Turkish Neurosurgery
Anocutaneous Reflex Revisited: How Valuable Is Its Determination in Children with Spina Bifida? A Descriptive Study in A Cohort of 217 Patients
Kerem Ozel1, Arzu Canmemis1, Nilufer Goknar2, Cengiz Candan2, Orkhan Alizada3, Ibrahim Alatas3
1University of Istanbul Medeniyet School of Medicine, Pediatric Surgery, Istanbul,
2University of Istanbul Medeniyet School of Medicine, Pediatric Nephrology, Istanbul,
3University of Baskent-Istanbul Hospital , Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.36527-21.2
Aim:The aim of the study was to determine the clinical value of anocutaneous reflex (AR) in children with neurogenic bladder due to spina bifida (SB).Material and Methods:Patients who were diagnosed as SB were evaluated prospectively. AR and bulbocavernous reflex (BCR) were examined. Patients were divided into those who had AR and who did not. Age, gender, diagnosis, presence of ventriculoperitoneal (VP) shunt, symptomatic urinary tract infections (UTI), leg movements, clean intermittent catheterization (CIC) and anticholinergic therapy, level of the lesion, urodynamic detrusor and sphincter activity were evaluated. Chi-square test and univariate regression analysis were done. The value of the AR was evaluated in two by two contingency table.Results:A total of 217 patients were evaluated. There were 109 boys and 108 girls. AR was present in 53 patients and absent in 164 patients. Anticholinergic therapy was necessary in 37,7% of patients with AR and in 23,8 % of without AR (p=0,015). Patients with AR had more higher level lesions (p=0,005), more detrusor overactivity, less detrusor underactivity (p=0,007). There were less detrusor sphincter dyssynergia (DSD) in AR patients (p=0,029). Specificity of AR was found to be 83% and positive predictive value 76% in predicting detrusor overactivity and positive predictive value was 80% in predicting DSD.Conclusion:AR determination is a valuable and simple tool in neurogenic bladder. This report delineates the clinical significance of this reflex and is the largest cohort describing this significance. This simple examination should not be skipped in the initial evaluation and follow up of these patients.
Corresponding author : Orkhan Alizada