The utility of a sensitive genitourinary exam in the management of pediatric bowel and bladder dysfunction.

INTRODUCTION

Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family.

OBJECTIVE

This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management.

METHODS

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.

RESULTS

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.

DISCUSSION

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.

CONCLUSION

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.