Screening of children with LUT dysfunction needs refining

By Sally Robertson, B.Sc.Feb 25 2013

Physicians should include screening for psychosocial comorbidities and obesity when evaluating children with lower urinary tract (LUT) dysfunction, say researchers.

In a prospective study of 358 children with LUT dysfunction, almost half of parents reported that their child had a psychiatric disorder, recent stressful experience (recent life stressor), or both.

In addition, a similar proportion of the children had an overweight or obese body mass index, a known risk factor for a less favorable response to treatment of LUT dysfunction.

Writing in the Journal of Urology, the researchers say that their "observations support recent recommendations to attempt to identify both known and previously unrecognized psychosocial factors that may interfere with therapy."

In their analysis of questionnaires completed by the parents of children (mean age, 9.7 years) presenting with nonneurogenic LUT dysfunction, the researchers found that the mean LUT symptom score (LUTSS) was 40.5 in boys and 40.8 in girls.

Parents reported that their child had a comorbid psychiatric disorder in 23% of cases, with attention deficit hyperactivity disorder being the most prevalent at 8%. In addition, 32% of the children had experienced a recent life stressor such as school problems, parental divorce, or abuse.

Children with a recent life stressor, psychiatric disorder, or both had a significantly higher LUTSS than children without any psychosocial comorbidities, report Paul Austin (Washington University School of Medicine, St Louis, Missouri, USA) and colleagues.

The study also showed that although the majority (53%) of children were a healthy weight, 17% were overweight and 29% were obese. Children in the lowest or highest fifth percentile for body mass index-for-age had a significantly higher LUTSS than normal weight and overweight children.

"Obesity has been shown to correlate with lower response rates to treatment of voiding dysfunction," note Austin and colleagues. "Future studies will confirm whether this was also observed in our patient population."

The study shows that it is important to identify comorbidities in children presenting with LUT dysfunction, say the researchers. Initial evaluation of the condition should involve screening for these comorbidities as this may help select children who might benefit from a multidisciplinary treatment approach, they add.

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