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CONGRESS OF THE ESPU
MATERIAL AND METHODS
Since 2010, 65 patients (38 girls, 27 boys ) underwent surgery of fetal repair of MMC at the University
Children's Hospital Zurich. 72 % (n=47) of the families are from all over Europe (Germany, France,
Russia, Austria, Italy, Sweden, Slovakia, UK). These children are closely monitored at the special-
ized multidisciplinary MMC centre and show several physical benefits e.g., motor function.
However, about 2/3 of the patients present a neurogenic bladder dysfunction and the continence
team is challenged by these new group of patients.
RESULTS
A summary of the challenges and opportunities in the continence care for a paediatric continence
nurse specialist will be presented e.g., CIC support in different countries with different standards or
being confronted with parent's expectations after surgery.
CONCLUSIONS
The fetal repair of MMC offers an opportunity to improve patient's health conditions, and enhance
the vision of treatment for health providers. However, the new treatment and its different impact on
physical function requires continuous attendance and medical as well as emotional support for the
families.
10:30–10:40
S5-5 (LO)
SIMPLE RECTAL ENEMA ALONE IS NOT SUFFICIENT
FOR URODYNAMIC STUDIES IN SPINA BIFIDA PATIENTS
Ezgi ALTUN TANIL
1
, Sibel TIRYAKI
2
, Ibrahim ULMAN
1
and Ali AVANOGLU
1
1) Ege University, Pediatric Surgery Division of Pediatric Urology, Izmir, TURKEY - 2) Ege University-Faculty
of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, TURKEY
PURPOSE
A simple rectal enema can often provide adequate emptiness of rectum to evaluate intraabdominal
pressure in most cases. However, it may not be effective in patients with spina bifida who have
severe constipation. The aim of this study was to compare different approaches to provide rectal
emptiness for urodynamic tests in spina bifida patients.
MATERIAL AND METHODS
After ethical approval, we prospectively recorded the findings of urodynamics in spina bifida pa-
tients. We performed urodynamic studies after a single rectal enema from March 2016 to March
2017 and after a three day rectal wash-out from March 2017 to September 2017. Two groups were
compared in terms of failure to complete the study.
RESULTS
Urodynamic studies were performed in 164 spina bifida patients during the study period. There
were 115 patients in the single enema and 49 patients in the three days wash-out group. There
were no significant differences between the groups in terms of age (91 and 98 months respectively,
p=0.722), sex (M/F:54/61 and 25/24, p=0.773), need for laxatives (24 % and 31 %, p=0.337) or
incontinence (14 % and 22 %, p=0.260). The procedure was terminated due to the presence of
stool in the rectum in none of the 49 patients in three days wash-out, but 29 of 115 (18 %) in the
simple enema group (p<0.001).
CONCLUSIONS
A single rectal enema may be inadequate for completing a urodynamic study in spina bifida patients
with severe constipation. A three-day intensive bowel cleansing warrants a successful study in most
cases.