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MacNeily AE, Afshar K, Hogues V, Kim S, Noparast M, Westwell-Roper C, Stewart SE. Prevalence of previously undiagnosed psychiatric symptom groupings in pediatric patients with bladder and bowel dysfunction. J Pediatr Urol 2024; 20:17.e1-17.e6. [PMID: 37858512 DOI: 10.1016/j.jpurol.2023.10.004] [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: 06/10/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION AND OBJECTIVE The incidence of concomitant psychiatric disorders in conjunction with bladder and bowel dysfunction (BBD) is thought to be higher than the general population. The identification of these disorders with validated tools followed by management may improve urological outcomes. The objective of this study was to determine the prevalence of undiagnosed psychiatric symptom groupings in children presenting with BBD. METHODS Consecutive patients 6-18 yrs with a clinical diagnosis of BBD, a score ≥11 on the Vancouver Symptom Score (VSS) and no prior psychiatric diagnoses were recruited. Two validated questionnaires (Child Behavior Checklist for Ages 6-18 (CBCL) and Autism Spectrum Quotient 10 (AQ-10)) were used to screen for psychiatric comorbidities. Descriptive statistics for demographic variables were presented. Distribution of VSS for normal & abnormal categories (borderline/clinical) of CBCL scores were compared by Mann-Whitney U test. Spearman correlation coefficient was used to examine the relationship between VSS domain scores and CBCL. RESULTS From Sept 2017-May 2022, 50 (17 male) of 110 eligible patients completed the study. Median VSS was 18 (11-33), indicating significant BBD. In 36 patients (72 %), at least one of the CBCL subscales scored as borderline/clinical. Thirty-two patients (64 %) scored in the abnormal range for Internalizing symptoms, 21 (42 %) for Externalizing symptoms, and 31 (62 %) for Total problem scores. Four patients of 48(8 %) scored ≥6 on the AQ-10. The only significant correlation found between CBCL and VSS sub scores was with the Bowel Habit Domain of VSS and Internalizing CBCL T-scores (P = 0.02). CONCLUSION This study identified a high prevalence of previously undiagnosed psychiatric symptom groupings in patients presenting with BBD, with a higher prevalence of internalizing and externalizing symptoms and autism traits than reported in the general population. These findings should encourage urologists to use validated tools to screen for psychiatric comorbidities with referral for further assessment as appropriate. This may prevent unnecessary urological testing, save valuable health resources and potentially improve treatment outcomes of BBD in this population.
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Affiliation(s)
- Andrew E MacNeily
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Kourosh Afshar
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Valerie Hogues
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Soojin Kim
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Maryam Noparast
- Division of Pediatric Urology, BC Children's Hospital. UBC Department of Urologic Sciences. 4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.
| | - Clara Westwell-Roper
- Division of Pediatric Psychiatry, BC Children's Hospital. UBC Department of Psychiatry. 4480 Oak St, Vancouver, British Columbia, Canada, V6H 3V4.
| | - S Evelyn Stewart
- Division of Pediatric Psychiatry, BC Children's Hospital. UBC Department of Psychiatry. 4480 Oak St, Vancouver, British Columbia, Canada, V6H 3V4.
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Admiraal M, van der Burg FAE, Hermanns H, Hermanides J, Hollmann MW, Benninga MA, de Jong J, Gorter RR, Stevens MF. Different Analgesia Techniques for Postoperative Pain in Children Undergoing Abdominal Surgery for Intractable Constipation: A Retrospective Cohort Study in a Single Tertiary Children's Hospital. J Clin Med 2024; 13:349. [PMID: 38256483 PMCID: PMC10816271 DOI: 10.3390/jcm13020349] [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: 12/01/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Functional constipation in the pediatric population is a prevalent issue that is usually well managed. However, in rare cases, conservative treatment fails, and surgical intervention is necessary. This retrospective cohort study aimed to describe and compare different perioperative analgesic techniques in children undergoing major abdominal surgery for intractable constipation. Conducted between 2011 and 2021, this study enrolled patients under 18 years old who underwent initial major abdominal surgery for intractable constipation (i.e., creation of ostomy or subtotal colectomy). Patients were categorized according to the perioperative analgesic technique (i.e., systemic, neuraxial, or truncal block). Of 65 patients, 46 (70.8%) were female, and the median age was 13.5 [8.8-16.1] years during initial major abdominal surgery. Systemic analgesia was used in 43 (66.2%), neuraxial in 17 (26.2%), and truncal blocks in 5 (7.7%) of the surgeries. Patients with neuraxial analgesia reported less postoperative pain (median [interquartile range] numeric rating scale (NRS) 2.0 [0-4.0]), compared to systemic analgesia (5.0 [2.0-7.0], p < 0.001) and to truncal blocks (5.0 [3.0-6.5], p < 0.001). In this preliminary investigation, neuraxial analgesia appears to be the most effective approach to reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. However, well-designed studies are warranted.
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Affiliation(s)
- Manouk Admiraal
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Fleur A. E. van der Burg
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Justin de Jong
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.d.J.); (R.R.G.)
| | - Ramon R. Gorter
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.d.J.); (R.R.G.)
| | - Markus F. Stevens
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.A.); (F.A.E.v.d.B.); (J.H.); (M.W.H.); (M.F.S.)
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Hayes LC, Cendron M. Comorbidity of Obsessive-Compulsive Symptomatology and Bowel and Bladder Dysfunction in a Tertiary Children's Hospital: A Case Series. Urology 2023; 176:156-161. [PMID: 36944400 DOI: 10.1016/j.urology.2023.01.049] [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: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To improve understanding of co-occurring obsessive-compulsive disorder (OCD) and bowel and bladder dysfunction (BBD) in an outpatient pediatric urology clinic setting. To provide a series of clinical care recommendations to enhance the identification and integrated medical and behavioral health treatment of these disorders. METHODS Authors participated in a series of discussions to define the patient population and specific aims for the study. Efforts were made to select index patients of diverse background despite limited sample availability. Three patients were ultimately selected for the study. RESULTS The case studies highlight the connection between urinary issues and underlying OCD symptoms. All patients were initially seen for medical treatment of urological symptoms, then referred for psychological evaluation, and were diagnosed with and received treatment for OCD. Similarities among the cases, including experience of phantom urinary incontinence, stressors present that contributed to symptoms, and obsessive fears of incontinence that led to compulsive behavior, were discussed. Differences between the cases, including patient age, sex, and compulsive behavior demonstrated (ie, urinary frequency, excessive wiping) were also reviewed. CONCLUSION Access to a behavioral health provider can enhance the identification of comorbid psychological disorders and can reduce duration of symptoms through appropriate psychological treatment. Authors provide recommendations for screening measures and reinforce importance of including basic education on psychiatric diagnoses and impact on urological symptoms in urology and pediatric fellowship training programs. Future research exploring prevalence of comorbid psychiatric conditions and efficacy of treatment interventions in a pediatric urology population would be beneficial.
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Affiliation(s)
- Lillian C Hayes
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Marc Cendron
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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