Published on in Urology Update
At the DOVE Center for Voiding and Bladder Function, we take wetting seriously. For more than 10 years, we have been quantifying lower urinary tract symptoms (LUTS) in children using a validated patient/parent completed voiding symptom score to monitor the severity of symptoms, track outcomes to treatment, and progress over time.
For many children, their condition improves and their symptoms score drops with first line measures such as constipation management, proper hydration, and timed voiding. For children whose symptom score does not improve, we are guided by the score toward further investigation and intervention.
Using the voiding symptom score to understand mental health diagnoses and LUTS
The voiding symptom score allows us to better characterize the DOVE patient population.
It is known that ADHD and other mental health diagnoses carry a risk for LUTS. CHOP Pediatric Urologist Jason Van Batavia, MD, led a study investigating the incidence and distribution of ADHD and psychiatric diagnoses among patients presenting with LUTS. Using the symptom score, he characterized the distribution of these conditions with respect to specific LUTS and identified that patients with these diagnoses present with more severe LUT symptomatology.
Future work will include using the symptom score to quantify how these patients respond to usual treatments compared to patients without these diagnoses.
Bladder preservation and prevention of LUTS
Evidence is emerging that voiding disorders in childhood carry a risk for incontinence and other LUTS in adulthood, particularly among women. Daytime LUTS are more common in girls, and more than 15% of women age 40 and over experience urinary incontinence, with significant impact on their physical and emotional health. While much is known about how to treat LUTS in girls and women, little research has been done in the area of prevention.
Amanda Berry, CRNP, is a member of the NIH/NIDDK Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. The consortium was established to expand research beyond the detection and treatment of LUTS, to the promotion and preservation of bladder health and prevention of LUTS.
With a mission to identify factors that promote bladder health across the life course and prevent the onset of LUTS, the consortium is investigating the risk and protective factors for bladder health at the individual level — and at all levels of social ecology — including where individuals live, attend school, and work, and the prevailing policies and practices that govern bathroom access in those settings. While it will take years to gather the evidence to develop prevention interventions to promote bladder health, the work has the potential to impact the health of girls as they progress through puberty, childbearing years, and menopause.