Psychosocial comorbidities and obesity are associated with lower urinary tract symptoms in children with voiding dysfunction.

PURPOSE: There is emerging awareness of comorbid psychosocial characteristics in children with lower urinary tract dysfunction. To explore the prevalence of these comorbidities and their relationship to lower urinary tract symptoms, we examined the psychosocial comorbidities and body mass index of children with lower urinary tract dysfunction. MATERIALS AND METHODS: We prospectively collected data on all new patients 6 to 17 years old with nonneurogenic lower urinary tract dysfunction who presented to a single nurse practitioner in 2011. Parents completed a 21-question lower urinary tract symptom score based on a validated questionnaire and a psychosocial questionnaire that screened for stressful life events and psychological diagnoses. We examined the correlation of body mass index percentile and psychosocial comorbidities with lower urinary tract symptom score. RESULTS: Of the 358 patients 28.5% were obese, 31.8% had a recent life stressor and 22.9% had a comorbid psychiatric disorder. Younger age correlated with a higher lower urinary tract symptom score (r = -0.34, p <0.0001). Children with a recent life stressor (p = 0.049), psychiatric disorder (p = 0.0026) or the 2 comorbidities (p = 0.039) had a significantly higher lower urinary tract symptom score than children without comorbidities. Underweight and obese children had a significantly higher lower urinary tract symptom score than healthy weight and overweight children (p = 0.009). CONCLUSIONS: Almost a third of the patients in our study were obese. More than 40% of the children had a psychiatric disorder and/or recent life stressor. Younger age, an underweight or obese body mass index and a recent stressful life event or psychiatric disorder correlated with a higher lower urinary tract symptom score. This study supports previous recommendations to screen for psychosocial comorbidities and obesity during the evaluation of pediatric lower urinary tract dysfunction.

Combination therapy with desmopressin and an anticholinergic medication for nonresponders to desmopressin for monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: Desmopressin is an approved medical therapy for the treatment of monosymptomatic primary nocturnal enuresis. In cases of limited response to desmopressin, we have added anticholinergic therapy to desmopressin (combination therapy). To evaluate this treatment strategy, we examined the efficacy of combination therapy for primary nocturnal enuresis in desmopressin-nonresponders. METHODS: Only patients with primary nocturnal enuresis refractory to the maximal dosage of desmopressin were enrolled. Children with lower urinary tract symptoms or bowel dysfunction were excluded, on the basis of a 3-day, 24-hour, frequency-volume chart and elimination record. Children continued to take desmopressin and were assigned randomly, in a double-blind manner, to receive either extended-release anticholinergic medication or placebo. Patients were reassessed after 1 month of therapy, with a 1-week nocturnal record. RESULTS: Forty-one desmopressin-nonresponders were enrolled, and 7 patients were excluded because of noncompliance. The treatment groups were equally matched with respect to age, gender, functional bladder capacity, and number of wet nights per week. After 1 month of treatment, there was a significant reduction in the mean number of wet nights in the combination therapy group, compared with the placebo group. With a generalized estimating equation approach, there was a significant 66% decrease in the risk of a wet episode, compared with the placebo group. CONCLUSIONS: This study represents the first prospective, placebo-controlled trial examining the effect of desmopressin in combination with long-acting, anticholinergic, bladder-relaxing therapy for monosymptomatic primary nocturnal enuresis.