina bifida is a birth defect that commonly causes bowel and bladder dysfunction in children with a significant negative impact on quality of life and emotional wellbeing. Fecal continence improves satisfaction and the quality of life of both children and their caretakers. Bowel management in children with spina bifida is hampered by limited controlled studies and variable practice within different institutions and subspecialists. The goals of a successful bowel management program in children with spina bifida consist of predictable bowel movements, social continence, and eventual independence. Treatment options range from conservative interventions such as diets and oral laxatives that modify stool consistency and transit, to trans-anal irrigations and antegrade continence enemas that facilitate predictable recto-sigmoid emptying and provide a greater degree of independence. In children, the treatment approach should be implemented in the context of the child's developmental age in order to allow for optimum social integration with their age-appropriate peers. We present a review of a stepwise approach to bowel management in children with spina bifida and the challenges related to the proposed treatment options.
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Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Leonel Rodriguez
- Colorectal and Pelvic Malformations Center, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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26
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Gregersen NH, Kvist K, Hindsø K, Born AP, Hoei-Hansen CE. The clinical features of paediatric neural tube defects changed in a tertiary care centre between 1997 and 2015. Acta Paediatr 2017; 106:837-840. [PMID: 28135771 DOI: 10.1111/apa.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/13/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kolja Kvist
- Department of Paediatric Surgery; University Hospital Rigshospitalet; Copenhagen Ø Denmark
| | - Klaus Hindsø
- Department of Orthopaedic Surgery; University Hospital Rigshospitalet; Copenhagen Ø Denmark
| | - Alfred Peter Born
- Department of Paediatrics; University Hospital Rigshospitalet; Copenhagen Ø Denmark
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27
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Abstract
Pediatric patients with either functional or organic bowel dysfunction may suffer from constipation and fecal incontinence and represent a complex group in whom management is often difficult. Many noninvasive and invasive treatments have been proposed, with variable efficacy and adverse effects. Transanal irrigation (TAI) is now an accepted alternative, in both children and adults, for bowel dysfunction that has not responded to conservative and medical therapies. There is, however, still some uncertainty about the use of TAI in pediatric populations. Hence, a group of specialists from different nations and pediatric disciplines, all with long-standing experience of bowel management in children, performed a literature search and had round table discussions to determine the best-practice use of TAI in the pediatric patient population. Based on these findings, this article provides best-practice recommendations on indications, patient selection, important considerations before treatment, patient and family training, treatment regimens, troubleshooting, and practical aspects of TAI. We conclude that careful patient selection, a tailored approach, directly supervised training, and sustained follow-up are key to optimize outcomes with TAI in children with functional or organic bowel dysfunction.
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Bakaniene I, Prasauskiene A, Vaiciene-Magistris N. Health-related quality of life in children with myelomeningocele: a systematic review of the literature. Child Care Health Dev 2016; 42:625-43. [PMID: 27381478 DOI: 10.1111/cch.12367] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/17/2016] [Accepted: 05/22/2016] [Indexed: 12/16/2022]
Abstract
Myelomeningocele (MMC) is the most complex congenital birth defect compatible with life. To provide the best health care for children with MMC, clinicians and researchers have to understand health and functional status of their patients as well as factors influencing their quality of life (QOL). The objective is to review studies that assess health-related quality of life (HRQOL) and determinants of HRQOL in children with MMC. The data sources include MEDLINE, along with reference lists of relevant reviews and included articles. Study eligibility criteria are quantitative studies that assess HRQOL using validated HRQOL instrument. Participants include children aged 0-18 years with diagnosis of MMC or spina bifida. Risk of bias was assessed using the Hayden system for non-randomized studies. Narrative synthesis and tables of results of HRQOL studies were conducted. Children with MMC have decreased HRQOL compared with normative population. Physical HRQOL is the most exposed aspect of QOL, while discrepancies in psychosocial domains vary by study. Many determinants of QOL have been found, and it is still not clear which determinant can be described as the strongest predictor. Psychosocial factors are the most consistent determinants of HRQOL.Heterogeneous study sample size, study designs, determinant and outcomes measures limited synthesis of findings. The HRQOL in children with MMC is complex and mediated by a number of associated medical problems, together with a variety of psychosocial and environmental factors. Future research is needed (a) on the relation between complex medical problems, functional independence, parent's and clinician's expectation and HRQOL in children and (b) to assess the differences in HRQOL by social environment and healthcare system.
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Affiliation(s)
- I Bakaniene
- Department of Children's Rehabilitation, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A Prasauskiene
- Department of Children's Rehabilitation, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - N Vaiciene-Magistris
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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