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Correia RR, Gameiro LFO, Trevisane NG, Bertanha M, Ortolan EVP, Lourenção PLTDA. Transcutaneous Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:life13020430. [PMID: 36836787 PMCID: PMC9960109 DOI: 10.3390/life13020430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/13/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of retentive fecal incontinence. Neuromodulation has been used to treat many health problems, with promising results. OBJECTIVE To conduct a systematic review of randomized clinical trials based on the effects of transcutaneous neuromodulation in treating constipation and retentive fecal incontinence in children and adolescents. METHODS A systematic review of randomized clinical trials was performed. Medline (PubMed), PEDro, SciELO, Cochrane (CENTRAL), Embase, and Scopus databases were searched from March 2000 to August 2022. We included clinical trials evaluating transcutaneous neuromodulation in children with constipation and fecal incontinence compared or associated with other types of treatment. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted the data. RESULTS Three studies with 164 participants were included in this review. Two meta-analyses were generated based on these studies. These analyses revealed that transcutaneous neuromodulation is an effective adjuvant treatment modality that improves children's constipation and retentive fecal incontinence. The methodological quality of the included studies was classified as high based on the assessment of the quality of evidence, with a high degree of confidence based on the GRADE system. CONCLUSIONS Transcutaneous neuromodulation is an effective adjuvant treatment modality for children with constipation and retentive fecal incontinence.
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Affiliation(s)
| | | | | | - Matheus Bertanha
- Botucatu Medical School, São Paulo State University—Unesp, Araraquara 01049-010, Brazil
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Das A, O'Kelly F, Wolf J, Hermes G, Wang M, Nemr C, Truscott S, Finnup J, Farhat W, Su R. Biofeedback therapy for children: What is the maximum number of sessions we should offer? J Pediatr Urol 2022:S1477-5131(22)00534-4. [PMID: 36944560 DOI: 10.1016/j.jpurol.2022.11.022] [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: 02/15/2022] [Revised: 07/02/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biofeedback therapy is an effective but resource intensive treatment for pediatric dysfunctional voiding. Based on our center's experience, we evaluated the rate of clinical improvement from biofeedback in order to identify the maximum number of sessions to offer patients. METHODS We reviewed 490 pediatric patients who underwent at least 6 sessions of biofeedback from 2013 to 2021. At each session, patients and their parents documented their urinary symptoms (urgency, frequency, pain, and difficulties with stream), incontinence, medications, and stool pattern. This longitudinal data was abstracted, and the log odds of urinary symptoms or incontinence was modelled with number of sessions as a predictor using generalized estimating equations and robust standard errors in SAS v9.4. Gender and bowel dysfunction were included as interactions terms. A logistic regression using absence of urinary symptoms at last biofeedback session as a dependent variable was done to further explore differences between genders. RESULTS Patients were predominantly female (324/490, 66%) with a mean age of 8.9 years (SD 3.3 years). Most common symptoms at presentation were urinary urgency (389/490, 79%) and urinary incontinence (413/490, 84%). Medication use was common at the time of the first session (191/490, 39%) with males more likely to be on alpha-blockers (54/166 vs 1/324, p < 0.001) and females more likely to be on antibiotic prophylaxis (68/324 vs 2/166, p < 0.001). The probability of having urinary symptoms or incontinence decreased up to session 11 (9 months from initial visit). There was slower rate of improvement after session 8 (3 months). Controlling for age, symptoms, and medication use at initial visit, male patients were less likely to report symptom resolution at the time of the last session (OR 0.55, 95% CI 0.33, 0.89). The nadir for reporting symptoms occurred by session 22 for male patients, compared to session 10 for female patients. CONCLUSIONS Clinical improvement from biofeedback for pediatric patients with dysfunctional voiding may take up to 9 months of therapy, but most cases that improve do so by 3 months. The effect of gender on biofeedback efficacy requires further study, but males may have slower response to biofeedback. Our data provides guidance on when maximum benefit from biofeedback can be expected before considering re-evaluation or other therapies for lower urinary tract symptoms.
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Affiliation(s)
- Arighno Das
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fardod O'Kelly
- Department of Urology, University College Dublin, Dublin, County Dublin, Ireland
| | - Josiah Wolf
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gabriella Hermes
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Muen Wang
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Clara Nemr
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sarah Truscott
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennika Finnup
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Walid Farhat
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ruthie Su
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Ramsay S, Lapointe É, Bolduc S. Comprehensive overview of the available pharmacotherapy for the treatment of non-neurogenic overactive bladder in children. Expert Opin Pharmacother 2022; 23:991-1002. [PMID: 35500302 DOI: 10.1080/14656566.2022.2072212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a chronic condition highly prevalent in children and causing bothersome symptoms. It is often associated with deterioration of quality of life and can be devastating for patients and their families. Prompt initiation of conservative measures should be the backbone of treatment. When conservative management fails, pharmacological options must be considered. AREAS COVERED Although antimuscarinics are considered the mainstay of pharmacological treatment for OAB, only two agents are currently approved for the pediatric population. Oxybutynin and propiverine are discussed in this review, as well as other non-approved antimuscarinic agents and β3-agonists with related literature to substantiate their use in children. Dual therapy along with medication adherence and persistence is also discussed. EXPERT OPINION The treatment of OAB in children is demanding and one must rely on a structured, stepwise approach to achieve success. Discussing conservative measures and prescribing medication is not enough. Clinicians should actively involve children and their families in the treatment, set realistic expectations, and closely monitor side effects and medication adherence to ensure maximal efficacy.
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Affiliation(s)
- Sophie Ramsay
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - Élisabeth Lapointe
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - Stéphane Bolduc
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
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Pokarowski M, Rickard M, Kanani R, Mistry N, Saunders M, Rockman R, Sam J, Varghese A, Malach J, Margolis I, Roushdi A, Levin L, Singh M, Lopes RI, Farhat WA, Koyle MA, Dos Santos J. Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction. Pediatr Qual Saf 2021; 6:e383. [PMID: 33718744 PMCID: PMC7952106 DOI: 10.1097/pq9.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care. METHODS We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients. RESULTS Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction. CONCLUSIONS Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
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Affiliation(s)
- Martha Pokarowski
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandy Rickard
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, North York, Ontario, Canada
| | - Niraj Mistry
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Megan Saunders
- Department of Pediatrics, North York General Hospital, North York, Ontario, Canada
| | - Rebecca Rockman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Sam
- Department of Pediatrics, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Abby Varghese
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Malach
- Department of Pediatrics, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Ivor Margolis
- Department of Pediatrics, William Osler Health Centre-Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Amani Roushdi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Leo Levin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Manbir Singh
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Walid A. Farhat
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A. Koyle
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana Dos Santos
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Iguchi N, Carrasco A, Xie AX, Pineda RH, Malykhina AP, Wilcox DT. Functional constipation induces bladder overactivity associated with upregulations of Htr2 and Trpv2 pathways. Sci Rep 2021; 11:1149. [PMID: 33441874 PMCID: PMC7806916 DOI: 10.1038/s41598-020-80794-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/23/2020] [Indexed: 01/23/2023] Open
Abstract
Bladder and bowel dysfunction (BBD) is a common yet underdiagnosed paediatric entity that describes lower urinary tract symptoms (LUTS) accompanied by abnormal bowel patterns manifested as constipation and/or encopresis. LUTS usually manifest as urgency, urinary frequency, incontinence, and urinary tract infections (UTI). Despite increasing recognition of BBD as a risk factor for long-term urinary tract problems including recurrent UTI, vesicoureteral reflux, and renal scarring, the mechanisms underlying BBD have been unclear, and treatment remains empirical. We investigated how constipation affects the lower urinary tract function using a juvenile murine model of functional constipation. Following four days of functional constipation, animals developed LUTS including urinary frequency and detrusor overactivity evaluated by awake cystometry. Physiological examination of detrusor function in vitro using isolated bladder strips, demonstrated a significant increase in spontaneous contractions without affecting contractile force in response to electrical field stimulation, carbachol, and KCl. A significant upregulation of serotonin receptors, Htr2a and Htr2c, was observed in the bladders from mice with constipation, paralleled with augmented spontaneous contractions after pre-incubation of the bladder strips with 0.5 µM of serotonin. These results suggest that constipation induced detrusor overactivity and increased excitatory serotonin receptor activation in the urinary bladder, which contributes to the development of BBD.
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Affiliation(s)
- Nao Iguchi
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Alonso Carrasco
- Children's Hospital Colorado, 13123 E 16th Avenue, B463, Aurora, CO, 80045, USA
- Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | - Alison X Xie
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Ricardo H Pineda
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA
| | - Duncan T Wilcox
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, 12700 E 19th Avenue, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, 13123 E 16th Avenue, B463, Aurora, CO, 80045, USA.
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Özen MA, Taşdemir M, Aygün MS, Necef I, Aydın E, Bilge I, Eroğlu E. Is there a unique symptom in lower urinary tract dysfunction in children? Low Urin Tract Symptoms 2020; 13:264-270. [PMID: 33137854 DOI: 10.1111/luts.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Lower urinary tract symptoms (LUTS), particularly urgency, incontinence and intermittency are common in children and it is suggested that the specific symptoms may be used for definite diagnosis for LUT dysfunction (LUTD). This study was performed to investigate the relationship between each LUTD and its associated symptoms, using uroflowmetry/electromyography (UF/EMG) as a diagnostic tool. METHODS Each patient was categorized into one of four LUT conditions which were overactive bladder (OAB), dysfunctional voiding (DV), underactive bladder and primary bladder neck dysfunction (PBND), according to UF/EMG results. Patients' complaints and findings were documented by using voiding dysfunction symptom score, bladder diary, urine analysis and ultrasonography. In addition, a detailed history of bowel habits (including use of Rome III criteria) was obtained. RESULTS There were 189 children of which 106 were female. The OAB was the largest group including 91 patients, followed by the DV group which had 61 patients. The symptoms specific to any LUTD group were constipation and hesitancy (P < .05). Hesitancy was present in 89.4% with PBND and constipation was present in 78.6% of patients with DV. None of other symptoms were able to differentiate any LUTD group from the other. CONCLUSIONS While certain symptoms are often presumed by clinicians to imply specific diagnoses, the main outcome of this study is that there is a generally weak correlation between the specificity of symptoms and LUTD. Symptoms-based approach may lead to misdiagnosis in LUTD. Thus, it may be essential to focus on the underlying pathologies and UF/EMG test may help this.
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Affiliation(s)
- Mehmet A Özen
- Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Mehmet Taşdemir
- Department of Pediatrics, Division of Pediatric Nephrology, Koç University School of Medicine, Istanbul, Turkey
| | - Murat S Aygün
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Işıl Necef
- Department of Psychiatry, Koc University School of Medicine, Istanbul, Turkey
| | - Emrah Aydın
- Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ilmay Bilge
- Department of Pediatrics, Division of Pediatric Nephrology, Koç University School of Medicine, Istanbul, Turkey
| | - Egemen Eroğlu
- Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey
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Keefe DT, Rickard M, Anderson P, Bagli D, Blais AS, Bolduc S, Braga LH, Brownrigg N, Chua M, Dave S, dos Santos J, Guerra L, Hayashi AH, Keays MA, Kim S, Koyle MA, Lee LC, Lorenzo AJ, MacLellan D, MacDonald L, MacNeily AE, Metcalfe PD, Moore K, Romao RL, Wang PZ. Prioritization and management recommendations of pediatric urology conditions during the COVID-19 pandemic. Can Urol Assoc J 2020; 14:E237-E250. [PMID: 32525802 PMCID: PMC7654666 DOI: 10.5489/cuaj.6693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel T. Keefe
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Anderson
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Darius Bagli
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne-Sophie Blais
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Stéphane Bolduc
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Luis H. Braga
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Natasha Brownrigg
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Joana dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Luis Guerra
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Allen H. Hayashi
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Mélise A. Keays
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Soojin Kim
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin A. Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda C. Lee
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Armando J. Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn MacLellan
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Landan MacDonald
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Andrew E. MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter D. Metcalfe
- Department of Surgery, Division of Pediatric Surgery, University of Alberta, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Katherine Moore
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Rodrigo L.P. Romao
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Surgery, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Z.T. Wang
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Ribeiro RS, Abreu GED, Dourado ER, Veiga ML, Lobo VA, Barroso U. BLADDER AND BOWEL DYSFUNCTION IN MOTHERS AND CHILDREN: A POPULATION-BASED CROSS-SECTIONAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:126-130. [PMID: 32401953 DOI: 10.1590/s0004-2803.202000000-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE To evaluate bladder and bowel dysfunction between mothers and children. METHODS A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS A total of 441 mother-child pairs was obtained. Children's mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers' mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn't any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.
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Affiliation(s)
- Rebeca Sadigursky Ribeiro
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Glícia Estevam de Abreu
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Eneida Regis Dourado
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Maria Luiza Veiga
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Victoria Andrade Lobo
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
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Özen MA, Mutluer T, Necef I, Shabsog M, Taşdemir M, Bilge I, Eroğlu E. The overlooked association between lower urinary tract dysfunction and psychiatric disorders: a short screening test for clinical practice. J Pediatr Urol 2019; 15:332.e1-332.e5. [PMID: 31072762 DOI: 10.1016/j.jpurol.2019.03.025] [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: 11/28/2018] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunction (LUTD) often presents with other associated comorbidities such as urinary tract infections, constipation, fecal incontinence, and vesicoureteral reflux. However, the psychiatric conditions that can be associated with LUTD tend to go unnoticed. The evaluation, diagnosis, and treatment of LUTD and psychiatric disorders in children are difficult and time-consuming. Moreover, there is currently no accepted consensus on this subject. OBJECTIVE In this study, the authors aimed to investigate the relationship between the subgroups of both LUTD and psychiatric disorders. STUDY DESIGN LUTD were divided into 4 groups by using voiding dysfunction symptom score (VDSS), bladder diary, and uroflowmetry/electromyography (UF/EMG) test. A short screening test for psychological problems was used to detect psychiatric disorders accompanying each LUTD group. In terms of psychiatric disorders, the patients were divided into two groups: externalizing and internalizing disorders. RESULTS A total of 156 children were diagnosed with LUTD. Seventy-six patients had overactive bladder (OAB), 53 had dysfunctional voiding (DV), 14 had primary bladder neck dysfunction (PBND), and 13 had underactive bladder (UAB). Psychiatric disorder was detected in 46 children (29.4%). Of these, 32 had an externalizing and 14 had an internalizing disorder. In terms of age, externalizing disorders were more common in children aged between 6 and 11 years (87.5%), whereas internalizing disorders were seen equally in both age groups. Among these, attention deficit hyperactivity disorder (ADHD) was the most common psychiatric disorder (16.1%). The LUTD groups with the most frequent psychiatric disorders were UAB (53.8%), PBND (35.7%), and OAB (28.9%). DISCUSSION Most of the studies investigating the relationship between the lower urinary tract and psychiatric disorders so far have been concerned with the lower urinary tract symptom (LUTS) (such as nighttime or daytime incontinence) and ADHD. However, the present study was performed according to the LUTD classification, which is primarily based on VDSS, bladder diary, and UF/EMG tests. Furthermore, psychiatric disorders were classified into their subgroups. The results have shown that around a quarter of children with LUTD also had comorbid psychiatric disorders. The relationship between LUTD and psychiatric disorders constitutes a critical point. Identifying this association can contribute to the comprehensive diagnosis and treatment for these patients. CONCLUSIONS LUTD and psychiatric disorders can be seen together, and this can be detected by the short screening test for psychological problems. Therefore, the authors think that patients who applied with LUTS should undergo this short test along with the routine urinary system examination and tests.
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Affiliation(s)
- M A Özen
- Department of Pediatric Surgery, Koç University, School of Medicine, Topkapı, Maltepe, 34010, Istanbul, Turkey.
| | - T Mutluer
- Department of Child and Adolescent Psychiatry, Koç University, School of Medicine, Turkey
| | - I Necef
- Department of Child and Adolescent Psychiatry, Koç University, School of Medicine, Turkey
| | - M Shabsog
- Koç University, School of Medicine, Topkapı, Maltepe, 34010, Istanbul, Turkey
| | - M Taşdemir
- Department of Pediatric Nephrology, Koç University Hospital, Topkapı, Maltepe, 34010, Istanbul, Turkey
| | - I Bilge
- Department of Pediatric Nephrology, Koç University Hospital, Topkapı, Maltepe, 34010, Istanbul, Turkey
| | - E Eroğlu
- Department of Pediatric Surgery, Koç University, School of Medicine, Topkapı, Maltepe, 34010, Istanbul, Turkey
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Khan A, Jhaveri R, Seed PC, Arshad M. Update on Associated Risk Factors, Diagnosis, and Management of Recurrent Urinary Tract Infections in Children. J Pediatric Infect Dis Soc 2019; 8:152-159. [PMID: 30053044 PMCID: PMC6510945 DOI: 10.1093/jpids/piy065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/19/2018] [Indexed: 01/16/2023]
Abstract
Recurrent urinary tract infection (rUTI) continues to challenge pediatric care providers. The diagnosis of an rUTI can be difficult, especially in young febrile children. Antibiotic resistance rates continue to rise, which limits oral treatment options. Prophylactic antibiotics are used commonly to manage rUTI, but their use increases the risk of rUTI with antibiotic-resistant strains without significantly reducing renal scarring. Alternative therapies for rUTI include probiotics and anthocyanidins (eg, cranberry extract) to reduce gut colonization by uropathogens and prevent bacterial adhesion to uroepithelia, but efficacy data for these treatments are sparse. The future of rUTI care rests in addressing the following contemporary issues: best diagnostic practices, risk factors associated with rUTI, and the prevention of recurrent infection. In this review, we summarize the state of the art for each of these issues and highlight future studies that will aim to take an alternative approach to managing rUTI.
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Affiliation(s)
- Anum Khan
- School of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine
| | - Patrick C Seed
- Ann and Robert H. Lurie Children’s Hospital and Stanley Manne Children’s Research Institute, Chicago, Illinois
| | - Mehreen Arshad
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Ryakitimbo A, Philemon R, Mazuguni F, Msuya L. Prevalence and antimicrobial sensitivity pattern of urinary tract infection among children with cerebral palsy, Moshi, Tanzania. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:59-65. [PMID: 29774893 PMCID: PMC5947104 DOI: 10.2147/phmt.s159766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Urinary tract infection (UTI) in children with cerebral palsy (CP) is a challenging yet common clinical condition. Children with CP bare the greatest risk of contracting UTI because of their difficulties in neuromotor control which lead to delay of bladder control, causing incomplete bladder emptying and urine retention. Method This was an analytical cross-sectional study that was conducted from September 2016 to March 2017 at Comprehensive Community Based Rehabilitation in Tanzania – Moshi and Kilimanjaro Christian Medical Centre Neurological Pediatrics Outpatient Clinic. All children who met the inclusion criteria were studied. Urine samples were collected at one point by catheterization, and urine dipstick and urine culture were done. Data were analyzed using SPSS version 20. Results A total of 99 children were enrolled in the study. The median age was 4 years (3–8 years); 53.5% were aged between 2 and 4 years. More than half were male. UTI was detected in 13.1% (n=13) of the children. Five causative agents of UTI were isolated, namely Escherichia coli, Proteus mirabilis, Klebsiella pneumonia, Staphylococcus aureus, and Enterococcus faecalis. The two most common organisms, E. coli and P. mirabilis, both had low sensitivity to ampicillin and co-trimoxazole while they were sensitive to ciprofloxacin and ceftriaxone. Conclusion UTI is a common finding among children with CP. E. coli and P. mirabilis are the commonest causative agents and are sensitive to ciprofloxacin and ceftriaxone but have low sensitivity to ampicillin and co-trimoxazole.
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Affiliation(s)
- Amon Ryakitimbo
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rune Philemon
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Festo Mazuguni
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Levina Msuya
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Pediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Jarczyk KS, Pieper P, Brodie L, Ezzell K, D'Alessandro T. An Integrated Nurse Practitioner-Run Subspecialty Referral Program for Incontinent Children. J Pediatr Health Care 2018; 32:184-194. [PMID: 29289407 DOI: 10.1016/j.pedhc.2017.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. METHODS Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. RESULTS Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. DISCUSSION This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations.
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Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J 2017; 11:S64-S72. [PMID: 28265323 DOI: 10.5489/cuaj.4411] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment. In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.
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Affiliation(s)
- Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roberto I Lopes
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
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Mishra B, Srivastava R, Agarwal J, Srivastava S, Pandey A. Behavioral and Psychosocial Risk Factors Associated with First and Recurrent Cystitis in Indian Women: A Case-control Study. Indian J Community Med 2016; 41:27-33. [PMID: 26917870 PMCID: PMC4746950 DOI: 10.4103/0970-0218.170962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The risk factors for urinary tract infections (UTIs) from developed countries are not applicable to women from developing world. Objective: To analyze the behavioral practices and psychosocial aspects pertinent to women in our region and assess their association with acute first time or recurrent UTI. Materials and Methods: Sexually active premenopausal women with their first (145) and recurrent (77) cystitis with Escherichia coli as cases and women with no prior history of UTI as healthy controls (257) were enrolled at a tertiary care hospital in India, between June 2011 and February 2013. Questionnaire-based data was collected from each participant through a structured face-to-face interview. Results: Using univariate and multivariate regression models, independent risk factors for the first episode of cystitis when compared with healthy controls were (presented in odds ratios [ORs] with its 95% confidence interval [CI]): Anal sex (OR = 3.68, 95% CI = 1.59-8.52), time interval between last sexual intercourse and current episode of UTI was <5 days (OR = 2.27, 95% CI = 1.22-4.23), use of cloth during menstrual cycle (OR = 2.36, 95% CI = 1.31-4.26), >250 ml of tea consumption per day (OR = 4.73, 95% CI = 2.67-8.38), presence of vaginal infection (OR = 3.23, 95% CI = 1.85-5.62) and wiping back to front (OR = 2.52, 95% CI = 1.45-4.38). Along with the latter three, history of UTI in a first-degree female relative (OR = 10.88, 95% CI = 2.41-49.07), constipation (OR = 4.85, 95% CI = 1.97-11.92) and stress incontinence (OR = 2.45, 95% CI = 1.18-5.06) were additional independent risk factors for recurrent cystitis in comparison to healthy controls. Conclusion: Most of the risk factors for initial infection are potentially modifiable but sufficient to also pose risk for recurrence. Many of the findings reflect the cultural and ethnic practices in our country.
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Affiliation(s)
- Bharti Mishra
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Richa Srivastava
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jyotsna Agarwal
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sugandha Srivastava
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Pandey
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol 2015; 5:13-9. [PMID: 26140267 PMCID: PMC4482817 DOI: 10.5662/wjm.v5.i2.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/03/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to find a safer, effective and acceptable alternative. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vaccinium Macrocarpon (cranberry), commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus (LA-5) and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli (E. coli) 83972 has resulted in subjective benefit and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interventions.
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Naseri M. Association of nocturnal enuresis with vesicoureteral reflux and renal cortical damage. Nephrourol Mon 2013; 4:448-53. [PMID: 23573464 PMCID: PMC3614278 DOI: 10.5812/numonthly.2030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 08/20/2011] [Accepted: 10/25/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of vesicoureteral reflux (VUR) is higher in enuretic children than in non-enuretic children. Recent studies have reported VUR in 6-23% of children with enuresis. OBJECTIVES To clarify the association of nocturnal enuresis with vesicoureteral reflux (VUR) and to identify children who are at risk for VUR. PATIENTS AND METHODS During 2007-2009, neurologically normal children who were referred with a chief complaint of nocturnal enuresis and had abnormal renal ultrasonography (US) results, daytime incontinence, abnormal results in urodynamic studies, urinary tract infection, or a history of VUR in their siblings were prospectively evaluated for VUR by voiding cystourethrography (VCUG). RESULTS A total of 60 children (26 boys and 34 girls) aged 5-17 (mean ± SD: 8.46 ± 2.45) years met the inclusion criteria and were enrolled in the study. Twenty-eight (46.7%) patients had mono-symptomatic nocturnal enuresis (MNE), and 32 (53.3%) had non-mono symptomatic nocturnal enuresis (NMNE). VUR was reported in 10 (16.7%) patients and posterior urethral valve (PUV) was found in 1 (1.7%) patient. The prevalence of VUR was significantly higher in patients with daytime incontinence and in girls (P = 0.016 and 0.003 respectively). We did not find any significant correlations between VUR and the form of enuresis (primary versus secondary), urinary tract infection, or any diurnal urinary symptoms other than daytime incontinence (P > 0.05 for all). of 10 renal scintigrams, 5 (50%) showed renal cortical defects. CONCLUSIONS VUR is uncommon in children with MNE and in those with NMNE who do not wet themselves during the day; however, it is a relatively common finding in enuretic children who have daytime incontinence. We recommend VCUG in all enuretic children who have daytime incontinence.
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Affiliation(s)
- Mitra Naseri
- Pediatric Nephrology Department, Dr Sheikh Children hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Mitra Naseri, Pediatric Nephrology Department, Dr Sheikh Children hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel.: +98-5117269021, Ext: 5, Fax: +98-5117277470, E-mail: ,
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Fonseca FF, Tanno FY, Nguyen HT. Current options in the management of primary vesicoureteral reflux in children. Pediatr Clin North Am 2012; 59:819-34. [PMID: 22857830 DOI: 10.1016/j.pcl.2012.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of vesicoureteral reflux (VUR) is varied and remains controversial, which is likely because children with VUR have different risks for urinary tract infection or renal injury. Consequently, the treatment of VUR needs to be individualized based on the patient's characteristics. In this article, the authors review the medical and surgical management options for VUR in the pediatric population. The authors hope to provide a systematic approach to determine which treatment is optimal for a specific patient.
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Affiliation(s)
- Fernando F Fonseca
- Department of Urology, Children's Hospital, Boston Harvard Medical School, Boston, MA 02115, USA
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19
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Effect of Rectal Distention on Lower Urinary Tract Function in Children. J Urol 2010; 184:1680-5. [DOI: 10.1016/j.juro.2010.03.120] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Indexed: 01/07/2023]
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Moylan S, Armstrong J, Diaz-Saldano D, Saker M, Yerkes EB, Lindgren BW. Are abdominal x-rays a reliable way to assess for constipation? J Urol 2010; 184:1692-8. [PMID: 20728159 DOI: 10.1016/j.juro.2010.05.054] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Currently to our knowledge no validated reliable tools are available to evaluate constipation in children. Abdominal x-rays are often done in clinical practice to evaluate patients with lower urinary tract symptoms. Although 3 previously published rating tools exist to score constipation based on x-ray, there is little information on their merits. We assessed these 3 tools for reliability among multiple practitioners. MATERIALS AND METHODS We retrospectively analyzed abdominal x-rays in a cohort of 80 patients between ages 4 and 12 years. X-rays were independently assessed by each of us using the previously published Barr, Leech and Blethyn scoring tools. Scores were analyzed for reliability using standard statistical methods. RESULTS The range of weighted κ score, indicating reliability, were 0.0491 to 0.4809 for the Barr, 0.1195 to 0.2730 for the Leech and 0.0454 to 0.4514 for the Blethyn method. Guidelines for κ scores are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-marginal reproducibility. ICC, another reliability measure, was 0.02577 for the Barr, 0.3313 for the Leech and 0.201 for the Blethyn method. ICC interpretations are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-poor. There was a trend toward good interrater reliability between more experienced urology practitioners with the Barr and Blethyn tools (0.48 and 0.45, respectively) but not between less experienced raters or with the Leech tool. CONCLUSIONS Currently available scoring tools to evaluate constipation by x-ray do not have good reliability among multiple examiners. Further research is needed to develop an alternate tool to increase the reliability of x-ray to assess constipation between multiple raters.
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Affiliation(s)
- Susan Moylan
- Division of Urology, Children's Memorial Hospital, Chicago, Illinois 60614, USA
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