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Liu X, Wang Z, Zhou Z, Yang S, Yang J, Wen Y, Zhang Y, Lv L, Hu J, Wang Q, Lu W, Wen JG. Prevalence, risk factors, psychological effects of children and adolescents with lower urinary tract symptoms: a large population-based study. Front Pediatr 2024; 12:1455171. [PMID: 39233869 PMCID: PMC11371695 DOI: 10.3389/fped.2024.1455171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/07/2024] [Indexed: 09/06/2024] Open
Abstract
Background Lower urinary tract symptoms (LUTS) are clinically frequent and seriously affect the psychological and mental health of children and adolescents. However, most studies on LUTS and its influence on the psychological behavior and mental health have focused on adults. This study aimed to investigate LUTS prevalence and associated factors in children and adolescents and explore its impact on psychological behavior. Materials and methods From October 2019 to November 2021, an epidemiological LUTS survey was carried out on 6,077 children aged 6-15 years old in 12 primary and secondary schools in China by using anonymous questionnaires. Results A total of 5,500 valid questionnaires were collected, and the total prevalence of four representative symptoms of LUTS: urgency, frequency, daytime urinary incontinence, and nocturnal enuresis was 19.46%, 14.55%, 9.75%, and 8.4%, respectively. The prevalence decreased with age, which decreased rapidly in children aged 6-12 years old. The incidence of LUTS in those who did not continue to use disposable diapers (DD) and began to perform elimination communication (EC) after the age of 1 was significantly higher than that of those who stopped using DD and started EC before 1 year of age (P < 0.05). There were significant differences in the occurrence of LUTS without toiled training (TT) (P < 0.05). The prevalence of LUTS in males was significantly higher than in females (P < 0.05). LUTS in children and adolescents with constipation was significantly higher compared to those without constipation (P < 0.05). The detection rate of abnormal psychological behavior in the LUTS group was 44.6%, which was significantly higher than that in the no LUTS group (21.4%, P < 0.05). The scores of emotional symptoms, conduct problems, hyperactivity, and peer communication problems were significantly higher in the LUTS group than the control group. Conclusions In Mainland China, the prevalence of LUTS in children and adolescents is high. Continued use of DD after 1 year of age, history of urinary tract infection, lack of TT, and constipation were risk factors for LUTS. EC before 1 year of age is a protective factor for LUTS. The prevalence of psychological behavioral abnormalities is high in children and adolescents with LUTS, which needs to be more concerned.
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Affiliation(s)
- Xingchen Liu
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Wang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhaokai Zhou
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuai Yang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Yang
- Surgical Reception Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yibo Wen
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanping Zhang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lei Lv
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinhua Hu
- Department of Urology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Qingwei Wang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Lu
- Department of Urology, Xinyang Central Hospital, Xinyang, Henan, China
| | - Jian Guo Wen
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Geist BK, Bammer-Zimmer R. Effects of Early Toilet Training and Elimination Communication With Respect to Diaper Types. Clin Pediatr (Phila) 2023; 62:901-907. [PMID: 36852780 DOI: 10.1177/00099228221145268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P < .001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P < .001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P < .001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years.
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Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair. J Pediatr Urol 2023:S1477-5131(23)00051-7. [PMID: 36801200 DOI: 10.1016/j.jpurol.2023.02.002] [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: 05/16/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Neourethral covering is an essential technique for preventing complications such as fistula and glans dehiscence in hypospadias repairs. The spongioplasty has been reported for neourethral coverage about 20 years ago. However, reports of the outcome are limited. OBJECTIVE This study aimed to retrospectively evaluate the short-term outcome of spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty (DIGU). METHODS From December 2019 to December 2020, 50 patients with primary hypospadias (median age at surgery, 37 months; range, 10 months-12 years) were treated by a single pediatric urologist. The patients underwent spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty in single stage. The penile length, glans width, urethral plate width and length, and the location of the meatus of the patients were recorded preoperatively. The patients were followed up,complications noted, and postoperative uroflowmetries at the one-year follow-up time were evaluated. RESULTS The average width of glans was 12.92 ± 1.86 mm. A minor penile curvature was observed in all patients (≤30°). The patients were followed up for 12-24 months, and 47 patients (94%) were free from complications. A neourethra formed with a slit-like meatus at the tip of the glans, and the urinary stream was straight. Three patients had coronal fistulae (3/50) and no glans dehiscence, and the mean ± SD Qmax of postoperative uroflowmetry was 8.13 ± 3.8 ml/s. DISCUSSION This study estimated the short-term outcome of the DIGU covered using spongioplasty with Buck's fascia as the second layer in patients diagnosed with primary hypospadias with a relatively small glans (average width <14 mm). However, only a few reports emphasize spongioplasty with Buck's fascia as the second layer and the DIGU procedure performed on a relatively small glans. The major limitations of this study were its short follow-up time and the retrospective data collection. CONCLUSIONS Dorsal inlay graft urethroplasty combined with spongioplasty with Buck's fascia as coverage is an effective procedure. In our study, this combination had good short-term outcomes for primary hypospadias repair.
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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Nilsson T, Leijon A, Sillén U, Hellström AL, Skogman BH. Bowel and bladder function in infant toilet training (BABITT) - protocol for a randomized, two-armed intervention study. BMC Pediatr 2022; 22:294. [PMID: 35590259 PMCID: PMC9118841 DOI: 10.1186/s12887-022-03355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up. METHODS This randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0-2 months or at 9-11 months of age. The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0-2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored. DISCUSSION This protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy of assisted infant toilet training on functional gastrointestinal disorders up to the age of 9 months. Furthermore, the study will evaluate whether assisted infant toilet training during the first year of life can prevent functional gastrointestinal and urinary tract disorders in children up to 4 years of age. If effective, assisted infant toilet training could be recommended in child healthcare settings and new evidence-based guidelines on infant toilet training could be implemented. TRIAL REGISTRATION The study protocol was retrospectively registered at ClinicalTrials. gov ( NCT04082689 ), initial release June 12th, 2019).
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Affiliation(s)
- Terese Nilsson
- Department of Family medicine and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.,Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - Anna Leijon
- Department of Family medicine and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.,Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - Ulla Sillén
- Department of Pediatric Surgery, Pediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anna-Lena Hellström
- Institute of Health and Care Sciences, University of Gothenburg, Göteborg, Sweden
| | - Barbro Hedin Skogman
- Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden. .,Department of Pediatrics and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.
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Yu JT, Mao QF, Ji FP, Zhao Y, Hu HJ, Zhang YP, Yang J, Wang QW, Lu W, Wen JG. Delayed elimination communication is a crucial factor in disposable diaper dependence in Chinese preschool-aged children. Front Pediatr 2022; 10:1053118. [PMID: 36699294 PMCID: PMC9869372 DOI: 10.3389/fped.2022.1053118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Elimination communication (EC) is considered to be a milestone in a child's development. Nowadays, a trend toward an older age at EC initiation has been observed globally, probably due to the convenience of disposable diaper use in daily life. The study aimed to identify potential risk factors for disposable diaper dependence (DDD) and evaluate whether an early/proper EC can reduce the risk of DDD among children in China. METHODS A cross-sectional study was performed on 13,500 children in mainland China from October 2019 to March 2020. An anonymous questionnaire was used to collect information including the sociodemographic characteristics, details about DDD and EC, and the effect of DDD on the quality of life of children. Data were analyzed by SPSS and R software. RESULTS The overall prevalence of DDD was 4.17% (4.31% in boys; 4.02% in girls) and decreased with age, from 8.71% at 2 years to 0.73% at 6 years (χ 2 trend = 210.392, P < 0.001). In univariable analysis, age, location or EC were associated with DDD. Four independent factors-age, location (urban), caregivers with high education levels (junior college or above) and delayed EC (after 12 months of age)-were identified to be significantly associated with DDD risk in logistic regression model. Compared with EC onset after 12 months of age, EC onset before 12 months of age was associated with a 79.6% (model 2) reduction in DDD. Four independent factors were selected to establish the nomogram for DDD based on the results of logistic regression analysis. The C-index (0.770) and the AUC (>0.7) indicated satisfactory discriminative ability of the nomogram. The calibration diagrams showed favorable consistency between the prediction of the nomogram and actual observations. CONCLUSION Our findings indicate the joint contribution of age, location, caregivers' education level and EC to DDD in Chinese preschool-aged children. Timely cessation of the use of disposable diapers and early/proper EC may help to reduce the risk of DDD in children.
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Affiliation(s)
- Jia-Ting Yu
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiu-Fang Mao
- Department of Urology, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Feng-Ping Ji
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhao
- Department of Urology, Nursing School Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hui-Jie Hu
- Department of Humanities Nursing, Sanquan College, Xinxiang Medical University, Xinxiang, China
| | - Yan-Ping Zhang
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Yang
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing-Wei Wang
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Lu
- Department of Urology, Affiliated Xinyang Hospital, Zhengzhou University & Xinyang Central Hospital, Xinyang, China
| | - Jian Guo Wen
- Henan Joint International Pediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Bender JM, Lee Y, Ryoo JH, Boucke L, Sun M, Ball TS, Rugolotto S, She RC. A Longitudinal Study of Assisted Infant Toilet Training During the First Year of Life. J Dev Behav Pediatr 2021; 42:648-655. [PMID: 34618722 DOI: 10.1097/dbp.0000000000000936] [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: 08/20/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous retrospective studies have examined elimination signals, stool toileting refusal, and completion age in Assisted Infant Toilet Training (AITT). The aim of this longitudinal cohort study was to describe the practice of AITT and caregiver satisfaction in a primarily Western setting during the first year of life. METHODS Families who started AITT before 4 months of age were recruited. Standardized interviews of caregivers were conducted at 1- to 2-month intervals. To identify trends over time, data were fitted to a linear mixed-effect model. Data were analyzed according to five 2-month blocks, starting at 3 to 4 months. RESULTS Of 85 participating families, 87 children started AITT at a mean age of 2.5 months. At all age intervals, 88% to 94% of caregivers could identify elimination signals. Toileting attempts decreased from 10/day at 3 to 4 months to 7/day at 11 to 12 months (p < 0.001). Many families (45%-53%) practiced AITT on a part-time basis. Daytime dryness was noted in 12% to 14% of infants throughout the first year. Although more than 63% of families used cloth or disposable diapers throughout this study, use of trainers and underwear increased significantly by 2- to 3-fold (p < 0.01 for both). Caregiver satisfaction was high overall. Although negatively associated with potty refusal, it was positively associated with daytime and nighttime dryness, perceived elimination signals, and a better understanding of their infant's needs (p < 0.001 for all). CONCLUSION This study demonstrates that AITT is a worthy viable alternative to the use of diapers even in Western settings. Better understanding of AITT provides a new perspective to properly meet infants' basic needs.
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Affiliation(s)
- Jeffrey M Bender
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Yelim Lee
- California Institute of Technology, Pasadena, CA
| | - Ji Hoon Ryoo
- College of Educational Sciences, Yonsei University, Seoul, Korea
| | - Laurie Boucke
- University of California, Santa Barbara, Santa Barbara, CA
| | - Min Sun
- University of Verona, Verona, Italy
| | - Thomas S Ball
- Fuller Theological Seminary School of Psychology, Pasadena, CA
| | | | - Rosemary C She
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Meister MR, Zhou J, Chu H, Coyne-Beasley T, Gahagan S, Yvette LaCoursiere D, Mueller ER, Scal P, Simon L, Stapleton AE, Stoll CRT, Sutcliffe S, Berry A, Wyman JF. Non-invasive bladder function measures in healthy, asymptomatic female children and adolescents: A systematic review and meta-analysis. J Pediatr Urol 2021; 17:452-462. [PMID: 34090791 PMCID: PMC8502197 DOI: 10.1016/j.jpurol.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/25/2021] [Accepted: 04/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children. OBJECTIVE To define normative reference ranges for non-invasive tests of bladder function in healthy, asymptomatic girls and adolescents. STUDY DESIGN A comprehensive search strategy was performed in seven electronic databases through October 2019. English-language studies reporting data on voiding frequency, voided and postvoid residual volumes (PVR) and uroflowmetry results in healthy, asymptomatic girls (mean age ≥ 5 years) were included. Two independent reviewers performed study review, data extraction, and quality assessment. Overall mean estimates and 95% confidence intervals for each bladder function parameter were calculated using random effects models, and 95% normative reference values were estimated. RESULTS Ten studies met eligibility criteria for the meta-analysis (n = 2143 girls, age range: 3-18). Mean estimates of maximum voided volume and PVR were 233.4 ml (95% CI 204.3-262.6; n = 1 study) and 8.6 ml (95% CI 4.8-12.4; n = 2 studies) respectively. Pooled mean estimates for uroflowmetry parameters were: 21.5 ml/s (95% CI 20.5-2.5) for maximum flow rate (n = 6 studies), 12.5 ml/s (95% CI 11.2-13.8) for mean flow rate (n = 6 studies), 6.8 s (95% CI 4.4-9.3) for time to maximum flow (n = 3 studies), 15.7 s (95% CI 13.0-18.5) for flow time (n = 3 studies), and 198.7 ml (95% CI 154.2-234.2) for voided volume (n = 9 studies). No studies reported estimates of voiding frequency. Between-study heterogeneity was high (89.0-99.6%). CONCLUSIONS Although we were able to calculate pooled mean estimates for several parameters, the small number of included studies and the wide age ranges of participants preclude generalization of reference values to all healthy girls. Further research is needed to determine normative reference values within specific age groups.
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Affiliation(s)
- Melanie R Meister
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS, USA.
| | - Jincheng Zhou
- Center for Design and Analysis, Amgen Inc., Thousand Oaks, CA, USA
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, Department of Pediatrics and Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sheila Gahagan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - D Yvette LaCoursiere
- Division of General Obstetrics and Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth R Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Urology and Obstetrics/Gynecology, Loyola University, Loyola University Medical Center, Chicago, IL, USA
| | - Peter Scal
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Laura Simon
- Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA
| | - Ann E Stapleton
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carolyn R T Stoll
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Disposable diaper overuse is associated with primary enuresis in children. Sci Rep 2020; 10:14407. [PMID: 32873840 PMCID: PMC7462848 DOI: 10.1038/s41598-020-70195-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/20/2020] [Indexed: 11/15/2022] Open
Abstract
This research investigated the association between prolonged disposable diaper (DD) wearing in infancy and primary enuresis (PNE). As a case–control study, we collected data from 376 children with enuresis and 379 healthy children who were sex- and age-matched at three tertiary care institutions in mainland China from August 2017 to July 2018. The results of adjusted logistic regression showed the odds ratios (95% confidence intervals) for PNE across the categories of age of daytime DD use cessation were as follows: ≥ 25 months: 1.00, 18–24 months: 0.25 (0.17–0.37), and ≤ 17 months: 0.11 (0.06–0.20), independent of age, mother education, residence, toilet training approach, breastfeeding duration, UTI, constipation, anaphylactic disease and family history. After a similar multivariable adjustment, increased age of daytime DD use (per-month) had a positive correlation with PNE, OR = 1.17, 95% CI 1.13–1.20 and non-linear relationship was detected, whose point was 21 months (the effect sizes and the 95%CI on the left and right sides of inflection point were 1.04 (0.99–1.10), P = 0.131 and 1.25 (1.18–1.31), P < 0.001). Subgroup analysis found that the effect of duration of disposable diaper exposure for each additional month, those children had accepted assisted infant toilet training/elimination communication (AITT/EC) practice had a lower risk of PNE (OR = 1.08, 95% CI 1.04–1.12), compared with those without AITT/EC practice (OR = 1.20, 95% CI 1.14–1.27), P for interaction < 0.001. In conclusion, the children diagnosed with primary enuresis after age 5 stopped using disposable diapers at daytime later than the control group. Association between duration of DD exposure and the risk of childhood enuresis is modified by AITT/EC practice. Timely cessation use of disposable diaper and practice AITT/EC may shorten the time to nocturnal continence, and the prospective cohort studies are needed to verify the discoveries.
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Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol 2020; 16:342-349. [PMID: 32253149 DOI: 10.1016/j.jpurol.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Affiliation(s)
- Alexandra Vermandel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Guido Van Hall
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium.
| | | | - Tinne Van Aggelpoel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Hedwig Neels
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Gunter De Win
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Stefan De Wachter
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
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Hussong J, Rosenthal A, Wagner C, Mattheus H, von Gontard A. Bladder and bowel control in a population-based sample: Associations to quality of life and behavioral problems of 4-6-year-old children participating in the German Health Interview and Examination Survey (KiGGS). J Pediatr Urol 2020; 16:194.e1-194.e9. [PMID: 32057647 DOI: 10.1016/j.jpurol.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prevalence rates for psychiatric comorbidities are high in incontinent children. We analyzed data from the KiGGS survey in order to assess the rate of preschool children with delayed or regular continence, the mean age of gaining continence, psychiatric problems, and quality of life in a nation-wide, representative sample. METHODS Parental questionnaire data of 3875 preschool children (4-6 years) were analyzed. Percentages of children with daytime, nighttime, and complete continence, and mean ages of gaining continence were calculated. Psychological and behavioral problems (SDQ), as well as Quality of life (KINDL-R), were assessed. RESULTS 16.9% showed delayed gaining of continence. Percentages of children with nighttime bladder continence were lower for boys (76.3%) than for girls (80.6%), and lower for children without (78.2%) than those with a migration status (79.2%). Complete continence was gained by more girls (83.9%) than boys (78.2%), more children from the former East Germany (82.4%) than former West Germany (81.1%), and by more migrants (82.7%) than nonmigrants (81.9%). Girls, children living in the former East of Germany, and migrants achieved continence consistently at an earlier age. Children with incontinence or continence ≥4 years showed significantly more psychological problems, less prosocial behavior and low quality of life. CONCLUSION The age at gaining continence is moderated by gender, German region, and migration status. Delayed achievement of continence is associated with more psychological problems and a lower quality of life. The importance of effective treatment of incontinence is emphasized by the results of this study.
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Affiliation(s)
- Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Alisha Rosenthal
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Hannah Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Van Aggelpoel T, Vermandel A, Fraeyman J, Massart M, Van Hal G. Information as a crucial factor for toilet training by parents. Child Care Health Dev 2019; 45:457-462. [PMID: 30828867 DOI: 10.1111/cch.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Toilet training (TT) is a milestone in a child's development. Nowadays, children complete TT later than previous generations. This can have detrimental consequences for the child, the parents, and the environment. TT is experienced as difficult and time-consuming; parents could benefit from guidelines to assist in this process. METHODS Focus group discussions (FGDs) were used to explore parents' experiences in an inductive approach applying purposive sampling. The FGDs aimed to explore the type of information parents wanted to receive on TT, from whom and how. RESULTS After six FGDs, including 37 participants with personal experience in TT, data saturation was achieved. The findings of this qualitative study show that reputable agencies, family, friends, day-care workers, and nursery school teachers were considered very helpful and trustworthy sources. TT information should be easily understandable and not contain scientific terms or much text. A colourful and illustrated brochure sent by regular mail is preferred. CONCLUSION Our study allows to develop a source of correct and wanted information about TT that parents can and want to use, which helps them completing this training more easily and timely.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Jessica Fraeyman
- Faculty of Social Sciences, Antwerp University, Antwerp, Belgium
| | - Michiel Massart
- Faculty of Social Sciences, Antwerp University, Antwerp, Belgium
| | - Guido Van Hal
- Faculty of Social Sciences, Antwerp University, Antwerp, Belgium
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Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol 2018; 33:381-394. [PMID: 28567611 PMCID: PMC5799351 DOI: 10.1007/s00467-017-3679-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 10/31/2022]
Abstract
In Dysfunctional voiding, failure of the external sphincter-pelvic floor complex to relax during micturition results in bladder outflow obstruction with a spectrum of presentation from more benign lower urinary tract dysfunction including recurrent urinary tract infections, to significant upper tract pathology and end-stage renal failure. There is no underlying neurological or anatomical cause and the condition is postulated to be a largely learnt behavior. Diagnosis relies on non-invasive urodynamics and in particular uroflowmetry, plus or minus EMG, which is also used in biofeedback, the mainstay of treatment. The etiology, presentation, diagnosis, and treatment with particular emphasis on non-invasive urodynamics are covered.
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Abstract
INTRODUCTION It has been suggested that infants with high-grade vesicoureteral reflux (VUR) have lower urinary tract dysfunction (LUTD) that is characterised by large bladder capacity (BC) and increased post-void residual (PVR). However, most of these infants have normal or small BC in early infancy and develop large capacity during the first year of life. OBJECTIVE This study aimed to see whether LUTD development during the infant years in children with high-grade VUR could be prevented by early reflux resolution. MATERIALS AND METHODS For early VUR intervention, endoscopic treatment (ET) was used in a randomised trial comprising 77 infants (55 boys) aged <8 months with VUR grade 4-5 (n = 30/n = 47); 39 were randomised to antibiotic prophylaxis and 38 to ET. Voiding cystourethrogram, free voiding observation (FVO) and renal scintigraphy were performed at baseline and after 1 year. Bladder capacity and PVR were obtained from FVO. LUTD was defined as a BC of ≥150% of expected and a PVR of ≥20 ml. RESULTS There were no differences in bladder function variables seen between the treatment groups, despite significant differences in VUR resolution. Analysing bladder function related to VUR outcome (VUR grade ≤2 vs grade >2), independent of treatment, showed that VUR grade ≤2 was associated with a smaller BC at 1 year (P = 0.050) (a tendency already seen at baseline) and a lower PVR at baseline (P = 0.010). PVR increased from baseline to 1 year (P = 0.037) in children with grade ≤2 VUR (Summary Table). The group with persistent bilateral grade 5 VUR at 1 year had more abnormal bladder variables compared with other study subjects, with a tendency of larger BC (P = 0.057), higher PVR (P = 0.0073) and more LUTD (P = 0.029) at baseline and a larger BC at 1 year (P = 0.016). In explanatory analyses, using logistic regression, a high PVR at baseline was identified as a predictor of VUR grade >2 (P = 0.046), persistent bilateral grade 5 VUR (P = 0.022), recurrent urinary tract infection (P = 0.034), and only a tendency was seen regarding new renal damage (P = 0.053). CONCLUSION There was no between-group difference seen in bladder function. In children with VUR resolution at follow-up, independent of treatment, BC decreased, whereas PVR increased. High PVR at baseline was a predictive factor for both non-resolution of high-grade VUR and recurrent urinary tract infection. The results suggest that LUTD cannot be prevented by early VUR resolution, but rather is an important prognostic factor for VUR outcome in both endoscopic and prophylactic treatment.
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Jacob H, Grodzinski B, Fertleman C. Fifteen-minute consultation: problems in the healthy child-toilet training. Arch Dis Child Educ Pract Ed 2016; 101:119-23. [PMID: 26933045 DOI: 10.1136/archdischild-2015-308973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 02/02/2016] [Indexed: 11/04/2022]
Abstract
Toilet training is a process that all healthy children go through. It is one of the developmental milestones for which parents most often seek medical help. Despite this, many paediatricians feel unconfident managing children presenting with a toilet training problem. We address some common questions arising when assessing and managing such a child, including identifying rare but important diagnoses not to miss.
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16
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Lundblad B, Johansson R, Wigert H, Hellström AL. Satisfying Toilet Needs in Pre-School <br/>—Experiences of 5 - 6 Years Old. Health (London) 2016. [DOI: 10.4236/health.2016.815164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Van der Cruyssen K, De Wachter S, Van Hal G, De Win G, Van Aggelpoel T, Vermandel A. The voiding pattern in healthy pre- and term infants and toddlers: a literature review. Eur J Pediatr 2015; 174:1129-42. [PMID: 26074371 DOI: 10.1007/s00431-015-2578-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/29/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Toilet training in Western culture starts between 18 and 24 months. At this age, a child is assumed to have procured the competences needed for bladder control. Since the knowledge of reference values of a normal micturition serves as a guide to diagnose urologic pathology, the aim of this systematic review is to obtain a more comprehensive picture of normal voiding pattern in healthy infants, who have not yet reached bladder control. The systematic literature search was performed in two databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Twenty-one studies were selected that demonstrate factors associated with voiding pattern. Diuresis, interrupted voiding, post-void residual urine and voiding frequency are parameters decreasing with age. Bladder capacity, the lowest volume triggering micturition, flow rate, voiding volume and the level of awake voiding expand with age. CONCLUSION When evaluating the voiding pattern in infants, the normal evaluation of micturition parameters in healthy normal developing infants must be taken into consideration. WHAT IS KNOWN • Different voiding parameters in healthy infants who are not yet toilet trained are reported. • Voiding was believed to be induced by a constant bladder volume, while nowadays, it is detected that infants possess a functional spino-pontospinal voiding pathway. WHAT IS NEW • Arousal was detected in less than 60 % of all preterm micturitions, while it was present in more than 90 % of the micturitions of healthy "term" infants. • Voided volume, bladder capacity, and flow rate tend to increase with age. In contrast, voiding frequency, post-void residual urine, and interrupted voiding diminishes with an increasing age.
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Affiliation(s)
- Kelly Van der Cruyssen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium,
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Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn 2015; 35:471-81. [PMID: 25772695 DOI: 10.1002/nau.22751] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/21/2015] [Indexed: 11/07/2022]
Abstract
AIM The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function. METHODS A variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited. RESULTS Following a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback. CONCLUSIONS The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children. Neurourol. Urodynam. 35:471-481, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Paul F Austin
- From the Division of Urology, Washington University in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri
| | - Stuart B Bauer
- Department of Urology, Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Bower
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Janet Chase
- The Children's Centre, Cabrini Hospital, Melbourne, Australia
| | | | - Piet Hoebeke
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Johan Vande Walle
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Germany
| | - Anne Wright
- Pediatrics, Evelina Children's Hospital, St. Thomas' Hospital, London, England
| | - Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Section of Paediatric Nephrology, Uppsala University, Uppsala, Sweden
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