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18497

Comorbid Conditions Among Children with Lower Urinary Tract Dysfunction

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Janine L. Oliver, MD, Mary Campigotto, FNP, Douglas E. Coplen, MD, FAAP, Erica J. Traxel, MD and Paul F. Austin, MD, FAAP, Pediatric Urology, Washington University School of Medicine, Saint Louis, MO

Purpose: There is emerging awareness of comorbid characteristics in children with lower urinary tract (LUT) dysfunction. The prevalence of psychiatric comorbidities is known to be high in children with LUT dysfunction and has been shown to be a risk factor for longer duration of LUT symptoms. Obesity has been shown to predict severity of LUT symptoms in adults, and is a growing problem in the pediatric population.  To explore the prevalence of these comorbidities, we examined the psychosocial characteristics and body habitus of children with LUT dysfunction.

Methods:  We reviewed the electronic medical records, LUT symptom score and psychosocial questionnaires of all new patients with non-neurogenic LUT dysfunction presenting to a single nurse practitioner over a 1-year period. School-aged children from 6-17 years old were selected. Parents completed two questionnaires: (1) a 21-question LUT symptom scoring system comprised of a validated 13-question incontinence symptom scoring system as well as 8 additional questions regarding their child's elimination pattern, including any history of urinary tract infections and bowel function, and (2) a psychosocial questionnaire comprised of 17 questions regarding known psychological diagnoses, externalizing or internalizing behavior patterns, and stressful life events.

Results: A total of 362 patients were seen in 2011.  LUT dysfunction characteristics included 47 (13%) patients with encopresis, 186 (51%) patients with daytime urinary incontinence and 100 (28%) patients with recurrent UTIs. The initial LUT symptom score revealed that the majority of patients had a score less than 50.

LUT Sx Score

<50

51-100

101-150

151-200

>200

No. (%)

259 (72%)

75 (21%)

22 (6%)

5 (1%)

1 (<1%)

The majority (65%) of patients were female (236 females vs. 126 males) and in the 6-9 yo age group (55%).  More patients had a low or normal BMI (80%) than an overweight or obese BMI (20%).

 

< 18.5 (Low BMI)

18.5-24.9 (Normal BMI)

25-29.9 (Overweight)

>30 (Obese)

177 (49%)

112 (31%)

35 (9.7%)

35 (9.7%)

Twenty-three percent of parents reported a psychiatric disorder for their child with the most prevalent being ADHD (9.4%) followed by generalized anxiety disorder (5%). Externalizing behaviors (such as aggressiveness and acting out) were reported in 61 patients (17%) and a significant life stress was reported in 119 patients (33%).

Conclusions: Contrary to observations in the adult population, the majority of pediatric patients with LUT dysfunction have a low BMI. In this study sample, most patients were female, early school-aged and often reported daytime urinary incontinence and recurrent UTIs with their LUT dysfunction. ADHD was the most commonly reported psychiatric disorder and history of a stressful life event was more prevalent than ADHD in this cohort of children. Despite multiple comorbidities, most patients initially have a low LUT symptom score. Further studies will determine how these comorbidities affect treatment outcomes.

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