Pathophysiological and Therapeutic Considerations for Non‐Neurogenic Lower Urinary Tract Dysfunction in Children

Abstract

Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children.

Efficacy and safety of intradetrusor onabotulinumtoxinA injection for managing paediatric non-neurogenic overactive bladder: A prospective case-series study

“…Non-neurogenic lower urinary tract dysfunction in the paediatric population is very common and is one of the important underlying causes of LUTS, UTI and VUR in affected children [1]. Bladder overactivity can be defined as the presence of voiding urgency, associated with increased daytime frequency and nocturia, with or without urinary incontinence (UI), in the absence of UTI or other obvious pathology [2].…”

“…Pelvic floor biofeedback training should be considered the initial treatment option in patients with nonneurogenic overactive bladder (OAB), as it is an effective treatment modality in children with treatment refractory OAB and dysfunctional voiding [5], or can be used as a supplementary to standard urotherapy [1].…”

“…Pharmacotherapy for OAB should have a better chance of curing various problems and improving self-esteem and quality of life in children with hyperactive bladder [1]. Oxybutynin, an M-cholinoblocker, is the 'gold standard' for the pharmacotherapy of childhood bladder dysfunction [4].…”

Non-Neurogenic Bladder Dysfunction in Children: Diagnosis and Procedure.

“…The process of urinary control is governed by the central nervous system from the fetus to adulthood and almost always occurs when the child is awake. 3,6 In the bladder transition phase from the infantile form to the adult form, the dis-coordination between the detrusor muscle and the urethral sphincter may occur transiently and normally as long as the children undergo toilet training. The change in urinary control starts from the gradual change of functional bladder capacity, the maturation of detrusor-sphincter coordination, and the gradual development of conscious control of the sphincter-sphincter-perineal complex.…”

“…3,8,12 Non-neurogenic bladder dysfunction affects the quality of the child's life both physically and psychosocially. [1][2][3]6 Physical effects include anatomical damage and renal function and urinary tract, either due to secondary infection in the form of renal scarring, vesicoureter reflux, or obstruction leads to chronic kidney disease. Psychosocial effects include impaired concentration or learning disorders, decreased self-confidence, and mental / emotional disturbance due to urinary problems.…”