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The Iowa Voiding Improvement Partnership experience: Early observations with a collaborative pediatric
K M Bonnett1, L L Fuller2, C S Cooper1
1Department of Urology, University of Iowa, Iowa City, IA 52242, USA.
Insights
A specialized clinic successfully treated children with bladder and bowel dysfunction (BBD), identifying psychological issues and improving symptoms. This multidisciplinary approach offers hope for difficult-to-treat pediatric BBD cases.
Area of Science:
- Pediatric Urology
- Child Psychology
- Multidisciplinary Healthcare
Background:
- Bladder and bowel dysfunction (BBD) is prevalent in children referred to pediatric urology.
- Co-occurring psychiatric issues complicate BBD treatment in pediatric patients.
- The University of Iowa Voiding Improvement Partnership (VIP) Clinic was established in 2013 to manage these complex cases.
Purpose of the Study:
- To assess the initial outcomes of the specialized VIP Clinic.
- To identify the range of urologic and psychological conditions managed by the clinic.
- To evaluate the effectiveness of VIP treatment on pediatric BBD symptoms.
Main Methods:
- Retrospective review of 66 patients evaluated at the VIP Clinic.
- Analysis of patient demographics, urologic diagnoses, and psychological conditions.
- Comparison of Pediatric Bladder and Bowel Dysfunction questionnaire scores from initial to most recent visits.
Main Results:
- 62% of patients required further psychological evaluation, indicating a high prevalence of undiagnosed psychiatric issues.
- Significant improvement in BBD symptoms was observed, with average Iowa BBD Questionnaire scores decreasing from 31 to 25 (P=0.03).
- 23% of patients achieved sufficient improvement to be discharged from uro-psychologic care.
Conclusions:
- Establishing a multidisciplinary uro-psychology clinic is feasible and beneficial.
- Such clinics can identify previously undiagnosed psychological comorbidities in children with BBD.
- The VIP Clinic model effectively improves treatment outcomes for pediatric patients with complex BBD.
Introduction:
Bladder and bowel dysfunction (BBD) are common problems in children presenting for pediatric urology referral. Psychiatric issues may be present in these children, making their treatment difficult. In 2013, the University of Iowa Voiding Improvement Partnership (VIP) Clinic was established for the treatment of these patients.
Study Objective:
This study sought to evaluate early experience with this specialized clinic, to determine the pre-existing urologic and psychologic conditions seen in these clinic patients, and to evaluate the clinical outcomes after VIP treatment.
Study Design:
A retrospective, Institutional Review Board-approved review of all patients seen in the VIP Clinic was performed. The following were evaluated: patient demographics, underlying urologic and psychologic diagnosis, and treatment decisions. All patients were asked to complete the University of Iowa Pediatric Bladder and Bowel Dysfunction questionnaire at each visit. Questionnaire scores from the patients' first and most recent clinic visits were compared.
Results:
To date, 66 patients have been evaluated at the VIP Clinic, accounting for 112 clinic visits. The mean age of the VIP patients was 8.5 years (range, 4-16) and 59% of the patients were female. Pre-existing urological conditions and psychological conditions are shown in the Summary Table. A large number (62%) of patients required further psychological evaluation, secondary to concern for an undiagnosed psychiatric issue. In addition, the clinic had improved patients' BBD symptoms over time. When first evaluated in clinic, patients had an average Iowa BBD Questionnaire score of 31 (range, 47-13), which improved to an average score of 25 (range, 47-7) (P = 0.03). In addition, 23% of the patients improved to where they could be discharged from uro-psychologic care.
Conclusions:
It was feasible to establish the present multidisciplinary uro-psychology clinic. Such a clinic may unearth undiagnosed psychological issues, and improve bowel and bladder dysfunction in these difficult-to-treat patients.
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