Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil.
Federal University of Juiz de Fora, SUPREMA, Juiz de Fora, Brazil.
J Pediatr Urol. 2019 Aug;15(4):376.e1-376.e7. doi: 10.1016/j.jpurol.2018.12.003. Epub 2018 Dec 27.
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.
To assess whether emotional and behavioral problems are more common in children and adolescents with LUTD.
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.
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).
Children and adolescents with LUTD have more emotional and behavioral problems, with bladder and bowel dysfunction being an aggravating factor for this association.
已经发现下尿路功能障碍（LUTD）与情绪和行为问题之间存在关联，尤其是在尿失禁的情况下。其他相关症状和功能性便秘的共存需要进一步研究。
评估 LUTD 患儿和青少年是否更常见情绪和行为问题。
一项在公共场所进行的多中心、横断面、基于人群的研究。父母回答了 5-14 岁儿童的尿和心理症状问题。排除了有神经问题或解剖学尿路异常的儿童/青少年。使用排尿功能障碍评分系统评估尿症状，罗马 III 诊断标准评估肠症状，以及长处和困难问卷（SDQ）评估情绪和行为问题。
在 806 名儿童/青少年中，53%为女性。平均年龄为 9.1 ± 2.7 岁。LUTD 的患病率为 16.4%。总体而言，26.2%的 SDQ 总分异常，29.2%的情绪问题亚量表异常，30%的行为问题亚量表异常。在有 LUTD 的儿童中，40.5%筛查出情绪/行为问题阳性，SDQ 总分（P < 0.001）和情绪问题（P < 0.001）、行为问题（P < 0.001）和多动（P = 0.037）亚量表均有显著相关性。尿急、尿失禁和排尿延迟与 SDQ 总分异常的患病率显著相关（P = 0.05；P = 0.004 和 P = 0.012）。膀胱和肠道功能障碍是情绪和行为问题的加重因素，无论是在 SDQ 总分还是在亚量表中，症状都更严重。在多变量分析中，与存在情绪和行为问题相关的独立因素是 LUTD（比值比[OR] = 1.91）、便秘（OR = 1.7）、在政府资助的学校学习（OR = 2.2）和家庭主要成员受教育程度低（OR = 1.9）。
LUTD 患儿和青少年有更多的情绪和行为问题，膀胱和肠道功能障碍是这种关联的加重因素。
