Definition of Reliable, Objective Criteria by Abdominal Radiography to Identify Occult Constipation in Children with Lower Urinary Tract Symptoms

Marks, Andrew; Vasquez, Evalynn; Moylan, Susan; Diaz-Saldano, Dawn; Schreiber, Jennifer; Saker, Martha C.; Lindgren, Bruce W.

doi:10.1016/j.juro.2012.10.019

Cited by 10 publications

(15 citation statements)

References 11 publications

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“…Simple plain radiography was performed routinely for the kidneys, ureters, and bladder before treatment to identify abnormalities in the spine and stool retention. Stool impaction was assessed based on the definitions presented by Marks et al [ 4 ]. Rectal stool and total stool length (RSL and TSL, respectively) were measured as surrogate markers.…”

Section: Methodsmentioning

confidence: 99%

“…The diagnosis and management of constipation for the treatment of LUTD or enuresis have likewise not been fully clarified. A simple question such as “Do you think your child has constipation?” may not be helpful for identifying the presence of constipation due to frequent inconsistencies among parental perceptions, symptoms, and the real amount of fecal loading [ 4 , 5 ]. Moreover, it is difficult to determine the severity of constipation that warrants treatment for LUTD.…”

Section: Introductionmentioning

confidence: 99%

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Time Course of Treatment for Primary Enuresis With Overactive Bladder

Lee

Park

2018

Int Neurourol J

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PurposeTo characterize the course of treatment for nonmonosymptomatic enuresis with overactive bladder (OAB) in a real clinical setting.MethodsData from 111 OAB patients with moderate to severe enuresis were analyzed. The baseline analysis included a questionnaire, voiding diary, uroflowmetry with postvoid residual urine measurement, and plain abdominal radiography of the kidneys, ureters, and bladder (KUB). Following standard urotherapy for 1 month, anticholinergic medication was administered with or without laxatives. Desmopressin was added if there was a partial response to OAB. Patients were followed every 3 months to evaluate the status of OAB and enuresis. Multivariate analysis was performed to identify predictors associated with the lack of complete response (CR) in enuresis at 12 months.ResultsFollowing 12 months of treatment, 64% and 88% of patients experienced at least partial response in enuresis and OAB, respectively. Urgency improved more quickly than enuresis, supporting the need to address daytime symptoms before enuresis. Seventy-nine patients (71%) had fecal impaction on KUB and/or subjective constipation. The combination of anticholinergics with either laxatives or desmopressin fared better than anticholinergics alone. Daytime incontinence and anticholinergics-only treatment were associated with a lack of CR during 12 months of treatment.ConclusionsThe data confirmed the validity of addressing OAB before treating enuresis. The results of this study also highlight the need to address fecal impaction. Patients should be counseled about the need for a prolonged course of treatment before starting treatment. Anticholinergics should be accompanied with either desmopressin or laxatives for better control of enuresis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time Course of Treatment for Primary Enuresis With Overactive Bladder

Lee

Park

2018

Int Neurourol J

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“…The selection process was not clearly described in all three studies. Among the included studies, two studies [22,23] were conducted in the USA and one study was conducted in Iran, involving a total of 416 children with constipation. None of the included studies recruited patients in a consecutive or random manner, or at least this was not clearly specified.…”

Section: Resultsmentioning

confidence: 99%

“…None of the included studies recruited patients in a consecutive or random manner, or at least this was not clearly specified. While the two case-control studies [22,24] compared AXRs of children with and without a clinical diagnosis of constipation, the cohort study [23] retrospectively collected data on AXRs and calculated the sensitivity and specificity based on a later diagnosis of constipation. The diagnosis of constipation was made by the Rome III criteria in one study, and in two of the studies the definition of constipation was not specified.…”

Section: Resultsmentioning

confidence: 99%

“…The diagnosis of constipation was made by the Rome III criteria in one study, and in two of the studies the definition of constipation was not specified. While in two of the studies the AXRs were interpreted by radiologists [25,26], in the third study both radiologists and clinicians interpreted the AXRs [22]. Table 1 shows the study characteristics.…”

Section: Resultsmentioning

confidence: 99%

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The Diagnostic Accuracy of Abdominal X-ray in Childhood Constipation: A Systematic Review of the Literature

Rodriguez,

Dahlwi,

Gould

et al. 2024

Gastrointestinal Disorders

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Background: Previous systematic reviews have found insufficient and conflicting evidence for an association between the clinical and radiographic diagnosis of functional constipation. Abdominal X-ray is frequently used for the diagnosis of functional constipation in clinical practice. The objective of this study was to evaluate the diagnostic accuracy of abdominal X-ray for the evaluation of functional constipation in children. Results: Three studies were included in the final qualitative analysis. They were heterogeneous in their study design, definition of constipation, and radiologic parameters used to evaluate the abdominal X-rays. Sensitivities ranged from 73–92%, specificities ranged from 26–92%, and diagnostic accuracies ranged from 78–90%. Methods: This study involved a systematic review of English literature published between 2012 and 2022 covering children 2–18 years of age with a diagnosis of functional constipation in whom abdominal X-ray was performed. The databases searched include Medline, Embase, and Scopus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) guidelines were followed. PROSPERO ID: CRD42022301833. Conclusions: There is insufficient evidence to support the use of abdominal X-ray as part of the diagnostic workup of functional constipation. More methodologically rigorous studies are needed to determine the utility of abdominal X-ray in the evaluation of functional constipation. The diagnosis of functional constipation should be based on history and clinical findings.

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