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Liu X, Wang Z, Zhou Z, Yang S, Yang J, Wen Y, Zhang Y, Lv L, Hu J, Wang Q, Lu W, Wen JG. Prevalence, risk factors, psychological effects of children and adolescents with lower urinary tract symptoms: a large population-based study. Front Pediatr 2024; 12:1455171. [PMID: 39233869 PMCID: PMC11371695 DOI: 10.3389/fped.2024.1455171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/07/2024] [Indexed: 09/06/2024] Open
Abstract
Background Lower urinary tract symptoms (LUTS) are clinically frequent and seriously affect the psychological and mental health of children and adolescents. However, most studies on LUTS and its influence on the psychological behavior and mental health have focused on adults. This study aimed to investigate LUTS prevalence and associated factors in children and adolescents and explore its impact on psychological behavior. Materials and methods From October 2019 to November 2021, an epidemiological LUTS survey was carried out on 6,077 children aged 6-15 years old in 12 primary and secondary schools in China by using anonymous questionnaires. Results A total of 5,500 valid questionnaires were collected, and the total prevalence of four representative symptoms of LUTS: urgency, frequency, daytime urinary incontinence, and nocturnal enuresis was 19.46%, 14.55%, 9.75%, and 8.4%, respectively. The prevalence decreased with age, which decreased rapidly in children aged 6-12 years old. The incidence of LUTS in those who did not continue to use disposable diapers (DD) and began to perform elimination communication (EC) after the age of 1 was significantly higher than that of those who stopped using DD and started EC before 1 year of age (P < 0.05). There were significant differences in the occurrence of LUTS without toiled training (TT) (P < 0.05). The prevalence of LUTS in males was significantly higher than in females (P < 0.05). LUTS in children and adolescents with constipation was significantly higher compared to those without constipation (P < 0.05). The detection rate of abnormal psychological behavior in the LUTS group was 44.6%, which was significantly higher than that in the no LUTS group (21.4%, P < 0.05). The scores of emotional symptoms, conduct problems, hyperactivity, and peer communication problems were significantly higher in the LUTS group than the control group. Conclusions In Mainland China, the prevalence of LUTS in children and adolescents is high. Continued use of DD after 1 year of age, history of urinary tract infection, lack of TT, and constipation were risk factors for LUTS. EC before 1 year of age is a protective factor for LUTS. The prevalence of psychological behavioral abnormalities is high in children and adolescents with LUTS, which needs to be more concerned.
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Affiliation(s)
- Xingchen Liu
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Wang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhaokai Zhou
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuai Yang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Yang
- Surgical Reception Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yibo Wen
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanping Zhang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lei Lv
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jinhua Hu
- Department of Urology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Qingwei Wang
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Lu
- Department of Urology, Xinyang Central Hospital, Xinyang, Henan, China
| | - Jian Guo Wen
- Paediatric Urodynamic Centre and Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Joint International Paediatric Urodynamic Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Van Aggelpoel T, De Wachter S, Neels H, Van Hal G, Roelant E, Vermandel A. Implementing a new method of group toilet training in daycare centres: a cluster randomised controlled trial. Eur J Pediatr 2021; 180:1393-1401. [PMID: 33230718 DOI: 10.1007/s00431-020-03879-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Despite the existing methods, a trend towards a later initiation and completion of toilet training has been seen in Western society. This study is the first to investigate prospectively the efficacy of intensive group toilet training in daycare centres. The primary outcome of interest is the duration until the child is toilet trained. A cluster randomised controlled trial was established in daycare centres; clusters of participants were randomly allocated to an intervention or control group. Intervention group was subjected to an intensive toilet training session. Innovative aspects of this toilet training method were a 2-h training on two consecutive days, carried out in small groups in daycare centres. Parents of children in the control group were encouraged to start TT in their own manner. Children were monitored until they were considered to be fully toilet trained during the day. Median toilet training duration in the intervention group was 2 weeks compared to 5 weeks in controls (p value log rank test = 0.007). The hazard of being clean during the follow-up of 6 weeks was twice as high in the intervention compared to controls (p = 0.018).Conclusion: The intervention had a significant influence on the duration of toilet training in healthy children, with a median duration of 2 weeks. Our findings are clinically relevant for daycare educators, having a considerable responsibility in the development of children.Trial Registration Number: ClinicalTrials.gov NCT04221776. What is Known: • Despite different existing methods, a later initiation of toilet training has been seen in Western society and coherent to this an increasing age of acquiring full bladder control. • Child daycare centres have a growing role in the toilet training process. What is New: • This is the first prospective report describing the results of a new method of toilet training healthy children in small groups in daycare centres. • The intervention had a significant influence on the duration of toilet training, with a median duration of 2 weeks.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium. .,Department of Urology, Antwerp University Hospital, Edegem, Belgium.
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Hedwig Neels
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Guido Van Hal
- Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital - University of Antwerp, Edegem, Belgium.,StatUa, Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Wyndaele JJ, Kaerts N, Wyndaele M, Vermandel A. Development Signs in Healthy Toddlers in Different Stages of Toilet Training: Can They Help Define Readiness and Probability of Success? Glob Pediatr Health 2020; 7:2333794X20951086. [PMID: 32923525 PMCID: PMC7450290 DOI: 10.1177/2333794x20951086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2020] [Accepted: 07/24/2020] [Indexed: 11/15/2022] Open
Abstract
There is much uncertainty about when to start toilet training. Age cannot be a strict stand-alone criterion, as every child has its own pace of development. We observed toilet training (TT) related development signs (DS) in healthy toddlers and determined which can help to define the proper time to start TT and to predict success. The study group consisted of 269 healthy children, in different stages of TT: not started, during, and after completion. Sitting stable, picking up small objects, and spontaneously putting objects in containers were present in all children and had no predictive value. All other DS were significantly more present in those who had started and became more prevalent during completion of TT. Age had a significant association with 13/15 DS. Understanding and following instructions, and having a broader vocabulary were significantly more present when TT had been started. Dry during midday nap reached no significance.
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Affiliation(s)
| | | | | | - Alexandra Vermandel
- University of Antwerp, Wilrijk, Belgium.,University Medical Center, Utrecht, The Netherlands
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Abstract
PURPOSE The physiopathology of the voiding and urinary continence was one of the hot topic of research these last few years. Unfortunately, anyone have already found a unique cause which could explain urinary incontinence (urge or stress). The concept of cognitive function highlights new ways of research to show the fundamental role of the cortex and the sub-cortex in these diseases. METHODS A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "cognition, urinary tract, urinary continence, neuroimaging, IRMf, micturition, urge, brain factor and cognitive therapy". In all the articles, 72 really dealt with micturition and cognition. RESULTS New imaging techniques allowed to show the relationship between the different brain area involved in the bladder control such as the periaqueductal gray, the hypothalamus, the insula, the anterior cingulated cortex and the prefrontal cortex. These cortical area are equally involved in cognition. An alteration of urinary continence implies a modification of activation of these cortical areas. CONCLUSION A better knowledge of the cognitive side of micturition and urinary continence will allow to improve the treatment of their associated diseases.
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