Impact of an interdisciplinary approach in children and adolescents with lower urinary tract dysfunction (LUTD).

Autor:	de Azevedo RV; Universidade Federal de Minas Gerais., Oliveira EA; Universidade Federal de Minas Gerais., Vasconcelos MM; Universidade Federal de Minas Gerais., de Castro BA; Universidade Federal de Minas Gerais., Pereira FR; Universidade Federal de Minas Gerais., Duarte NF; Universidade Federal de Minas Gerais., de Jesus PM; Universidade Federal de Minas Gerais., Vaz GT; Faculdade de Ciencias Médicas., Lima EM; Universidade Federal de Minas Gerais.
Jazyk:	English; Portuguese
Zdroj:	Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia [J Bras Nefrol] 2014 Oct-Dec; Vol. 36 (4), pp. 451-9.
DOI:	10.5935/0101-2800.20140065
Abstrakt:	Introduction: The lower urinary tract dysfunction (LUTD) corresponds to changes in the filling or emptying of urine caused by neurogenic, anatomical and functional alterations. Objective: To evaluate the impact of treatment in children and adolescents with LUTD. Methods: Historical cohort of 15 year follow-up with the participation of 192 patients (123F, 69M), aged 0.1 to 16.8 years, analyzed at admission (T0) and at final follow-up (T1). Most patients belong to a neurologic bladder dysfunction group (60.4%). The treatment was uroterapy with behavioral and cognitive intervention, timed voiding, oral hydration, laxative diet, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enema, treatment of urinary tract infection (UTI) and, in refractory cases, surgical procedures such as continent and incontinent urinary diversion (vesicostomy), bladder augmentation and conduit for performing antegrade colonic enema. Results: The main symptoms were daytime urinary incontinence (82.3%), the non-monosymptomatic nocturnal enuresis (78.6%), fecal incontinence (54.2%) and constipation (47.9%). There was a significant reduction of urinary tract infection (p = 0.0027), daytime urinary incontinence (p < 0.001), nocturnal enuresis (p < 0.001), fecal incontinence (p = 0.010) and of vesicoureteral reflux (p = 0.01). There was significant increase in the use of CIC (p = 0.021), of anticholinergic therapy (p < 0.001) and decrease of chemoprophylaxis (p < 0.001). Conclusion: This study showed that treatment of LUTD in children must be individualized, and requires constant monitoring of clinical, laboratory and imaging to minimize the risk of kidney damage.
Databáze:	MEDLINE
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