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Souza Santos MKV, Estevam de Abreu G, Pamponet CN, Calasans MT, Taniguchi TM, Veiga ML, Braga AAM, Barroso U. Cross-cultural adaptation and validation of the constipation scoring system for the pediatric population: A new tool to be used for constipated children. J Pediatr Urol 2024; 20:222.e1-222.e8. [PMID: 38195295 DOI: 10.1016/j.jpurol.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The Rome IV criteria are used to characterize constipation and its subtypes, but not its severity. Conversely, the constipation scoring system (CSS) is a tool designed to assess the level of constipation severity and assist clinicians in selecting suitable therapeutic strategies. Although validated for adults, this score has yet to be validated for children. OBJECTIVE To adapt and validate the CSS for the pediatric population. METHODS Children and adolescents of 4-17 years of age with no morphological or neurological abnormalities of the gastrointestinal system were randomly selected during general consultation with a pediatrician and evaluated between November 2021 to April 2022. The Rome IV criteria were considered the gold-standard detection method. The adapted version was initially assessed on 30 children to assess comprehension and then administered to another 100 children. The internal consistency of the adapted questionnaire was assessed in a test-retest procedure with a two-week interval. RESULTS One hundred patients with a mean age of 8.61 ± 3.25 years were assessed. Of these, 51 (51 %) were male. Most children (n = 91) received a score of 1-10 (the total CSS score can range from 0 to 30 points). The correlation between the pediatric version of the CSS and the Rome IV criteria was substantial, as shown by a positive Spearman correlation (r2) of 0.553 (p < 0.001). Cronbach's alpha between the test-retest responses was 0.97. When each item of the questionnaire was assessed individually, a greater level of internal consistency was found, indicating adequate internal reliability. DISCUSSION The current study broadens the horizon with the emergence of new diagnostic aid for FC in Brazilian children and adolescents. In addition, this study provides the cornerstone for future research to determine the diagnostic accuracy of the CSS and its prognostic value for monitoring the treatment. The loss of a follow-up rate (26 %) during the telephone "test-retest" phase was a limitation. Using a subjective questionnaire such as the Rome IV criteria as the gold standard method may also represent a limitation. Further research is required on the use of objective diagnostic tools for FC including colonic transit time, anal manometry, cine-defecography, and electromyography. CONCLUSION The CSS was successfully adapted for use with the pediatric population and was well accepted, confirming its language and psychometric validity in aiding the diagnosis of functional constipation. This was the first step towards validating the use of this score in other countries and cultures to assess the severity of constipation in children.
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Affiliation(s)
| | - Glicia Estevam de Abreu
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil.
| | - Clara Nunes Pamponet
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil
| | - Maria Thais Calasans
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil
| | - Thiago Masahi Taniguchi
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil
| | - Maria Luiza Veiga
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil
| | | | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde Pública, Centro de Distúrbios Miccionais Na Infância, Salvador, BA, Brazil
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Nunes NC, de Abreu GE, Dourado ER, Veiga ML, Nacif A, de Andrade Calasans MT, Braga AANM, Barroso U. Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction. Int Braz J Urol 2023; 49:688-699. [PMID: 37903006 PMCID: PMC10947615 DOI: 10.1590/s1677-5538.ibju.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 11/01/2023] Open
Abstract
PURPOSE Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. MATERIALS AND METHODS This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. RESULTS Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. CONCLUSION RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.
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Affiliation(s)
- Noel Charlles Nunes
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Glicia Estevam de Abreu
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Eneida Regis Dourado
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Maria Luiza Veiga
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Ananda Nacif
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Maria Thaís de Andrade Calasans
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Ana Aparecida Nascimento Martinelli Braga
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
| | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde PúblicaCentro de Distúrbios Urinários na InfânciaSalvadorBABrasilCentro de Distúrbios Urinários na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
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Maffei HVL, Vidolin E, Reis JND, Freitas MD, Cabral BH, Trigo-Rocha F. OCCULT AND SEMI-OCCULT CONSTIPATION IN CHILDREN WITH MONOSYMPTOMATIC OR NON MONOSYMPTOMATIC ENURESIS. Arq Gastroenterol 2023; 60:410-418. [PMID: 38018546 DOI: 10.1590/s0004-2803.230402023-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. OBJECTIVE To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). METHODS Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). RESULTS Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. CONCLUSION In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.
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Affiliation(s)
- Helga Verena L Maffei
- Universidade Estadual Paulista, Faculdade de Medicina, Departamento de Pediatria, Botucatu, SP, Brasil
| | - Eliana Vidolin
- Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, SP, Brasil
| | | | | | | | - Flavio Trigo-Rocha
- Hospital Municipal Infantil Menino Jesus, São Paulo, SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Urologia, São Paulo, SP, Brasil
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Verkuijl SJ, Trzpis M, Broens PM. The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 77:47-54. [PMID: 37098114 PMCID: PMC10259211 DOI: 10.1097/mpg.0000000000003804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence. METHODS For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria. RESULTS The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06-7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78-9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24-3.42). CONCLUSIONS Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
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Affiliation(s)
- Sanne J. Verkuijl
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Verkuijl SJ, Trzpis M, Broens PMA. Development and validation of the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Eur J Pediatr 2023; 182:615-623. [PMID: 36414869 PMCID: PMC9899161 DOI: 10.1007/s00431-022-04714-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED There are no compatible tools that assess bowel function in young children, older children, and adults. This precludes clinical follow-up and longitudinal scientific research. Our aim was therefore to develop and validate a bowel function questionnaire equivalent to the pediatric (8-17 years) and adult (≥ 18 years) Groningen Defecation and Fecal Continence (DeFeC) questionnaires for children from the age of 1 month to 7 years. We developed, validated, and translated the Early Pediatric Groningen DeFeC (EP-DeFeC) questionnaire according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The EP-DeFeC incorporates different validated bowel function scoring systems, including the Rome IV criteria that are also included in the pediatric and adult DeFeC. We assessed feasibility and reproducibility by a test-retest survey. The study population (N = 100) consisted of the parents/caregivers of children whose median age was 4.0 (IQR 2.0-5.0) years. The mean interval between testing and retesting was 2.7 ± 1.1 months. None of the respondents commented on ambiguities regarding the questions. The overall median time taken to complete the EP-DeFeC was 8.7 min (IQR 6.8-11.8). The overall observed agreement was 78.9% with an overall kappa coefficient of 0.51, indicating moderate agreement. CONCLUSION The EP-DeFeC is a feasible, reproducible, and validated questionnaire for assessing bowel function in children from the age of 1 month to 7 years. If used in combination with its pediatric (8-17 years) and adult (≥ 18 years) equivalents, this questionnaire enables longitudinal follow-up of bowel function from infancy to adulthood. WHAT IS KNOWN • Bowel function problems are common among young children. • Unfortunately, there are no compatible tools that assess bowel function in young children, older children, and adults, which precludes clinical follow-up and longitudinal scientific research. WHAT IS NEW • The Early Pediatric Groningen Defecation and Fecal Continence (EP-DeFeC) questionnaire is validated to assess bowel function in children from the age of 1 month to 7 years. • If used together with its pediatric and adult equivalents, longitudinal follow-up of bowel function from infancy to adulthood becomes possible.
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Affiliation(s)
- Sanne J Verkuijl
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, the Netherlands.
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M A Broens
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700 RB, Groningen, the Netherlands
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Sinha S, Vasudeva P, Bharadwaj S, Mittal A. Role of Pelvic Organ Crosstalk in Dysfunction of the Bowel and Bladder. Curr Bladder Dysfunct Rep. [DOI: 10.1007/s11884-022-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Fecal incontinence (FI) is a commonly occurring disease of high concern. It is characterized by voluntary and involuntary defecation in children and adolescents. It is not only a physical disease but also a psychological and behavioral disorder. FI poses a serious burden on individuals and their families and therefore has become a social problem. Unfortunately, the management of FI among children is still a challenge because the etiology varies widely. Constipation has been found to be the most common cause, while sphincter dysfunction and neurogenic abnormalities may also play a role. Currently, no consensus guidelines exist, and the criteria for selecting optional methods remain unclear. It is therefore necessary to improve the efficacy of diagnosis and management strategies of FI in children. This review focused on the classification and etiology, discussed the diagnosis and management methods of FI in children and adolescents, and aimed to guide future studies.
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Affiliation(s)
- Zhe-Ying Shen
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Zhang
- Department of Pediatric Orthopedics, Dalian Women and Children's Medical Center, Dalian, China
| | - Yu-Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shu-Cheng Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Vasconcelos MMDA, Bastos JM, Arana IE, Teixeira IB, Lima EM, Carvalho TA, de Bessa J, Mrad FCDC. Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting. Int Braz J Urol 2021; 47:969-978. [PMID: 34260173 PMCID: PMC8321464 DOI: 10.1590/s1677-5538.ibju.2020.0978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. MATERIALS AND METHODS A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. RESULTS The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items "When your child wants to pee, can't he wait? "Your child holds the pee by crossing his legs, crouching or dancing?" were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). CONCLUSION Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.
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Affiliation(s)
- Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José Murillo Bastos
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
- Hospital e Maternidade Terezinha de JesusJuiz de ForaMGBrasilHospital e Maternidade Terezinha de Jesus, Juiz de Fora, MG, Brasil
| | - Isaac Eduardo Arana
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Isabela Benevenuto Teixeira
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Eleonora Moreira Lima
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - Tânia Antunes Carvalho
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de UrologiaSantanaBABrasilDepartamento de Urologia, Universidade Estadual de Feira de Santana, BA, Brasil
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas GeraisUnidade de NefrologiaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia, Universidade Federal de Minas Gerais, Unidade de Nefrologia, Belo Horizonte, MG, Brasil
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Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
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