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Rakowska-Silska M, Jobs K, Paturej A, Kalicki B. Voiding Disorders in Pediatrician's Practice. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2020; 14:1179556520975035. [PMID: 33293883 PMCID: PMC7705800 DOI: 10.1177/1179556520975035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/22/2020] [Indexed: 01/23/2023]
Abstract
Voiding disorders result usually from functional disturbance. However, relevant
organic diseases must be excluded prior to diagnosis of functional disorders.
Additional tests, such as urinalysis or abdominal ultrasound are required.
Further diagnostics is necessary in the presence of alarm symptoms, such as
secondary nocturnal enuresis, weak or intermittent urine flow, systemic
symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in
the lumbar region, altered sensations in the perineum. Functional micturition
disorders were thoroughly described in 2006, and revised in 2015 by ICCS
(International Children’s Continence Society) and are divided into storage
symptoms (increased and decreased voiding frequency, incontinence, urgency,
nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency,
dysuria), and symptoms that cannot be assigned to any of the above groups
(voiding postponement, holding maneuvers, feeling of incomplete emptying,
urinary retention, post micturition dribble, spraying of the urinary stream).
Functional voiding disorders are frequently associated with constipation.
Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract
symptoms are accompanied by problems with defecation. Monosymptomatic enuresis
is the most common voiding disorder encountered by pediatricians. It is
diagnosed in children older than 5 years without any other lower urinary tract
symptoms. Other types of voiding disorders such as: non-monosymptomatic
enuresis, overactive and underactive bladder, voiding postponement, bladder
outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually
require specialized diagnostics and therapy. Treatment of all types of
functional voiding disorders is based on non-pharmacological recommendations
(urotherapy), and such education should be implemented by primary care
pediatricians.
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Affiliation(s)
- Magda Rakowska-Silska
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Aleksandra Paturej
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
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Gilliam E, Hoffman JD, Yeh G. Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet 2020; 97:168-178. [PMID: 31420870 PMCID: PMC6917879 DOI: 10.1111/cge.13624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a heterogenous group of connective tissue disorders associated with significant morbidity. The urogenital aspects of these disorders are understudied and there is little guidance on the prevalence, types, or outcomes of urogenital complications in EDS/HSD. Our objective was to perform a scoping review to characterize and synthesize the literature reporting urogenital and pelvic complications in EDS/HSD patients. We performed a systematic search of three databases (Medline, CINAHL, Embase) to January 2019. English language, full-text articles reporting on urogenital or pelvic complications in EDS/HSD were included. A total of 105 studies were included (62 case reports/series, 43 observational) involving patients with hypermobile (23%), vascular (20%), classical (12%) EDS, and HSD (24%). Some studies looked at multiple subtypes (11%) or did not report subtype (33%). Reported complications included urinary (41%), gynecological (36%), obstetrical (25%), renal (9%), and men's health problems (7%), with some studies reporting on multiple areas. Urinary and gynecological complications were most prevalent in patients with HSD, while a broad range of complications were reported in EDS. While further research is required, results suggest a higher index of suspicion for urogenital problems is probably warranted in this population.
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Affiliation(s)
- Elizabeth Gilliam
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jodi D. Hoffman
- Division of Genetics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Gloria Yeh
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Pacey V, Tofts L, Adams RD, Munns CF, Nicholson LL. Quality of life prediction in children with joint hypermobility syndrome. J Paediatr Child Health 2015; 51:689-95. [PMID: 25622801 DOI: 10.1111/jpc.12826] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 12/17/2022]
Abstract
AIMS To assess the child- and parent-reported health-related quality of life (HRQOL) of children with joint hypermobility syndrome (JHS), to compare these with other chronic paediatric conditions and to determine whether symptoms experienced by children with JHS can predict their HRQOL. METHODS Eighty-nine children with JHS and one of their parents completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scale, the Multidimensional Fatigue Scale and the Pediatric Pain Questionnaire. Anthropometric measures and reported symptoms were recorded. Child-reported HRQOL scores were compared with parent report, and both child- and parent-reported HRQOL scores of children with JHS were compared with those of children with other chronic conditions. Stepwise multiple regression was undertaken to determine whether any combination of measures could predict HRQOL. RESULTS Parent- and child-reported HRQOL scores were strongly correlated (r = 0.6-0.84, all P < 0.001); however, parents of children with JHS perceived lower overall HRQOL (mean difference = 4.44, P = 0.001), physical (mean difference = 7.11, P < 0.0001) and emotional functioning (mean difference = 5.24, P = 0.011) than their children. When considered together with previously reported HRQOL scores for children with other chronic conditions, parent and child scores were similarly strongly correlated (r = 0.93, P = 0.001). Multiple regression revealed that 75% of the variance in child-reported HRQOL scores was accounted for by a child's level of pain and fatigue, and presence of stress incontinence symptoms (P < 0.0001). CONCLUSION Children with JHS experience poor HRQOL and disabling fatigue, with parent scores providing a good proxy. Pain, fatigue and the presence of stress incontinence symptoms have the greatest impact on their HRQOL.
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Affiliation(s)
- Verity Pacey
- Physiotherapy Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Biomedical Sciences, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Louise Tofts
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger D Adams
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig F Munns
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Endocrinology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Leslie L Nicholson
- Kids Rehab, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Biomedical Sciences, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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