Lower urinary tract dysfunction in children: what do pre-school teachers know about it?

OBJECTIVE: To evaluate the basic knowledge of pre-school teachers who deal with children between the ages of 4 and 7 years, who present signs of lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: We performed a survey with 50 teachers from 9 private schools working with pre-school children. The criteria for selection were if teachers were certified or non-certified elementary school teachers - NCEST and the amount of professional experience. RESULTS: Thirty-three teachers considered that the normal daily urinary frequency should be from 4 to 7 times. Two of the 50 teachers considered it normal to urinate less than 4 times per day and 15 teachers considered more than 7 times per day as normal. There was no difference between the 2 categories of certified or NCEST nor between those with more or less than five years of professional experience. Thirty-three percent believed that to urinate more than 4 times during a class period (4-5 hours) could indicate a urinary problem. There was a statistically significant difference among the certified and NCEST but not in terms of time of professional experience. If during this period the child would not ask to urinate, only 18 percent considered that as an indication of urinary problem. When asked about the symptoms that would indicate urinary urgency and urge incontinence, only 24 percent of the teachers connected it with urinary problem. There was no difference in terms of professional background or professional experience in these 2 last analyses. CONCLUSION: Our data shows evidences that private pre-schools teachers are not well informed of the clinical manifestation of LUTD.

Etiology of urinary tract infection in scholar children

OBJECTIVE: To prospectively assess the prevalence of vesicourethral dysfunction in children over 3 years old, comparing it with the occurrence rate for other potential factors that cause urinary infection in this age range. MATERIALS AND METHODS: 36 girls and 9 boys were assessed, with mean age of 6.4 years, ranging from 3 to 13.9 years. These children were prospectively assessed regarding the presence of symptoms of lower urinary tract dysfunction. These data were compared with the retrospective assessment of other potential risk factors for urinary infection. Ultrasonography was performed in 28 children and voiding cystourethrogram was performed in 26 patients. RESULTS: Vesicourethral dysfunction was diagnosed in 39 (87 percent) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77 percent) had urinary incontinence, 12 (31 percent) pollakiuria and 3 (8 percent) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22 percent) girls and phimosis in 2 (22 percent) boys. Obstipation was diagnosed in 10 (22 percent) cases. Significant post-voiding residue was detected in 4 (13 percent) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19 percent) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4 percent) cases there was not an apparent cause for the infection. CONCLUSION: Vesicourethral dysfunction is a major cause of urinary infection in children with ages above 3 years old. In cases where voiding dysfunction in not present, other predisposing factors must be assessed. However, only 4 percent of the patients did not present an apparent urologic cause for the infection.