Pediatric Nephrology

, Volume 33, Issue 12, pp 2207–2219 | Cite as

Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society

  • Stephen YangEmail author
  • Michael E. Chua
  • Stuart Bauer
  • Anne Wright
  • Per Brandström
  • Piet Hoebeke
  • Søren Rittig
  • Mario De Gennaro
  • Elizabeth Jackson
  • Eliane Fonseca
  • Anka Nieuwhof-Leppink
  • Paul Austin



We present a consensus view from the International Children’s Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae.


A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement.


BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented.


This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.


Bladder bowel dysfunction Urinary tract infection Consensus statement 



Bladder bowel dysfunction


Bristol Stool Form Scale


Dysfunctional elimination syndrome


Dysfunctional voiding


Dysfunctional voiding symptom score


Lower urinary tract


Lower urinary tract dysfunction


Post-void residual urine


Urinary tract infection


Vesicoureteral reflux


Voiding cystourethrogram


Urodynamic and videourodynamic study


Antegrade continence enema


Clean intermittent catheterization


Source of funding


Compliance with ethical standards

Conflict of interest


Supplementary material

467_2017_3799_MOESM1_ESM.doc (115 kb)
ESM 1 (DOC 115 kb)


  1. 1.
    Koff SA, Wagner TT, Jayanthi VR (1998) The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 160:1019–1022PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Dias CS, Silva JM, Diniz JS, Lima EM, Marciano RC, Lana LG, Trivelato AL, Lima MS, Simöes e Silva AC, Oliveira EA (2010) Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux. Pediatr Infect Dis J 29:139–144PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Giurici N, Pennesi M (2012) Importance of bladder bowel dysfunction in patients with urinary tract infection. J Pediatr 161:370PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    O’Regan S, Yazbeck S, Schick E (1985) Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol 23:152–154PubMedPubMedCentralGoogle Scholar
  5. 5.
    Kistner M (2009) Dysfunctional elimination behaviors and associated complications in school-age children. J Sch Nurs 25:108–116PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A (2015) Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 136:e13–e21PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Mathews R, Bhatnagar S, Ivanova A, Mattoo TK, Moxey-Mims M, Carpenter MA, Pohl HG, Greenfield S (2016) Recurrent urinary tract infections in children with bladder and bowel dysfunction. Pediatrics 137:e20152982CrossRefGoogle Scholar
  8. 8.
    Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T (2016) 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. Neurourol Urodyn 35:471–481PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Bauer SB, Austin PF, Rawashdeh YF, de Jong TP, Franco I, Siggard C, Jorgensen TM; International Children’s Continence Society (2012) International Children’s Continence Society’s recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 31:610-614Google Scholar
  10. 10.
    Rawashdeh YF, Austin P, Siggaard C, Bauer SB, Franco I, de Jong TP, Jorgensen TM, International Children’s Continence Society (2012) International Children’s Continence Society’s recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children. Neurourol Urodyn 31:615–620PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Chase J, Austin P, Hoebeke P, McKenna P, International Children’s Continence Society (2010) The management of dysfunctional voiding in children: a report from the standardisation Committee of the International Children’s Continence Society. J Urol 183:1296–1302PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Hoebeke P, Bower W, Combs A, De Jong T, Yang S (2010) Diagnostic evaluation of children with daytime incontinence. J Urol 183:699–703PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Neveus T, Eggert P, Evans J, Macedo A, Rittig S, Tekgül S, Vande Walle J, Yeung CK, Robson L, International Children’s Continence Society (2010) Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society. J Urol 183:441–447PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S, American Academy of Pediatrics; European Society for Paediatric Urology; European Society for Paediatric Nephrology; International Children’s Continence Society (2012) Practical consensus guidelines for the management of enuresis. Eur J Pediatr 171:971–983PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Burgers RE, Mugie SM, Chase J, Cooper CS, von Gontard A, Rittig CS, Homsy Y, Bauer SB, Benninga MA (2013) 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 190:29–36PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Franco I, von Gontard A, De Gennaro M, International Children’s Continence Society (2013) Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children’s Continence Society. J Pediatr Urol 9:234–243PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bagli D, Bower WF, Renson C, Kawauchi A, Yang SS (2017) Treatment of daytime urinary incontinence: a standardization document from the International Children’s Continence Society. Neurourol Urodyn 36:43–50PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Koppen IJ, von Gontard A, Chase J, Cooper CS, Rittig CS, Bauer SB, Homsy Y, Yang SS, Benninga MA (2016) Management of functional nonretentive fecal incontinence in children: recommendations from the International Children’s Continence Society. J Pediatr Urol 12:56–64PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Arshad M, Seed PC (2015) Urinary tract infections in the infant. Clin Perinatol 42:17–28PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Gupta P, Mandal J, Krishnamurthy S, Barathi D, Pandit N (2015) Profile of urinary tract infections in paediatric patients. Indian J Med Res 141:473–477PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Nogueira PC, Paz Ide P (2016) Signs and symptoms of developmental abnormalities of the genitourinary tract. J Pediatr 92(3 Suppl 1):S57–S63CrossRefGoogle Scholar
  22. 22.
    Shaikh N, Morone NE, Bost JE, Farrell MH (2008) Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 27:302–308PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1A):5S–13SPubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Tekgül S, European Association of Urology; European Society for Pediatric Urology (2015) Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 67:546–558PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Van Batavia JP, Ahn JJ, Fast AM, Combs AJ, Glassberg KI (2013) Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction. J Urol 190(4 Suppl):1495–1499PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessman HA, Hoberman A (2016) Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr 170:848–854PubMedCrossRefGoogle Scholar
  27. 27.
    Sillén U (2001) Bladder function in healthy neonates and its development during infancy. J Urol 166:2376–2381PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Chen Y, Wen JG, Li Y, Li YD, Li ZZ, Konttinen YT (2012) Twelve-hour daytime observation of voiding pattern in newborns <4 weeks of age. Acta Paediatr 101:583–586PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Olsen LH, Grothe I, Rawashdeh YF, Jørgensen TM (2010) Urinary flow patterns in first year of life. J Urol 183:694–698PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Lee L, Koyle M (2014) The role of bladder and bowel dysfunction (BBD) in pediatric urinary tract infections. Curr Bladder Dysfunct Rep 9:188–196CrossRefGoogle Scholar
  31. 31.
    Wen JG, Ren CC, Chen Y, Lu YT, Yang L, Cui LG, Wen L, Jia LH, Li YL, Zhang Q (2014) Free voiding patterns in preterm and full-term newborn infants are different between males and females. Acta Paediatr 103:e450–e453PubMedCrossRefGoogle Scholar
  32. 32.
    Steer CD, Emond AM, Golding J, Sandhu B (2009) The variation in stool patterns from 1 to 42 months: a population-based observational study. Arch Dis Child 94:231–233PubMedCrossRefGoogle Scholar
  33. 33.
    Vandenplas Y, Abkari A, Bellaiche M, Benninga M, Chouraqui JP, Çokura F, Harb T, Hegar B, Lifschitz C, Ludwig T, Miqdady M, de Morais MB, Osatakul S, Salvatore S, Shamir R, Staiano A, Szajewska H, Thapar N (2015) Prevalence and health outcomes of functional gastrointestinal symptoms in infants from birth to 12 months of age. J Pediatr Gastroenterol Nutr 61:531–537PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Çamurdan AD, Beyazova U, Özkan S, Tunç VT (2014) Defecation patterns of the infants mainly breastfed from birth till the 12th month: prospective cohort study. Turk J Gastroenterol 25(Suppl 1):1–5PubMedGoogle Scholar
  35. 35.
    Zeevenhooven J, Koppen IJ, Benninga MA (2017) The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr 20:1–13PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Vaz GT, Vasconcelos MM, Oliveira EA, Ferreira AL, Magalhães PG, Silva FM, Lima EM (2012) Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol 27:597–603PubMedCrossRefGoogle Scholar
  37. 37.
    Von Gontard A, Baeyens D, Van Hoecke E, Warzak WJ, Bachmann C (2011) Psychological and psychiatric issues in urinary and fecal incontinence. J Urol 185:1432–1437CrossRefGoogle Scholar
  38. 38.
    Equit M, Klein AM, Braun-Bither K, Gräber S, von Gontard A (2014) Elimination disorders and anxious-depressed symptoms in preschool children: a population-based study. Eur Child Adolesc Psychiatry 23:417–423PubMedGoogle Scholar
  39. 39.
    Zhao PT, Velez D, Faiena I, Creenan EM, Barone JG (2015) Bullying has a potential role in pediatric lower urinary tract symptoms. J Urol 193(5 Suppl):1743–1748PubMedCrossRefGoogle Scholar
  40. 40.
    Alpaslan AH, Koçak U, Avci K, Güzel HI (2016) Association between elimination disorders and abusive maternal attitudes. J Forensic Legal Med 40:22–27CrossRefGoogle Scholar
  41. 41.
    Veloso LA, Mello MJ, Ribeiro Neto JP, Barbosa LN, Silva EJ (2016) Quality of life, cognitive level and school performance in children with functional lower urinary tract dysfunction. J Bras Nefrol 38:234–244PubMedCrossRefGoogle Scholar
  42. 42.
    Mugie SM, Benninga MA, Di Lorenzo C (2011) Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol 25:3–18PubMedCrossRefGoogle Scholar
  43. 43.
    Mugie SM, Di Lorenzo C, Benninga MA (2011) Constipation in childhood. Nat Rev Gastroenterol Hepatol 8:502–511CrossRefGoogle Scholar
  44. 44.
    Wald A, Sigurdsson L (2011) Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol 25:19–27CrossRefGoogle Scholar
  45. 45.
    Burgers R, de Jong TP, Visser M, Di Lorenzo C, Dijkgraaf MG, Benninga MA (2013) Functional defecation disorders in children with lower urinary tract symptoms. J Urol 189:1886–1891PubMedCrossRefGoogle Scholar
  46. 46.
    Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M (2016) Functional disorders: children and adolescents. Gastroenterology. CrossRefGoogle Scholar
  47. 47.
    Chang SJ, Tsai LP, Hsu CK, Yang SS (2015) Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children. Pediatr Nephrol 30:1131–1137PubMedCrossRefGoogle Scholar
  48. 48.
    Chung KL, Chao NS, Liu CS, Tang PM, Liu KK, Leung MW (2014) Abnormal voiding parameters in children with severe idiopathic constipation. Pediatr Surg Int 30:747–749PubMedCrossRefGoogle Scholar
  49. 49.
    Ambartsumyan L, Siddiqui A, Bauer S, Nurko S (2016) Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts. Neurogastroenterol Motil 28:924–933PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Giramonti KM, Kogan BA, Agboola OO, Ribons L, Dangman B (2005) The association of constipation with childhood urinary tract infections. J Pediatr Urol 1:273–278PubMedCrossRefGoogle Scholar
  51. 51.
    Mulvey MA, Schilling JD, Martinez JJ, Hultgren SJ (2000) Bad bugs and beleaguered bladders: interplay between uropathogenic Escherichia Coli and innate host defenses. Proc Natl Acad Sci U S A 97:8829–8835PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Chrzan R, Klijn AJ, Vijverberg MA, Sikkel F, de Jong TP (2008) Colonic washout enemas for persistent constipation in children with recurrent urinary tract infections based on dysfunctional voiding. Urology 71:607–610PubMedCrossRefGoogle Scholar
  53. 53.
    Loening-Baucke V (1997) Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 100(2 Pt 1):228–232PubMedCrossRefGoogle Scholar
  54. 54.
    Jodal U, Smellie JM, Lax H, Hoyer PF (2006) Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the international reflux study in children. Pediatr Nephrol 21:785–792PubMedCrossRefGoogle Scholar
  55. 55.
    Alexander SE, Arlen AM, Storm DW, Kieran K, Cooper CS (2015) Bladder volume at onset of vesicoureteral reflux is an independent risk factor for breakthrough febrile urinary tract infection. J Urol 193:1342–1346PubMedCrossRefGoogle Scholar
  56. 56.
    Arlen AM, Alexander SE, Wald M, Cooper CS (2016) Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. J Pediatr Urol 12:288.e1–288.e5CrossRefGoogle Scholar
  57. 57.
    Vincent SA (1966) Postural control of urinary incontinence. The curtsy sign. Lancet 2:631–632PubMedCrossRefGoogle Scholar
  58. 58.
    Martins G, Minuk J, Varghese A, Dave S, Williams K, Farhat WA (2016) Non-biological determinants of paediatric bladder bowel dysfunction: a pilot study. J Pediatr Urol 12:109.e1–109.e6CrossRefGoogle Scholar
  59. 59.
    Dos Santos J, Varghese A, Williams K, Koyle MA (2014) Recommendations for the management of bladder bowel dysfunction in children. Pediatr Therapeut 4:191CrossRefGoogle Scholar
  60. 60.
    Hoebeke P, Van Laecke E, Raes A, Van Gool JD, Vande Walle J (1999) Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction. BJU Int 83:294–298PubMedCrossRefGoogle Scholar
  61. 61.
    Klijn AJ, Bochove-Overgaauw D, Winkler-Seinstra PL, Dik P, de Jong TP (2012) Urethral meatus deformities in girls as a factor in dysfunctional voiding. Neurourol Urodyn 31:1161–1164PubMedCrossRefGoogle Scholar
  62. 62.
    Dubrovsky AS, Foster BJ, Jednak R, Mok E, McGillivray D (2012) Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys. CMAJ 184:E796–E803PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Furtado PS, Lordêlo P, Minas D, Menezes J, Veiga ML, Barroso U Jr (2014) The influence of positioning in urination: an electromyographic and uroflowmetric evaluation. J Pediatr Urol 10:1070-1075PubMedCrossRefGoogle Scholar
  64. 64.
    CC S, Chang SJ, Yang SS (2014) Postvoiding urine accumulation in the vestibule in a girl complaining of postvoiding urine incontinence. Low Urin Tract Symptoms 6:185–186CrossRefGoogle Scholar
  65. 65.
    Lopes I, Veiga ML, Braga AA, Brasil CA, Hoffmann A, Barroso U Jr (2015) A two-day bladder diary for children: is it enough? J Pediatr Urol 11:348.e1–348.e4CrossRefGoogle Scholar
  66. 66.
    Maternik M, Chudzik I, Krzeminska K, Żurowska A (2016) Evaluation of bladder capacity in children with lower urinary tract symptoms: comparison of 48-hour frequency/volume charts and uroflowmetry measurements. J Pediatr Urol 12:214.e1–214.e5CrossRefGoogle Scholar
  67. 67.
    Chung JM, Kim KS, Kim SO, Kim JM, Park S, Park JS, Oh MM, Lee SD, Korean Children’s Continence and Enuresis Society (2013) Evaluation of bladder capacity in Korean children younger than 24 months: a nationwide multicenter study. World J Urol 31:225–228PubMedCrossRefGoogle Scholar
  68. 68.
    Tsai JD, Chang SJ, Lin CC, Yang SS (2014) Incomplete bladder emptying is associated with febrile urinary tract infection in infants. J Pediatr Urol 10:1222–1226PubMedCrossRefGoogle Scholar
  69. 69.
    Farhat W, Bägli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A, McLorie GA (2000) The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 164(3 Pt 2):1011–1015PubMedCrossRefGoogle Scholar
  70. 70.
    Hoen LA, Korfage IJ, Verhallen JT, van Ledden-Klok MJ, van den Hoek J, Blok BF, Scheepe JR (2016) Vancouver symptom score for dysfunctional elimination syndrome: reliability and validity of the Dutch version. J Urol 196:536–541PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Drzewiecki BA, Thomas JC, Pope JC 4th, Adams MC, Brock JW 3rd, Tanaka ST (2012) Use of validated bladder/bowel dysfunction questionnaire in the clinical pediatric urology setting. J Urol 188(4 Suppl):1578-1583PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Altan M, Çitamak B, Bozaci AC, Mammadov E, Doğan HS, Tekgül S (2017) Is there any difference between questionnaires on pediatric lower urinary tract dysfunction? Urology 103:204–208PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Riegler G, Esposito I (2001) Bristol Scale Stool Form. A still valid help in medical practice and clinical research. Tech Coloproctol 5:163–164PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Tangal S, Gökçe Mİ, Özayar A, Gülpınar B, Haliloğlu AH, Burgu B, Özdiler E (2014) Evaluation of a new ultrasound measurement tool for the diagnosis of dysfunctional voiding in pediatric population: full/empty bladder wall thickness ratio. Urology 83:1369–1372PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Godbole P, Raghavan A, Searles J, Roberts J, Walters SJ (2013) Dynamic pelvic floor ultrasound for lower urinary tract symptoms in children—initial report on normative values. J Pediatr Urol 9(6 Pt A):950–954PubMedCrossRefGoogle Scholar
  76. 76.
    AAP Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 128:595–610CrossRefGoogle Scholar
  77. 77.
    Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, Gurgoze MK, Bressan S, Smolkin V, Tuerlinckx D, Stefanidis CJ, Vaos G, Leblond P, Gungor F, Gendrel D, Chalumeau M (2013) Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI. Pediatrics 131:870–879PubMedCrossRefGoogle Scholar
  78. 78.
    Karavanaki K, Haliotis FA, Sourani M, Kariyiannis C, Hantzi E, Zachariadou L, Avlonitis S, Papassotiriou I, Stefanidis CJ (2007) DMSA scintigraphy in febrile urinary tract infections could be omitted in children with low procalcitonin levels. Infect Dis Clin Pract 15:377–381CrossRefGoogle Scholar
  79. 79.
    Berger MY, Tabbers MM, Kurver MJ, Boluyt N, Benninga MA (2012) Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 161:44–50.e1-2PubMedCrossRefGoogle Scholar
  80. 80.
    Yang SS, Chiang IN, Hsieh CH, Chang SJ (2014) The Tzu chi nomograms for maximum urinary flow rate (Qmax) in children: comparison with Miskolc nomogram. BJU Int 113:492–497PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Kutlu O, Koksal IT, Guntekin E, Kukul E (2010) Role of spinning top urethra in dysfunctional voiding. Scand J Urol Nephrol 44:32–37PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P, International Children’s Continence Society Standardization Subcommittee (2015) International Children’s Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn 34:640–647PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Fernández-Ibieta M, Ayuso-González L (2016) Dysfunctional voiding in pediatrics: a review of pathophysiology and current treatment modalities. Curr Pediatr Rev 12:292–300PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Trial Investigators RIVUR, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA (2014) Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 370:2367–2376CrossRefGoogle Scholar
  85. 85.
    de Bessa J Jr, de Carvalho Mrad FC, Mendes EF, Bessa MC, Paschoalin VP, Tiraboschi RB, Sammour ZM, Gomes CM, Braga LH, Bastos Netto JM (2015) Antibiotic prophylaxis for prevention of febrile urinary tract infections in children with vesicoureteral reflux: a meta-analysis of randomized, controlled trials comparing dilated to nondilated vesicoureteral reflux. J Urol 193(5 Suppl):1772-1777Google Scholar
  86. 86.
    Robinson JL, Le Saux N (2016) Management of urinary tract infections in children in an era of increasing antimicrobial resistance. Expert Rev Anti-Infect Ther 14:809–816PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Vasconcellos R, de Azevedo M, Oliveira EA, de Almeida Vasconcelos MM, de Castro BAC, Pereira FR, Duarte NFV, de Jesus PMR, Vaz GTB, Lima EM (2014) Impact of an interdisciplinary approach in children and adolescents with lower urinary tract dysfunction (LUTD). J Bras Nefrol 36:451–459Google Scholar
  88. 88.
    Wolfe-Christensen C, Manolis A, Guy WC, Kovacevic N, Zoubi N, El-Baba M, Kovacevic LG, Lakshmanan Y (2013) Bladder and bowel dysfunction: evidence for multidisciplinary care. J Urol 190:1864–1868PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Fusch C, Hungerland E, Scharrer B, Moeller H (1993) Water turnover of healthy children measured by deuterated water elimination. Eur J Pediatr 152:110–114PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Rush EC, Chhichhia P, Kilding AE, Plank LD (2010) Water turnover in children and young adults. Eur J Appl Physiol 110:1209–1214PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Wennergren HM, Oberg BE, Sandstedt P (1991) The importance of leg support for relaxation of the pelvic floor muscles. A surface electromyograph study in healthy girls. Scand J Urol Nephrol 25:205–213PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Kakizaki H, Kita M, Watanabe M, Wada N (2016) Pathophysiological and therapeutic considerations for non-neurogenic lower urinary tract dysfunction in children. Low Urin Tract Symptoms 8:75–85PubMedCrossRefPubMedCentralGoogle Scholar
  93. 93.
    Joinson C, Heron J, Von GA, Butler U, Emond A, Golding J (2009) A prospective study of age at initiation of toilet training and subsequent daytime bladder control in school-age children. J Dev Behav Pediatr 30:385–393PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Hellstrom AL, Sillen U (2001) Early potty training advantageous in bladder dysfunction. Decreases the risk of urinary infection. Lakartidningen 98:3216–3219PubMedPubMedCentralGoogle Scholar
  95. 95.
    Yang SS, Zhao LL, Chang SJ (2011) Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurourol Urodyn 30:1253–1257PubMedPubMedCentralGoogle Scholar
  96. 96.
    Jansson UB, Hanson M, Hanson E, Hellstrom AL, Sillen U (2000) Voiding pattern in healthy children 0 to 3 years old: a longitudinal study. J Urol 164:2050–2054PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Duong TH, Jansson UB, Holmdahl G, Sillen U, Hellstrom AL (2010) Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol 6:501–505PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Koenig JF, McKenna PH (2011) Biofeedback therapy for dysfunctional voiding in children. Curr Urol Rep 12:144–152PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Kajbafzadeh AM, Sharifi-Rad L, Ghahestani SM, Ahmadi H, Kajbafzadeh M, Mahboubi AH (2011) Animated biofeedback: an ideal treatment for children with dysfunctional elimination syndrome. J Urol 186:2379–2384PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Fazeli MS, Lin Y, Nikoo N, Jaggumantri S, Collet JP, Afshar K (2015) Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials. J Urol 193:274–279PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA (2011) Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol 7:342–348PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Kumsar Ş, Keskin U, Akay A, Bilgilisoy UT, Erdem ŞR, Peşkircioğlu ÇL, Özkardeş H (2015) Effects of sacral neuromodulation on isolated urinary bladder function in a rat model of spinal cord injury. Neuromodulation 18:67–74PubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Wright AJ, Haddad M (2017) Electroneurostimulation for the management of bladder bowel dysfunction in childhood. Eur J Paediatr Neurol 21:67–74PubMedCrossRefPubMedCentralGoogle Scholar
  104. 104.
    Sulkowski JP, Nacion KM, Deans KJ, Minneci PC, Levitt MA, Mousa HM, Alpert SA, Teich S (2015) Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg 50:1644–1647PubMedCrossRefPubMedCentralGoogle Scholar
  105. 105.
    Shaikh N, Abedin S, Docimo SG (2005) Can ultrasonography or uroflowmetry predict which children with voiding dysfunction will have recurrent urinary tract infections? J Urol 174(4 Pt 2):1620–1622PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Chang SJ, Chiang IN, Hsieh CH, Lin CD, Yang SS (2013) Age- and gender-specific nomograms for single and dual post-void residual urine in healthy children. Neurourol Urodyn 32:1014–1018PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Yang SS, Chiang IN, Lin CD, Chang SJ (2012) Advances in non-surgical treatments for urinary tract infections in children. World J Urol 30:69–75PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Pohl HG, Bauer SB, Borer JG, Diamond DA, Kelly MD, Grant R, Briscoe CJ, Doonan G, Retik AB (2002) The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. BJU Int 89:923–927PubMedCrossRefPubMedCentralGoogle Scholar
  109. 109.
    Hanna-Wakim RH, Ghanem ST, El Helou MW, Khafaja SA, Shaker RA, Hassan SA, Saad RK, Hedari CP, Khinkarly RW, Hajar FM, Bakhash M, El Karah D, Akel IS, Rajab MA, Khoury M, Dbaibo GS (2015) Epidemiology and characteristics of urinary tract infections in children and adolescents. Front Cell Infect Microbiol 5:45PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Peters CA, Skoog SJ, Arant BS Jr, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (2010) Summary of the AUA guideline on Management of Primary Vesicoureteral Reflux in children. J Urol 184:1134-1144PubMedCrossRefPubMedCentralGoogle Scholar
  111. 111.
    Austin PF, Homsy YL, Masel JL, Cain MP, Casale AJ, Rink RC (1999) Alpha-adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol 162(3 Pt 2):1064–1067PubMedCrossRefPubMedCentralGoogle Scholar
  112. 112.
    Kramer SA, Rathbun SR, Elkins D, Karnes RJ, Husmann DA (2005) Double-blind placebo controlled study of alpha-adrenergic receptor antagonists (doxazosin) for treatment of voiding dysfunction in the pediatric population. J Urol 173:2121–2124PubMedCrossRefPubMedCentralGoogle Scholar
  113. 113.
    Yucel S, Akkaya E, Guntekin E, Kukul E, Akman S, Melikoglu M, Baykara M (2005) Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. J Urol 174(4 Pt 2):1612–1615PubMedCrossRefPubMedCentralGoogle Scholar
  114. 114.
    Kajbafzadeh AM, Baradaran N, Sadeghi Z, Tourchi A, Saeedi P, Madani A, Ataei N, Taghavinejad AM, Mohsseni MJ (2010) Vesicoureteral reflux and primary bladder neck dysfunction in children: urodynamic evaluation and randomized, double-blind, clinical trial on effect of α-blocker therapy. J Urol 184:2128–2133PubMedCrossRefPubMedCentralGoogle Scholar
  115. 115.
    Ayan S, Kaya K, Topsakal K, Kilicarslan H, Gokce G, Gultekin Y (2005) Efficacy of tolterodine as a first-line treatment for non-neurogenic voiding dysfunction in children. BJU Int 96:411–414PubMedCrossRefGoogle Scholar
  116. 116.
    Kilic N, Balkan E, Akgoz S, Sen N, Dogruyol H (2006) Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability. Int J Urol 13:105–108PubMedCrossRefGoogle Scholar
  117. 117.
    Alloussi S, Mürtz G, Braun R, Gerhardt U, Heinrich M, Hellmis E, Horn W, Marschall-Kehrel D, Niklas K, Raabe M, Rössler T, Seibt B, Siemer S, Schultz-Lampel D, Walter H, Wiedeking B, Alloussi S, Bock P, Strugala G, Madersbacher H (2010) Efficacy, tolerability and safety of propiverine hydrochloride in comparison to oxybutynin in children with urge incontinence due to overactive bladder: results of a multicentre observational cohort study. BJU Int 106:550–556PubMedCrossRefPubMedCentralGoogle Scholar
  118. 118.
    Marschall-Kehrel D, Feustel C, Persson de Geeter C, Stehr M, Radmayr C, Sillén U, Strugala G (2009) Treatment with propiverine in children suffering from nonneurogenic overactive bladder and urinary incontinence: results of a randomized placebo-controlled phase 3 clinical trial. Eur Urol 55:729–736PubMedCrossRefPubMedCentralGoogle Scholar
  119. 119.
    Blais AS, Nadeau MK, Genois L, Bolduc S (2016) Prospective pilot study of Mirabegron in pediatric patients with overactive bladder. Eur Urol 70:9–13PubMedCrossRefPubMedCentralGoogle Scholar
  120. 120.
    Franco I, Landau-Dyer L, Isom-Batz G, Collett T, Reda EF (2007) The use of botulinum toxin a injection for the management of external sphincter dyssynergia in neurologically normal children. J Urol 178:1775–1780PubMedCrossRefPubMedCentralGoogle Scholar
  121. 121.
    Steinhardt GF, Naseer S, Cruz OA (1997) Botulinum toxin: novel treatment for dramatic urethral dilatation associated with dysfunctional voiding. J Urol 158:190–191PubMedCrossRefPubMedCentralGoogle Scholar
  122. 122.
    Mangera A, Apostolidis A, Andersson KE, Dasgupta P, Giannantoni A, Roehrborn C, Novara G, Chapple C (2014) An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol 65:981–990PubMedCrossRefPubMedCentralGoogle Scholar
  123. 123.
    t Hoen LA, van den Hoek J, Wolffenbuttel KP, van der Toorn F, Scheepe JR (2015) Breaking the vicious circle: Onabotulinum toxin a in children with therapy-refractory dysfunctional voiding. J Pediatr Urol 11:119:e1–e6Google Scholar
  124. 124.
    Vricella GJ, Campigotto M, Coplen DE, Traxel EJ, Austin PF (2014) Long-term efficacy and durability of botulinum-a toxin for refractory dysfunctional voiding in children. J Urol 191(5 Suppl):1586–1591PubMedCrossRefPubMedCentralGoogle Scholar
  125. 125.
    Sorokan ST, Finlay JC, Jefferies AL, Canadian Paediatric Society, Fetus and Newborn Committee, Infectious Diseases and Immunization Committee (2015) Newborn male circumcision. Paediatr Child Health 20:311–320PubMedCrossRefPubMedCentralGoogle Scholar
  126. 126.
    Hiraoka M, Tsukahara H, Ohshima Y, Mayumi M (2002) Meatus tightly covered by the prepuce is associated with urinary infection. Pediatr Int 44:658–662PubMedCrossRefPubMedCentralGoogle Scholar
  127. 127.
    Moreno G, Corbalán J, Peñaloza B, Pantoja T (2014) Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev 9:CD008973Google Scholar
  128. 128.
    Williams GJ, Craig JC, Carapetis JR (2013) Preventing urinary tract infections in early childhood. Adv Exp Med Biol 764:211–218PubMedCrossRefPubMedCentralGoogle Scholar
  129. 129.
    Kose E, Yavascan O, Turan O, Kangin M, Bal A, Alparslan C, Sirin Kose S, Kuyum P, Aksu N (2013) The effect of circumcision on the frequency of urinary tract infection, growth and nutrition status in infants with antenatal hydronephrosis. Ren Fail 35:1365–1369PubMedCrossRefPubMedCentralGoogle Scholar
  130. 130.
    Morris BJ, Wiswell TE (2013) Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis. J Urol 189:2118–2124PubMedCrossRefPubMedCentralGoogle Scholar
  131. 131.
    Zee RS, Herbst KW, Kim C, McKenna PH, Bentley T, Cooper CS, Herndon CD (2016) Urinary tract infections in children with prenatal hydronephrosis: a risk assessment from the Society for Fetal Urology Hydronephrosis Registry. J Pediatr Urol 12:261.e1–261.e7CrossRefGoogle Scholar
  132. 132.
    Silay MS, Tanriverdi O, Karatag T, Ozcelik G, Horasanli K, Miroglu C (2011) Twelve-year experience with Hinman–Allen syndrome at a single center. Urology 78:1397–1401PubMedCrossRefGoogle Scholar
  133. 133.
    Handel LN, Barqawi A, Checa G, Furness PD III, Koyle MA (2003) Males with Down’s syndrome and nonneurogenic neurogenic bladder. J Urol 169:646–649PubMedCrossRefGoogle Scholar
  134. 134.
    Christison-Lagay ER, Rodriguez L, Kurtz M, St Pierre K, Doody DP, Goldstein AM (2010) Antegrade colonic enemas and intestinal diversion are highly effective in the management of children with intractable constipation. J Pediatr Surg 45:213–219PubMedCrossRefGoogle Scholar
  135. 135.
    Chong C, Featherstone N, Sharif S, Cherian A, Cuckow P, Mushtaq I, De Coppi P, Cross K, Curry J (2016) 5 years after an ACE: what happens then? Pediatr Surg Int 32:397–401PubMedCrossRefGoogle Scholar
  136. 136.
    Basson S, Zani A, McDowell S, Athanasakos E, Cleeve S, Phelps S, Charlesworth P (2014) Antegrade continence enema (ACE): predictors of outcome in 111 patients. Pediatr Surg Int 30:1135–1141PubMedCrossRefGoogle Scholar
  137. 137.
    Hunziker M, Mohanan N, D’Asta F, Puri P (2012) Incidence of febrile urinary tract infections in children after successful endoscopic treatment of vesicoureteral reflux: a long-term follow-up. J Pediatr 160:1015–1020PubMedCrossRefGoogle Scholar
  138. 138.
    Dwyer ME, Husmann DA, Rathbun SR, Weight CJ, Kramer SA (2013) Febrile urinary tract infections after ureteroneocystostomy and subureteral injection of dextranomer/hyaluronic acid for vesicoureteral reflux—do choice of procedure and success matter? J Urol 189:275–282PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2017

Authors and Affiliations

  • Stephen Yang
    • 1
    Email author
  • Michael E. Chua
    • 1
    • 2
    • 3
  • Stuart Bauer
    • 4
  • Anne Wright
    • 5
  • Per Brandström
    • 6
  • Piet Hoebeke
    • 7
  • Søren Rittig
    • 8
  • Mario De Gennaro
    • 9
  • Elizabeth Jackson
    • 10
  • Eliane Fonseca
    • 11
  • Anka Nieuwhof-Leppink
    • 12
  • Paul Austin
    • 13
  1. 1.Department of UrologyTaipei Tzu-Chi Hospital, and Buddhist Tzu Chi UniversityTaipeiTaiwan
  2. 2.Department of UrologyThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Institute of UrologySt. Luke’s Medical CenterQuezon CityPhilippines
  4. 4.Department of UrologyBoston Children’s HospitalBostonUSA
  5. 5.Department of Paediatric NephrourologyEvelina Children’s HospitalLondonUK
  6. 6.Department of PediatricsThe Queen Silvia Children’s HospitalGothenburgSweden
  7. 7.Department of UrologyGhent University HospitalGhentBelgium
  8. 8.Department of PediatricsAarhus UniversityAarhusDenmark
  9. 9.Department of UrologyBambino Gesù Children’s Hospital of RomeRomeItaly
  10. 10.Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  11. 11.Department of PediatricsRio de Janeiro State UniversityRio de JaneiroBrazil
  12. 12.University Medical Centre-Wilhelmina KinderziekenhuisUtrechtNetherlands
  13. 13.Department of UrologySt Louis Children’s HospitalSt. LouisUSA

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