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Bladder bowel dysfunction in children with Down's syndrome
Nikita R Bhatt1, Louise Murchison2, George Yardy3
1Department of Urology, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Heath Rd, Ipswich, IP4 5PD, UK. nikitarb89@gmail.com.
Insights
Bladder Bowel Dysfunction (BBD) is common in Down's Syndrome (DS) and often requires surgery. Early identification and management are crucial for protecting the renal tract in these patients.
Area of Science:
- Pediatric Urology
- Genetics
- Gastroenterology
Background:
- Bladder Bowel Dysfunction (BBD) is a recognized condition in individuals with Down's Syndrome (DS).
- Understanding the specific challenges faced by DS patients with BBD is essential for effective care.
Purpose of the Study:
- To determine the incidence, demographics, presentation, complications, and bladder management strategies in Down's Syndrome patients experiencing Bladder Bowel Dysfunction.
- To consolidate the largest available cohort of BBD cases in DS patients.
Main Methods:
- A systematic review adhering to PRISMA guidelines was conducted.
- Searches were performed on MEDLINE and SCOPUS using specific keywords related to Down's Syndrome and voiding dysfunction.
- A case series from two pediatric urology centers was incorporated.
Main Results:
- The study included 38 patients with BBD and DS, with a mean age of 12 years and a 2:1 male:female ratio.
- Common presentations included functional constipation (90%), recurrent urinary tract infections (38%), and enuresis (56%).
- Over 56% of patients required surgical intervention, with medical and behavioral treatments showing limited success.
Conclusions:
- BBD is prevalent in DS patients and can lead to severe complications necessitating surgical intervention.
- Standard interventions are often unreliable due to poor patient compliance.
- Early identification and management are vital for renal tract protection; regular screening for urogenital anomalies in DS is recommended.
Introduction:
Bladder Bowel Dysfunction (BBD) has been described in patients with Down's Syndrome (DS). Our aim was to report the incidence, demographics, presentation, complications and management of the bladder in DS patients with BBD.
Methods:
A systematic review was performed using PRISMA guidelines and search terms "{[(trisomy 21) OR down's syndrome]} AND [("non-neurogenic") OR voiding dysfunction]" in the search engines MEDLINE and SCOPUS. We also include a case series from two paediatric urology centres.
Results:
A total of 38 patients with BBD and DS were included. Mean age was 12 years (newborn to 21 years), the male:female ratio was 2:1. Functional constipation (90%), recurrent urinary tract infections (38%) and enuresis were common at presentation (56%), while over 56% patients required surgical intervention. Medical treatment and behavioral modification were less successful while intermittent catheterisation did not work.
Conclusion:
This study reviews the largest cohort of patients with BBD in DS. It is common with serious consequences requiring operative intervention. Usual interventions are unreliable due to poor compliance. Early identification and management protect the renal tract. Regular screening for urogenital anomalies in DS is currently not performed. We recommend a thorough history of bladder function in DS patients to identify these cases early.
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