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The utility of a sensitive genitourinary exam in the management of pediatric bowel and bladder dysfunction
Lindsey Austenfeld1, Lacy Dillon1, Jennika Finup2
1Children's Mercy Hospital- Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Insights
Genitourinary (GU) examinations in children with bladder and bowel dysfunction (BBD) rarely reveal significant findings. Most children with BBD have normal GU exams, and omitting these exams does not appear to compromise care quality.
Area of Science:
- Pediatric Urology
- Child Health
- Clinical Diagnostics
Background:
- Bladder and bowel dysfunction (BBD) significantly impacts children and their families.
- BBD is a common pediatric disorder with physical and psychological consequences.
Purpose of the Study:
- To evaluate the frequency of clinically significant genitourinary (GU) findings in pediatric BBD cases.
- To determine if GU examination findings influence the management of BBD.
Main Methods:
- A cross-sectional study analyzed the relationship between GU findings and BBD management in pediatric patients.
- Data included demographics, urinary symptoms, GU exam results, and interventions.
- Clinically significant findings were defined as abnormalities requiring medical or surgical intervention.
Main Results:
- 91% of patients had normal GU examination findings and required no additional intervention.
- Abnormal GU findings were observed in 9% of patients.
- 83% of patients with abnormal findings required an intervention (e.g., medication, procedure, surgery).
Conclusions:
- The incidence of clinically significant GU examination findings in pediatric BBD is low.
- Normal GU exam findings were present in 91% of the study cohort, aligning with literature suggesting normal anatomy in most BBD cases.
- Omitting GU examinations in BBD evaluations may not negatively impact patient care quality.
Introduction:
Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family.
Objective:
This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management.
Methods:
A cross-sectional, descriptive, correlational research design was used to study the relationship between GU examination findings and management of pediatric BBD. Data captured were baseline characteristics, urinary symptoms, GU examination findings, and required interventions. Clinically significant GU examination findings were defined as abnormalities requiring medical management such as prescription medications, in-office surgical procedures, or operating room surgical procedures. The primary outcome of interest included GU examination findings and treatments for additional diagnosis discovered during the physical examination. Clopper-Pearson 95 % confidence intervals (CI) were calculated for GU interventions needed for each exam outcome type. Fisher's Exact test was used to determine an association between GU examination findings and additional interventions.
Results:
Sixty-six patients met inclusion criteria. 91 % (n = 60) had GU examination findings within normal limits and no one (0 %, 95 % CI: 0.000, 0.059) required an additional intervention. 9 % (n = 6) returned with abnormal findings. Five (83 %0.95 % CI: 0.359, 0.996) of the patients with abnormal GU examination findings required an intervention such as a procedure, prescribed medication, or surgery.
Discussion:
The literature suggests normal anatomy in 98 % of children with BBD, while 91 % of our study cohort demonstrated normal exam findings. Patients with abnormal findings were offered interventions that are not considered standard BBD care. Nearly all patients with an abnormal examination chose to proceed with an intervention to address the abnormal finding. Previous BBD studies have not explicitly mentioned genital assessments or the significance of a GU examination. Current literature lacks standardization of physical exam components during BBD visits, however, many agree that a detailed clinical history is essential in diagnosing BBD. For patients with refractory BBD who are not improving with standard care, an in-person GU examination would be warranted. Additionally, radiologic imaging should be considered for patients who do not respond to initial therapies.
Conclusion:
Our study demonstrates that the rate of clinically significant examination findings during BBD visits is low. Omitting GU examinations does not appear to compromise the quality of care.
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