The applicability of the urine color scale in pediatric urology.

AIMS: To determine the level of agreement between healthcare professionals, patients and their parents/guardians in the interpretation of the urine color scale (UCS) in cases of urinary dysfunction, analyzing the applicability of the scale as a diagnostic tool determining the hydration status. METHODS: This was a cross-sectional study involving 5-17-year-old patients with lower urinary tract symptoms (LUTS) and enuresis. The study was conducted in a public healthcare referral center for pediatric urology in the Brazilian state of Bahia between October 2019 and March 2020. The Kolmogorov-Smirnov test was used to assess the distribution of the variables. Agreement was assessed using the kappa coefficient and weighted kappa. The z-test was used to determine significant differences between the kappa and weighted kappa. The statistical analysis was conducted using SPSS, version 14, and significance was established at p < 0.05. RESULTS: Forty-four patients were included. The kappa value was 32.4% (p = 0.000) for the agreement between healthcare professionals and patients, 41.9% (p = 0.000) for agreement between healthcare professionals and parents/guardians, and 25.0% (p = 0.001) for agreement between patients and parents/guardians. The weighted kappa was 70.6% (p = 0.000) for agreement between healthcare professionals and patients, 82.4% (p = 0.000) for agreement between healthcare professionals and parents/guardians, and 51.5% (p = 0.001) for agreement between patients and parents/guardians. There was a statistically significant difference in kappa values when the healthcare professionals were compared with the other groups. CONCLUSIONS: Although there were some inconsistencies in interpretation, the UCS proved to be a useful tool with which to evaluate patients' hydration status.

Use of ChatGPT in Urology and its Relevance in Clinical Practice: Is it useful?

ABSTRACT Purpouse: One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. Materials and Methods: ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. Results and Conclusion: ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.

Use of ChatGPT in Urology and its Relevance in Clinical Practice: Is it useful?

PURPOUSE: One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. MATERIALS AND METHODS: ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. RESULTS AND CONCLUSION: ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.

Cross-cultural adaptation and validation of the constipation scoring system for the pediatric population: A new tool to be used for constipated children.

BACKGROUND: The Rome IV criteria are used to characterize constipation and its subtypes, but not its severity. Conversely, the constipation scoring system (CSS) is a tool designed to assess the level of constipation severity and assist clinicians in selecting suitable therapeutic strategies. Although validated for adults, this score has yet to be validated for children. OBJECTIVE: To adapt and validate the CSS for the pediatric population. METHODS: Children and adolescents of 4-17 years of age with no morphological or neurological abnormalities of the gastrointestinal system were randomly selected during general consultation with a pediatrician and evaluated between November 2021 to April 2022. The Rome IV criteria were considered the gold-standard detection method. The adapted version was initially assessed on 30 children to assess comprehension and then administered to another 100 children. The internal consistency of the adapted questionnaire was assessed in a test-retest procedure with a two-week interval. RESULTS: One hundred patients with a mean age of 8.61 ± 3.25 years were assessed. Of these, 51 (51 %) were male. Most children (n = 91) received a score of 1-10 (the total CSS score can range from 0 to 30 points). The correlation between the pediatric version of the CSS and the Rome IV criteria was substantial, as shown by a positive Spearman correlation (r2) of 0.553 (p < 0.001). Cronbach's alpha between the test-retest responses was 0.97. When each item of the questionnaire was assessed individually, a greater level of internal consistency was found, indicating adequate internal reliability. DISCUSSION: The current study broadens the horizon with the emergence of new diagnostic aid for FC in Brazilian children and adolescents. In addition, this study provides the cornerstone for future research to determine the diagnostic accuracy of the CSS and its prognostic value for monitoring the treatment. The loss of a follow-up rate (26 %) during the telephone "test-retest" phase was a limitation. Using a subjective questionnaire such as the Rome IV criteria as the gold standard method may also represent a limitation. Further research is required on the use of objective diagnostic tools for FC including colonic transit time, anal manometry, cine-defecography, and electromyography. CONCLUSION: The CSS was successfully adapted for use with the pediatric population and was well accepted, confirming its language and psychometric validity in aiding the diagnosis of functional constipation. This was the first step towards validating the use of this score in other countries and cultures to assess the severity of constipation in children.

Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction

ABSTRACT Purpose: Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. Materials and Methods: This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. Results: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. Conclusion: RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction.

PURPOSE: Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. MATERIALS AND METHODS: This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. RESULTS: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. CONCLUSION: RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

Quality of life and psychological aspects in children with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation - A prospective multicenter study.

OBJECTIVE: To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB). METHODS: This international, multicenter, prospective cohort study involved individuals of 6-16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol. RESULTS: Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Median DVSS was 11 (range 6-13.5) and 3 (range 0-7), (p < 0.001), and median ICIQ-CLUTS was 12 (range 9-14) and 9 (range 5.7-12), (p < 0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9-59.7) to 39 (range 29-53.15) following treatment (p = 0.04). Median total SDQ score before and after treatment was 17 (range 13.5-21) and 15 (range 12-21), respectively (p = 0.939). CONCLUSION: Parasacral TENS was associated with a significant improvement in urinary symptoms and QoL; however, there was no change in psychological symptoms, as measured using the SDQ.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly

ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

Time until maximum flow rate uroflowmetry: A new parameter for predicting failure of transcutaneous electrical nerve stimulation (TENS) in treating children and adolescents with overactive bladder.

AIM: To analyze uroflowmetry as a predictor of the outcome of treatment with parasacral transcutaneous electrical nerve stimulation (TENS) in patients with pure overactive bladder. METHODS: Thirty-eight patients of 5-16 years of age were included in this prospective cohort study. All the patients had been seen at a referral clinic between 2006 and 2015. All had a diagnosis of pure overactive bladder and were treated with TENS. Parameters established at pretreatment uroflowmetry were evaluated, with patients then being separated into two groups based on their visual analogue scale (VAS) score immediately following TENS. The variables analyzed at uroflowmetry were: maximum flow rate, curve pattern (bell or tower-shaped), time until maximum flow and voided volume. RESULTS: The mean age of the children evaluated was 7.26 years (SD: 2.62) (95%CI: 6.4-8.13) and 73.7% were girls. No association was found between maximum flow rate, curve pattern (bell or tower-shaped) or voided volume and the complete resolution of symptoms following treatment. Nevertheless, a shorter time until maximum flow was associated with a greater likelihood of treatment failure. CONCLUSION: The time until maximum flow rate before treatment is a potential predictor of the outcome of TENS treatment.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly.

PURPOSE: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. MATERIALS AND METHODS: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. RESULTS: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. CONCLUSION: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

Urgency in children with overactive bladder or voiding postponement: What's the difference?

INTRODUCTION: Overactive bladder (OAB) and voiding postponement (VP) can share the same symptom of urgency, but with different pathophysiology, including the cerebral interpretation of bladder filling. The objective of the present study was to compare the clinical, psychological and sociodemographic features of children with urgency for OAB with those who presented urgency for VP (UrVP). METHODS: A retrospective cross-sectional study with an analytical component was conducted with patients of 5-14 years of age with urinary urgency between January, 2014, and January, 2019. Urinary symptoms were evaluated using the Dysfunctional Voiding Scoring System (DVSS) questionnaire, constipation using the Rome IV criteria and psychological symptoms using the Strengths and Difficulties Questionnaire (SDQ). All the patients had bell-shaped or tower-shaped curves at uroflowmetry and no significant post-void residual volume at ultrasonography. Patients were classified as having OAB or UrVP depending on whether they voided >3 or ≤3 times/day, respectively. RESULTS: Median age of the 101 children/adolescents included was 9 years, with no significant difference between the groups. The prevalence of OAB was 60.4%. Girls constituted 57.4% of the sample but 67.5% of the postponement group, although no independent association was found between sex and diagnosis. The prevalence of constipation was 75.2%, with no difference between the groups. The children with OAB had higher behavioral hyperactivity scores and more intense externalizing symptoms, although there was no significant difference between the groups for the SDQ total difficulties score. In the multivariate analysis, the independent clinical factors associated with a diagnosis of OAB were behavioral hyperactivity (OR = 5.134), urge incontinence (OR = 4.694) and MVV/EBC (%) (OR = 0.983). CONCLUSION: More behavioral problems, particularly hyperactivity, were found in children with OAB compared to those with UrVP. No statistically significant difference was found between the groups evaluated insofar as their sociodemographic characteristics are concerned. Furthermore, as expected, there was a strong association between the symptom of urge incontinence and lower MVV/EBC in the children and adolescents with OAB compared to those with voiding postponement.

O fazer dos estágios curriculares na formação em psicologia: uma experiência coletiva / The making of curricular internships in psychology training: a collective experience

O presente trabalho apresenta a concepção e o fazer dos estágios básicos e específicos do curso de Psicologia da Escola Bahiana de Medicina e Saúde Pública (EBMSP), instituição vocacionada para a saúde. Em seguida, descreve o funcionamento das referidas práticas, apresentando o contexto na qual elas estão inseridas e o processo de gestão do processo. Os estágios ocupam um lugar diferenciado na organização curricular do curso de Psicologia da EBMSP, pois oferecem aos discentes possibilidades de articulação entre teoria e prática de maneira crítica e reflexiva, conforme orientação das Diretrizes Curriculares Nacionais para os Cursos de Graduação de Psicologia. Os componentes fazem parte do eixo pré-profissionalizante e possibilitam a experiência em espaços e processos diversos de trabalho, nas duas ênfases do curso, Saúde e Trabalho. As atividades acontecem ao longo do quarto e quinto ano e são mediadas por vários participantes: corpo discente, corpo docente, coordenação e supervisor de campo. É a organização acadêmica e pedagógica dos estágios que permite a oferta de experiências práticas diferenciadas para o desenvolvimento de competências relacionadas ao fazer do Psicólogo. Observa-se que ao longo dos 20 anos do curso de Psicologia da EBMSP, os estágios estão em aprimoramento contínuo com foco na construção da identidade profissional do discente. Evidenciase, a partir da avaliação dos discentes, docentes e dos supervisores de campo que o egresso do curso de Psicologia da EBMSP, apresenta uma formação generalista, com competências práticas adquiridas para atuarem nos campos da saúde e trabalho com elevado nível técnico, integrados de forma crítica à sociedade, à realidade e ao mundo de trabalho.

This work presents the conception and implementation of basic and specific internships in the Psychology course at the Bahiana School of Medicine and Public Health (EBMSP), an institution dedicated to health. Then, it describes the functioning of these practices, presenting the context in which they are inserted and the process management process. The internships occupy a different place in the curricular organization of the Psychology course at EBMSP, as they offer students possibilities of articulation between theory and practice in a critical and reflective way, as guided by the National Curricular Guidelines for Psychology Undergraduate Courses. The components are part of the pre-professional axis and enable the experience in different work spaces and processes, in the two emphases of the course, Health and Work. The activities take place over the fourth and fifth year and are mediated by several participants: student body, faculty, coordination and field supervisor. It is the academic and pedagogical organization of the internships that allows the offering of different practical experiences for the development of skills related to the Psychologist's work. It is observed that throughout the 20 years of the Psychology course at EBMSP, the internships are in continuous improvement with a focus on building the student's professional identity. It is evident from the evaluation of students, teachers and field supervisors that the graduate of the Psychology course at EBMSP, presents a generalist training, with practical skills acquired to work in the fields of health and work with high technical level, integrated critically to society, reality and the world of work.

Association between stress and lower urinary tract symptoms in children and adolescents.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. MATERIALS AND METHODS: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. RESULTS: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%).Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p<0.01) and psychophysiological reactions (p <0.05). CONCLUSION: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

Association between stress and lower urinary tract symptoms in children and adolescents

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

Risk factors for urinary tract infection in children with urinary urgency

ABSTRACT Purpose To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. Materials and Methods A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. Results Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. Conclusions These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Risk factors for urinary tract infection in children with urinary urgency.

PURPOSE: To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. MATERIALS AND METHODS: A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. RESULTS: Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. CONCLUSIONS: These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

OBJECTIVE: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). MATERIAL AND METHODS: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. RESULTS: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. CONCLUSION: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

ABSTRACT Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. Results: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. Conclusion: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.