Symptoms Of Lower Urinary Tract Dysfunction Research Articles

Cross-cultural adaptation, translation, and validation of the Arabic version of the short form of Neurogenic Bladder Symptoms Score.

The Neurogenic Bladder Symptom Score-Short Form (NBSS-SF) evaluates the impact of disease-specific symptoms on the quality of life (QoL) in individuals with neurogenic bladder (NB). There is no data on the validity and reliability of the NBSS-SF questionnaire in the Arabic language, so this study aimed at providing the translation, cultural adaptation, and validation of the Arabic NBSS-SF in patients with multiple sclerosis (MS) and spinal cord injury (SCI). The original English language version of the NBSS-SF was translated into Arabic according to the cultural and linguistic adaptation algorithm. People with SCI and MS completed the NBSS-SF, demographic and clinical information, and Qualiveen QoL questionnaire. Responses were recorded twice within a 14-day period. Psychometric properties such as content validity, construct validity, internal consistency, and test-retest reliability were tested. Internal consistency and test-retest reliability was evaluated using Cronbach's alpha, and the intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by comparing the NBSS-SF with the Qualiveen questionnaire. Thirty-nine patients with MS and 97 with SCI participated in the study. The internal consistency for the overall NBSS-SF score (Cronbach's α of 0.82) and for each subdomain was variable (urinary incontinence 0.82; storage/voiding 0.73; consequences 0.53). ICC was 0.93 for the overall score and 0.96 for the urinary incontinence subdomain, 0.74 for storage/voiding, and 0.91 for consequences. The correlation analysis showed a significantly strong correlation between the QoL item of NBSS-SF and the Qualiveen total score (r = 0.72, p < 0.000). There was a significant moderate positive correlation between the total scores on the Arabic version of the NBSS-SF and the subdomains of the Qualiveen, including limitations (r = 0.51, p = 0.04), fears (r = 0.57, p = 0.04), feelings (r = 0.46, p = 0.01), and constraints (r = 0.59, p = 0.03). Our results showed that the Arabic version of NBSS-SF is a valid and reliable instrument for evaluating neurogenic lower urinary tract dysfunction symptoms in the Arabic population suffering from SCI and MS.

Implementation of sacral neuromodulation for urinary indications. A Danish prospective study during the initial 15 months of a new service in a tertiary referral hospital

Objective Sacral neuromodulation (SNM) is a well-established treatment modality for idiopathic overactive bladder and urgency incontinence, idiopathic fecal incontinence and non-obstructive urinary retention. This study describes the start-up phase of establishing the SNM service. Primary objective: To investigate the patient-reported outcome measures of SNM on lower urinary tract dysfunction symptoms. Secondary objectives: To investigate bowel function, sexual satisfaction and to monitor SNM safety. Materials and methods Twenty-two patients with refractory idiopathic and neurogenic lower urinary tract dysfunction were offered a two-stage test-phase procedure and SNM device implantation. On completing the study, the patients rated their satisfaction with the treatment using a five-point Likert scale and a bother score of urinary, bowel and sexual symptoms on a scale of 1–10 (the worst). Their complications were assessed. Results Nineteen patients (86%) were responders during the test phase and had the pulse generator implanted. Seventeen patients were very satisfied/satisfied. A statistically significant change in urinary symptoms bother score was observed in the idiopathic and neurogenic patients, a reduction from 10 to 4 (p = .0057) and 10 to 3 (p = .014), respectively. Eleven patients (58%) had symptoms from two or three pelvic compartments. Nine patients (47%) had complications. All but one event was resolved. Conclusions SNM is safe in this heterogeneous group of patients with refractory lower urinary tract dysfunction of various etiologies. A substantial improvement was observed in the pelvic organ dysfunction, demanding a multidisciplinary approach. More studies are required to standardize the evaluation of the subjective and objective outcomes of SNM.

Sexual dimorphic impacts of systemic vincristine on lower urinary tract function

Vincristine (VCR) is one of the most common chemotherapy agents used in pediatric oncology. Despite the well-known VCR-induced peripheral neuropathy, potential impacts of VCR on lower urinary tract (LUT) function remain poorly defined. We investigated the effects of systemic VCR exposure in childhood on LUT function by using juvenile mice treated with VCR (4 mg/kg) or saline and evaluated at 5 weeks later. VCR induced a decreased urinary frequency with increased functional bladder capacity and non-void contractions. There were no changes in detrusor contractility between the groups. VCR exposure caused sexual dimorphic changes; in females, increased intravesical pressure at micturition and downregulations of a major player in bladder afferent firing, Htr3b, in the bladders, and Cav1.2 in the lumbosacral dorsal root ganglia (Ls-DRG), while male mice displayed increases in bladder compliance and detrusor activity, upregulations of IL-2, Trpa1 and Itga1 in the bladders and neuroinflammation-related genes, P2×4, P2×7, IL-2 and CD68 in the Ls-DRG. These results suggest that that systemic VCR exposure caused sensory neuropathy via sex-dimorphic mechanisms, leading to altered LUT function. These changes might clinically present as gender-specific signs or symptoms of LUT dysfunction, and follow-up urological assessment may be of benefit for pediatric cancer patients treated with VCR.

MP55-11 A PROSPECTIVE SURVEY STUDY OF LOWER URINARY TRACT DYSFUNCTION (LUTD) IN CHILDHOOD CANCER SURVIVORS AFTER VINCRISTINE AND/OR DOXORUBICIN CHEMOTHERAPY

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-11 A PROSPECTIVE SURVEY STUDY OF LOWER URINARY TRACT DYSFUNCTION (LUTD) IN CHILDHOOD CANCER SURVIVORS AFTER VINCRISTINE AND/OR DOXORUBICIN CHEMOTHERAPY Hecht Sarah, Alan Quach, Dexiang Gao, Andrew Brazell, Gemma Beltran, Jennifer Pyrzanowski, Nao Iguchi, Anna Malykhina, Duncan Wilcox, and Nicholas Cost Hecht SarahHecht Sarah More articles by this author , Alan QuachAlan Quach More articles by this author , Dexiang GaoDexiang Gao More articles by this author , Andrew BrazellAndrew Brazell More articles by this author , Gemma BeltranGemma Beltran More articles by this author , Jennifer PyrzanowskiJennifer Pyrzanowski More articles by this author , Nao IguchiNao Iguchi More articles by this author , Anna MalykhinaAnna Malykhina More articles by this author , Duncan WilcoxDuncan Wilcox More articles by this author , and Nicholas CostNicholas Cost More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as LUTD. METHODS: Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years old completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and the presence of LUTD, defined as DVSS scores above gender-specific thresholds (males≥9, females≥6), were compared across cohorts. RESULTS: Median DVSS scores were higher in the study cohort (6 vs 4, p=0.003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs 21%, p=0.014; OR 1.8). Sub-analysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs 30%, p=0.013, OR 1.9), Figure. A post hoc analysis eliminating the DVSS “stress” domain (by removing 3 points from the stress domain for those who had responded affirmatively) was completed to control for the potential stressful impact of a cancer diagnosis. In this analysis, median DVSS sum scores remained significantly higher in the study cohort (4.5 vs 3, p=0.002). Similarly, even without the contribution of the stress domain, children in the study cohort were significantly more likely to exceed threshold scores for LUTD (27.5% vs 12.3%, p=0.016). CONCLUSIONS: Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to report symptoms of LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD. Source of Funding: NIH/Colorado CTSA Grants UL1TR002535/KL2TR002534 (NC). NIH/NIDDK K23 DK125673 (NC) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e962-e963 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hecht Sarah More articles by this author Alan Quach More articles by this author Dexiang Gao More articles by this author Andrew Brazell More articles by this author Gemma Beltran More articles by this author Jennifer Pyrzanowski More articles by this author Nao Iguchi More articles by this author Anna Malykhina More articles by this author Duncan Wilcox More articles by this author Nicholas Cost More articles by this author Expand All Advertisement Loading ...

Versatility of conjoined ureteric reimplantation in children with complicated duplex systems

This study aims to demonstrate the versatility and safety of conjoined ureteric reimplantation (CUR) in addressing various lower tract problems of complicated renal duplexes, including VUR, ureteroceles, ureteric obstruction and ectopia. Retrospective analysis of 66 children with complicated duplexes undergoing CUR between June 2008 - June 2018. Median post-CUR follow-up was 42 months. Data collected included: Demographics, CUR indications, pre and post-operative sonographic characteristics, UTI, moiety function, VUR, continence, hypertension and need for subsequent surgical procedures. CUR was performed primarily in 59 children. Twenty-eight had high grade VUR, 15 had ureteroceles plus high grade VUR, 8 had ureteroceles only. Eight had obstructed or ectopic ureters. CUR was performed secondarily in 7 children who despite previous duplex system surgery, had ongoing infection due to residual VUR, punctured ureteroceles or residual upper and lower-moiety ureteric stumps. Forty-two patients (63.6%) had pre-operative febrile UTI, but post-CUR, 23 (54.8%) of these had no further UTI. Overall post-CUR non-febrile UTI rate was 34.8%. Forty-one of 47 patients (87.2%) had improvement/resolution of hydro/ureter post-CUR. Of the 55 patients >3.5 years of age, post-CUR lower urinary tract dysfunction symptoms occurred in 3 patients (5.5%). All moiety function was preserved. Additional surgery post-CUR was required in 3 cases (4.5%): for laparoscopic excision of poorly-functioning dilated lower-moiety and ureter for ongoing pyuria despite CUR; for lower moiety PUJ obstruction; and finally for heminephrectomy of dysplastic upper-moiety associated with hypertension. CUR is a safe and versatile technique to effectively reconstruct and address lower tract problems associated with complex duplexes. Dilated upper tracts decompress well without impairment of moiety function, UTI risk reduction is provided, continence is preserved and further surgery is rarely required following CUR.

Contemporary diagnosis of lower urinary tract dysfunction.

Introduction: Diagnosis of lower urinary tract (LUT) dysfunction starts with categorization in clinical syndromes, and initial management is based on the assumptions about pathophysiology that these syndromes contain. However, clinical practice guidelines are ambiguous in clinical specialists’ diagnosis of dysfunction after failure of initial management. This is a narrative and critical review of the existing evidence, and the aim is to suggest practice improvements in the process of clinical specialists’ diagnosis for patients resistant to initial management. Methods and Results: Evidence is collated on the basis of the author’s personal preference in combination with good clinical practice general principles. Statements and suggestions to improve reflect personal opinion. For two groups of patients with LUT dysfunction, the strategy of initial diagnosis is summarized and desirable principles of secondary care diagnosis are discussed. More specifically, a structure for the contemporary care of women with signs and symptoms of urinary incontinence is described and for that of the group of men older than 45 years with symptoms of LUT dysfunction. Conclusions: Urodynamic testing is the undisputed gold standard for objective assessment and is the only way to stage and grade the dysfunction. Clinical practice guidelines and clinical specialists are too modest about the use and applicability of objective or urodynamic testing for referred persons with LUT dysfunction that is resistant to initial pragmatic management. Objective assessment and diagnosis are mainstays in secondary care, and the indication to perform objective assessments in patients with LUT dysfunction should be advised much more specifically in guidelines and practice recommendations.

Obesity and lower urinary tract dysfunction in children and adolescents: Further research into new relationships

Lower urinary tract dysfunction (LUTD) involves faults in the filling and emptying phases of bladder function in toilet-trained children with no previous infection or any other obvious pathology. Lower urinary tract dysfunction is associated with conditions such as vesicoureteral reflux, recurrent urinary infection, behavioral alterations and decreased quality of life. The literature suggests an association between LUTD and obesity; however, the association between each individual symptom and obesity has yet to be evaluated. To evaluate the association between excess weight and LUTD in children and adolescents in a community-based sample. This cross-sectional study included 423 children and adolescents aged 5-17 years, and randomly selected in public places and schools between May and July 2015. The participants and their mothers completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire, except for the questions on constipation and with the addition of a question on enuresis. They also completed the Rome III questionnaire, in which two positive responses defined the presence of constipation. Participants were classified as being of normal weight, overweight or obese, which was based on the BMI-for-age indicator. Mean age was 9.7 years (SD 2.9), with girls comprising 50.6% of the sample and adolescents 52.5%. The prevalence of LUTD was 7.1%, with 13.5% of participants being overweight and 12.1% obese (Figure). Constipation was present in 5.9% of participants and enuresis in 10.8%. In the multivariate analysis, three factors were independently and significantly associated with a positive DVSS: age <10 years (β=0.76; 95% CI: 0.34-1.18), constipation (β=1.79; 95% CI: 0.88-2.70) and obesity (β=0.89; 95% CI: 0.25-1.52). Only bladder filling symptoms were associated with obesity. This may be explained by the fact that both obese individuals and those with emptying symptoms were shown to have activation alterations in the same brain regions. One limitation of this study was the use of questionnaires alone to diagnose LUTD and constipation. Only the bladder-emptying symptoms of LUTD appear to be associated with obesity. This hypothesis may serve as a basis for future studies.

Lower urinary tract dysfunction symptoms by Modified Dysfunctional Voiding Scoring System in school age (6-12 years) children

Main objective of the study was to identify lower urinary tract dysfunction (LUTD) symptoms in children aged 6-12 years by using Modified Dysfunctional Voiding Scoring System (DVSS) and the association of these symptoms with age, sex and other socio-demographic factors. It was an observational study done in 380 normal healthy children between 6-12 years of age attending pediatric OPDs of SMS Medical College jaipur in a period of one year. MODIFIED DVSS was applied in these children and their parents were interviewed. Cut off point considered as indicator of LUTD was >6 for girls and >9 for boys. Different proportions were compared with Chi-square test and Odds ratio. 92 children out of 380, had LUTD score >6 for females and >9 for males. Prevalence of LUTD was 24.2%. LUTD symptoms were more common in 6-9 years of age than the 9-12 yrs age group and the difference was significant statistically (p=0.000) (OR= 2.678, 95%CI= 1.611-4.451) .LUTD symptoms were more common in females (p= 0.018).Female sex was a risk factor for LUTD (OR= 1.662, 95% CI= 1.025-2.694). LUTD symptoms were not affected significantly by type of school, availability of separate toilet facilities in school and residential area of children (p> 0.05) Diurnal urinary incontinence, holding maneuvers, urinary urgency, voiding pain and straining were more commonly present with score 3(high symptom severity) whereas constipation and decreased urinary frequency were more commonly present with score 2 (low symptom severity). The prevalence of LUTD symptom was quite high (24.2%) in school age children. Prevalence of LUTD symptoms was high among children from lower age group and in females.

Clinical course of a cohort of children with non‐neurogenic daytime urinary incontinence symptoms followed at a tertiary center

ObjectiveTo characterize a cohort of children with non‐neurogenic daytime urinary incontinence followed‐up in a tertiary center. MethodsRetrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. ResultsFemale patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow‐up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow‐up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non‐invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. ConclusionsThis subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one‐third of the patients treated at the tertiary level remained refractory to treatment.

Mental disorders in children and adolescents with lower urinary tract dysfunction.

Lower urinary tract dysfunction (LUTD) affects about 2-25% of the pediatric population and is associated with the presence of emotional and behavioral disorders. The purpose of this literature review was to identify studies focusing on mental disorders in children and adolescents with LUTD. The prevalence of these disorders is high - ranging from about 20 to 40% - in children with symptoms of LUTD and comorbidities. The presence of emotional and behavioral symptoms impact in the treatment of the dysfunction, self-esteem of patients and caregivers. Despite the association between mental/behavioral disorders and LUTD be well documented in the literature, the investigation of psychiatric symptoms in clinical practice is still not common and should be stimulated.

Clinical course of a cohort of children with non-neurogenic daytime urinary incontinence symptoms followed at a tertiary center

ObjectiveTo characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. MethodsRetrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. ResultsFemale patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. ConclusionsThis subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment.

Uroflowmetry with pelvic floor electromyography: inter-rater agreement on diagnosis of pediatric non-neurogenic voiding disorders

Uroflowmetry with electromyography (uroflow-EMG) is commonly used for evaluation of lower urinary tract (LUT) function in children. Diagnostic criteria based largely on uroflow-EMG findings have previously been proposed for several conditions collectively termed non-neurogenic voiding disorders (NNVDs). These include dysfunctional voiding (DV), idiopathic detrusor overactivity disorder (IDOD), detrusor underutilization disorder (DUD), and primary bladder neck dysfunction (PBND). It is unknown whether practitioners with varying levels of training and experience can apply the diagnostic criteria for these conditions with a high level of consistency. To assess inter-rater agreement on diagnosis of NNVDs using uroflow-EMG studies. Six raters performed post hoc evaluation of 84 uroflow-EMG studies and associated clinical data from children with symptoms of LUT dysfunction and no evidence of neurologic or anatomic abnormalities. Each rater was asked to categorize the uroflow-EMG studies as being consistent with DV, IDOD, DUD, PBND, or normal/unclassifiable. A consensus diagnosis was noted for studies on which at least four raters agreed. Inter-rater agreement was assessed via calculation of unweighted Fleiss' kappa statistics. Overall inter-rater agreement on NNVD diagnoses was moderate (kappa 0.46, 95% CI 0.38-0.54). Agreement between individual raters ranged from 0.33 (fair) to 0.74 (substantial) (Figure). There was no consensus on diagnosis for 20 patients (24%). Several factors may contribute to inter-rater disagreement on diagnosis of NNVDs. These include instances where patients satisfy one criterion for a particular diagnosis while missing others - or have findings consistent with more than one diagnosis. Strategies to address this may involve simplifying the diagnostic criteria, developing a clear algorithm that prioritizes certain criteria, and/or allowing assignment of multiple diagnoses. Practitioners could also benefit from standardized education regarding the diagnostic criteria for NNVDs. Potential limitations of this analysis included the use of just one uroflow-EMG study per patient in almost all cases. Also, the raters had variable levels of previous experience using the diagnostic criteria for NNVDs, and it is possible that they were not always applied as originally intended. If this were the case, it would support development of a standardized education tool to facilitate practitioner understanding and application of the criteria. Uroflow-EMG has shown promise for improving clinical management of NNVDs associated with pediatric LUT dysfunction. However, inter-rater agreement on NNVD diagnoses using current criteria is suboptimal. Various mechanisms should be explored to improve consistency in practitioners' diagnosis of NNVDs.

The influence of positioning in urination: An electromyographic and uroflowmetric evaluation

PurposeWe conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD). Materials and methodsNinety-four children between the ages of 3 and 14 years with symptoms of LUTD were evaluated. All underwent uroflowmetry and electromyography tests (abdominal and perineal) in two different positions: oriented position (trunk bent slightly forward and feet flat) and atypical position (standing on toes for boys and buttocks not in contact with the lavatory seat and legs flexed in girls). We excluded nine patients due to suspicions of outside interference or elements complicating the analysis of charts. ResultsAmong patients evaluated 55 (64.7%) were girls and 30 (35.3%) were boys with an average age of 8.5 years. Children urinating in atypical position showed higher levels of perineal electrical activity than when they were in normal position (p = 0.018). However, there was no difference in the pattern of the curve if normal or abnormal when comparing the two groups (p = 0.824). When evaluated separately, the boys demonstrated no difference between positions, in relation to perineal electrical activity (p = 0.412) or abdominal electrical activity (p = 0.202). ConclusionsThe electrical activity of the pelvic floor musculature is decreased in the oriented position when compared to atypical positions in female children. Our data suggest that special attention should be given to adopting an adequate posture during urination for girls with LUTD.

Prevalence of lower urinary tract symptoms in school-age children

Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6-12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p < 0.001), children aged 6-8 (p < 0.028), and attended the school with the lowest social level (p < 0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.

Comparative analysis of the frequency of lower urinary tract dysfunction among institutionalised and non‐institutionalised children

To evaluate the level of symptoms of lower urinary tract dysfunction (LUTD) in orphans in institutions, and compare these data with schoolchildren of the same age group who were not institutionalised, as LUTD in children is related to factors such as social isolation and low self-esteem, with other psychological changes also being cited, although it is unknown whether these problems are primary or secondary to the symptoms of LUTD. Children institutionalised in orphanages with no parental presence and who are isolated from a family environment are probably more sensitive to psychological disturbances. Psychological changes have been associated with symptoms of urgency and urinary incontinence. Thus 89 orphans were compared with 143 schoolchildren not in institutions. A questionnaire was devised and completed by the care-taking staff in the orphanage, while for the schoolchildren the parents completed the questionnaire. The mean age in the institutionalised children was 7.9 years and that of the control group 7.8 years (P = 0.32). Thirty-nine (44%) of the orphans were boys, vs 74 (54%) of the control group (P = 0.17). The incidence of urgency, diurnal urinary incontinence, nocturnal enuresis and constipation in the orphans and in the control group were: 45 (51%) and 57 (40) (P = 0.17), 36 (40%) and 19 (13%) (P < 0.001), 39 (47%) and 38 (27%) (P = 0.002), and 27 (30%) and 43 (30%) (P = 0.76), respectively. Children living in orphanages have a significantly higher level of diurnal urinary incontinence and nocturnal enuresis than those not in an institution.

The association of obstructive defecation, lower urinary tract dysfunction and the benign joint hypermobility syndrome: a case-control study.

It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.