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Bladder Disorders

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Pediatric Nephrology

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Abstract

Lower urinary tract (LUT) dysfunction is clinically relevant for three main reasons: (1) it may cause urinary tract infections (UTIs), mainly from the accumulation of residual urine; (2) it may adversely affect renal function from febrile UTIs or high intravesical pressure; and (3) it may cause incontinence and thus substantially lower the child’s quality of life.

The function of the LUT is intimately associated with that of the bowel; constipation is both a common cause and consequence of many kinds of bladder dysfunction. Among the types of lower urinary tract dysfunction, detrusor overactivity is the main cause of daytime urinary incontinence in childhood. The condition is benign but socially harmful and needs to be differentiated from more serious conditions such as neurogenic bladder or urethral obstruction. The two cornerstones of treatment are urotherapy and eradication of concomitant constipation. Urotherapy includes instructing the child to keep a regular voiding and drinking schedule. If first-line therapy is unsuccessful, anticholinergic medication is often warranted. Another LUT disorder, voiding dysfunction, i.e., the habitual sphincter contraction during voiding, is common in children with detrusor overactivity. It may be self-limiting but may also result in residual urine and UTIs and can in severe cases be part of a syndrome indistinguishable from the neurogenic bladder and carry the same risks. A third disorder, neurogenic bladder dysfunction, most often caused by spinal dysraphism, is characterized by detrusor sphincter dyssynergia. This condition very often leads to recurrent UTIs and high intravesical pressures, threatening kidney function. The introduction of clean intermittent catheterization has improved the renal prognosis tremendously for the children affected by the disorder.

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References

  1. Austin P, Bauer S, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. J Urol. 2014;191(6):1863–5.

    Article  PubMed  Google Scholar 

  2. Koff SA. Estimating bladder capacity in children. Urology. 1983;21:248.

    Article  CAS  PubMed  Google Scholar 

  3. Holmdahl G, Hanson E, Hanson M, Hellström A-L, Hjälmås K, Sillén U. Four-hour voiding observation in healthy infants. J Urol. 1996;156:1809–12.

    Article  CAS  PubMed  Google Scholar 

  4. Bijos A, Czerwionka-Szaflarska M, Mazur A, Romanczuk W. The usefulness of ultrasound examination of the bowel as a method of assessment of functional chronic constipation in children. Pediatr Radiol. 2008;37(12):1247–52.

    Article  Google Scholar 

  5. Joensson IM, Siggaard C, Rittig S, Hagstroem S, Djurhuus JC. Transabdominal ultrasound of rectum as a diagnostic tool in childhood constipation. J Urol. 2008;179(5):1997–2002.

    Article  PubMed  Google Scholar 

  6. Nevéus T, Sillén U. Lower urinary tract function in childhood; Normal development and common functional disturbances. Acta Physiol. 2013;207(1):85–92.

    Article  Google Scholar 

  7. Duong TH, Jansson UB, Holmdahl G, Sillén U, Hellström A-L. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol. 2010;6(5):501–5.

    Article  PubMed  Google Scholar 

  8. Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga M. Functional defecation disorders among children with lower urinary tract symptoms. J Urol. 2013;189(5):1886–91.

    Article  PubMed  Google Scholar 

  9. Yazbeck S, Schick E, O’Regan S. Relevance of constipation to enuresis, urinary tract infection and reflux. A review. Eur Urol. 1987;13(5):318–21.

    Article  CAS  PubMed  Google Scholar 

  10. Franco I. The central nervous system and its role in bowel and bladder control. Curr Urol Rep. 2011;12:153–7.

    Article  PubMed  Google Scholar 

  11. Burgers R, Liem O, Canon S, Mousa H, Benninga MA, Di Lorenzo C, et al. Effect of rectal distention on lower urinary tract function in children. J Urol. 2010;184(suppl 4):1680–5.

    Article  PubMed  Google Scholar 

  12. Dourado ER, de Abreu GE, Santana JC, Macedo RR, da Silva CM, Rapozo PMB, et al. Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study. J Pediatr Urol. 2019;15(4):376.e1–7.

    Article  CAS  Google Scholar 

  13. Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology. 2016; [ePub ahead of print].

    Google Scholar 

  14. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527–37.

    Article  PubMed  Google Scholar 

  15. Joinson C, Heron J, von Gontard A. Psychological problems in children with daytime wetting. Pediatrics. 2006;118(5):1985–93.

    Article  PubMed  Google Scholar 

  16. Allen TD. The non-neurogenic neurogenic bladder. J Urol. 1977;117:232–8.

    Article  CAS  PubMed  Google Scholar 

  17. Clothier JC, Wright AJ. Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol. 2018;33:381–94.

    Article  PubMed  Google Scholar 

  18. Hinman F, Bauman FW. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol. 1973;109:727–32.

    Article  CAS  PubMed  Google Scholar 

  19. Ochoa B, Gorlin RJ. Urofacial (ochoa) syndrome. Am J Med Genet. 1987;27(3):661–7.

    Article  CAS  PubMed  Google Scholar 

  20. Varlam DE, Dippell J. Non-neurogenic bladder and chronic renal insufficiency in childhood. Pediatr Nephrol. 1995;9(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  21. Nseyo U, Santiago-Lastra Y. Long-term complications of the neurogenic bladder. Urol Clin North Am. 2017;44(3):355–66.

    Article  PubMed  Google Scholar 

  22. Tuite GF, Thompson DNP, Austin PF, Bauer SB. Evaluation and management of tethered cord syndrome in occult spinal dysraphism: recommendations from the international children’s continence society. Neurourol Urodyn. 2018;37(3):890–903.

    Article  PubMed  Google Scholar 

  23. Agarwalla PK, Dunn IF, Scott M, Smith ER. Tethered cord syndrome. Neurosurg Clin N Am. 2007;18(3):531–47.

    Article  PubMed  Google Scholar 

  24. Marzuillo P, Diplomatico M, Marotta R, Perrone L, Miraglia Del Giudice E, Polito C, et al. Extraordinary daytime only urinary frequency in childhood: Prevalence, diagnosis, and management. J Pediatr Urol. 2018;14(2):177.e1–6.

    Article  Google Scholar 

  25. Mattsson S, Gladh G. Urethrovaginal reflux – a common cause of daytime incontinence in girls. Pediatrics. 2003;111(1):136–9.

    Article  PubMed  Google Scholar 

  26. Logan BL, Blais S. Giggle incontinence: evolution of concept and treatment. J Pediatr Urol. 2017;13(5):430–5.

    Article  PubMed  Google Scholar 

  27. Hansson S, Hjälmås K, Jodal U, Sixt R. Lower urinary tract dysfunction in girls with untreated asymptomatic or covert bacteriuria. J Urol. 1990;143:333–5.

    Article  CAS  PubMed  Google Scholar 

  28. Hansson S, Martinell J, Stokland E, Jodal U. The natural history of bacteriuria in childhood. Inf Dis Clin North Am. 1997;11(3):499–512.

    Article  CAS  Google Scholar 

  29. Liu JX, Leung VY, Chu WC, Sreedhar B, Metrewell C, Yeung CK. Characteristics of the bladder in infants with urinary tract infections: an ultrasound study. Pediatr Radiol. 2008;38(10):1084–8.

    Article  PubMed  Google Scholar 

  30. Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bägli D, Bower WF, et al. Treatment of daytime urinary incontinence: a standardization document from the International Children’s Continence Society. Neurourol Urodyn. 2015;36(1):43–50.

    Article  CAS  PubMed  Google Scholar 

  31. Burgers RE, Mugie SM, Chase J, Cooper CS, von Gontard A, Rittig CS, et al. Management of functional constipation in children with lower urinary tract symptoms; Report from the Standardization Committee of the International Children’s Continence Society. J Urol. 2013;190(1):29–36.

    Article  PubMed  Google Scholar 

  32. Hagstroem S, Rittig S, Kamperis K, Djurhuus JC. Timer watch assisted urotherapy in children. A randomised controlled trial. J Urol. 2010;184(4):1482–8.

    Article  PubMed  Google Scholar 

  33. Schäfer SK, Niemczyk J, von Gontard A, Pospeschill M, Becker N, Equit M. Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis. Eur Child Adolesc Psychiatry. 2017;27(8):949–64.

    Article  PubMed  Google Scholar 

  34. Gish P, Mosholder AD, Truffa M, Johann-Liang R. Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases. J Pediatr. 2009;155(3):432–4.

    Article  CAS  PubMed  Google Scholar 

  35. Medhi B, Mittal N, Bansal D, Prakash A, Sarangi SC, Nirthi B. Comparison of tolterodine with standard treatment in pediatric patients with non-neurogenic dysfunctional voiding/over active bladder: a systematic review. Indian J Physiol Pharmacol. 2013;57(4):343–53.

    CAS  PubMed  Google Scholar 

  36. Raes A, Hoebeke P, Segaert I, Van Laecke E, Dehoorne J, Vande Walle J. Retrospective analysis of efficacy and tolerability of tolterodine in children with overactive bladder. Eur Urol. 2004;45(2):240–4.

    Article  CAS  PubMed  Google Scholar 

  37. Deeks ED. Mirabegron: a review in overactive bladder syndrome. Drugs. 2018;78(8):833–44.

    Article  CAS  PubMed  Google Scholar 

  38. Blais AS, Nadeau G, Moore K, Genois L, Bolduc S. Prospective pilot study of mirabegron in pediatric patients with overactive bladder. Eur Urol. 2016;70(1):9–13.

    Article  PubMed  Google Scholar 

  39. Chase J, Austin P, Hoebeke P, McKenna P. The management of dysfunctional voiding in children: a report from the standardisation committee of the International Children’s Continence Society. J Urol. 2010;183(4):1296–302.

    Article  PubMed  Google Scholar 

  40. Rawashdeh YF, Austin P, Siggaard C, Bauer SB, Franco I, de Jong TP, et al. International children’s continence society’s recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn. 2012;31(5):615–20.

    Article  CAS  PubMed  Google Scholar 

  41. Koff SA, Byard MA. The daytime urinary frequency syndrome of childhood. J Urol. 1988;140(5 Pt 2):1280–1.

    Article  CAS  PubMed  Google Scholar 

  42. Berry AK, Zderic S, Carr M. Methylphenidate for giggle incontinence. J Urol. 2009;182(4 Suppl):2028–32.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

    Tryggve Nevéus

  2. Harvard Medical School, Boston, MA, USA

    Carlos R. Estrada

  3. Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Paul F. Austin

Authors
  1. Tryggve Nevéus
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  2. Carlos R. Estrada
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  3. Paul F. Austin
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Corresponding author

Correspondence to Tryggve Nevéus .

Editor information

Editors and Affiliations

  1. Division of Nephrology, Department of Pediatric Specialties, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy

    Francesco Emma

  2. Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein

  3. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Arvind Bagga

  4. Division of Pediatric Nephrology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Carlton M. Bates

  5. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust and University College London Institute of Child Health, London, UK

    Rukshana Shroff

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Nevéus, T., Estrada, C.R., Austin, P.F. (2022). Bladder Disorders. In: Emma, F., Goldstein, S.L., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-52719-8_52

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  • DOI: https://doi.org/10.1007/978-3-030-52719-8_52

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52718-1

  • Online ISBN: 978-3-030-52719-8

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