Symptoms Of Voiding Dysfunction Research Articles

Quality of Life among Children with Enuresis Attending at El-Minia General Hospital

Children with enuresis may experience one or more of the following emotion problems: feeling of guilt, frustration, social isolation, fear of being discovered, confusion and intense embarrassment. This study aimed to assess the quality of life of children with enuresis and determine the relationship between enuresis and quality of life of enuretic children .A descriptive research design was used to conduct the study in the Pediatric Out-patient and Urology clinics in El-Minia General Hospital. It included 210 children (111male and 99 female), aged from 5 to 18 years with no pathologic enuresis. Four tools were used for collecting data; Tool (1): A structured interview questionnaire: included personal data and data related to enuresis; Tool (2), Socio-economic scale, Tool (3), Dysfunctional Voiding and Incontinence Symptoms Score Questionnaire (DVSS) and Tool (4), Pediatric urinary incontinence quality of life instrument (PIN-Q) to assess the impact of enuresis on child’s quality of life. This study results revealed that, the majority of children had primary and nocturnal enuresis (89.5% and 71.4%, respectively), there was correlation between the DVSS and PINQ score (P=0.003). Also, it was found that, QOL is worse in male children and worsens with age (p=0.001). Conclusion: there was a positive relation between DVSS and PIN-Q score. Self-esteem, family &home and mental health were the most effect domains. Recommendation: psychological counseling is required when the child’s self-confidence, self-esteem, or interpersonal relationship is deteriorating.

The association of age of toilet training and dysfunctional voiding.

ObjectiveTo determine whether age of toilet training is associated with dysfunctional voiding in children.Materials and methodsWe compared patients referred to the urologic clinics for voiding dysfunction with age-matched controls without urinary complaints. Characteristics including age and reason for toilet training, method of training, and encopresis or constipation were compared between both groups.ResultsInitiation of toilet training prior to 24 months and later than 36 months of age were associated with dysfunctional voiding. However, dysfunctional voiding due to late toilet training was also associated with constipation.ConclusionDysfunctional voiding may be due to delayed emptying of the bowel and bladder by children. The symptoms of dysfunctional voiding are more common when toilet training early, as immature children may be less likely to empty in a timely manner, or when training late due to (or in association with) constipation.

Long-Term Followup of Men Born with Hypospadias: Urological and Cosmetic Results

We present data on long-term functional and cosmetic results after hypospadias surgery. Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis. A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p <0.001). More patients than controls reported voiding dysfunction symptoms (p = 0.003). Patients had a lower maximum urinary flow rate than controls (p = 0.001). These differences were most prominent between patients with proximal hypospadias and controls. Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood.

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

PurposeUrinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Children's Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children.Materials and MethodsThe questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The children's voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded.ResultsThe participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI.ConclusionsOur findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of children's voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Cross-cultural validated adaptation of dysfunctional voiding symptom score (DVSS) to Japanese language and cognitive linguistics in questionnaire for pediatric patients

Validated questionnaire for evaluation of pediatric lower urinary tract symptoms (LUTS) is of a great need. We performed cross-cultural validated adaptation of Dysfunctional Voiding Symptom Score (DVSS) to Japanese language, and assessed whether children understand and respond to questionnaire correctly, using cognitive linguistic approach. We translated DVSS into two Japanese versions according to a standard validation methodology: translation, synthesis, back-translation, expert review, and pre-testing. One version was written in adult language for parents, and the other was written in child language for children. Pre-testing was done with 5 to 15-year-old patients visiting us, having normal intelligence. A specialist in cognitive linguistics observed the response by children and parents to DVSS as an interviewer. When a child could not understand a question without adding or paraphrasing the question by the parents, it was defined as 'misidentification'. We performed pretesting with 2 trial versions of DVSS before having the final version. The pre-testing for the first trial version was done for 32 patients (male to female ratio was 19 : 13). The pre-testing for the second trial version was done for 11 patients (male to female ratio was 8 : 3). In DVSS in child language, misidentification was consistently observed for representation of time or frequency. We completed the formal validated translation by amending the problems raised in the pre-testing. The cross-cultural validated adaptation of DVSS to child and adult Japanese was completed. Since temporal perception is not fully developed in children, caution should be taken for using the terms related with time or frequency in the questionnaires for children.

A comparison of dysfunctional voiding scores between patients with nocturnal enuresis and healthy children

To compare dysfunctional voiding symptom scores (DVSSs) between enuretic children and nonenuretic controls and to investigate associated factors that may affect DVSS. A questionnaire including demographic features, educational status of parents, DVSS questions, and urinary tract infection (UTI) history was designed. A total of 269 patients were included; Group 1 comprised 161 patients with no voiding symptoms and Group 2 comprised 108 patients with nocturnal enuresis (NE). Children with DVSS of greater than 8.5 were suspected to have dysfunctional voiding. The results were evaluated using SPSS 15.0 with Kruskal-Wallis and multivariate logistic regression tests. The median DVSS was 2 (interquartile range [IQR]: 1-3) in Group 1 and 8 (IQR: 5-12) in Group 2. The percentage of children with DVSS greater than 8.5 was 0.6% in Group 1 and 53.1% in Group 2 (P = 0.01). The percentage of children with UTI history was significantly higher in Group 2 (34.3%) than Group 1 (15.9%) (P = 0.03). An increase in the educational level of the father decreased DVSS by 0.5-fold. Presence of UTI history increased DVSS 2.5-fold. The DVSS is a rapid, easy tool for determining abnormal voiding parameters in children. Children with NE had higher DVSSs, which was significantly affected by the father's educational status and the child's UTI history.

Promising Molecular Targets and Biomarkers for Male BPH and LUTS

Benign prostatic hyperplasia (BPH) is a major health concern for aging men. BPH is associated with urinary voiding dysfunction and lower urinary tract symptoms (LUTS), which negatively affects quality of life. Surgical resection and medical approaches have proven effective for improving urinary flow and relieving LUTS but are not effective for all men and can produce adverse effects that require termination of the therapeutic regimen. Thus, there is a need to explore other therapeutic targets to treat BPH/LUTS. Complicating the treatment of BPH/LUTS is the lack of biomarkers to effectively identify pathobiologies contributing to BPH/LUTS or to gauge successful response to therapy. This review will briefly discuss current knowledge and will highlight new studies that illuminate the pathobiologies contributing to BPH/LUTS, potential new therapeutic strategies for successfully treating BPH/LUTS, and new approaches for better defining these pathobiologies and response to therapeutics through the development of biomarkers and phenotyping strategies.

Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

646 DOES ROUTINE RENAL ULTRASOUND CHANGE MANAGEMENT IN THE FOLLOW UP OF PATIENTS WITH VESICOURETERAL REFLUX?

You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013646 DOES ROUTINE RENAL ULTRASOUND CHANGE MANAGEMENT IN THE FOLLOW UP OF PATIENTS WITH VESICOURETERAL REFLUX? Jan Rudzinski, Bryce Weber, Armando Lorenzo, Darius Bagli, Walid Farhat, Elizabeth Harvey, and Joao Luiz Pippi Salle Jan RudzinskiJan Rudzinski Calgary, Canada More articles by this author , Bryce WeberBryce Weber Calgary, Canada More articles by this author , Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author , Darius BagliDarius Bagli Toronto, Canada More articles by this author , Walid FarhatWalid Farhat Toronto, Canada More articles by this author , Elizabeth HarveyElizabeth Harvey Toronto, Canada More articles by this author , and Joao Luiz Pippi SalleJoao Luiz Pippi Salle Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.199AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal ultrasound (RUS) is commonly obtained during follow up evaluation and management of children with vesicoureteral reflux (VUR). Little data exists regarding the role of follow up RUS in children VUR. We sought to evaluate the impact of follow up RUS on the change in clinical management of patients with VUR. METHODS A prospective analysis of consecutive children with a previous diagnosis of VUR, seen in the outpatient clinic with a routine follow up RUS within the past 4 months (Nov 2010-Feb 2011). Variables collected included: demographic data (age, gender and length of follow up), VUR history (VUR grade, laterality, previous surgery, previous renal scars, number of previous urinary tract infections (UTI), and UTI since the last visit), dysfunctional voiding symptoms, along with concurrent RUS findings (renal growth, change in hydronephrosis or new renal scarring) were recorded. Change in management at the time of the visit was defined as the prescription of new medication, restarting antibiotic therapy, nurse counselling for voiding dysfunction, surgery, or further investigations (i.e. DMSA). On RUS, change was considered to be a change in grade of hydronephrosis or presence of new renal scarring. RESULTS The study included 114 consecutive patients. The mean age was 4.5 yrs old, mean age of VUR diagnosis was 1.7 years, with the average child followed for a mean of 2.8 years. A change in management with stable ultrasound findings occurred in 14 patients, in which the change included ordering a DMSA in 9 (64%), nurse counselling for dysfunctional voiding in 3 (21%), and booking surgery in 2 patients (14%). Overall a change on RUS was seen in 4 patients (3 with worsening hydronephrosis and one with suspected new scars). When all the collected variables where analyzed for influence on change in follow up management, only a history of UTI since the last follow up visit was found to be significant (P<0.001). CONCLUSIONS The RUS findings in the great majority of patients followed for VUR remain stable or with minimal changes. The only major variable showing a significant effect on change in management in this prospective analysis was a history of UTI since last follow up visit. In our study, clinical decisions were based on recent history rather than RUS findings. In an era of restricted resources coupled with the limitations of RUS, the value of follow up RUS for children with VUR may need to be further revisited. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e264 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Rudzinski Calgary, Canada More articles by this author Bryce Weber Calgary, Canada More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Darius Bagli Toronto, Canada More articles by this author Walid Farhat Toronto, Canada More articles by this author Elizabeth Harvey Toronto, Canada More articles by this author Joao Luiz Pippi Salle Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The evaluation of urinary incontinence in preschool age children

Introduction: The urinary incontinence can be classified as organic and functional in children. In the etiology of the functional voiding disorders such as urge incontinence, lazy bladder and dysfunctional voiding several theories have been proposed. However, the exact etiology or pathogenetic mechanisms of the functionel urinary incontinence are not completely understood. It can be considered that toilet training or life style may be important in the etioloy of the urinary incontinence in preschool children. The aim of this study was to evaluate the voiding features of the children aged between 5-6 years. Materials and Methods: Between May 2010 and August 2010 a total of 271 children aged between 5-6 years were included to the study. The approval of the hospital ethics committee and written informed consent were obtained. Children were evaluated with dysfunctional voiding and incontinence symptoms score questionnaire. Children with neurogenic bladder, vesicoureteral reflux, metabolic disorder, history of recurrent urinary tract infection were excluded from the study. Results: Urinary incontinence was detected in 107 children (39.5%). The mean age of the children with or without urinary incontinence was 5.81±0.39 year and 5.88±0.33 years, respectively (p=0.142). There were no statistically significant difference in children with or without urinary incontinence in terms of body mass index, paternal or maternal age or duration of breastfeeding (p&gt;0.05) (Table 1). The quality of life was affected negatively in 69 children (64.5%) with urinary incontinence. In contrast the quality of life was affected negatively only in 25 children (15.2%) without urinary incontinence. The quality of life was 12.05 fold worse in children with urinary incontinence than in children without urinary incontinence. Conclusion: Although in this study, it is revealed that urinary incontinence rates were relatively higher compared to literature in preschool age children studies in larger, randomised and controlled series are needed to confirm these results.&nbsp;

Constipation in children with isolated overactive bladders

ObjectiveTo evaluate the prevalence of constipation in children with isolated overactive bladder (IOAB) and no micturition complaints. Materials and methodsA questionnaire was used to evaluate constipation in 51 children with IOAB, as well as in a control group of 74 children between the ages of 4 and 14 years. The Rome III criteria for children were used to assess constipation. IOAB was defined as the presence of symptoms such as urgency with or without daytime incontinence or frequency, a bell-shaped uroflow, and no post-residual urine. ResultsMean patient ages were 7.94 (±2.8) and 8.28 (±3.4) years in the OAB and control group, respectively (p = 0.54). Twenty-eight (54.9%) of the OAB group were girls, and 34 (45.9%) were girls in the control group (p = 0.32). More of the children with IOAB had constipation than those without urinary symptoms (54.9% vs. 29.7%, p = 0.005; or 2.87, 95% CI: 1.3–6.0). The results were statistically significant regarding the following Rome III criteria: “history of stool retention”, “presence of painful or hard bowel movements”, “the presence of a large fecal mass in the rectum” and “large diameter stools which may obstruct the toilet”. Within the group with OAB, constipation was more common among males (p = 0.05). There was no association between the type of OAB symptoms and constipation. The average dysfunctional voiding symptom score was 9.76 (±4.1). Eleven children (21.6%) presented alterations on ultrasound. Girls with OAB presented more frequently with UTI than boys (18 vs. 10, p = 0.13). ConclusionThis was the first comparative study with respect to constipation in children with IOAB and without urinary symptoms. Children with IOAB have a greater risk of having constipation compared to those with no urinary symptoms.

Posterior Tibial Nerve Stimulation vs Parasacral Transcutaneous Neuromodulation for Overactive Bladder in Children

Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly. A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant. We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence.

Prevalence and risk factors of enuresis nocturna in primary school children in Denizli

Purpose: In this study we aimed to investigate the prevalence and associated risk factors of enuresis nocturna in primary school children in Denizli. Materials and methods: The consent has been obtained from Ministry of Education of Denizli with the date of 30/03/2005 and the number of 8820. A total of 8 primary schools in Denizli city-center and 6 in the districts were randomly selected. The questionnaire which includes sociodemographic properties of families, medical histories of children and “Dysfunctional Voiding and Incontinence Scoring System” were filled by the parents of 2353 children who are aged between 7-14. The children with a history of neurological/urological diseases and diurnal enuresis (daytime and nighttime wetting) were excluded. Descriptive, analytic and logistic regression analyses have been used for the statistical evaluations. Results: The participation rate was 91.9% (2164 people). The overall prevalence of enuresis nocturna was 19.2% with a tendency to decrease with increasing age. School performance of the child, socioeconomic level of the family, education levels of the parents, positive family history, daytime wetting, history of urinary tract in fection, constipation and dysfunctional voiding symptoms were statistically significant with enuresis nocturna (p<0.05). Male gender, early age, low educational performance of the mother and positive family history were independent risk factors for enuresis nocturna. Conclusion: Enuresis nocturna is a common health problem among primary school children. While planning the treatment strategies of enuretic children, associated risk factors for this condition should be considered. Our survey is the first cross-sectional study that investigates the micturation habits and prevalence of enuresis nocturna among Turkish primary school children by a Turkish validated symptom score. Pam Med J 2013;6(2):82-90

Primary Severe Hypospadias: Comparison of Reoperation Rates and Parental Perception of Urinary Symptoms and Cosmetic Outcomes Among 4 Repairs

We compared complication rates, urinary symptoms and cosmetic outcomes as perceived by parents of patients undergoing 1 of 4 repairs for proximal hypospadias associated with ventral curvature. A total of 93 patients underwent hypospadias repair between 2004 and 2010. In patients requiring no urethral plate transection the repair consisted of tubularized incised plate urethroplasty (26 patients) or onlay island flap urethroplasty (31). In patients requiring urethral plate transection the repair consisted of onlay island flap on albuginea (18 patients) or 2-stage repair (18). Complications were assessed by chart review. A customized questionnaire and the Pediatric Penile Perception Score were administered to parents to evaluate their perception of urinary symptoms and cosmetic outcomes, respectively. After a median followup of 4.5 years (range 2.2 to 8.4) complications developed in 21 patients (23%) without any difference among procedures or between patients who did and did not require urethral plate transection. Parents of 75 patients (80%) participated in the survey without differences among repairs (p = 0.35). Reported urinary symptoms were not different among repairs. For Pediatric Penile Perception Score the only difference concerned the question about penile length (p = 0.03), with the score being significantly better for the techniques requiring urethral plate transection (p = 0.05). The 2-stage repair had a significantly better score for the question about penile length and overall Pediatric Penile Perception Score than all other techniques. Overall complication rates were comparable among repairs and did not increase after urethral plate transection. Urinary symptoms as reported by parents were comparable among the procedures. Perceived penile length was significantly better after urethral plate transection. The 2-stage repair yielded the best cosmetic results.

Do Symptoms of Voiding Dysfunction Predict Urinary Retention?

We assessed the relationship between symptoms of voiding dysfunction and elevated postvoid urinary residual (PVR). Cross-sectional study of women presenting for initial evaluation from February through July 2011. Charts were reviewed for demographics, voiding dysfunction symptoms, and examination findings. Urinary retention was defined as PVR of 100 ml or more. Data are presented as median (interquartile range) or proportion; test characteristics are reported with 95% confidence intervals. Of 641 eligible women, 57 women (8.9%) had urinary retention. Of these, 32 women (56.1%) had at least one symptom of voiding dysfunction, most commonly, sensation of incomplete emptying (30.1%). Sensitivity and positive predictive values of voiding dysfunction symptoms were low. Of 254 women reporting voiding symptoms, most (87.5%) had PVR of less than 100 ml and were significantly more likely to have other pelvic floor symptoms and findings. Patients' symptoms do not predict urinary retention. Postvoid urinary residual should be measured, and other causes of voiding dysfunction symptoms should be considered.

Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy

Although lower urinary tract dysfunction (LUTD) in patients with cerebral palsy (CP) has been previously documented by clinical observations and urodynamic tests, its correlation with upper urinary tract deterioration (UUTD) has not been demonstrated. This paper documents symptoms and urodynamic findings of LUTD and their relationship with UUTD in 33 children with CP. By sonography, 4 of these children were found to have UUTD. Age was found to correlate with UUTD, but gender difference and mental or motor functions did not. When comparing urinary symptoms with UUTD, incontinence (n = 31) did not correlate, but on the other hand symptoms of detrusor sphincter dyssynergia (interrupted voiding, urinary retention, hesitancy; n = 5) and culture proven febrile urinary tract infections (n = 4) did. Abnormal urodynamics findings were not diagnostic. We conclude that, apart from incontinence, dysfunctional voiding symptoms and febrile urinary tract infections are valuable indicators of UUTD.

Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting

Questionnaires to quantify pediatric bladder/bowel dysfunction have recently been developed as research instruments. We evaluated our use of a bladder/bowel dysfunction questionnaire in a busy clinical setting. We distributed a validated bladder/bowel dysfunction questionnaire to all new pediatric urology outpatients older than age 4 years from May 1 to July 31, 2010. We instructed families to complete the questionnaire without assistance. Physicians were blinded to responses during the study period. We compared total scores between groups of patients with bladder/bowel dysfunction related and bladder/bowel dysfunction unrelated primary diagnoses. We also compared individual item scores pertaining to urinary incontinence, dysuria, nocturnal enuresis and constipation in patients with those specific primary ICD-9 diagnosis codes to those of other bladder/bowel dysfunction related diagnoses. Of 358 questionnaires reviewed 91 (25%) could not be adequately scored. Of the remaining 267 patients 134 had bladder/bowel dysfunction related diagnoses and 133 had bladder/bowel dysfunction unrelated diagnoses. The patients with bladder/bowel dysfunction related diagnoses had a higher score on the validated questionnaire (p <0.001). Patients with primary ICD-9 diagnoses for urinary incontinence (p = 0.0026, p = 0.0164), dysuria (p = 0.008) and nocturnal enuresis (p <0.0001) had higher scores on corresponding items of the questionnaire than those with other bladder/bowel dysfunction related diagnoses. The ICD-9 diagnosis of constipation was not associated with higher scores for constipation related items. A validated bladder/bowel dysfunction questionnaire is a useful tool in the pediatric urology clinical setting that correlates well with physician assessment. The questionnaire can help patients and their families better define their bladder/bowel symptoms before their visit. Some families will not be able to fill out the questionnaire appropriately.

Enuresis—an unattended comorbidity of childhood obesity

Obstructive sleep apnea (OSA), attention deficit/hyperactivity disorder (ADHD), type 2 diabetes mellitus and psychopathological problems co-occur at increased rates among both obese and enuretic children. We hypothesized that the prevalence of enuresis will be increased in obese children and adolescents. A cross-sectional study. 281 children and adolescents aged 7-18 years, who completed a questionnaire regarding enuresis, medical conditions and sociodemographic parameters; 158 were normal weight, 37 overweight (85thBMI (body mass index)<95th percentiles) and 86 obese (BMI95th percentile). Occurrence of enuresis among obese children and adolescents. Enuresis was reported in 14 (8.8%) normal weight, 6 (16%) overweight and 26 (30%) obese youth. Odds ratio (OR)=6.5, 95% confidence interval (CI)=2.67-15.78 for enuresis among obese compared with normal weight (P<0.0001). Each increment of one BMI-Z score unit was associated with an increased risk of enuresis, OR of 2.14, 95% CI (1.46-3.12), P=0.00008. Male gender (OR 2.84, 95% CI (1.10-5.58), P=0.028), first-degree relative with current/past enuresis (OR 4.24, 95% CI (1.62-11.08), P=0.003), voiding dysfunction symptoms (OR 3.067, 95% CI (1.05-9.00), P=0.041) and ADHD (OR 2.31, 95% CI (0.99-5.34), P=0.051) increased the risk of enuresis. OSA-related symptoms, academic achievements in school, sharing a bedroom, family size relative to number of rooms in home, parental education, family status and religious observance were not found to increase the risk for enuresis. Obese children are at increased risk for enuresis. Enuresis should be clarified during the primary workup of every obese child and adolescent.

Correlation between clinical manifestations of nocturnal enuresis and attentional performance in children with attention deficit hyperactivity disorder (ADHD)

Children with attention deficit hyperactivity disorder (ADHD) tend to be more vulnerable to various forms of voiding dysfunction and nocturnal enuresis (NE). We attempt to compare the clinical manifestations and attentional performance between ADHD children with NE and those without NE. We consecutively enrolled children diagnosed with ADHD in child and adolescent psychiatric clinics. The questionnaires for evaluation of ADHD symptoms and voiding dysfunction symptoms were administered to all study participants. All participants also received the Test Battery for Attention Performance (TAP) for assessment of attentional function. A total of 53 children were enrolled in this study, comprising 47 boys and six girls. The prevalence rate of NE was 28.3%. Children in the NE group had statistically significant higher dysfunctional voiding symptom score (5.40±3.66 vs.3.16±2.74; p=0.018) and two subscales of "When I wet myself, my underwear is soaked" (p<0.001) and "I miss having a bowel movement every day" (p=0.047). There were no significant differences with regard to all psychiatric evaluations between the NE and non-NE groups. In the TAP test, the NE group showed a significantly shorter reaction time in the domain of inhibitory control, working memory, and auditory sustained attention than the non-NE group. Children with ADHD have a high prevalence of NE. ADHD children with NE had a significantly higher dysfunctional voiding symptom score and shorter reaction time in most domains of the TAP test. Further study is needed to discern the impact of NE on the neuropsychological function of ADHD children.

Identification of lower urinary tract voiding dysfunction in females by using video-urodynamic study

To assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female. A total of 126 female patients with sign and symptoms of lower urinary tract voiding dysfunction underwent VUD from December 2008 to January 2011 in Beijing Chaoyang Hospital. The causes of voiding dysfunction were analyzed based on VUD findings. Neurogenic voiding dysfunction was found in 30 patients (23.8%), non-neurogenic voiding dysfunction was found in 96 patients (76.2%). The 72 patients suffered from recurrent urinary tract infection (57.1%) and 23 patients suffered from hydronephrosis (18.3%). Based on special characteristics of video-urodynamic study, a total of 126 patients were classified as: (1) Bladder outlet obstruction (BOO) was found in 65 patients. Of them, bladder neck obstruction in 40 patients (61.5%), their VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck did not open in a funnel shape and no contrast was found in urethra. Distal urethral stricture in 22 patients (33.8%), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, proximal urethra dilated and no contrast was found in distal urethral. Urethral sphincter obstruction in 3 patients (including detrusor-sphincter dyssynergia in 1 and sphincterismus in 2 patients), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, sphincteric urethra did not open, proximal urethra dilated and no contrast was found in distal urethral. (2) Detrusor areflexia (DA) was found in 39 patients (2 patients with hydronephrosis), the VUD finding was: no voluntary detrusor contraction in voiding phase, and abdominal pressure voiding pattern. (3) OAB was found in 3 patients, which VUD findings was frequent involuntary detrusor contraction at storage period with or without urine leakage. (4) Low compliance bladder was found in 17 patients (13.5%), 16 patients with hydronephrosis, the VUD showed that increased bladder storage pressure with significantly decreased bladder safe capacity and compliance, appearance of the bladder as "Christmas tree", with or without ureteral reflux. (5) And stress urinary incontinence (SUI) was in 2. The main causes of female BOO may be non-neurogenic conditions or organic obstruction. VUD would offer valuable information for confirmed diagnosis of voiding dysfunction in female patients.