Evaluation of Functional Lower Urinary Tract Dysfunction in Children: Are the Physicians Complying with the Current Guidelines?

Abstract

Objective. To elucidate whether the diagnostic and treatment approaches of the physicians for functional lower urinary tract dysfunction (LUTD) in children is complying with the current guidelines. Material and Methods. We have conducted an internet-based national survey for the physicians from different departments randomly sampled from the database of Turkish Paediatric Urology Society. Participants were asked to answer two-page questionnaire consisting of 4 main sections: “demography,” “working conditions,” “daily practice,” and “scientific knowledge.” Kruskal Wallis and multiple logistic regression were used for statistical analyses. Results. Of the 117 departments a total of 93 have completed the survey (n: 58 urology; n: 35 paediatric nephrology). Routine use of a questionnaire with validated symptom scoring system was found to be 13.9%. Of the participants, only 38.7% were asking all of the patients to fill the bladder diary. During treatment, only 24.7% were applying standard urotherapy for every patient. Almost half of the clinicians (45.1%) believed that they were personally insufficient during the evaluation of those children. Finally, 86% reported that children with LUTD were not adequately approached. Conclusions. Evaluation of LUTD in children is not complying with the current guidelines. General approach for those children needs to be revisited by the clinicians.

Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

“…Additionally, studies have shown that urotherapy reduces the need for surgery in patients with VUR and decreases constipation and the number of urinary tract infections ( 15 ). In addition, several authors reported that in many studies without biofeedback, successful results were obtained with standard urotherapy ( 14 , 16 , 17 ).…”

The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women

“…The same document states that patient‐reported outcomes (PRO) constitute the greatest source of information on the impact of symptoms and the treatment benefit from the patient's perspective. The bladder diary (BD) is the most commonly used instrument to evaluate UI and “urgency” in clinical trials, although it is rarely used in the regular practice of urologists, and not used at all by primary care physicians, even although its use is recommended in the initial evaluation of patients with UI by the guidelines of the European Association of Urology as a semi‐objective measurement of evaluation for LUTS. According to a recent review of the published studies focused on the development and validation of different BD in terms of format, contents and duration, none of them fulfill the standards established to be regarded valid.…”

Paediatricians’ perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study

“…12 Paediatricians, who are the first to see young patients in the medical system, may be best positioned to identify and provide this type of treatment. However, only onefourth of urologists and nephrologists indicated they followed standard guidelines, 13 and even less is known about paediatricians. Questionnaire-based assessments of healthcare providers worldwide have demonstrated insufficient knowledge to meet guideline-recommended care.…”