JU INSIGHT Pediatric Bladder Bowel Dysfunction With Associated Neuropsychiatric Developmental Disorders

By: Fardod O’Kelly, MD, MBA, MB, MA, FFSEM, FEBU, FRCS (Urol), Beacon Hospital, University College Dublin, Ireland; Lisette A. t’Hoen, MD, PhD, Erasmus MC University Medical Center, Rotterdam-Sophia Children’s Hospital, The Netherlands; Selcuk Silay, MD, PhD, FEBU, FEAPU, Biruni University, Istanbul, Turkey; Rianne J.M. Lammers, MD, PhD, FEBU, FEAPU, University Medical Center Groningen, The Netherlands; Simone Sforza, MD, PhD, Paediatric Urology, Meyer Children Hospital, University of Florence, Italy; Edoardo Bindi, MD, PhD, AOU delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy; Numan Baydilli, MD, PhD, FEBU, Erciyes University Faculty of Medicine, Kayseri, Turkey; Muhammet I. Donmez, MD, PhD, FEBU, FEAPU, I˙stanbul University I˙stanbul Faculty of Medicine, Turkey; Irene Paraboschi, MD, PhD, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Ahmed Atwa, MD, FEBU, FEAPU, Urology and Nephrology Center, Mansoura University, Egypt; Anne-Francoise Spinoit, MD, PhD, FEBU, FEAPU, Ghent University Hospital, Ghent University, Belgium; Beatriz Banuelos Marco, MD, PhD, FEBU, FEAPU, University Hospital El Clinico, Madrid, Spain; On behalf of the EAU-YAU Paediatric Urology Working Group | Posted on: 15 Dec 2023

O’Kelly F, t’Hoen LA, Silay S, et al. Neuropsychiatric developmental disorders in children are associated with an impaired response to treatment in bladder bowel dysfunction: a prospective multi-institutional European observational study. J Urol. 2023; 210(6):899-907.

Study Need and Importance

Bladder and bowel dysfunction (BBD) is a common but underdiagnosed pediatric entity representing up to 47% of pediatric urology consults and is especially prevalent in children with a neuropsychiatric developmental disorder (NPDD). BBD may be associated with secondary vesicoureteral reflux and recurrent urinary tract infections which ultimately may lead to renal scarring. BBD negatively affects children’s quality of life and self-esteem; therefore, early diagnosis and treatment of BBD are critical to avoid secondary comorbidities.

What We Found

In a cohort of 240 children followed a minimum of 1 year following bladder retraining, bowel management, and pelvic floor physiotherapy with biofeedback, those children with BBD and an NPDD were more likely to have a longer duration of symptoms prior to referral, more symptoms, higher objective scoring severity, lower quality of life, higher medication costs prior to referral (15.4%), and higher treatment resistance compared to those without an NPDD. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the NPDD cohort (Figure).

Figure. Rates of resolution of bladder bowel dysfunction with bladder retraining and physiotherapy (± biofeedback) in patients with neuropsychiatric developmental disorders compared to controls.

Limitations

There are a number of limitations here including that NPDD diagnoses were formally made prior to enrolment and not revalidated in the hospital. Measurement of patient compliance was also outside the scope of this study with results based on interval symptom scores. There were also no specific behavioral interventions for patients with NPDD which may have further reduced symptoms, increased compliance to treatment, and improved outcomes.

Interpretation for Patient Care

Patients with an NPDD exhibit more severe BBD at baseline and throughout treatment with a lower overall quality of life and higher medication costs at referral. While significant improvement in objective and subjective scores is achievable, it is important that parents’ and caregivers’ expectations are managed regarding higher levels of treatment resistance over a longer period of time.