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European Journal of Pediatrics
Published in: European Journal of Pediatrics 7/2020

01-07-2020 | Vesicorenal Reflux | Review

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children

Authors: Serdar Tekgul, Raimund Stein, Guy Bogaert, Shabnam Undre, Rien J. M. Nijman, Josine Quaedackers, Lisette ‘t Hoen, Radim Kocvara, Mesrur Selcuk Silay, Christian Radmayr, Hasan Serkan Dogan

Published in: European Journal of Pediatrics | Issue 7/2020

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Abstract

The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.
Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
What is Known:
• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.
What is New:
• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
Literature
1.
2.
Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T (2016) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn. 35(4):471–481PubMedCrossRef
3.
Hellström AL, Hanson E, Hansson S, Hjälmås K, Jodal U (1990) Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. 149(6):434–437PubMedCrossRef
4.
Bakker E, van Sprundel M, van der Auwera JC, van Gool JD, Wyndaele JJ (2002) Voiding habits and wetting in a population of 4,332 Belgian schoolchildren aged between 10 and 14 years. Scand J Urol Nephrol. 36(5):354–362PubMedCrossRef
5.
Söderstrom U, Hoelcke M, Alenius L, Söderling AC, Hjern A (2004) Urinary and faecal incontinence: a population-based study. Acta Paediatr. 93(3):386–389PubMedCrossRef
6.
Sureshkumar P, Craig JC, Roy LP, Knight JF (2000) Daytime urinary incontinence in primary school children: a population-based survey. J Pediatr. 137:814–818PubMedCrossRef
7.
Sureshkumar P, Jones M, Cumming R, Craig J (2009) A population based study of 2,856 school-age children with urinary incontinence. J Urol. 181(2):808–815 discussion 815-6PubMedCrossRef
8.
Veiga ML, Lordêlo P, Farias T, Barroso C, Bonfim J, Barroso U Jr (2013) Constipation in children with isolated overactive bladders. J Pediatr Urol 9(6 Pt A):945–949PubMedCrossRef
9.
Bower WF, Moore KH, Shepherd RB, Adams RD (1996) The epidemiology of childhood enuresis in Australia. Br J Urol. 78(4):602–606PubMedCrossRef
10.
Bloom DA, Seeley WW, Ritchey ML, McGuire EJ (1993) Toilet habits and continence in children: an opportunity sampling in search of normal parameters. J Urol. 149(5):1087–1090PubMedCrossRef
11.
Mattsson S (1994) Urinary incontinence and nocturia in healthy schoolchildren. Acta Paediatr. 83(9):950–954PubMedCrossRef
12.
Vaz GT, Vasconcelos MM, Oliveira EA, Ferreira AL, Magalhães PG, Silva FM, Lima EM (2012) Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol. 27(4):597–603PubMedCrossRef
13.
Borch L, Hagstroem S, Bower WF, Siggaard Rittig C, Rittig S (2013) Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr. 102(5):e215–e220PubMedCrossRef
14.
Franco I (2007) Overactive bladder in children. Part 1: pathophysiology. J Urol. 178(3 Pt 1):761–768 discussion 768PubMedCrossRef
15.
Niemczyk J, Equit M, Hoffmann L, von Gontard A (2015) Incontinence in children with treated attention-deficit/hyperactivity disorder. J Pediatr Urol 11(3):141.e1–141.e6CrossRef
16.
von Gontard A, Equit M (2015) Comorbidity of ADHD and incontinence in children. Eur Child Adolesc Psychiatry. 24(2):127–140CrossRef
17.
Hjalmas K, Hoebeke PB, de Paepe H (2000) Lower urinary tract dysfunction and urodynamics in children. Eur Urol. 38(5):655–665PubMedCrossRef
18.
Chang SJ, Hsieh CH, Yang SS (2012) Constipation is associated with incomplete bladder emptying in healthy children. Neurourol Urodyn. 31(1):105–108PubMedCrossRef
19.
Chen JJ, Pugach J, West D, Naseer S, Steinhardt GF (2003) Infant vesicoureteral reflux: a comparison between patients presenting with a prenatal diagnosis and those presenting with a urinary tract infection. Urology 61(2):442–446 discussion 446-7PubMedCrossRef
20.
Pfister C, Dacher JN, Gaucher S, Liard-Zmuda A, Grise P, Mitrofanoff P (1999) The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction. BJU Int. 84(9):1054–1057PubMedCrossRef
21.
Parekh DJ, Pope JC 4th, Adams MC, Brock JW 3rd. (2001) The use of radiography, urodynamic studies and cystoscopy in the evaluation of voiding dysfunction. J Urol. 165(1):215–218PubMedCrossRef
22.
Schewe J, Brands FH, Pannek J (2002) Voiding dysfunction in children: role of urodynamic studies. Urol Int. 69(4):297–301PubMedCrossRef
23.
Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U (2015) Hoebeke P; International Children’s Continence Society Standardization Subcommittee. International Children’s Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn. 34(7):640–647PubMedCrossRef
24.
von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol. 185(4):1432–1436CrossRef
25.
Lopes I, Veiga ML, Braga AA, Brasil CA, Hoffmann A, Barroso U Jr (2015) A two-day bladder diary for children: is it enough? J Pediatr Urol 11(6):348.e1–348.e4CrossRef
26.
Hoebeke P, Bower W, Combs A, De Jong T, Yang S (2010) Diagnostic evaluation of children with daytime incontinence. J Urol. 183(2):699–703PubMedCrossRef
27.
Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S (2005) Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol. 173(3):969–973PubMedCrossRef
28.
Farhat W, Bägli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A, McLorie GA (2000) The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 164(3 Pt 2):1011–1015PubMedCrossRef
29.
Burgers RE, Mugie SM, Chase J, Cooper CS, von Gontard A, Rittig CS, Homsy Y, Bauer SB, Benninga MA (2013) Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol. 190(1):29–36PubMedCrossRef
30.
31.
Beksac AT, Koni A, Bozacı AC, Dogan HS, Tekgul S (2016) Postvoidal residual urine is the most significant non-invasive diagnostic test to predict the treatment outcome in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol 12(4):215.e1–215.e8CrossRef
32.
Yang SS, Wang CC, Chen YT (2003) Home uroflowmetry for the evaluation of boys with urinary incontinence. J Urol 169:1505–1510PubMedCrossRef
33.
Neveus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, Jørgensen TM, Rittig S, Walle JV, Yeung CK, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 176:314–324PubMedCrossRef
34.
van Gool JD, de Jong TP, Winkler-Seinstra P, Tamminen-Möbius T, Lax H, Hirche H, Nijman RJ, Hjälmås K, Jodal U, Bachmann H, Hoebeke P, Walle JV, Misselwitz J, John U (2014) Bael A; European Bladder Dysfunction Study (EU BMH1-CT94-1006). Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence. Neurourol Urodyn. 33(5):482–487PubMedCrossRef
35.
Hellstrom AL (1992) Urotherapy in children with dysfunctional bladder. Scand J Urol Nephrol Suppl. 141:106–107PubMed
36.
37.
Schäfer SK, Niemczyk J, von Gontard A, Pospeschill M, Becker N, Equit M (2018) Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis. Eur Child Adolesc Psychiatry. 27(8):949–964PubMedCrossRef
38.
Brownrigg N, Braga LH, Rickard M, Farrokhyar F, Easterbrook B, Dekirmendjian A, Jegatheeswaran K, DeMaria J, Lorenzo AJ (2017) The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: a randomized controlled trial. J Pediatr Urol 13(4):374.e1–374.e8CrossRef
39.
Vesna ZD, Milica L, Stanković I, Marina V, Andjelka S (2011) The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding. J Pediatr Urol. 7(3):336–341PubMedCrossRef
40.
Campos RM, Gugliotta A, Ikari O, Perissinoto MC, Lúcio AC, Miyaoka R, D’Ancona CA (2013) Comparative, prospective, and randomized study between urotherapy and the pharmacological treatment of children with urinary incontinence. Einstein (SaoPaulo). 11(2):203–208CrossRef
41.
De Paepe H, Renson C, Van Laecke E, Raes A, Vande Walle J, Hoebeke P (2000) Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int. 85(7):889–893PubMedCrossRef
42.
Barroso U Jr, Tourinho R, Lordêlo P, Hoebeke P, Chase J (2011) Electrical stimulation for lower urinary tract dysfunction in children: a systematic review of the literature. Neurourol Urodyn 30(8):1429–1436PubMedCrossRef
43.
Bower WF, Yeung CK (2004) A review of non-invasive electro neuromodulation as an intervention for non-neurogenic bladder dysfunction in children. Neurourol Urodyn. 23(1):63–67PubMedCrossRef
44.
De Paepe H, Renson C, Van Laecke E, Van Laecke E, Raes A, Van Hoecke E, Van Daele J, Vande WJ (1998) Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. Br J Urol. 81(Suppl 3):109–113PubMedCrossRef
45.
Vijverberg MA, Elzinga-Plomp A, Messer AP, van Gool JD, de Jong TP (1997) Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence. Eur Urol. 31(1):68–72PubMedCrossRef
46.
Lordêlo P, Soares PV, Maciel I, Macedo A Jr, Barroso U Jr (2009) Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results. J Urol. 182(6):2900–2904PubMedCrossRef
47.
Ladi-Seyedian S, Kajbafzadeh AM, Sharifi-Rad L, Shadgan B, Fan E (2015) Management of non-neuropathic underactive bladder in children with voiding dysfunction by animated biofeedback: a randomized clinical trial. Urology. 85(1):205–210PubMedCrossRef
48.
Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA (2011) Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol. 7(3):342–348PubMedCrossRef
49.
Kajbafzadeh AM, Sharifi-Rad L, Ladi-Seyedian SS, Mozafarpour S (2016) Transcutaneous interferential electrical stimulation for the management of non-neuropathic underactive bladder in children: a randomised clinical trial. BJU Int. 117(5):793–800PubMedCrossRef
50.
Featherstone N, Stanwell J, Affleck S, Wang K, Murphy F, Boddy SA (2013) Ephedrine hydrochloride: novel use in the management of resistant non-neurogenic daytime urinary incontinence in children. J Pediatr Urol 9(6 Pt A):915–918PubMedCrossRef
51.
Kramer SA, Rathbun SR, Elkins D, Karnes RJ, Husmann DA (2005) Double-blind placebo controlled study of alpha-adrenergic receptor antagonists (doxazosin) for treatment of voiding dysfunction in the pediatric population. J Urol. 173(6):2121–2124 discussion 2124PubMedCrossRef
52.
Nijman RJ, Borgstein NG, Ellsworth P, Djurhuus JC (2005) Tolterodine treatment for children with symptoms of urinary urge incontinence suggestive of detrusor overactivity: results from 2 randomized, placebo controlled trials. J Urol. 173(4):1334–1339PubMedCrossRef
53.
Marschall-Kehrel D, Feustel C (2009) Persson de Geeter C, Stehr M, Radmayr C, Sillén U, Strugala G. Treatment with propiverine in children suffering from nonneurogenic overactive bladder and urinary incontinence: results of a randomized placebo-controlled phase 3 clinical trial. Eur Urol. 55(3):729–736PubMedCrossRef
54.
Newgreen D, Bosman B, Hollestein-Havelaar A, Dahler E, Besuyen R, Snijder R, Sawyer W, Rittig S, Bolduc S (2017) Long-term safety and efficacy of solifenacin in children and adolescents with overactive bladder. J Urol. 198(4):928–936PubMedCrossRef
55.
Hoebeke P, De Caestecker K, Vande Walle J, Dehoorne J, Raes A, Verleyen P, Van Laecke E (2006) The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J Urol. 176(1):328–330 discussion 330-1PubMedCrossRef
56.
Fernandez N, Chua ME, Ming JM, Silangcruz JM, Zu’bi F, Dos Santos J, Lorenzo AJ, Braga LH, Lopes RI (2017) Neurostimulation therapy for non-neurogenic overactive Bladder in children: a meta-analysis. Urology. 110:201–207PubMedCrossRef
Metadata
Title
EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children
Authors
Serdar Tekgul
Raimund Stein
Guy Bogaert
Shabnam Undre
Rien J. M. Nijman
Josine Quaedackers
Lisette ‘t Hoen
Radim Kocvara
Mesrur Selcuk Silay
Christian Radmayr
Hasan Serkan Dogan
Publication date
01-07-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 7/2020
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-020-03681-w

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