Austenfeld Lindsey, Dillon Lacy, Finup Jennika, Noel-MacDonell Janelle, Wickham Azadeh
Children's Mercy Hospital- Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
American Family Children's Hospital, University of Wisconsin-Madison, 1675 Highland Ave, Madison, WI, 53792, USA.
J Pediatr Urol. 2025 Apr;21(2):370-374. doi: 10.1016/j.jpurol.2024.12.016. Epub 2024 Dec 24.
Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family.
This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management.
A cross-sectional, descriptive, correlational research design was used to study the relationship between GU examination findings and management of pediatric BBD. Data captured were baseline characteristics, urinary symptoms, GU examination findings, and required interventions. Clinically significant GU examination findings were defined as abnormalities requiring medical management such as prescription medications, in-office surgical procedures, or operating room surgical procedures. The primary outcome of interest included GU examination findings and treatments for additional diagnosis discovered during the physical examination. Clopper-Pearson 95 % confidence intervals (CI) were calculated for GU interventions needed for each exam outcome type. Fisher's Exact test was used to determine an association between GU examination findings and additional interventions.
Sixty-six patients met inclusion criteria. 91 % (n = 60) had GU examination findings within normal limits and no one (0 %, 95 % CI: 0.000, 0.059) required an additional intervention. 9 % (n = 6) returned with abnormal findings. Five (83 %0.95 % CI: 0.359, 0.996) of the patients with abnormal GU examination findings required an intervention such as a procedure, prescribed medication, or surgery.
The literature suggests normal anatomy in 98 % of children with BBD, while 91 % of our study cohort demonstrated normal exam findings. Patients with abnormal findings were offered interventions that are not considered standard BBD care. Nearly all patients with an abnormal examination chose to proceed with an intervention to address the abnormal finding. Previous BBD studies have not explicitly mentioned genital assessments or the significance of a GU examination. Current literature lacks standardization of physical exam components during BBD visits, however, many agree that a detailed clinical history is essential in diagnosing BBD. For patients with refractory BBD who are not improving with standard care, an in-person GU examination would be warranted. Additionally, radiologic imaging should be considered for patients who do not respond to initial therapies.
Our study demonstrates that the rate of clinically significant examination findings during BBD visits is low. Omitting GU examinations does not appear to compromise the quality of care.
膀胱和肠道功能障碍（BBD）是一种常见疾病，会对儿童及其家庭造成不良的身体和心理影响。
本研究旨在评估临床显著的敏感泌尿生殖系统（GU）检查结果的检出率，以及这些结果是否会影响BBD的管理。
采用横断面、描述性、相关性研究设计，研究GU检查结果与小儿BBD管理之间的关系。收集的数据包括基线特征、泌尿系统症状、GU检查结果和所需干预措施。临床显著的GU检查结果定义为需要药物治疗、门诊手术或手术室手术等医疗管理的异常情况。主要关注的结果包括GU检查结果和体格检查期间发现的需要进一步诊断的治疗方法。计算每种检查结果类型所需GU干预措施的Clopper-Pearson 95%置信区间（CI）。采用Fisher精确检验确定GU检查结果与额外干预措施之间的关联。
66例患者符合纳入标准。91%（n = 60）的患者GU检查结果在正常范围内，无人（0%，95%CI：0.000，0.059）需要额外干预。9%（n = 6）的患者检查结果异常。GU检查结果异常的患者中有5例（83%，95%CI：0.359，0.996）需要进行诸如手术、处方药或手术等干预。
文献表明，98%的BBD儿童解剖结构正常，而我们研究队列中的91%患者检查结果正常。检查结果异常的患者接受了不被视为标准BBD护理的干预措施。几乎所有检查结果异常的患者都选择进行干预以解决异常发现。以往的BBD研究未明确提及生殖器评估或GU检查的意义。目前的文献缺乏BBD就诊期间体格检查组成部分的标准化，然而，许多人一致认为详细的临床病史对诊断BBD至关重要。对于标准治疗无效的难治性BBD患者，有必要进行当面的GU检查。此外，对于初始治疗无反应的患者，应考虑进行放射影像学检查。
我们的研究表明，BBD就诊期间临床显著检查结果的发生率较低。省略GU检查似乎不会影响护理质量。
