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Urgency in children with overactive bladder or voiding postponement: What's the difference?
Samuel Gomes Cardoso1, Beatriz Paixão Argollo1, Ana Aparecida Nascimento Martinelli Braga1
1Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
Insights
Children with overactive bladder (OAB) exhibit more behavioral issues, especially hyperactivity, compared to those with voiding postponement (VP). Urge incontinence is strongly linked to OAB in pediatric patients.
Area of Science:
- Pediatric Urology
- Child Psychology
Background:
- Overactive bladder (OAB) and voiding postponement (VP) present with urinary urgency but differ in pathophysiology.
- Understanding these differences is crucial for accurate diagnosis and treatment in children.
Purpose of the Study:
- To compare clinical, psychological, and sociodemographic features of children experiencing urgency due to OAB versus VP (UrVP).
Main Methods:
- Retrospective cross-sectional study of 101 children (5-14 years) with urinary urgency.
- Evaluated symptoms using DVSS, constipation with Rome IV criteria, and psychological aspects with SDQ.
- Classified patients into OAB (>3 voids/day) or UrVP (≤3 voids/day) groups.
Main Results:
- OAB prevalence was 60.4%. No significant differences in age or constipation prevalence between groups.
- Children with OAB showed higher behavioral hyperactivity and externalizing symptoms.
- Multivariate analysis identified behavioral hyperactivity, urge incontinence, and MVV/EBC as independent factors for OAB diagnosis.
Conclusions:
- Children with OAB demonstrate more behavioral problems, particularly hyperactivity, than those with UrVP.
- Sociodemographic characteristics were similar between groups.
- Urge incontinence strongly associated with OAB and lower MVV/EBC in pediatric patients.
Introduction:
Overactive bladder (OAB) and voiding postponement (VP) can share the same symptom of urgency, but with different pathophysiology, including the cerebral interpretation of bladder filling. The objective of the present study was to compare the clinical, psychological and sociodemographic features of children with urgency for OAB with those who presented urgency for VP (UrVP).
Methods:
A retrospective cross-sectional study with an analytical component was conducted with patients of 5-14 years of age with urinary urgency between January, 2014, and January, 2019. Urinary symptoms were evaluated using the Dysfunctional Voiding Scoring System (DVSS) questionnaire, constipation using the Rome IV criteria and psychological symptoms using the Strengths and Difficulties Questionnaire (SDQ). All the patients had bell-shaped or tower-shaped curves at uroflowmetry and no significant post-void residual volume at ultrasonography. Patients were classified as having OAB or UrVP depending on whether they voided >3 or ≤3 times/day, respectively.
Results:
Median age of the 101 children/adolescents included was 9 years, with no significant difference between the groups. The prevalence of OAB was 60.4%. Girls constituted 57.4% of the sample but 67.5% of the postponement group, although no independent association was found between sex and diagnosis. The prevalence of constipation was 75.2%, with no difference between the groups. The children with OAB had higher behavioral hyperactivity scores and more intense externalizing symptoms, although there was no significant difference between the groups for the SDQ total difficulties score. In the multivariate analysis, the independent clinical factors associated with a diagnosis of OAB were behavioral hyperactivity (OR = 5.134), urge incontinence (OR = 4.694) and MVV/EBC (%) (OR = 0.983).
Conclusion:
More behavioral problems, particularly hyperactivity, were found in children with OAB compared to those with UrVP. No statistically significant difference was found between the groups evaluated insofar as their sociodemographic characteristics are concerned. Furthermore, as expected, there was a strong association between the symptom of urge incontinence and lower MVV/EBC in the children and adolescents with OAB compared to those with voiding postponement.
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