Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil.
Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil.
J Pediatr Urol. 2019 Oct;15(5):529.e1-529.e7. doi: 10.1016/j.jpurol.2019.07.021. Epub 2019 Aug 5.
A presumed association between more severe lower urinary tract symptoms (LUTS) and more severe functional constipation (FC) remains unconfirmed. Because the Rome IV criteria do not quantify FC, an adult constipation scoring system was modified and adapted for use in children.
The objective of this study was to assess the correlation between FC severity as determined by the modified constipation scoring system and LUTS severity in children/adolescents and the correlation between this modified scoring system and the Rome IV criteria.
This was a cross-sectional study including 5- to 17-year-old patients with LUTS, with or without FC. Patients with neurological and/or anatomical abnormalities of the genitourinary and/or gastrointestinal tract were excluded. Girls with Dysfunctional Voiding Symptom Score (DVSS) ≥6 and boys with DVSS ≥9 were diagnosed with lower urinary tract dysfunction (LUTD). Patients with at least two positive Rome IV criteria were considered constipated. The severity of FC according to the adapted constipation scoring system was classified as mild for scores of 1-10, moderate for scores 11-20, and severe for scores 21-30.
Of 128 patients with LUTS, 71 (55.5%) were female. Lower urinary tract dysfunction was detected in 107 patients (83.6%) and was more common in girls. Functional constipation was present in 80 patients (62.5%). Constipated children had higher constipation scores and DVSS, with both scores increasing with the severity of FC. Correlation was moderate between the constipation score and the DVSS (þ = 0.5, p < 0.001) and was strong between positivity for a greater number of Rome IV criteria and the constipation score (þ = 0.7, p < 0.001). Most of the constipated patients had mild or moderate FC, while in 30 non-constipated patients, the constipation score indicated mild FC.
Patients from a specialist center are more likely to have more severe medical problems, and this may have influenced the correlation between the scores. The modifications made to the constipation scoring system require a future validation study. Nevertheless, this study provides new data on urinary dysfunction and its association with FC and highlights the need to investigate occult bowel symptoms that could affect the treatment of urinary dysfunction.
The intensity of FC as measured by the modified constipation scoring system correlated with the severity of the urinary symptoms in children/adolescents with LUTS/LUTD. In constipated patients, there was a correlation between the modified constipation scoring system and the Rome IV criteria. In non-constipated patients, the constipation scoring system identified symptoms/signs of bowel dysfunction not picked up by the Rome IV criteria. Finally, constipation score modified for use in children and adolescents could be important for research purpose and particularly having a prognostic importance.
下尿路症状（LUTS）越严重与功能性便秘（FC）越严重之间的假定关联尚未得到证实。由于罗马 IV 标准没有量化 FC，因此修改并改编了成人便秘评分系统，以用于儿童。
本研究的目的是评估通过改良便秘评分系统确定的 FC 严重程度与儿童/青少年 LUTS 严重程度之间的相关性，以及该改良评分系统与罗马 IV 标准之间的相关性。
这是一项横断面研究，包括有或没有 FC 的 5 至 17 岁 LUTS 患者。排除了泌尿生殖和/或胃肠道有神经和/或解剖异常的患者。女孩的排尿功能障碍症状评分（DVSS）≥6，男孩的 DVSS≥9 被诊断为下尿路功能障碍（LUTD）。至少有两个阳性罗马 IV 标准的患者被认为患有便秘。根据改良便秘评分系统，FC 严重程度的分类为轻度（评分 1-10）、中度（评分 11-20）和重度（评分 21-30）。
在 128 名有 LUTS 的患者中，有 71 名（55.5%）为女性。107 名（83.6%）患者检出下尿路功能障碍，女孩中更常见。80 名（62.5%）患者患有功能性便秘。便秘儿童的便秘评分和 DVSS 较高，随着 FC 严重程度的增加，这两个评分也会增加。便秘评分与 DVSS 之间呈中度相关（þ=0.5，p<0.001），与罗马 IV 标准阳性数之间呈强相关（þ=0.7，p<0.001）。大多数便秘患者为轻度或中度 FC，而在 30 名非便秘患者中，便秘评分显示轻度 FC。
来自专科中心的患者更有可能存在更严重的医疗问题，这可能影响了评分之间的相关性。对便秘评分系统的修改需要进行未来的验证研究。尽管如此，本研究提供了有关尿失禁及其与 FC 之间关联的新数据，并强调需要调查可能影响尿失禁治疗的隐匿性肠症状。
改良便秘评分系统评估的 FC 严重程度与有 LUTS/LUTD 的儿童/青少年的尿症状严重程度相关。在便秘患者中，改良便秘评分系统与罗马 IV 标准之间存在相关性。在非便秘患者中，便秘评分系统发现了罗马 IV 标准未检出的肠功能障碍症状/体征。最后，改良的儿童和青少年便秘评分系统对于研究目的可能很重要，尤其是具有预后意义。
