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Is there a unique symptom in lower urinary tract dysfunction in children?
Mehmet A Özen1, Mehmet Taşdemir2, Murat S Aygün3
1Department of Pediatric Surgery, Koç University School of Medicine, Istanbul, Turkey.
Insights
Diagnosing pediatric lower urinary tract dysfunction (LUTD) based solely on symptoms like urgency or incontinence can be unreliable. Uroflowmetry/electromyography (UF/EMG) testing is recommended for accurate diagnosis.
Area of Science:
- Pediatric Urology
- Urodynamics
- Child Health
Background:
- Lower urinary tract symptoms (LUTS) are common in children, with urgency, incontinence, and intermittency frequently observed.
- Specific symptoms are often presumed to indicate definite diagnoses for lower urinary tract dysfunction (LUTD).
Purpose of the Study:
- To investigate the relationship between specific LUTD conditions and their associated symptoms in children.
- To evaluate the diagnostic utility of uroflowmetry/electromyography (UF/EMG) in differentiating LUTD types.
Main Methods:
- Children were classified into four LUTD categories: overactive bladder (OAB), dysfunctional voiding (DV), underactive bladder, and primary bladder neck dysfunction (PBND) using UF/EMG.
- Data collected included voiding dysfunction symptom scores, bladder diaries, urinalysis, ultrasonography, and bowel habit history (Rome III criteria).
Main Results:
- The study included 189 children (106 female); OAB (91 patients) and DV (61 patients) were the most common diagnoses.
- Constipation and hesitancy were the only symptoms significantly associated with specific LUTD groups (P < .05).
- Hesitancy was noted in 89.4% of PBND cases, and constipation in 78.6% of DV cases, but other symptoms did not reliably differentiate LUTD types.
Conclusions:
- There is a generally weak correlation between specific symptoms and LUTD diagnoses in children.
- A symptoms-based approach may lead to misdiagnosis of LUTD.
- Focusing on underlying pathologies and utilizing UF/EMG testing is essential for accurate diagnosis.
Objectives:
Lower urinary tract symptoms (LUTS), particularly urgency, incontinence and intermittency are common in children and it is suggested that the specific symptoms may be used for definite diagnosis for LUT dysfunction (LUTD). This study was performed to investigate the relationship between each LUTD and its associated symptoms, using uroflowmetry/electromyography (UF/EMG) as a diagnostic tool.
Methods:
Each patient was categorized into one of four LUT conditions which were overactive bladder (OAB), dysfunctional voiding (DV), underactive bladder and primary bladder neck dysfunction (PBND), according to UF/EMG results. Patients' complaints and findings were documented by using voiding dysfunction symptom score, bladder diary, urine analysis and ultrasonography. In addition, a detailed history of bowel habits (including use of Rome III criteria) was obtained.
Results:
There were 189 children of which 106 were female. The OAB was the largest group including 91 patients, followed by the DV group which had 61 patients. The symptoms specific to any LUTD group were constipation and hesitancy (P < .05). Hesitancy was present in 89.4% with PBND and constipation was present in 78.6% of patients with DV. None of other symptoms were able to differentiate any LUTD group from the other.
Conclusions:
While certain symptoms are often presumed by clinicians to imply specific diagnoses, the main outcome of this study is that there is a generally weak correlation between the specificity of symptoms and LUTD. Symptoms-based approach may lead to misdiagnosis in LUTD. Thus, it may be essential to focus on the underlying pathologies and UF/EMG test may help this.
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