1
|
Wagstaff B, Panabokke G, Barker A, Khosa J, Samnakay N. Boys with bladder dysfunction may have posterior urethral valves - A simple framework to aid investigation. J Pediatr Urol 2024; 20:1057-1063. [PMID: 39307661 DOI: 10.1016/j.jpurol.2024.09.004] [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] [Received: 05/27/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 11/30/2024]
Abstract
BACKGROUND Bladder dysfunction (BD) is a common presenting complaint to paediatric urology outpatient clinics, accounting for up to 47% of referrals and affecting one in ten children of toilet training age. Boys with bladder dysfunction have been shown to have higher rates of posterior urethral valves (PUV) however when to consider cystourethroscopy in this group is unclear. OBJECTIVE Our primary aim was to assess the likelihood of detecting PUV in a cohort of boys of toilet training age presenting to a paediatric urologist with symptoms of bladder dysfunction. Our secondary aim was to assess whether resection of PUV was associated with improved clinical outcome. STUDY DESIGN Retrospective review of male patients aged 4-16 (January 2007 to December 2023), referred to paediatric urologist in an Australian outpatient clinic with BD undergoing cystourethroscopy. Those with known renal tract or spinal pathology were excluded. Patients were divided into four groups according to their symptoms/investigation results. Patients were followed up to assess improvement in symptoms following resection of PUV. RESULTS 247 boys were included in this study with a median age of 8.1 years. 81/247 (32.8%) had PUV on cystourethroscopy. The highest incidence of PUV 13/25 (52%) was in those patients with BD, haematuria or UTI and ultrasound (USS) changes. There was no difference in outcome improvement in those who underwent resection of PUV when compared with those without PUV. DISCUSSION Our study findings concur with results from previous literature identifying higher rates of PUV in older boys with bladder dysfunction. We have utilised straightforward clinical criteria to provide a targeted framework for screening with cystourethroscopy. There was no difference in outcomes when PUV was resected, compared to those without PUV. Limitations of this study include the retrospective nature, possible selection and reporting biases. CONCLUSION The likelihood of detecting PUV in our cohort of boys aged 4-16 with bladder dysfunction was 32.8%. The four groups provide clinicians with guidance on who may benefit from cystoscopy. This study provides future scope for a prospective interventional study of PUV in boys with BD.
Collapse
Affiliation(s)
- Benjamin Wagstaff
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia.
| | - Gayathri Panabokke
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia
| | - Andrew Barker
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia
| | - Japinder Khosa
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia
| | - Naeem Samnakay
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, Western Australia, 6009, Australia; Division of Surgery, Medical School, University of Western Australia, Crawley, Western Australia Australia; Institute for Paediatric Perioperative Excellence, University of Western Australia, Crawley, Western Australia Australia
| |
Collapse
|
2
|
Rodriguez P, Rehfuss A, Howe A, Giramonti K, Feustel PJ, Kogan BA. Bowel bladder dysfunction in control children in a pediatric urology office. J Pediatr Urol 2024; 20:385.e1-385.e6. [PMID: 38531758 DOI: 10.1016/j.jpurol.2024.03.008] [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] [Received: 09/24/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Bowel bladder dysfunction (BBD) is common in children. Risk factors for BBD include age, gender, obesity, and behavioral issues such as ADHD. We investigated the modified Swedish Bowel-Bladder questionnaire as a sensitive indicator of BBD in healthy children. OBJECTIVES We tested the usefulness of the Swedish Bowel-Bladder Questionnaire (BBQ) as an indicator of BBD in children not complaining of bowel/bladder dysfunction at the time of their visit to a pediatric urologist. Our secondary aim was to identify correlations between BBQ scores and risk factors such as gender, BMI, and ADHD. STUDY DESIGN All families in our Pediatric Urology practice with patients >30 months old who were reportedly toilet trained were provided the Swedish BBQ. Total score as well as sub-scores for storage, emptying, and constipation were prospectively collected. Presenting diagnosis, gender, BMI, and ADHD history were collected. BBQ scores for patients with voiding dysfunction were compared to controls: a) those with genital problems (e.g. hydrocele/undescended testes), b) those with CAKUT (congenital anomalies of the kidneys and urinary tract). BBQ scores were analyzed as a continuous variable vs the potential risk factors (ADHD, obesity, age, and gender) using univariable/multivariable regression analysis. RESULTS The median BBQ score for the 328 control patients (95 CAKUT and 233 genital) was 2.25 with an IQR: 1 to 6. In contrast, the median BBQ was higher for those with possible voiding dysfunction; n = 282; 9 with an IQR: 5 to 15). Total BBQ score exceeded 6 in 16% (52/328) of control patients. On multivariable analysis, age-adjusted total BBQ scores increased with ADHD in our controls (p = 0.03) but were unaffected by gender or BMI. On multivariable analysis of the voiding dysfunction group, total BBQ scores similarly decreased with age (p < 0.001) and increased with ADHD (p < 0.001) and were affected by gender (p = 0.024). BMI percentile had no significant effect in either cohort. DISCUSSION AND CONCLUSION The Swedish BBQ was used in a U.S population and demonstrated trends towards increased voiding dysfunction associated with younger age, female gender, and ADHD. We learned that voiding dysfunction in children with ADHD is not associated with constipation and improves over time. Additionally, 16% of children with genital or urinary abnormalities and no voiding complaints have noticeable BBD uncovered by the BBQ. Hence, we conclude that the Swedish BBQ is a sensitive indicator of BBD even in children not complaining of those problems.
Collapse
|
3
|
Steinhardt G. Commentary on Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial. J Pediatr Urol 2024; 20:128-129. [PMID: 37852806 DOI: 10.1016/j.jpurol.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
|
4
|
Hoppman T, Ouchi T, Dong Y, Barber TD, Weatherly DL, Steinhardt GF. Sonographically Determined Fecal Width: An Objective Indicator of Management of Bladder and Bowel Dysfunction in Children. Urology 2024; 184:224-227. [PMID: 38176617 DOI: 10.1016/j.urology.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To test whether sonographically determined fecal width (SDFW) correlates with symptom improvement in a population of children with bladder and bowel dysfunction (BBD) managed with standard urotherapy (SU), even for those patients lacking initial bowel complaints. METHODS We retrospectively analyzed 200 pediatric BBD patients managed with SU for at least 3 months. Self-reported symptom improvement (complete, partial, no response) following International Children's Continence Society guidelines was tabulated. Patients with complex urologic diagnoses other than vesicoureteral reflux (VUR) were excluded. Pharmacotherapy choice, physical therapy (PT), urinary tract infection (UTI) occurrence, and VUR status were tabulated. SDFW was recorded. Non-parametric analysis of variants (ANOVA) and parametric/non-parametric t testing were used for analysis. RESULTS Patients had a mean age of 9.5 years (4-12). Forty-eight patients had no gastrointestinal complaints at presentation. Urotherapy yielded complete, partial, and no responses in 14% (n = 27), 33% (n = 67), and 53% (n = 106) of patients, respectively. The average SDFW for those patients with complete response (2.6 cm) was smaller than the SDFW of those with a partial response (3.1 cm) or no response (3.3 cm) (P = .0001). Non-compliance led to greater SDFW compared to compliant patients (3.7 cm and 3.1 cm, respectively, P = .0001). Fecal width was unaffected by VUR, UTI, PT, or pharmacotherapy. CONCLUSION SDFW correlates well with symptom improvement in pediatric patients managed for BBD, confirming our hypothesis. SDFW is reasonable as single objective parameter to identify successful management in patients with BBD, extending to those without bowel complaints at presentation.
Collapse
Affiliation(s)
| | | | - Yiqing Dong
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Theodore D Barber
- Helen DeVos Children's Hospital/ Urologic Consultants Grand Rapids, MI
| | - David L Weatherly
- Helen DeVos Children's Hospital/ Urologic Consultants Grand Rapids, MI
| | | |
Collapse
|
5
|
Finup JL, Bhatia VP, Perry DM, Truscott SJ, Cannon ST, O'Kelly F, Farhat WA. Personalized Pre-clinic Nursing Telemedicine Visit: An Efficient and Efficacious Approach for Bowel and Bladder Dysfunction in Children. Urology 2023; 179:158-163. [PMID: 37348658 DOI: 10.1016/j.urology.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and efficacy of a Registered Nurse (RN) led educational pre-clinic telephone call on compliance and outcomes in children with bowel and bladder dysfunction (BBD). METHODS A retrospective chart review of a prospectively applied protocol in a single academic institution was performed for children aged 4-17 presenting with BBD. All children underwent a pre-clinic RN telemedicine visit where they were educated on pathophysiology of BBD, provided personalized urotherapy and bowel recommendations and instructed to complete pre-clinic questionnaires and voiding diaries. Patients were evaluated by a provider 4weeks following RN call. Data collected included compliance with forms, bowel management and need for imaging/testing, medications, and biofeedback. Patients were considered to improve with urotherapy alone if they were discharged from urology without the need for medications and/or biofeedback. RESULTS In total, 277 patients completed an RN call and 224 patients attended a provider visit between December 2020 and June 2022. Mean age was 9.4years (3:1 Female to Male ratio). During the RN call, 154 (56%) patients had bowel management initiated. Of the 224 patients seen by a provider, 69% (n = 154) had symptom improvement or resolution with urotherapy alone. Thirty-eight patients (17%) enrolled in biofeedback with 7 (3%) completing all 8 sessions. Thirty-two patients (14%) required medication for daytime bladder symptoms. CONCLUSION Our novel RN-led pre-clinic telemedicine visit demonstrates excellent compliance and patient outcomes for children with BBD and can reduce the use of unnecessary imaging, medications, and time-consuming treatments such as biofeedback.
Collapse
Affiliation(s)
| | | | - Dana M Perry
- University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | | | | | - Walid A Farhat
- University of Wisconsin Hospitals and Clinics, Madison, WI
| |
Collapse
|
6
|
Ko JS, Corbett C, Fischer KM, Berry A, Weiss DA, Long CJ, Zderic SA, Van Batavia JP. Impact of Race, Gender, and Socioeconomic Status on Symptom Severity at Time of Urologic Referral. J Racial Ethn Health Disparities 2023; 10:1735-1744. [PMID: 35960437 PMCID: PMC10339358 DOI: 10.1007/s40615-022-01357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The Dysfunctional Voiding and Incontinence Scoring System (DVISS) is a validated tool to evaluate lower urinary tract dysfunction (LUTD) severity in children. DVISS provides a quantitative score (0-35) including a quality-of-life measure, with higher values indicating more/worse symptoms. Clinically, variability exists in symptom severity when patients present to pediatric urology with LUTD. We hypothesized that symptom severity at consultation varied based on race, gender, and/or socioeconomic status. METHODS All urology encounters at a single institution with completed modified DVISS scores 6/2015-3/2018 were reviewed. Initial visits for patients 5-21 years old with non-neurogenic LUTD were included. Patients with neurologic disorders or genitourinary tract anomalies were excluded. Wilcoxon rank sum tests compared scores between White and Black patients and between male and female patients. Multiple regression models examined relationships among race, gender, estimated median household income, and insurance payor type. All statistics were performed using Stata 15. RESULTS In total, 4086 initial patient visits for non-neurogenic LUTD were identified. Median DVISS scores were higher in Black (10) versus White (8) patients (p < 0.001). Symptom severity was higher in females (9) versus males (8) (p < 0.001). When estimated median income and insurance payer types were introduced into a multiple regression model, race, gender, and insurance payer type were significantly associated with symptom severity at presentation. CONCLUSIONS Race, gender, and socioeconomic status significantly impact LUTS severity at the time of urologic consultation. Future studies are needed to clarify the etiologies of these disparities and to determine their clinical significance.
Collapse
Affiliation(s)
- Joan S Ko
- Division of Urology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Katherine M Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen A Zderic
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jason P Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| |
Collapse
|
7
|
Madaan A, Chhapola V, Tiwari S. Vancouver Symptom Score for Dysfunctional Elimination Syndrome: Hindi translation and validation. Neurourol Urodyn 2023. [PMID: 37092805 DOI: 10.1002/nau.25183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Bladder and bowel dysfunction (BBD) is a common problem in school-aged children and is evaluated using questionnaires. Among available questionnaires, "Vancouver Symptom Score for Dysfunctional Elimination Syndrome" (VSSDES) is considered superior in validity and reliability. We translated VSSDES into Hindi and performed validity and reliability testing of Hindi-VSSDES in children aged 4-16 years with lower urinary tract dysfunction (LUTD). METHODS In this cross-sectional study, we followed Consensus-based Standards for the selection of health Measurement Instruments recommendation to develop Hindi-VSSDES. Forward-translation-harmonization-back-translation-expert committee review-prefinal version sequence of translation was followed by cognitive debriefing. One hundred and sixteen children with symptoms suggestive of LUTD and 106 healthy controls were recruited. Construct validity of Hindi-VSSDES was assessed via structural validity (factor analysis) and hypotheses testing. In addition, test-retest reliability and internal-consistency reliability were assessed. RESULTS Hindi-VSSDES had acceptable face validity. Factor analysis identified four factors representing three domains. All a priori hypotheses were met. The questionnaire displayed excellent convergent validity and discriminative ability (area under receiver operating characteristic curve 0.83). The cutoff scores for screening and diagnosis were 7 and 11, respectively. Scores were comparable whether children self-filled the questionnaire or parents were proxy. Scores in girls were significantly higher. It had an excellent test-retest reliability (intraclass correlation coefficient = 0.96) and Cronbach's ɑ was 0.62. The smallest detectable change was 4.1 points. Median time to complete the questionnaire was 7 min and majority (91%) rated it as easy. CONCLUSIONS Hindi-VSSDES is the first validated and reliable Hindi questionnaire for children with BBD. Clinimetric properties of responsiveness and interpretability are yet to be tested.
Collapse
Affiliation(s)
- Aishwarya Madaan
- Department of Pediatrics, Kalawati Saran Children's Hospital & Lady Hardinge Medical College, New Delhi, India
| | - Viswas Chhapola
- Department of Pediatrics, Kalawati Saran Children's Hospital & Lady Hardinge Medical College, New Delhi, India
| | - Soumya Tiwari
- Department of Pediatrics, Kalawati Saran Children's Hospital & Lady Hardinge Medical College, New Delhi, India
| |
Collapse
|
8
|
Agreement between the visual analogue scale (VAS) and the dysfunctional voiding scoring system (DVSS) in the post-treatment evaluation of electrical nerve stimulation in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:740.e1-740.e8. [PMID: 36123285 DOI: 10.1016/j.jpurol.2022.07.032] [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: 01/28/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Electrical nerve stimulation is one of the most commonly used and well-tolerated treatments for overactive bladder (OAB); however, different studies have used different instruments to assess patients' response to treatment. OBJECTIVE To analyze agreement between use of the visual analogue scale (VAS) and the Dysfunctional Voiding Scoring System (DVSS) for assessing improvement in urinary symptoms following electrical nerve stimulation treatment in children and adolescents with OAB. STUDY DESIGN A cross-sectional analytical study including children and adolescents of 4-17 years of age diagnosed with OAB who underwent 20 sessions of transcutaneous (TENS) or percutaneous (PENS) electrical nerve stimulation. The DVSS and the VAS were used to assess daytime urinary symptoms before and following treatment. While the DVSS was always applied by a physician, the VAS was applied separately by a physiotherapist and then by a physician. Treatment was considered successful when the DVSS score was zero and the VAS score was ≥90%. Correlations between post-treatment VAS and DVSS scores were evaluated using the kappa coefficient. The VAS scores evaluated by the different professionals were compared for agreement using intraclass correlation and the Bland-Altman plot. RESULTS Data from 49 cases were available for analysis. Of these, 27 (55.1%) were girls. Mean age was 7.1 ± 2.6 years. There was agreement between the two instruments used, the DVSS and the VAS, in 36/49 patients (73.5%), with a moderate Kappa of 0.44. There was moderate agreement between the VAS scores applied by the two different professionals. DISCUSSION imitations of the present study include the small sample size and the fact that the inter-observer evaluation was conducted following a single sequence, i.e. all the patients were first evaluated by the physiotherapist and then by the physician, which may have biased answers and the post-treatment VAS scores. Furthermore, although the child participated actively in completing the questionnaires, in cases of divergent answers, the questions were redirected to the responsible adult, and the final answer may not fully represent the patient's true situation. CONCLUSION The present study found moderate agreement between the DVSS and the VAS, and moderate agreement between VAS scores when the instrument was applied by two different professionals. Although both tools appear to be important, and possibly complementary, a DVSS score of zero precludes the need to apply the VAS.
Collapse
|
9
|
Improvement in bladder function in children with functional constipation after a bowel management program. Pediatr Surg Int 2022; 38:1473-1479. [PMID: 35930047 PMCID: PMC9362461 DOI: 10.1007/s00383-022-05157-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We sought to determine if children with functional constipation (FC) would have an improvement in bladder function with treatment of constipation with a bowel management program (BMP). METHODS A single-institution review was performed in children aged 3-18 with FC who underwent a BMP from 2014 to 2020. Clinical characteristics, bowel management details, and the Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSS), Baylor Continence Scale (BCS), and Cleveland Clinic Constipation Score (CCCS) were collected. Data were analyzed using linear mixed effect modeling with random intercept. RESULTS 241 patients were included with a median age of 9 years. Most were White 81 and 47% were female. Univariate tests showed improvement in VSS (- 3.6, P < 0.0001), BCS (- 11.96, P < 0.0001), and CCCS (- 1.9, P < 0.0001) among patients having undergone one BMP. Improvement was noted in VSS and CCCS among those with more than one BMP (VSS: - 1.66, P = 0.023; CCCS: - 2.69, P < 0.0001). Multivariate tests indicated undergoing a BMP does result in significant improvement in VSS, BCS, and CCCS (P < 0.0001). CONCLUSIONS There is significant improvement in bladder function in children with FC who undergo a BMP. For patients with bowel and bladder dysfunction and FC, a BMP is a reasonable treatment strategy for lower urinary tract symptoms.
Collapse
|
10
|
Sommer-Joergensen V, Sarcevic J, Haecker FM, Holland-Cunz S, Gros SJ, Frech-Dörfler M. Dysfunctional Voiding and Incontinence Scoring System for Children and Adolescents: A Tool to Predict Clinical Course and Outcome. Eur J Pediatr Surg 2022; 32:429-434. [PMID: 35114717 DOI: 10.1055/s-0041-1741543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) in children are common. In 2005, Akbal et al published the dysfunctional voiding and incontinence scoring system (DVAISS) to assess patient's symptoms. Our study aimed to determine the value of this scoring system for predicting the severity and clinical course of voiding abnormalities in children and adolescents. MATERIAL AND METHODS Patients' symptoms were scored using the DVAISS in children and adolescents with LUTS presenting for the first time to our pediatric urology department between January 2010 and December 2015. We correlated the calculated score with voiding volume, clinical course, and outcome. RESULTS A total of 168 patients (113 boys, 55 girls; age 5-18 years) with isolated LUTS were included. In 53 patients (group 1), the DVAISS score was less than or equal to 8.5 and in the other 115 patients (group 2), the score was greater than 8.5 suggestive for relevant voiding abnormalities. Patients in group 1 showed a significantly higher average voiding volume (200 vs. 110 mL, p = 0.001). The median time for symptom resolution was significantly higher in group 2 than group 1 (14 vs. 8 months; p = 0.018). The severity of LUTS could be determined by these parameters. CONCLUSION Based on the DVAISS, a prediction of the clinical course and approximate treatment duration is possible. Therefore, the DVAISS is useful to assess LUTS in children and is also a valuable tool in rating the severity of the disease. It is also a quite precise predictor of the time needed to resolve the symptoms.
Collapse
Affiliation(s)
| | - Jelena Sarcevic
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, BS, Switzerland
| | - Frank-Martin Haecker
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, BS, Switzerland.,Department of Pediatric Surgery, Ostschweizer Kinderspital, St Gallen, St Gallen, Switzerland
| | - Stefan Holland-Cunz
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, BS, Switzerland
| | - Stephanie J Gros
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, BS, Switzerland
| | - Martina Frech-Dörfler
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, BS, Switzerland
| |
Collapse
|
11
|
Bladder Dysfunction After Ureteral Reimplantation. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
Sumboonnanonda A, Sawangsuk P, Sungkabuth P, Muangsampao J, Farhat WA, Piyaphanee N. Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study. BMC Pediatr 2022; 22:288. [PMID: 35581653 PMCID: PMC9110931 DOI: 10.1186/s12887-022-03360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital - Thailand's largest national tertiary referral center. METHODS: Children aged 4-12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA). RESULTS A total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03). CONCLUSIONS BBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.
Collapse
Affiliation(s)
- Achra Sumboonnanonda
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Punnarat Sawangsuk
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Patharawan Sungkabuth
- Pediatric Nursing Division, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Janpen Muangsampao
- Pediatric Nursing Division, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Walid A Farhat
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| |
Collapse
|
13
|
Casal-Beloy I, García-Novoa MA, García González M, Acea Nebril B, Somoza Argibay I. Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children. J Pediatr Urol 2021; 17:644.e1-644.e10. [PMID: 34176749 DOI: 10.1016/j.jpurol.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays there is still no ideal treatment for paediatric overactive bladder. Initial management measures (urotherapy and constipation control), resolve 40% of cases. The second line of treatment in overactive bladder is anticholinergic drugs, above all oxybutynin. Although most patients improve with these therapies, the complete resolution rate is around 30-40%. Sacral transcutaneous electrical nerve stimulation has recently emerged as a new alternative in the management of patients with refractory paediatric overactive bladder. However, only a few studies have been done to compare the effectiveness of this therapy versus conventional drugs. OBJETIVE The objective of the present study is to compare, in children with overactive bladder, the efficacy of the sacral transcutaneous electrical nerve stimulation versus oxybutynin therapy. MATERIALS AND METHODS We performed a prospective and randomized study of patients with diagnosis of overactive bladder treated with sacral transcutaneous electrical nerve stimulation versus oxybutynin, during the period July 2018-July 2020. Patients refractory to standard urotherapy and constipation management randomly received one of the therapeutic alternatives. Treatment was maintained for 6 months. RESULTS 86 patients were included in the study: 40 patients received electrotherapy (group 1) and 46 patients received oxybutynin (group 2). Before starting the treatment assigned both groups were comparable related to the voiding symptomatology as well as the severity of the overactive bladder. Sacral transcutaneous electrical nerve stimulation was significantly more effective than oxybutynin, with a higher percentage of complete resolution of symptoms in the management of paediatric overactive bladder. VOIDING DIARY All the parameters obtained with the voiding calendar significantly improved in both groups at the end of the treatment. The increase in MaVV was significantly higher in group-1. DVISS (DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM) We observed a progressive decrease in the mean score obtained in the DVISS questionnaire over time in both groups. This decrease was significantly higher in group-1 compared to group-2 (p < 0.005). The mean value obtained in the DVISS questionnaire in group-1 was 6 (interquartile range: 3-9) at the end of the treatment (lower than the diagnostic cut-off point for daytime condition in the DVISS, 8.5). In group-2, the mean value obtained in the DVISS questionnaire was 10 (interquartile range: 8.75-13.25), higher than the cut-off point. COMPLICATIONS A greater number of adverse effects was obtained in group-2 (26.1% versus 15%, p < 0.05). Constipation (n: 6, 10.9%), and abdominal pain (n: 2,4.3%) were the most frequent adverse effects in this group. The adverse events reported in group-1 were contact dermatitis (n: 1.2%) and fecal losses [2] or urgency [5]. CONCLUSION Oxybutynin and sacral transcutaneous electrical nerve stimulation are both effective therapies in the management of paediatric overactive bladder. However, electrotherapy has been shown to be a more effective therapy with a complete clinical resolution rate in a larger number of patients. Furthermore, the rate of adverse effects secondary to electrotherapy is significantly lower than those treated with oxybutynin.
Collapse
Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - María Alejandra García-Novoa
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - Benigno Acea Nebril
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Iván Somoza Argibay
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
Collapse
|
15
|
Carleo B, Anderson K, Prevost CP, Pohlman KA. Patient-centered outcomes used in pediatric focused manual therapies research studies: a secondary data analysis of a systematic review. J Patient Rep Outcomes 2021; 5:31. [PMID: 33796988 PMCID: PMC8017068 DOI: 10.1186/s41687-021-00305-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background Patient-reported outcome measurements (PROM) are instruments that seek a patient’s health or functional status. Inclusion of standardized PROMs in research studies and clinical practice provides a more comprehensive understanding of an intervention from the patient’s viewpoint. This secondary analysis identified PROM usage and appropriateness of references for property measurements from clinical trials included in a recent systematic review of pediatric manual therapy. Methods All included manuscripts within a recent systematic review had two authors extract PROM and associated property measurement data, including the property measurements supporting citations. Inclusion criteria for the articles were published clinical trials (observational or experimental) of pediatric children receiving manual therapy (any profession) for any condition between 2001-March 2018. For each PROM’s associated property measurement, two authors used the COSMIN study design checklist to appraise the quality of the cited study to evaluate the property measurement. Results Of the 50 manuscripts included in the systematic review, 20 manuscripts reported the use of 52 PROMs. Of the 52 PROMs assessed, 31 did not make a statement about the instrument’s property measurement, 7 PROMs had property measurements stated but not referenced, 4 PROMs stated that the property measurement information was unknown, and 10 had property measurement data with reference(s). These 10 PROMs with referenced property measurements were from 7 unique PROMs: constipation assessment scale, satisfaction visual analog scale (VAS), crying time diary, sleep diary, fear avoidance belief questionnaire (FABQ), pain VAS, and autism treatment evaluation checklist. The assessment of the referenced property measurements found that several property measurement’s dimensions had not been assessed and those that had were evaluated were done so with poor or fair standards. Conclusions This secondary analysis finds that clinical studies of pediatric manual therapy lack consistent use of PROMs with high quality property measurements. Further research to establish and implement PROMs to be used in future research studies and in clinical settings should become a priority for professions using manual therapy in children. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00305-1.
Collapse
Affiliation(s)
- Beth Carleo
- Palmer College of Chiropractic, 4777 City Center Parkway, Port Orange, FL, 32129, USA
| | - Kristian Anderson
- Performance Chiropractic, 4350 South Washington Street Suite 100, Grand Forks, ND, 58201, USA
| | - Carol Parnell Prevost
- Palmer College of Chiropractic, 4777 City Center Parkway, Port Orange, FL, 32129, USA
| | | |
Collapse
|
16
|
Karaci M. Obesity contributes to lower urinary system voiding dysfunction in childhood. Ir J Med Sci 2021; 190:1459-1463. [PMID: 33433844 DOI: 10.1007/s11845-020-02461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity continues to be a leading public health concern in the world. AIM The aim of our study was to investigate the relationship between obesity, lower urinary tract symptoms (LUTS), and voiding dysfunction. METHODS The study included students aged between 6 and 16 years in Zonguldak. Anthropometric measurements were performed in 404 children using appropriate methods. The body mass index (BMI) of children was calculated. Obesity was defined as a BMI at or above the 95th percentile for age- and sex-specific percentiles of Turkish children. Non-obese children with a BMI below the 85th percentile were defined as the control group. Lower urinary tract voiding dysfunction (LUTVD) was assessed with the dysfunctional voiding and incontinence scoring system (DVISS). RESULTS Of the children participated in the study, 151 (37.4%) were obese and 253 (62.6%) were at a normal weight. There were no significant differences in gender and mean age between the obese and non-obese children (p = 0.81). Monosymptomatic nocturnal enuresis (MSNE) was present in 43 children (10.6%), daytime symptoms were present in 38 children (9.4%), and voiding dysfunction was present in 34 children (8.4%) in the study. These symptoms were more common in the obese group (p = 0.001, p = 0.001, and p = 0.0001, respectively). In our survey study, we found a serious relationship between both bladder emptying symptoms and storage symptoms and obesity (p = 0.0001). CONCLUSION Obese children are at increased risk for enuresis and voiding dysfunction. Screening and treating obese children for the respective symptoms are significantly important for their quality of life.
Collapse
Affiliation(s)
- Mehmet Karaci
- Department of Pediatrics, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, University of Medical Sciences, Emek mahallesi, Namık Kemal caddesi, Sancaktepe, 34785, İstanbul, Turkey.
| |
Collapse
|
17
|
Schmidt AM, Hirsch K, Schroth M, Stehr M, Schäfer FM. Acute urinary retention in children. J Pediatr Urol 2020; 16:842.e1-842.e6. [PMID: 32900634 DOI: 10.1016/j.jpurol.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 08/15/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Acute urinary retention is a common emergency in adult patients, foremost in older men. In childhood urinary retention is a rare entity with only sparse literature on the etiology. OBJECTIVE To assess the etiology and treatment of acute urinary retention in the pediatric population and assess age and sex distribution. STUDY DESIGN A retrospective analysis of all patients admitted to our emergency department with acute urinary retention between 2005 and 2019 was performed. Exclusion criteria were newborns (because of physiologic postnatal oliguria) and postoperative urinary retention during the same hospital stay. RESULTS 113 children with acute urinary retention (ICD: R33) meeting the above criteria were identified. 16 Patients were excluded because of incomplete medical charts. 97 children were included into the study (age 0.5-18.3 years, mean age 5.3 years). 89 patients had one episode, 8 patients two episodes. A peak around the third year of age was observed. Sex ratio showed a 2:1 male to female distribution. Most common etiology was balanoposthitis (15.5%) and acute constipation/fecal impaction (15.5%). Traumatic urinary retention was found in 11.4% of the cases. Urinary tract infection were found 7.2%. No underlying reason could be found in 12.4% (idiopathic urinary retention). Other causes included febrile non-urinary infection (8.2%), subvesical obstruction (4.1%), vulvovaginitis (3.1%) and urethritis (2.1%). In 50% of the cases of urinary retention under 1 year of age (2 out of 4) an underlying tumor (rhabdomyosarcoma, sacral teratoma) was identified. DISCUSSION Age and sex distribution were similar to previously published series; however, this study shows a marked difference concerning the etiology: e. g. we identified a significantly higher proportion of functional disorders as a reason for acute urinary retention in childhood. It is hypothesized that this is partly because previously published studies originate from areas (USA, Israel, Iran) with different socio-demographic and cultural background. CONCLUSION AUR in children is a rare condition with very heterogeneous causes. Although the majority of cases exhibit mild underlying conditions, serious reasons, such as malignant diseases especially in the first year of life, must be excluded. AUR relief without catheterization is a child-friendly approach in cases of mild inflammatory or functional disorders and can help to minimize traumatization.
Collapse
Affiliation(s)
- Ana-Marija Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Karin Hirsch
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Michael Schroth
- Department of Pediatrics and Pediatric Emergency Care, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany.
| |
Collapse
|
18
|
Johnston AW, Routh JC, Purves JT, Wiener JS, Sinani A, Holl EK. Immune Expression in Children With Vesicoureteral Reflux: A Pilot Study. Urology 2020; 148:254-259. [PMID: 33049235 DOI: 10.1016/j.urology.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To perform an exploratory, descriptive pilot study of the systemic and local immune environment in patients with vesicoureteral reflux (VUR) and bladder-bowel dysfunction (BBD). METHODS Consecutive children with VUR undergoing intravesical ureteral reimplantation were enrolled. Patients were assessed for presence of BBD by reported patient history and validated questionnaire. Fresh blood and bladder tissue, collected at the time of surgery, were immediately processed for analysis. Immune cell compositions were determined via flow cytometry. Immune cell activation was also defined at the time of analysis. LegendPlex assay analysis was utilized to define levels of circulating chemokines and cytokines. RESULTS A total of 7 patients were enrolled. Although percentages of circulating immune cells in the blood of those with VUR/BBD and VUR alone were similar, within bladder tissue, VUR/BBD demonstrated increased immune infiltrates compared to VUR alone. Bladder sample analysis showed that B cells, and Effector Memory and Naïve T cell percentages were significantly increased in VUR/BBD patients compared to VUR patients. T cell expression of PD1 was increased in bladder tissues of BBD/VUR. Additionally, analysis of circulating neutrophils displayed significantly increased upregulation of PDL-1 in patients with VUR/BBD vs those with VUR only. CONCLUSION These pilot data suggest an immune-rich microenvironment is present within VUR. Severity of inflammation appeared to correlate with presence of BBD. This implies that targeting pelvic inflammation may be a novel therapy for children with VUR- or non-VUR-related BBD. Follow-up studies are currently underway.
Collapse
Affiliation(s)
- Ashley W Johnston
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC.
| | - Jonathan C Routh
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - J Todd Purves
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - John S Wiener
- Division of Urologic Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Angela Sinani
- Dept of Chemical and Biomolecular Engineering, University of Delaware, Newark, DE
| | - Eda K Holl
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC
| |
Collapse
|
19
|
Afshar K, Dos Santos J, Blais AS, Kiddoo D, Dharamsi N, Wang M, Noparast M. Canadian Urological Association guideline for the treatment of bladder dysfunction in children. Can Urol Assoc J 2020; 15:13-18. [PMID: 33007188 DOI: 10.5489/cuaj.6975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Darcie Kiddoo
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nafisa Dharamsi
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Mannan Wang
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Maryam Noparast
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
20
|
Assessment and validation of a screening questionnaire for the diagnosis of pediatric bladder and bowel dysfunction. J Pediatr Urol 2019; 15:528.e1-528.e8. [PMID: 31445857 DOI: 10.1016/j.jpurol.2019.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Pediatric bladder and bowel dysfunction (BBD) is a common problem in children. However, the current ability to diagnosis and quantify pediatric BBD is limited as only a few validated instruments exist. In addition, the current questionnaires are limited by their lack of psychometric processing and methods of validation. To address these issues, the authors developed a new questionnaire to objectively diagnose pediatric BBD symptoms. This study aimed to evaluate the performance of this newly devised objective instrument in diagnosing and quantifying the symptomatology of BBD in children. MATERIALS AND METHODS An 18-item, 5-point questionnaire was developed using both a literature review and expert opinions. The total questionnaire score could range from 0 to 72. Questions were subgrouped into six symptom categories: (1) nocturnal enuresis, (2) lower urinary tract symptoms, (3) urinary holding, (4) infrequent urination, (5) bowel symptoms, and (6) daytime urinary incontinence. The questionnaire also assessed the degree of bother associated with the symptoms. Patients were divided into cases and controls, and these two groups were compared. DISCUSSION/RESULTS A total of 1265 new patients (758 cases and 507 controls) completed the new BBD questionnaire. The mean age of the whole study cohort was 9.5 years (range, 3-19 years). The total mean questionnaire score was significantly higher at 23 (3-58) in the cases, compared with 8 (0-35) in the controls (p < 0.001) (Summary Figure). Reliability analysis of the 18-item instrument showed a Cronbach's alpha reliability coefficient of 0.80 for the scale. CONCLUSIONS This new instrument provides a valid and reliable method for diagnosis of pediatric BBD and classification of patients into subcategories of BBD based on their specific symptoms.
Collapse
|
21
|
Outcomes of Bladder Preservation Following Treatment for Rhabdomyosarcoma. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Rickard M, Farhat W. Commentary to 'Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature'. J Pediatr Urol 2018; 14:502. [PMID: 30414713 DOI: 10.1016/j.jpurol.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M Rickard
- The Hospital for Sick Children, Urology, 555 University Ave, Canada
| | - W Farhat
- The Hospital for Sick Children, Urology, 555 University Ave, Canada.
| |
Collapse
|