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Bowel control, bladder function, and quality of life in children with cloacal malformations

Örtqvist, Lisa ; Holmdahl, Gundela ; Borg, Helena ; Bjornland, Kristine ; Lilja, Helene ; Stenström, Pernilla LU orcid ; Qvist, Niels ; Hagen, Trine Sæther ; Pakarinen, Mikko and Wester, Tomas , et al. (2023) In Journal of Pediatric Surgery 58(10). p.1942-1948
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bowel function, Children, Cloacal malformation, Constipation, Fecal incontinence, Quality of life, Urinary incontinence, Urinary tract
in
Journal of Pediatric Surgery
volume
58
issue
10
pages
1942 - 1948
publisher
Elsevier
external identifiers
  • scopus:85146131874
  • pmid:36635159
ISSN
0022-3468
DOI
10.1016/j.jpedsurg.2022.12.003
language
English
LU publication?
yes
id
5614ab81-2b6d-4eff-928f-04d1e29a5fae
date added to LUP
2023-02-16 14:57:16
date last changed
2024-04-14 03:55:17
@article{5614ab81-2b6d-4eff-928f-04d1e29a5fae,
  abstract     = {{<p>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.</p>}},
  author       = {{Örtqvist, Lisa and Holmdahl, Gundela and Borg, Helena and Bjornland, Kristine and Lilja, Helene and Stenström, Pernilla and Qvist, Niels and Hagen, Trine Sæther and Pakarinen, Mikko and Wester, Tomas and Rintala, Risto}},
  issn         = {{0022-3468}},
  keywords     = {{Bowel function; Children; Cloacal malformation; Constipation; Fecal incontinence; Quality of life; Urinary incontinence; Urinary tract}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1942--1948}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Pediatric Surgery}},
  title        = {{Bowel control, bladder function, and quality of life in children with cloacal malformations}},
  url          = {{http://dx.doi.org/10.1016/j.jpedsurg.2022.12.003}},
  doi          = {{10.1016/j.jpedsurg.2022.12.003}},
  volume       = {{58}},
  year         = {{2023}},
}