Management of Functional Constipation in Children with Lower Urinary Tract Symptoms: Report from the Standardization Committee of the International Children's Continence Society

Pomočování v dětské, ale i v adolescentní populaci představuje významný psychosociální problém. Četností výskytu, asi 15-20 % pětiletých, 2-6 % sedmiletých dětí, do adolescence se trvale pomočuje 1-2 %, se řadí k nejčastějším onemocněním u dětí. Dle ICCS (International Children's Continence Society) je polysymptomatické pomočování (NMNE) řazeno mezi inkontinence s poruchou funkce dolních cest močových, monosymptomatická enuréza (MNE) je pak definována jako samostatná jednotka. Volní kontrola plnění a vyprazdňování močového měchýře je dynamicky se vyvíjejícím funkčním procesem, který přímo závisí na věku jedince. S věkem se postupně reflexní vyprazdňování měchýře mění na volní, kontrolované, zprostředkované cestou mozkové kory (obvykle ukončeno ve 4 letech věku). Diagnostické postupy (anamnéza, pitná/mikční karta, kalendář pomočování, fyzikální vyšetření, ultrazvuk, urodynamické vyšetření aj.) by měly zejména spolehlivě odlišit MNE od NMNE. K léčbě MNE pomočování by se nemělo přistupovat dříve než po dosažení 5 let věku (pitná/mikční režimová opatření, farmakoterapie, alarmy event. alternativní léčba). U NMNE je pak nutné nejprve léčit primární příčinu poruchy vyprazdňování se (např. neurogenní poruchy, subvezikální obstrukce, infekce močových cest, obstipaci aj.). I přes primárně úspěšnou léčbě je nutno počítat s vysokým procentem recidiv po ukončení terapie.

Does KUB play a role in the diagnosis of bladder bowel dysfunction?

BackgroundThis study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians.MethodsA total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea).ResultsA total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P < 0.001). Treatment duration was longer among PGs for > 6 months (63.8%) than < 3 months among general pediatricians (59.2%, P < 0.001). Fecal disimpaction and rectal enema were practiced among 78.8% and 58.5% of pediatricians, respectively. High dose medication for initial treatment phase was prescribed by 70.7% of pediatricians, primarily within the first 2 weeks (48.3%). The most commonly prescribed medications in children aged > 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002).ConclusionDiscrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.

Ausscheidungsstörungen in Kindheit und Jugend

Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Objective:To investigate behavioral factors for predicting severity of nocturnal enuresis and compare response rates in different compliance groups of behavioral interventions.Methods:Three hundred eleven children diagnosed with nocturnal enuresis were enrolled. This study was conducted at Beijing Children’s Hospital affiliated to the Capital Medical University from September 2016 to December 2016. Correlation of severity of enuresis and behavioral factors was investigated. All patients were treated with desmopressin based on behavioral interventions. After twomonth treatment, the patients were grouped according to the compliance of behavioral therapy. Then response rates in different compliance groups were compared.Results:Multivariate analysis revealed stool frequency, drinking water before going to bed, awaking the child to toilet at night, and appetite were independent risk factors affecting the severity of enuresis. The complete response rate of enuresis and partial response ratein fullcompliance group are higher than thoseof partial compliance and non-compliance group(21.9% vs 11.3%, 78.1% vs 59.8%; 21.9% vs 0%, 78.1% vs 49.1%; P<0.01). The complete response rate and partial response rate of partial compliance group are higher than those of the non-compliance group (P<0.01).Conclusions:Stool frequency, drinking water before going to bed, awaking the child to toilet at night, and appetite are independent predictive factors affecting the severity of enuresis. Good compliance of behavioral interventions may have a crucial role for better therapeutic outcomes.

Establishment of a nomogram for predicting functional constipation among children in China: Using the Rome IV criteria

Urinary tract infections (UTIs) represent an important cause of febrile illness in young children and can lead to renal scarring and kidney failure. However, diagnosis and treatment of recurrent UTI in children is an area of some controversy. Guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence and European Society of Paediatric Radiology differ from each other in terms of the diagnostic algorithm to be followed. Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are also areas of considerable debate. In this review, we collate and appraise recently published literature in order to formulate evidence-based guidance for the diagnosis and treatment of recurrent UTI in children.

The aetiology of micturition disorders in children is multifactorial and still unclear. The perinatal factors may play a role in the development of children's urinary incontinence. We compared each type of micturition disorders in terms of length of gestation, birthweight, family history of bedwetting and delivery type. Data were from 488 patients of the Department of Pediatrics and Nephrology, Children's Clinical Hospital of the Medical University of Bialystok, and included: age, sex, clinical diagnosis, perinatal history, constipation, history of vesicoureteral reflux, family history of nocturnal enuresis, urodynamic diagnosis, bladder capacity. We performed statistical analysis using Mann-Whitney and Spearman tests. Combined daytime-nocturnal incontinence made a higher percentage and nocturnal enuresis made a lower percentage of clinical diagnoses in children with low birthweight compared with group of normal birthweight. In children with micturition disorders, lower birthweight was associated with smaller bladder capacity than normal for age. Low birthweight might predispose to combined daytime-nocturnal incontinence. We are the first to show that patients suffering from micturition disorders with low birthweight present lower estimated bladder capacity than age-matched children. Thus, we assume that low birthweight may have strong clinical relevance in children's micturition disorders.

Fecal Retention in Overactive Bladder (OAB) in Children: Perspective of a Pediatric Gastroenterologist