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Published on: August 14, 2019
Impact of an interdisciplinary approach in children and adolescents with lower urinary tract dysfunction (LUTD)
Roberta Vasconcellos Menezes de Azevedo1, Eduardo Araújo Oliveira1, Monica Maria de Almeida Vasconcelos1
1Universidade Federal de Minas Gerais.
Insights
Individualized treatment for pediatric lower urinary tract dysfunction (LUTD) significantly reduces symptoms like incontinence and infections. Continuous monitoring is crucial to prevent kidney damage in children with LUTD.
Area of Science:
- Pediatric Urology
- Nephrology
- Rehabilitation Medicine
Background:
- Lower urinary tract dysfunction (LUTD) encompasses diverse urinary filling and emptying issues stemming from neurogenic, anatomical, or functional causes.
- LUTD significantly impacts children's quality of life, necessitating effective management strategies.
Purpose of the Study:
- To assess the long-term impact of a comprehensive treatment approach on children and adolescents diagnosed with lower urinary tract dysfunction (LUTD).
Main Methods:
- A 15-year historical cohort study involved 192 pediatric patients (0.1-16.8 years) with LUTD, predominantly neurogenic bladder dysfunction (60.4%).
- Treatment modalities included urotherapy, behavioral interventions, timed voiding, hydration, laxatives, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enemas, and surgical options for refractory cases.
Main Results:
- Significant reductions were observed in urinary tract infections (p=0.0027), daytime urinary incontinence (p<0.001), nocturnal enuresis (p<0.001), and fecal incontinence (p=0.010).
- Vesicoureteral reflux also showed a significant decrease (p=0.01).
- Treatment led to increased use of CIC (p=0.021) and anticholinergic therapy (p<0.001), with a decrease in chemoprophylaxis (p<0.001).
Conclusions:
- Individualized treatment plans are essential for managing pediatric LUTD.
- Constant clinical, laboratory, and imaging monitoring is vital to mitigate the risk of renal damage in these patients.
Introduction:
The lower urinary tract dysfunction (LUTD) corresponds to changes in the filling or emptying of urine caused by neurogenic, anatomical and functional alterations.
Objective:
To evaluate the impact of treatment in children and adolescents with LUTD.
Methods:
Historical cohort of 15 year follow-up with the participation of 192 patients (123F, 69M), aged 0.1 to 16.8 years, analyzed at admission (T0) and at final follow-up (T1). Most patients belong to a neurologic bladder dysfunction group (60.4%). The treatment was uroterapy with behavioral and cognitive intervention, timed voiding, oral hydration, laxative diet, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enema, treatment of urinary tract infection (UTI) and, in refractory cases, surgical procedures such as continent and incontinent urinary diversion (vesicostomy), bladder augmentation and conduit for performing antegrade colonic enema.
Results:
The main symptoms were daytime urinary incontinence (82.3%), the non-monosymptomatic nocturnal enuresis (78.6%), fecal incontinence (54.2%) and constipation (47.9%). There was a significant reduction of urinary tract infection (p = 0.0027), daytime urinary incontinence (p < 0.001), nocturnal enuresis (p < 0.001), fecal incontinence (p = 0.010) and of vesicoureteral reflux (p = 0.01). There was significant increase in the use of CIC (p = 0.021), of anticholinergic therapy (p < 0.001) and decrease of chemoprophylaxis (p < 0.001).
Conclusion:
This study showed that treatment of LUTD in children must be individualized, and requires constant monitoring of clinical, laboratory and imaging to minimize the risk of kidney damage.
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