Abstract General Information

Title

BRAIN BLADDER FLOW: DO PATIENTS WITH LUTS AND NEUROPSYCHIATRIC DISORDERS HAVE DIFFERENCES IN UROFLOWS?

Introduction and objective

Lower Urinary Tract Symptoms (LUTS) affect up to 20% of school age children and patients with LUTS have been shown to have an increased prevalence of neuropsychiatric disorders (NPD). However, little is known about whether these patients have differences in presenting symptoms or objective parameters like uroflow pattern. We investigated whether pediatric patients with LUTS and NPD have differences in their uroflow patterns compared to the general population and hypothesized that more of these patients would have abnormal uroflows compared to patients without NPD.

Method

We identified patients seen at our institution for LUTS from 5/2014 to 1/2016 who completed a uroflow. We excluded those with neurogenic bladder or known urologic abnormalities. Demographic data, the presence of a NPD, presenting symptoms, and DVISS score at initial and final visit were abstracted on chart review. Uroflow curves were classified into pattern types based on ICCS criteria. Presenting symptoms, DVISS scores and uroflow patterns were compared between patients with and without NPD.

Results

381 patients were included with median age 9 years. There were more females without NPD (54.8% vs. 43%, p=0.048). ADHD (52%), general anxiety (32%) and developmental delay (30%) were the most frequent NPD. Both the initial (14 vs. 10) and final (11 vs. 7) DVISS scores were higher in patients with NPD (p<0.001). Encopresis was the only symptom that was significantly more common in patients with NPD (2.8% vs. 11%, p=0.003). Patients with NPD were more likely to have an abnormal (non-bell shaped) uroflow curve (41.3% vs. 64.1%, p<0.001) and were more likely to have a non-smooth (interrupted or plateau type) curve (18.5% vs. 44%, p<0.001) with a staccato flow being the most common pattern (n=39, 39%).

Conclusion

Providers who care for children with LUTS must consider patients’ neuropsychiatric health when diagnosing and treating LUTS. Our data suggests that LUT symptomatology is more severe when NPD are present and that these patients are more likely to have abnormal uroflow curves. Further work is needed to determine whether standard treatments for LUT dysfunction work as effectively in children with NPD as those without.