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Bladder and bowel dysfunction (BBD) is a spectrum of lower urinary tract symptoms and voiding dysfunction accompanied by functional constipation and / or encopresis and may represent up to 47% of paediatric urology consultations. The BBD cycle pattern begins when children who postpone urination / defaecation for longer periods exhibit reduced sensation to evacuate. It is a potential cause of significant physical and psychosocial burden for children and families, and can be associated with secondary vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTI). This is a prospective observational study conducted across 12 European centres. Newly referred English-speaking patients with BBD symptoms aged 5-12 years old were included. Patients were asked if their child had a history of formal neuropsychiatric developmental disorders (NPDD) e.g. autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), developmental coordination disorder or obsessive-compulsive disorder. Parents completed two questionnaires looking at voiding dysfunction and bladder / bowel symptoms. Costs of medications prior to paediatric urology referral were also calculated. In total, 240 patients were recruited. There were 156 male (65%) and 84 female (35%) patients. There were more male patients with pre-existing NPDD. Following a one-year bladder retraining, bowel management and pelvic floor physiotherapy programme with biofeedback, those children with BBD and NPDD were more likely to have had a longer duration of symptoms prior to referral, more symptoms, higher objective scoring severity, lower quality of life, higher medication costs prior to referral and higher treatment resistance compared to those without NPDD. This is an interesting study which may help paediatric urologists / paediatricians managing patients with BBD and NPDD to set reasonable expectations for families and GPs. Patients without NPDD are approximately six times more likely to gain full resolution of their symptoms at the one-year point. Potentially in refractory patients, it may be worth looking further to ensure there are no subtle or occult neuropsychiatric developmental disorders. These findings may also allow development of unique treatment strategies to improve the treatment outcomes in this patient population.

Neuropsychiatric developmental disorders in children are associated with an impaired response to treatment in bladder bowel dysfunction: a prospective multi-institutional European observational study.
O’Kelly F, t’Hoen LA, Silay S, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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