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Rossetti CM, Simonetti GD, Bianchetti MG, Lava SAG, Treglia G, Agostoni C, Milani GP, de Winter JP. Kidney and urogenital abnormalities in Down syndrome: a meta-analysis. Ital J Pediatr 2024; 50:79. [PMID: 38641829 PMCID: PMC11031854 DOI: 10.1186/s13052-024-01636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Reviews on Down syndrome do not or only marginally address the issue of kidney and urogenital tract abnormalities, and lower urinary tract dysfunctions. Hence, we performed a meta-analysis of the literature. METHODS: A literature search was undertaken in the Library of Medicine, Web of Science and Excerpta Medica. The search algorithm combined various keywords: (Down syndrome OR trisomy 21 OR mongolism) AND (kidney OR urinary tract OR bladder) AND (malformation OR dysfunction OR anomaly OR abnormality OR size). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used. RESULTS Eight case-control studies were retained for the final analysis. Three studies addressed the prevalence of kidney and urogenital tract abnormalities: an increased pooled relative risk of 5.49 (95%-CI: 1.78-16.93) was observed in Down syndrome. Penile malformations, obstructive malformations (including urethral valves), dilated urinary tract system, and kidney hypodysplasia were especially common. Three reports addressed the prevalence of lower urinary tract dysfunction: an increased pooled relative risk of 2.95 (95%-CI: 1.15-7.56) was observed. Finally, an autoptic study and an ultrasound study disclosed a reduced kidney size in Down syndrome. CONCLUSIONS This meta-analysis indicates that abnormalities of the kidney and urogenital tract, lower urinary tract dysfunctions, and a reduced kidney size present with an increased frequency in individuals with Down syndrome.
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Affiliation(s)
- Caterina Maria Rossetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via Buffi 13, Lugano, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via Buffi 13, Lugano, Switzerland
| | - Mario G Bianchetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via Buffi 13, Lugano, Switzerland.
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, via Buffi 13, Lugano, Switzerland
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - J Peter de Winter
- Department of Development and Regeneration, Leuven, Belgium
- Department of Pediatrics, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
- Leuven Child and Youth Institute, Leuven, Belgium
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Ranchin B, Bidault V, Zekre F, DeMul A, Sanlaville D, Bacchetta J. Kidney and urological involvement in Down syndrome: frequent, underestimated, but associated with impaired quality of life and risk of kidney failure. Pediatr Nephrol 2024; 39:347-355. [PMID: 37386331 DOI: 10.1007/s00467-023-05986-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/01/2023]
Abstract
Patients with Down syndrome (DS) are at risk of multiorgan dysfunction; kidney and urological impairment are common. This is due to a likely increased risk of congenital kidney and urological malformations (odds ratio of 4.5 compared to the general population in one study), more frequent associated comorbidities at risk of kidney dysfunction (such as prematurity in 9-24% of children, intrauterine growth retardation or low birth weight in 20%, and congenital heart disease in 44%), and more frequent lower urinary tract dysfunction (reported in 27-77% of children with DS). If present, malformations and comorbidities at risk of kidney dysfunction warrant regular kidney monitoring in addition to their treatment. Serum creatinine in children with DS has been shown to be higher than in the general population and asymptomatic hyperuricemia is reported in 12-33% of children or young adults with DS. Moreover cryptorchidism and testicular cancer are also more common and should be detected by clinical examination. Thus, persons with DS at risk of presenting kidney and urological impairment should be identified by prenatal ultrasonography, comorbidities at risk of kidney sequelae considered, and during regular medical follow-up, clinically examined and questioned to diagnose testicular anomalies and lower urinary tract dysfunction. This is of importance as such kidney and urological impairments are associated with impaired quality of life and mental health, and risk of kidney failure.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Franck Zekre
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Aurelie DeMul
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Damien Sanlaville
- Service de Génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Sud Charles Mérieux, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
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Trinh TH, Nguyen NM, Lam KT, Pham TN, Vu NT, Truong LNU, Tran VQ. Anorectal manometry findings in relation with long-term functional outcomes of the patients operated on for Hirschsprung's disease compared to the reference-based population. Pediatr Surg Int 2023; 39:131. [PMID: 36800080 DOI: 10.1007/s00383-023-05402-4] [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] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE This study investigated anorectal manometry (AM) findings and bowel function of patients operated on for Hirschsprung's disease (HD). METHODS A cross-sectional study was conducted at Children's Hospital 2. Patients operated on for HD from January 2015 to January 2020 were reviewed. Their clinical characteristics, bowel function, and manometric findings were investigated and compared with the references. RESULTS Ninety-five patients and 95 references were enrolled. Mean ages were 6.6 ± 2.2 years and 7.2 ± 2.9 years,; fecal incontinence rates were 25.3% and 2.1%, and constipation rates were 12.6% and 4.2 for the patients versus the references, respectively. Anal resting pressures were significantly decreased in the patients compared to the references (53.2 ± 16.1 mmHg versus 62.2 ± 14.0 mmHg; p < 0.05). Among the patients, the anal resting pressure was significantly decreased in the incontinents than in the continents (46.0 ± 10.6 mmHg versus 55.6 ± 16.9 mmHg, p < 0.05). During the sensation test, the value of maximum tolerated volume was significantly decreased in the incontinents than in the continents (135.9 ± 47.9 mL versus 166.6 ± 58.3 mL, p < 0.05). CONCLUSION AM is an objective method providing beneficial information that could guide a more adapted management in HD patients with defecation disorders.
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Affiliation(s)
- Tung Huu Trinh
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam.,Department of Pediatrics, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Ngoc Minh Nguyen
- Department of Pediatrics, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Kim Thien Lam
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Thach Ngoc Pham
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Nhan Truong Vu
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam
| | - Linh Nguyen Uy Truong
- University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, District 5, Ho Chi Minh City, Vietnam
| | - Viet Quoc Tran
- Department of Pediatric Surgery, Children's Hospital 2, 14 Ly Tu Trong, Ben Nghe ward, District 1, Ho Chi Minh City, Vietnam.
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Toilet Training in Children and Adolescents with Down Syndrome. J Dev Behav Pediatr 2022; 43:e381-e389. [PMID: 35026787 DOI: 10.1097/dbp.0000000000001058] [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] [Received: 04/14/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although the challenges of toilet training for children and adolescents with Down syndrome (DS) are well-known, details such as specific associations with comorbidities and related exacerbating factors are lacking. This study aims to characterize the nature of toilet training in a cohort of children and adolescents with DS and evaluate characteristics and comorbid conditions that may contribute to or prolong toilet training success in those with DS. METHOD This was a retrospective, cross-sectional study investigating toilet training in children and adolescents with DS. A survey was completed by 137 patients' parents or guardians as part of their care experience in the clinic. RESULTS Although toilet training on average began at age 3.40 years (SD = 1.47), children and adolescents with DS typically began telling caregivers they needed to use the toilet at 4.80 years (SD = 2.11), no longer used diapers during the day at 5.03 years (SD = 1.98) and night at 5.88 years (SD = 2.48), and were described by their caregivers as being fully toilet trained at 6.60 years (n = 28; SD = 2.43; range = 3.00-14.00 years). There was a linear trend in the age groups between 2 to 4 years (n = 37), 5 to 7 years (n = 42), 8 to 12 years (n = 39), and 13 to 17 years (n = 19) and the proportion of children and adolescents fully toilet trained (2 to 4 years = 0.040, 5 to 7 years = 0.211, 8 to 12 years = 0.278, and 13 to 17 years = 0.529). Typical readiness signs that children and adolescents with DS display and those most predictive of toileting success are reported. Placing the child on a schedule was the most successful (45.2%) training method identified by parents, with 55.8% of the families trying this approach. Children and adolescents aged 8 to 12 years with behavioral challenges were more likely (75.0%) to have daytime accidents compared with those without (25.9%), p = 0.006. CONCLUSION Children and adolescents with DS in this sample started toilet training at 3.4 years and completed toilet training at 6.6 years. Even after completing toilet training, many children and adolescents continue to require support from their caregivers with some aspects of toilet training. Skill loss associated with various life events, behavioral challenges, medical diagnoses, and inconsistencies in toileting expectations across settings are factors caregivers believe contribute to delayed toilet training. Caregivers found that a consistent toileting schedule, using reinforcers, and providing prompting to use the toilet were the most successful methods.
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Garriboli M, Ibrahim S, Clothier J. Spontaneous bladder rupture secondary to posterior urethral valves in a boy with Down syndrome. BMJ Case Rep 2021; 14:e240857. [PMID: 34551910 PMCID: PMC8461274 DOI: 10.1136/bcr-2020-240857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 3-year-old boy with Down syndrome who developed a bladder rupture as a consequence of an undiagnosed posterior urethral valve (PUV). He had a history of urinary tract infections and constipation and was acutely admitted in poor condition and underwent laparotomy that revealed peritoneal sepsis secondary to bladder perforation. Bladder was drained using a suprapubic catheter and the condition of the boy gradually improved. Once stable, a cystourethroscopy confirmed the presence of PUV. Video-urodynamic studies performed at the check cystoscopy showed the bladder to be of reduced compliance (end fill pressure at 100 mL fill 30 cmH2O) with raised voiding pressures (76-100 cmH2O) and significant incomplete bladder emptying. Currently, the patient is doing very well, serum creatinine has normalised, he is infection-free and thriving; his bladder is managed with a vesicostomy.
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Affiliation(s)
- Massimo Garriboli
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL, London, UK
| | - Shimaa Ibrahim
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Clothier
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kızılay F, İrer B, Özalp Kızılay D, Şimşir A, Kalemci S, Şen V, Altay B, Çoğulu Ö. Evaluation of lower urinary tract symptoms in children with Down syndrome: A prospective, case‐controlled cohort study. Neurourol Urodyn 2020; 39:833-840. [DOI: 10.1002/nau.24293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/11/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Fuat Kızılay
- Department of Urology Ege University Hospital Izmir Turkey
| | - Bora İrer
- Department of Urology Izmir Metropolitan Municipality Esrefpasa Hospital Izmir Turkey
| | - Deniz Özalp Kızılay
- Department of Pediatric Endocrinology Cigli Regional Training Hospital Izmir Turkey
| | - Adnan Şimşir
- Department of Urology Ege University Hospital Izmir Turkey
| | - Serdar Kalemci
- Department of Urology Ege University Hospital Izmir Turkey
| | - Volkan Şen
- Department of Urology Manisa State Hospital Manisa Turkey
| | - Barış Altay
- Department of Urology Ege University Hospital Izmir Turkey
| | - Özgür Çoğulu
- Department of Medical Genetics Ege University Hospital Izmir Turkey
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Abstract
OBJECTIVE To characterize bladder and bowel toileting skill acquisition in children with fragile X syndrome and to identify associated demographic, behavioral, and clinical factors. METHODS Using baseline data from the Fragile X Online Registry With Accessible Research Database (FORWARD), bivariate analyses and logistic regression models were used to identify differences between subjects who were and were not bowel and/or bladder trained by the age of 10 years. Cox proportional hazard models were used to assess the rate of completion of toilet training (TT) as a function of sex and autism spectrum disorder (ASD) diagnosis. RESULTS In bivariate analyses, male sex, lower language level, inability to write one's name, more impaired intellectual level, ASD, and more severe behavioral deficits all predicted lack of bladder training (n = 313, p < 0.001) and bowel training (n = 300, p = 0.0004-0.0001) by the age of 10 years. In logistic regression models, lower level of language acquisition (p < 0.001) and higher Aberrant Behavior Checklist Irritability scores (p < 0.04) were associated with lower odds of bladder training by the age of 10 years. Lower level of language acquisition (p < 0.001) and ASD (p < 0.025) were associated with lower odds of bowel training by the age of 10 years. For both bladder and bowel training, Cox proportional hazard models indicated that delayed training was associated with male sex, lower levels of language acquisition, and ASD for both bladder training (n = 486; p < 0.001) and bowel training (n = 472; p < 0.001). CONCLUSION These findings emphasize the importance of both slower language development and ASD diagnosis in predicting bowel and bladder training delays and can be used to develop and evaluate targeted approaches to TT based on sex, ASD diagnosis, and other clinical features identified in this study.
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Choi EK, Lee YJ, Lee H, Jung E. Bladder and Bowel Dysfunction in Korean Children with Down Syndrome and Parental Quality of Life. J Pediatr Nurs 2019; 49:e74-e80. [PMID: 31677829 DOI: 10.1016/j.pedn.2019.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Children with Down syndrome (DS) are more likely to experience bladder bowel dysfunction (BBD) than typically developing children, which could in turn have a serious effect on children with DS and on their parents and other family members. This study aimed to explore the prevalence of BBD in Korean children with DS and its effect on parental quality of life (QOL). DESIGN AND METHODS To assess BBD and parental QOL, we used self-administered questionnaires (Dysfunctional Voiding Symptom Score [DVSS], Rome IV criteria, and World Health Organization Quality of Life scale [WHOQOL-BREF]) for parents of children with DS. We collected data from 86 parents between September and October 2017 through an online community website. RESULTS DVSS was elevated in 26.7% of the children with DS. Specifically, 14% had daytime urinary incontinence, and 33.7% had functional constipation. Moreover, 18.6% of children had BBD according to the DVSS and Rome IV criteria. The sensitivity and specificity of DVSS to functional constipation was 55.17% and 87.72%, respectively. The BBD score and total parental QOL score were statistically correlated (r = 0.291, p = 0.007). CONCLUSIONS Although children with DS are a high-risk group for BBD, their BBD symptoms are often overlooked because of their intellectual disability. Consequently, this could negatively affect children's and family's health and QOL in the long term. PRACTICE IMPLICATIONS Health-care providers should reconsider a routine check-up of BBD in children with DS. If a child has BBD, health-care providers should consult a urologist to determine the appropriate diagnosis and intervention.
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Affiliation(s)
- Eun Kyoung Choi
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea.
| | - Yong Ju Lee
- Department of Pediatrics, Hallym University, Kangnam Sacred Heart Hospital, Seoul, South Korea.
| | - Hooyun Lee
- Severance Children's Hospital, Yonsei University Healthcare System, Seoul, South Korea.
| | - Eunyoung Jung
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea.
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Pini Prato A, Arnoldi R, Sgrò A, Felici E, Racca F, Nozza P, Mariani N, Mosconi M, Mazzola C, Mattioli G. Hirschsprung disease and Down syndrome: From the reappraisal of risk factors to the impact of surgery. J Pediatr Surg 2019; 54:1838-1842. [PMID: 30814038 DOI: 10.1016/j.jpedsurg.2019.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The association of Hirschsprung disease (HSCR) and Down Syndrome (DS) is not uncommon (HSCR+DS). This paper aims at reporting the results of a 24-year series focusing on surgical approach, complications and long term outcome. MATERIALS AND METHODS The notes of all patients admitted with a diagnosis of HSCR+DS have been retrospectively reviewed. Surgical details, intraoperative complications, long term issues and functional outcome have been recorded. The results have been compared to those of patients without DS and were assessed based on surgical approach. RESULTS A total of 23 HSCR+DS out of a series of 385 HSCR (6%) have been included. Preoperative enterocolitis (HAEC) was reported by 32%. Associated anomalies were detected in more than half of the patients. In particular, Congenital Heart Defects (CHDs) were reported by 57%. Postoperative complications (mostly symptomatic anal sphincter achalasia) were experienced by 55%. Constipation was experienced by 30%; severe continence issues, by 53%. One patient suffering from severe CHDs died. With regard to complications, only symptomatic anal achalasia requiring intrasphincteric BoTox injection was significantly more frequent in HSCR+DS (30% vs 10%, p = 0.0071). Similarly, continence proved to be significantly worse in HSCR+DS. DISCUSSION With the exception of symptomatic anal achalasia, HSCR+DS patients proved not to have a higher likelihood of complications compared to HSCR alone. On the other hand, functional results in the long term are worse. As a consequence, long term follow up and personalized rehabilitation programs are warranted for this delicate subset of HSCR patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Rossella Arnoldi
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Sgrò
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabrizio Racca
- Unit of Pediatric Anesthesia, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Nozza
- Pathology Unit, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Pathology Unit, Ospedali Galliera, Genova, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Narcisio Mariani
- Pathology Unit, Ospedali Galliera, Genova, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Mosconi
- Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy
| | - Cinzia Mazzola
- Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy
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Mrad FCDC, Figueiredo AAD, Bessa Jr. JD, Bastos Netto JM. Prolonged toilet training in children with Down syndrome: a case‐control study. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mrad FCDC, Figueiredo AAD, Bessa JD, Bastos Netto JM. Prolonged toilet training in children with Down syndrome: a case-control study. J Pediatr (Rio J) 2018; 94:286-292. [PMID: 28869807 DOI: 10.1016/j.jped.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. METHODS A case-control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. RESULTS The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p=0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p=0.001). Among children with DS, females completed toilet training earlier (p=0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with the presence of lower urinary tract symptoms or functional constipation and the age of beginning and completing toilet training in both groups. CONCLUSION Children with Down syndrome experienced prolonged toilet training time. Prospective longitudinal studies are essential to gain insight into the toilet training of these children.
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Affiliation(s)
- Flávia Cristina de Carvalho Mrad
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Belo Horizonte, MG, Brazil.
| | - André Avarese de Figueiredo
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil
| | - José de Bessa
- Universidade Estadual de Feira de Santana (UEFS), Departamento de Cirurgia, Feira de Santana, BA, Brazil
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Hospital e Maternidade Therezinha de Jesus, Departamento de Cirurgia, Juiz de Fora, MG, Brazil
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Tran VQ, Mahler T, Bontems P, Truong DQ, Robert A, Goyens P, Steyaert H. Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease. J Neurogastroenterol Motil 2018; 24:70-78. [PMID: 29179287 PMCID: PMC5753905 DOI: 10.5056/jnm17019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/25/2017] [Accepted: 07/12/2017] [Indexed: 12/29/2022] Open
Abstract
Background/Aims Although many advances in the management of Hirschsprung’s disease have recently been achieved, postoperative outcomes of these patients remain difficult in a non-negligible number of cases. Therefore, this study aims at investigating characteristics of anorectal manometry and its relationship with postoperative outcomes during long-term follow-up in Hirschsprung patients. Methods Patients over 4 years of age operated on for Hirschsprung’s disease were interviewed to complete detailed questionnaires on bowel function. The patients who consented to undergo an anorectal manometry during follow-up were enrolled in this study. We investigated their clinical characteristics, manometric findings, and their postoperative bowel function. Results Nineteen patients out of 53 patients (35.8%) were enrolled, 68.4% who were male. Mean age of patients at manometry was 11.3 ± 6.3 years. Twelve out of 19 patients (63.2%) were incontinent. The mean anal resting pressures of incontinent patients were significantly lower than continent patients (47 ± 12 mmHg versus 63 ± 11 mmHg, P < 0.05, t test). Due to neurological impairment, only 11 patients (57.9%) were able to perform a complete manometry. A dyssynergic defecation was found in 4 patients during strain tests. Maximum tolerated volume of the incontinent patients was significantly lower than that of the continent patients (97 ± 67 mL versus 181 ± 74 mL, P < 0.05, t test). Conclusion Anorectal manometry is an objective method providing useful information that could guide a more adapted management in patients with defecation disorders after Hirschsprung’s disease operation.
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Affiliation(s)
- Viet Q Tran
- Department of Pediatric Surgery, City Children's Hospital, Ho Chi Minh City, Vietnam.,Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Tania Mahler
- Department of Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Bontems
- Department of Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Dinh Q Truong
- Department of Pediatric Surgery, City Children's Hospital, Ho Chi Minh City, Vietnam
| | - Annie Robert
- Faculté de santé publique, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de recherche EPID Epidémiologie et Biostatistique - Université catholique de Louvain (UCL), Brussels, Belgium
| | - Philippe Goyens
- Laboratory of Pediatrics, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Henri Steyaert
- Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Brussels, Belgium
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13
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Niemczyk J, von Gontard A, Equit M, Medoff D, Wagner C, Curfs L. Incontinence in persons with Down Syndrome. Neurourol Urodyn 2016; 36:1550-1556. [DOI: 10.1002/nau.23146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/05/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Justine Niemczyk
- 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
| | - Monika Equit
- Department of Clinical Psychology and Psychotherapy; Saarland University; Saarbruecken Germany
| | - David Medoff
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Homburg Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Homburg Germany
| | - Leopold Curfs
- Department of Clinical Genetics; Governor Kremers Centre; Maastricht University Medical Centre; Maastricht The Netherlands
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14
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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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15
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Nair LD, Sagayaraj B, V T T R, Kumar R. Incontinence in Intellectual Disability: An Under Recognized Cause. J Clin Diagn Res 2015; 9:SD01-2. [PMID: 26500975 DOI: 10.7860/jcdr/2015/14019.6448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022]
Abstract
Many children with Down syndrome may develop urinary incontinence during adolescence or nearing adulthood. Most often low mental ability, behavioural issues, urinary tract infection, hypothyroidism, atlanto-axial subluxation or sexual abuse may be suspected to be the reason. We report a case of Down syndrome with tethered cord syndrome (TCS) and Lipoma of Filum terminale with Cauda equina in normal position, as a cause of bowel and bladder incontinence. The need for operating with Cauda Equina in normal position is debated. But a conscious decision was taken to operate and the incontinence improved markedly which was documented by using a standardized questionnaire (King's questionnaire) and thereby making a difference in the child's life. A literature search did not result in any case of Down syndrome with tethered cord syndrome and secondary incontinence as presentation. Considering the possibility of TCS as a cause of incontinence, often neglected even in normal children, careful evaluation and correction of such problems will make a difference in the life of many intellectually disabled children. Incontinence should not be casually attributed to intellectual disability without ruling out other causes.
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Affiliation(s)
| | - Benjamin Sagayaraj
- Associate Professor, Department of Paediatrics, Saveetha Medical College , Thandalam, Chennai, India
| | - Rajan V T T
- Assistant Professor, Department of Neurosurgery, Saveetha Medical College , Thandalam, Chennai, India
| | - Radha Kumar
- Professor, Department of Paediatrics, Saveetha Medical College , Thandalam, Chennai, India
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16
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Baskin LS. This Month in Pediatric Urology. J Urol 2015. [DOI: 10.1016/j.juro.2015.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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