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Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder
F O'Kelly1, L A t'Hoen2, S Silay3
1Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
Insights
Pediatric bladder and bowel dysfunction is more severe in children with neuropsychiatric developmental disorders, showing less improvement with treatment and higher costs. Managing expectations is key for better outcomes.
Area of Science:
- Pediatric Urology
- Developmental Pediatrics
- Health Economics
Background:
- Bladder and bowel dysfunction (BBd) is a common pediatric condition, often underdiagnosed, accounting for significant urology consults.
- Patients with neuropsychiatric developmental disorders (NDDs) may experience unique challenges with BBd.
- Understanding treatment outcomes and costs in diverse pediatric populations is crucial for effective healthcare management.
Purpose of the Study:
- To assess 1-year functional outcomes of standard BBd treatment in pediatric patients.
- To compare outcomes between children with and without NDDs.
- To conduct an initial cost analysis of BBd treatment.
Main Methods:
- Prospective observational study across European academic centers (July 2020-November 2022).
- Recruited 240 new pediatric BBd patients.
- Utilized sociodemographic surveys, NDD diagnosis information, and validated functional questionnaires (e.g., DVSS, CBBQD).
Main Results:
- Patients with NDDs showed diminished improvement in BBd symptoms (DVSS, CBBQD scores) compared to controls.
- The odds of full symptom resolution were significantly lower (5.7 times) in the NDD cohort.
- Medication costs at referral were 15.4% higher for the NDD group (€37,625.36 vs €32,603.76).
Conclusions:
- Pediatric patients with NDDs present with more severe BBd, experience lower quality of life, and exhibit greater treatment resistance.
- Higher medication costs are associated with BBd in children with NDDs.
- Managing parental/caregiver expectations is vital for addressing treatment resistance in this cohort.
Purpose:
Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis.
Materials And Methods:
This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores.
Results:
A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group.
Conclusions:
This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.
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