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Diagnostic value of the pediatric lower urinary tract symptom score in children with overactive bladder
Cem Akbal1, Ahmet Şahan, T Emre Şener
1Pediatric Urology Division, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey, cakbal@gmail.com.
Insights
The pediatric lower urinary tract symptom score (SS) effectively assesses overactive bladder (OAB) severity and guides diagnostic testing. High SS scores in children with OAB indicate a greater likelihood of upper urinary tract issues.
Area of Science:
- Pediatric Urology
- Nephrology
- Diagnostic Imaging
Background:
- Overactive bladder (OAB) in children presents diagnostic challenges.
- Assessing OAB severity and identifying associated renal pathology is crucial for effective management.
Purpose of the Study:
- To evaluate the pediatric lower urinary tract symptom score (SS) for determining overactive bladder (OAB) severity.
- To explore the correlation between SS results and standard diagnostic methods in pediatric OAB cases.
Main Methods:
- Symptom scores (SS) were collected pre- and 6 months post-treatment in 294 children with OAB.
- Data included uroflowmetry-electromyography, bladder capacity, bladder diaries, and upper urinary tract evaluations.
- Standard OAB treatments were administered, with non-responders undergoing further diagnostics.
Main Results:
- Abnormal ultrasonography findings correlated with significantly higher pre- and 6-month SS (p = 0.016).
- Non-responders with vesicoureteral reflux (VUR) or renal scarring showed higher pre-treatment SS (p = 0.030).
- Abnormal MRI findings in non-responders were associated with higher SS.
Conclusions:
- High 6-month SS in pediatric OAB patients suggests increased upper urinary tract pathology.
- Low pre-treatment SS can minimize the need for extensive laboratory and diagnostic tests.
- The SS tool aids in reducing urodynamics and other tests for diagnosing renal damage in pediatric OAB.
Purpose:
The aims were (1) to assess the pediatric lower urinary tract symptom score (SS) prior to treatment as a means of determining severity of overactive bladder (OAB) and (2) to investigate relationships between SS results and those of standard diagnostic modalities.
Materials And Methods:
Symptom scores were recorded pre- and 6 months SS for 294 children with OAB unrelated to neurological disorder. Uroflowmetry-electromyography data, total bladder capacity, and a 2-day bladder diary were also recorded, and upper urinary tract deterioration was investigated as indicated. Overactive bladder was treated with standard approaches. No response to treatment was defined as 0-49% reduction in OAB-related symptoms based on SS results. Non-responders underwent additional evaluations as indicated.
Results:
Two hundred forty-one patients (97%; mean age 9.8 ± 2.8 years; mean follow-up 11 months; range 6-18 months) completed the study. One hundred thirteen (47%) required ultrasonography (USG), and those with abnormal USG had a significantly higher pre- and 6 months SS (p = 0.016). All non-responders (n = 38; 16%) underwent urodynamics evaluation, 34 underwent spinal magnetic resonance imaging (MRI), 34 underwent voiding cystourethrography (VCUG), and 34 underwent dimercaptosuccinic acid scanning (DMSA). Non-responders with terminal detrusor hyperactivity had significantly lower SS after therapy (p = 0.09). Non-responders with abnormal MRI had higher pre- and 6 months SS than those with normal MRI. Thirteen (38%) of the non-responders who required VCUG had vesicoureteral reflux (VUR), and this subgroup had higher pre-treatment SS (p = 0.030). Seven (21%) of the non-responders who required DMSA had scarring, and all 7 had VUR. The subgroup with scarring had higher pre-treatment SS (p = 0.030).
Conclusion:
Pediatric OAB patients with high 6 months SS have a higher incidence of additional upper urinary tract pathology. Those with low pre-treatment SS require fewer laboratory tests and other assessments. The SS tool can reduce the number of urodynamics evaluations, and other tests required to diagnose renal damage in children with OAB.
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