Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts

Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy

BACKGROUND

An association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI) is well-known. However, a question less explored is whether children with UTI early in life also have increased prevalence of BBD after they are toilet-trained. In this study, consecutively selected children with pyelonephritis during their first year of life were assessed for BBD at pre-school age.

METHODS

Ninety-two children (51 boys) hospitalized due to pyelonephritis during their first year of life were assessed for BBD at median age 5.4 years. A validated BBD questionnaire, along with urine flow and residual volume measurements, was used for diagnosing BBD. During follow-up, the group was well-characterized regarding renal status, vesicoureteral reflux (VUR), and recurrent UTI.

RESULTS

BBD was diagnosed in 35/92 (38%), of which the majority was sub-diagnosed with dysfunctional voiding (DV). There was a strong association between BBD and recurrent UTI during follow-up (p < 0.0001), but only a slight association with VUR status at presentation. Nevertheless, in the group with both BBD and VUR, recurrent UTI was four times higher (12/13, 92%) than in children who had neither VUR nor BBD (23%), (p = 0.0008). BBD was also associated with kidney damage (p = 0.017).

CONCLUSION

In children with pyelonephritis during the first year of life, 38% had BBD at pre-school age, regardless of whether they had VUR or not. The study shows an important association between BBD and recurrent UTI, so an assessment of BBD is therefore recommended for pre-school children with UTI, especially when they have history of pyelonephritis during infancy.

The complex relationship between urinary and defecatory disorders in young and adolescent girls

PURPOSE OF REVIEW

Scientific advancements have led to enhanced clarity about the interrelationship between urinary tract pathology and functional bowel disturbances. The present article will review the current literature regarding the cause, pathophysiology, diagnosis, and treatment of lower urinary tract dysfunction and abnormal bowel habits in young and adolescent girls.

RECENT FINDINGS

Complex neurological, physiological mechanisms and functional behaviors exist that contribute to the development of coexisting urinary symptoms and defecatory disorders in young and adolescent girls. Bladder bowel dysfunction (BBD) in childhood and adolescence is carried into adulthood creating a lifetime health burden.

SUMMARY

Practitioners should be aware and actively screen for conditions mimicking BBD with time-efficient and effective history-taking and physical exams that reduce anxiety and fear. The present review provides guide to comprehensive treatment strategies for managing complex pelvic floor disorders including urinary incontinence, defecatory disorders, pelvic and perineal pain, and constipation. More research is needed to elucidate pathophysiology and optimal treatment strategies of the BBD.

Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society

BACKGROUND

We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae.

METHODS

A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement.

RESULTS

BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented.

CONCLUSIONS

This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.

Factors Associated with Urinary Incontinence in Pregnant Adolescents: A Case-Control Study

STUDY OBJECTIVE

To evaluate the factors associated with urinary incontinence (UI) in pregnant adolescents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A case-control study was conducted in 3 Brazilian public hospitals. Adolescents between the ages of 10 and 19 years with gestational age of 27 weeks or more were included. The sample size was calculated using the Open-epi (http://www.openepi.com/Menu/OE_Menu.htm) 3.01 program considering gestational obesity as an associated factor. The resulting sample consisted of 658 volunteers, 329 in the case group (with UI) and 329 in the control group (without UI). The subjects responded to the evaluation form containing information about the outcome of interest and possible associated factors. Stata 14.0 software (StataCorp) was used to perform multivariate logistic analysis.

RESULTS

The variables age between 10 and 14 years (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.13-5.35; P = .023), previous UI (OR, 1.9; 95% CI, 1.36-2.75; P < .001), and constipation (OR, 1.7; 95% CI, 1.23-2.42; P = .002) were associated with UI in pregnant adolescents. Multigravida was not a factor associated (OR, 0.5; 95% CI, 0.31-0.66; P < .001) for UI in pregnant adolescents.

CONCLUSION

Attention must be given to primigravidae between the ages of 10 and 14 years who report previous UI and/or constipation to ensure referral to the appropriate health care professional for early prevention of UI.