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Bladder dysfunction in Duchenne muscular dystrophy: A narrative review
R R Kikkert1, J M Fock2, G J F J Bos3
1Department of Urology, University Medical Centre Groningen, the Netherlands.
Introduction:
Duchenne muscular dystrophy (DMD), a severe, progressive disease, causes loss of function of skeletal muscles. Urological symptoms in DMD include detrusor overactivity, bladder hypocontractility, urinary incontinence, detrusor-sphincter dyssynergia and urolithiasis. This narrative review summarises available evidence and provides recommendations for bladder dysfunction management.
Materials And Methods:
A literature search was performed using the PubMed, Scopus, Embase, Cochrane and Web of Science search engines. The objectives of the review were: to investigate the incidence of lower urinary tract symptoms (LUTS), defecation problems, urinary tract infections (UTIs) and urolithiasis and the impact of urological problems on the quality of life of children with DMD. Following PRISMA guidelines and applying the Patient, Intervention, Comparison, Outcome (PICO) framework, nine non-randomised studies were selected, and MINORS criteria were used to validate their quality.
Results:
All selected studies included DMD patients alone or in a mixed cohort with Becker Muscular Dystrophy (BMD) patients (DMD: 76-84 %). Diagnosis was mostly confirmed clinically. A single institute study design was noted for alle publications. Only one study incorporated short follow-up. Inclusion of a urologist in multidisciplinary teams was uncommon. Definitions and assessments of LUTS varied widely, and their prevalence ranged from 32 % to 85 %. Most frequently reported LUTS were hesitancy, urgency, day-time or night-time urinary incontinence and frequency. The prevalence of concomitant defecation problems ranged from 32 % to 70 %. Information on UTIs, urolithiasis, quality of life and intervention outcomes, for example, anticholinergics use was sparse.
Conclusions:
DMD is a progressive muscle disease with urological complications. This review revealed a high prevalence of LUTS, including hesitancy, urgency, and incontinence, along with significant defecation issues. However, limited information is available on UTI, urolithiasis, quality of life, and treatment outcomes for these symptoms. Special attention is warranted for LUTS and bowel function. Multidisciplinary treatment including a paediatric urologist is beneficial.
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