CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2020; 29(04): 217-224
DOI: 10.1055/s-0040-1713925
Original Article | Artículo Original
Pediatric Urology/Urología Pediátrica

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology

Prevalencia de la disfunción de la vejiga y del intestino en la consulta ambulatoria de urología y nefrología pediátrica
1   Department of Urology, Pediatric Urology and Nephrology Clinic, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
2   School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
,
1   Department of Urology, Pediatric Urology and Nephrology Clinic, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
,
1   Department of Urology, Pediatric Urology and Nephrology Clinic, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
2   School of Medicine, Universidad de los Andes, Bogotá DC, Colombia
,
Anamaría Ramos
1   Department of Urology, Pediatric Urology and Nephrology Clinic, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
,
3   Division of Urology, Seattle Children’s Hospital University of Washington, Seattle, Washington, United States
,
Jaime Pérez
1   Department of Urology, Pediatric Urology and Nephrology Clinic, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia
› Institutsangaben
Funding sources The present study was supported by a research grant from the Joint Call for Research of Hospital Universitario Fundación Santa Fe de Bogotá and the School of Medicine at Universidad de los Andes (August 17th, 2018).

Abstract

Objective Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology.

Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models.

Results The median age was 9 years old (interquartile range [IQR]: 6–13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001).

Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

Resumen

Objetivo El síndrome de disfunción de la vejiga y del intestino (DVI) se define como la presencia de alteraciones funcionales en ambos órganos. El correcto diagnóstico y tratamiento previene la exposición de los pacientes a múltiples manejos antibióticos, procedimientos invasivos y estudios radiológicos. El objetivo de este estudio es estimar la prevalencia de DVI en la consulta ambulatoria de urología y nefrología pediátrica.

Métodos Se evaluó una cohorte prospectiva de 334 pacientes de 5 a 18 años. Se aplicó el cuestionario de Puntuación de Síntomas del Tracto Urinario Inferior (Pediatric Lower Urinary Tract Symptom Score, PLUTSS), cuyo resultado mayor a 8 fue considerado significativo. Adicionalmente, se usó la Escala de Heces de Bristol (Bristol Stool Scale) y los Criterios Roma IV (Rome IV Criteria) para estreñimiento e incontinencia fecal. Los factores de riesgo se evaluaron bajo modelos de regresión logística.

Resultados La edad mediana fue de 9 años (rango intercuartil [RIC]: 6–13). El cuestionario PLUTSS fue significativo en 16,5% de los niños, y se observó estreñimiento en 31,9%, e incontinencia fecal en 4%. La prevalencia de DVI fue de 27,8%. El sexo femenino (razón de probabilidades [RP]: 2.47; p = 0.002) y desordenes psicológicos (RP: 4.637; p = 0.024) fueron considerados factores de riesgo. La evaluación del cuestionario PLUTSS mostró relevancia en incontinencia (RP: 3.059; p = 0.038), enuresis (RP: 8.532; p < 0.001), flujo intermitente (RP: 9.211; p = 0.004), frecuencia (RP: 6.73; p = 0.005), y estreñimiento (RP: 34.46; p < 0.001).

Conclusiones La prevalencia de DVI fue de 27.8% en la consulta ambulatoria. Es importante prevenir complicaciones asociadas y la exposición a múltiples tratamientos antibióticos, procedimientos invasivos e imagenológicos, que adicionalmente generan altos costos al sistema de salud.



Publikationsverlauf

Eingereicht: 10. April 2020

Angenommen: 26. Mai 2020

Artikel online veröffentlicht:
06. Oktober 2020

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  • References

  • 1 Franco I, Austin PF, Bauer SB, von Gontard A, Homsy Y. Pediatric incontinence: Evaluation and clinical management [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2015. [cited 2018 Jun 6]. eds. from: http://doi.wiley.com/10.1002/9781118814789
  • 2 Austin PF, Bauer SB, Bower W. et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn 2016; 35 (04) 471-481
  • 3 Borch L, Hagstroem S, Bower WF, Siggaard Rittig C, Rittig S. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr 2013; 102 (05) e215-e220
  • 4 Sampaio C, Sousa AS, Fraga LGA, Veiga ML, Bastos Netto JM, Barroso Jr U. Constipation and Lower Urinary Tract Dysfunction in Children and Adolescents: A Population-Based Study. Front Pediatr 2016; 4: 101 http://journal.frontiersin.org/article/10.3389/fped.2016.00101
  • 5 van Engelenburg-van Lonkhuyzen ML, Bols EMJ, Bastiaenen CHG, Benninga MA, de Bie RA. Childhood Bladder and Bowel Dysfunction Questionnaire: Development, Feasibility and Aspects of Validity and Reliability. J Pediatr Gastroenterol Nutr 2017; 64 (06) 911-917
  • 6 Chase J, Austin P, Hoebeke P, McKenna P. International Children's Continence Society. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children's Continence Society. J Urol 2010; 183 (04) 1296-1302
  • 7 Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001; 87 (06) 575-580
  • 8 von Gontard A. Enuresis im Kindesalter: Psychiatrische, somatische and molekulargenetische Zummenhänge. Professorial thesis (Habilitation). University of Cologne; 1995
  • 9 Koff SA, Murtagh DS. The uninhibited bladder in children: effect of treatment on recurrence of urinary infection and on vesicoureteral reflux resolution. J Urol 1983; 130 (06) 1138-1141
  • 10 Schulman SL. Voiding dysfunction in children. Urol Clin North Am 2004; 31 (03) 481-490 , ix
  • 11 Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998; 160 (3 Pt 2): 1019-1022
  • 12 Somoza-Argibay I, Méndez-Gallart R, Rodríguez-Ruíz M, Vergara I, Pértega S, Akbal C. [Validation of the spanish version of the pediatric lower urinary tract symptoms scale (PLUTSS)]. Arch Esp Urol 2017; 70 (07) 645-653
  • 13 Aguiar LM, Franco I. Bladder Bowel Dysfunction. Urol Clin North Am 2018; 45 (04) 633-640
  • 14 Burgers R, de Jong TPVM, Visser M, Di Lorenzo C, Dijkgraaf MGW, Benninga MA. Functional defecation disorders in children with lower urinary tract symptoms. J Urol 2013; 189 (05) 1886-1891
  • 15 Vaz GT, Vasconcelos MM, Oliveira EA. et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol 2012; 27 (04) 597-603
  • 16 Peng C-H, Chen S-F, Kuo H-C. Videourodynamic analysis of the urethral sphincter overactivity and the poor relaxing pelvic floor muscles in women with voiding dysfunction. Neurourol Urodyn 2017; 36 (08) 2169-2175
  • 17 Yang S, Chua ME, Bauer S. et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol 2018; 33 (12) 2207-2219 DOI: 10.1007/s00467-017-3799-9.
  • 18 Arlen AM, Dewhurst LL, Kirsch SS, Dingle AD, Scherz HC, Kirsch AJ. Phantom urinary incontinence in children with bladder-bowel dysfunction. Urology 2014; 84 (03) 685-688
  • 19 Zhao PT, Velez D, Faiena I, Creenan EM, Barone JG. Bullying has a potential role in pediatric lower urinary tract symptoms. J Urol 2015; 193 (5, Suppl) 1743-1748
  • 20 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 (1-2Suppl1): S64-S72
  • 21 Shaikh N, Hoberman A, Keren R. et al. Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction. Pediatrics 2016; 137 (01) e20152982
  • 22 Robinson JL, Le Saux N. Management of urinary tract infections in children in an era of increasing antimicrobial resistance. Expert Rev Anti Infect Ther 2016; 14 (09) 809-816
  • 23 Peters CA, Skoog SJ, Arant Jr BS. et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. J Urol 2010; 184 (03) 1134-1144
  • 24 Toska A, Geitona M. Antibiotic resistance and irrational prescribing in paediatric clinics in Greece. Br J Nurs 2015; 24 (01) 28-33
  • 25 Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients--a white paper executive summary. Radiology 2006; 240 (03) 621-622
  • 26 Munro L. Basic of radiation protection. How to achieve ALARA: Working tips and guidelines. World Health Organization; 2004
  • 27 Rittig S. Childhood incontinence highlights from the Aarhus Ghent Spring School (and ICCS) - PDF [Internet]. [cited 2019 Aug 2]. Available from: https://docplayer.net/12002577-Childhood-incontinence-highlights-from-the-aarhus-ghent-spring-school-and-iccs.html