High BMI may negatively impact treatment response in paediatric LUT dysfunction
Children with lower urinary tract (LUT) dysfunction and elevated body mass index (BMI) are highly likely to experience treatment failure, a recent study suggests.
The study included 100 paediatric patients with non-neurogenic LUT dysfunction (mean age at diagnosis 7.7 years; 54 percent female). Evaluations including BMI, lower urinary tract symptoms, constipation, medical and psychologic comorbidities, and imaging and treatment outcomes were performed during an 18-month period.
BMI was normalized by age and gender according to percentiles: underweight (<5th percentile), healthy (5th to <85th percentile), overweight (85th to <95th percentile) and obese (>95th percentile). Uni- and multivariate logistic regression analyses facilitated identification of treatment response predictors.
Of the patients, 69 were of normal weight, 22 were overweight and nine were obese. Over a median follow-up of 15.3 months, treatment response was complete in 15 percent, partial in 63 percent and not observed in the remaining 22 percent.
Univariate analysis found nonresponse to treatment to be statistically associated with elevated BMI (p=0.04) and history of urinary tract infection (p=0.01). After adjustments for all other variables, the likelihood of treatment failure was 3.1 (95 percent CI, 1.11 to 8.64; p=0.03)-fold increased among children with higher BMI (>85th percentile).
Bladder-bowel management involves a bowel programme and timed voiding regimen, with additional treatment modalities tailored according to the prevailing symptoms, researchers said. The present data show that school-aged children with a BMI ≥85th percentile are more than three times likely to experience treatment failure when adjusting for all other patient characteristics including constipation and a history of urinary tract infection, they added.
Study limitations include the relatively small sample size, lack of uroflow with electromyography to confirm the presence or the absence of detrusor sphincter dyssynergia, and inconsistent anticholinergic dosing.
Children with LUT dysfunction often present with urinary urgency, frequency and incontinence. Having a prevalence ranging from 5 to 17 percent globally, symptoms of LUT dysfunction potentially cause major distress and negatively affect the quality of life of school-aged children. Learned unhealthy voiding habits such as holding can induce or exacerbate LUT dysfunction. [J Urol 2016;195:1232–1238]