Abstract General Information

Title

THE INFLUENCE OF SCHOOL CHARACTERISTICS ON THE PREVALENCE OF LOWER URINARY TRACT SYMPTOMS: A SYSTEMATIC REVIEW

Introduction and objective

Lower urinary tract dysfunction (LUTD) is a common chronic condition in children. Since children spend most of their time at school, it is important to determine school related factors influencing LUTD. The goal of this study is to systematically review the evidence concerning the influence of school characteristics on the prevalence of lower urinary tract symptoms (LUTS) and related conditions in primary and secondary school children.

Method

This systematic review was drafted following the recommendations of the Preferred Reported Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The research was conducted by consulting PubMed, Web of Science and CINAHL in November 2022. The first screening was based on title and abstract, after which a full-text screening was performed. Articles reporting the influence of school characteristics on the prevalence of LUTS and related conditions in primary and secondary school children were eligible. Included studies were scored on methodological and reporting quality using the QualSyst tool for Assessment of included studies and the EBRO guidelines were applied to define the level of evidence.

Results

A total of six studies were elected, of which two case-control studies and four cross-sectional studies. Four of the studies investigated the influence of bullying on LUTS, reporting a significantly higher severity of LUTS when bullied more. Also, when children were physically bullied and in case of a higher self-perceived victimization, the severity of LUTS scored significantly higher. A cause-effect relationship could not be found. The teacher’s role in bathroom use and LUTS was surveyed in one study, concerning their beliefs and knowledge. A sizeable proportion of teachers were found to be unaware of the required amount of drinking (49.3%) and urination (24.6%) per day. Two of the included studies established the relationship between LUTS and a variety of flaws in bathroom infrastructure and the dissatisfaction of school-going children. Evidence showed a significant association between these deficiencies and different LUTS. School toilet infrastructure is often substandard, causing many children to postpone micturition or defecation.

Conclusion

Even though school has an important role in the prevention or treatment of LUTD, this systematic review found that teachers' knowledge of LUTD is limited and their classroom rules on drinking and toilet behaviour often hinder proper lower urinary tract health.