Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study. Issue 4 (August 2019)

• Record Type: Journal Article
• Authors: Dourado, E.R.; de Abreu, G.E.; Santana, J.C.; Macedo, R.R.; da Silva, C.M.; Rapozo, P.M.B.; Netto, J.M.B.; Barroso, U.
• Is Part Of: Journal of pediatric urology. Volume 15:Issue 4(2019)
• Page Start: 376.e1
• Page End: 376.e7
• Publication Date: 2019-08
• Subjects: Lower urinary tract dysfunction -- Urinary symptoms -- Emotional/behavioral problems -- Child -- Adolescent -- Bladder/bowel dysfunction; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2018.12.003
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Background: An association has been found between lower urinary tract dysfunction (LUTD) and emotional and behavioral problems, particularly in cases of urinary incontinence. Other associated symptoms and the coexistence of functional constipation require further investigation. Objective: To assess whether emotional and behavioral problems are more common in children and adolescents with LUTD. Study design: A multicenter, cross-sectional, population-based study conducted in public places. Parents answered questions on urinary and psychological symptoms in their children aged 5–14 years. Children/adolescents with neurological problems or anatomical urinary tract abnormalities were excluded. The Dysfunctional Voiding Scoring System was used for assessing urinary symptoms, the Rome III Diagnostic Criteria for evaluating bowel symptoms, and the Strengths and Difficulties Questionnaire (SDQ) for evaluating emotional and behavioral problems. Results: Of the 806 children/adolescents included, 53% were female. The mean age was 9.1 ± 2.7 years. The prevalence of LUTD was 16.4%. Overall, 26.2% had abnormal scores in the overall SDQ scale, 29.2% in the emotional problems subscale, and 30% in the conduct problems subscale. Of the children with LUTD, 40.5% screened positive for emotional/behavioral problems, with a significant association being found for the overall SDQ scale ( P < 0.001) and for the emotional problems ( P < 0.001), conduct problems ( P < 0.001), and hyperactivity ( P = 0.037) subscales. Urinary urgency, urinary incontinence, and voiding postponement were significantly associated with a greater prevalence of abnormalities in the overall SDQ score ( P = 0.05; P = 0.004, and P = 0.012, respectively). Bladder and bowel dysfunction was an aggravator of emotional and behavioral problems, with more intense symptoms, both in the overall SDQ scale and in the subscales. In the multivariate analysis, the factors independently associated with the presence of emotional and behavioral problems were LUTD (odds ratio [OR] = 1.91), constipation (OR = 1.7), studying in a government-funded school (OR = 2.2), and poor education of the head of the family (OR = 1.9). Conclusions: Children and adolescents with LUTD have more emotional and behavioral problems, with bladder and bowel dysfunction being an aggravating factor for this association. Table Factors independently associated with the Strengths and Difficulties Questionnaire overall score for emotional and behavioral problems. Table Factors Initial model Final model Odds ratio (95%CI) P -value Odds ratio (95%CI)0 P -value a Education level of the head of the family 1.91 (1.1–3.3) 0.015 1.9 (1.1–3.3) 0.016 LUTD 3.1 (1.7–5.4) 0.002 2.6 (1.5–4.6) 0.000 Child attends a government-funded school 2.2 (1.4–3.5) 0.001 2.3 (1.5–3.7) 0.000 Constipation 1.7 (1.1–2.7) 0.037 1.7 (1.1–2.7) 0.031 Sex 1.5 (0.9–2.2) 0.061 – – LUTD: lower urinary tract dysfunction; 95% CI: 95% confidence interval. a Logistic regression.