- Email: [email protected]
About the article: Prevalence of lower urinary tract symptoms in individuals with down syndrome
Journal of Pediatric Urology (2015) 11, 230e231
Letter to the Editor
About the article: Prevalence of lower urinary tract symptoms in individuals with down syndrome*
To the Editor, Journal of Pediatric Urology:
In the study published by our group, titled ‘Prevalence of lower urinary tract symptoms in individuals with Down syndrome’ (Mrad FCC, et al. J Pediatr Urol 2014; 10:844e9), we found a 27.3% (23/84) prevalence of lower urinary tract symptoms (LUTS) and higher frequency in young males with Down syndrome (DS), and a strong association between LUTS and functional constipation. Four years after collecting the data for that study, we decided to review these 23 patients with DS and LUTS by reapplying the Dysfunctional Voiding Symptom Score (DVSS) [1] adapted and validated for the Brazilian population [2]. We observed that 47.83% (11/23) of these individuals improved their DVSS score and 45.45% (5/11) showed improvement in constipation, using the Rome III criteria [3]. Of these 11 patients, 54.54% (6/11) were male and 45.46% (5/11) female, and all of them were older than 10 years of age at the time of re-evaluation. Therefore, in this reassessment, we observed a reduction in symptoms with an increase in age. These findings are compatible with those of Rihtman et al. [4] who showed that in individuals with DS aged from 6 to 16 years, there is an improvement in motor and cognitive skills, which could therefore lead to a better voiding pattern. Although all families were instructed to seek a pediatric urologist for evaluation and treatment of dysfunctional voiding after the first assessment, none of them did so. Despite this advice, when responding to the DVSS for the second time, many caregivers stated that after participation in the study they began to pay more attention and were more aware of their child’s urinary problem. This was
different from the first assessment, when we noted that a great portion of caregivers felt that needing assistance during micturition would be normal for DS patients. An improvement in constipation was found in 45.45% (5/11) of the individuals who showed improved LUTS. This was probably because after the first evaluation these patients were counseled regarding diet and also trained to use the toilet. Three of them also received drug treatment with polyethylene glycol (PEG 4000) at 0.5 g/kg/day. This finding reinforces the need to approach the issue of constipation in children with DS and LUTS [5]. It is important to emphasize that the DS is a genetically determined condition and highlights human diversity; all the actions described in this study aim to improve the quality of life of these people and their families. The process of rehabilitation and inclusion into society should include treatment of urinary and bowel symptoms to improve and achieve a better quality of life.
Acknowledgments Again we are grateful to all the participants for their dedication and the Ambulatory Interdisciplinary Team of Down Syndrome of the Department of Health of Children and Adolescents (Unified Health System-SUSBrazil).
References [1] Farhat W, Bagli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A, et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 2000;164:1011e5. [2] Calado AA, Araujo EM, Barroso Jr U, Netto JM, Filho MZ, Macedo Jr A, et al. Cross-cultural adaptation of the dysfunctional voiding score symptom (DVSS) questionnaire for Brazilian children. Int Braz J Urol 2010;36:458e63. [3] Rasquim A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders:
DOI of original article: http://dx.doi.org/10.1016/j.jpurol.2014.02.011. The institution at which the work was performed: Center for Interdisciplinary Research in Urology Federal University of Juiz de Fora, Minas Gerais, Jose ¸o Kelm8er s/n e Campus Universitario, 36036900, Brazil. Tel.: þ55 (32) 21023978. Email: [email protected]. ´ Lourenc *
http://dx.doi.org/10.1016/j.jpurol.2015.06.004 1477-5131/ª 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Letter to the Editor children/adolescents. Gastroenterology 2006;130:1527e37. [4] Rihtman T, Tekuzener E, Parush S, Tenenbaum A, Bachrach SJ, Ornoy A. Are the cognitive functions of children with Down syndrome related to their participation? Dev Med Child Neurol 2010;52:72e8. [5] Burguers RE, Mugie SM, Chase J, Cooper CS, Von Gontard A, Ritting CS, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2013;190:29e36 [Review].
Fla ´via Cristina de Carvalho Mrad* Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
231 Jose ´ de Bessa Jr. State University of Feira de Santana, Feira de Santana, Bahia, Brazil Andre ´ Avarese de Figueiredo Jose ´ Murillo Bastos Netto Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil *Correspondence to: F.C. de Carvalho Mrad, Ludwig Van Beethoven 80, Juiz de Fora, 36036634, MG, Brazil, Tel.: þ55 (32) 88526360 E-mail addresses: [email protected], fonsecamreis@ terra.com.br (F.C. de Carvalho Mrad) 10 June 2015 Available online 24 June 2015
Letter to the Editor
About the article: Prevalence of lower urinary tract symptoms in individuals with down syndrome*
To the Editor, Journal of Pediatric Urology:
In the study published by our group, titled ‘Prevalence of lower urinary tract symptoms in individuals with Down syndrome’ (Mrad FCC, et al. J Pediatr Urol 2014; 10:844e9), we found a 27.3% (23/84) prevalence of lower urinary tract symptoms (LUTS) and higher frequency in young males with Down syndrome (DS), and a strong association between LUTS and functional constipation. Four years after collecting the data for that study, we decided to review these 23 patients with DS and LUTS by reapplying the Dysfunctional Voiding Symptom Score (DVSS) [1] adapted and validated for the Brazilian population [2]. We observed that 47.83% (11/23) of these individuals improved their DVSS score and 45.45% (5/11) showed improvement in constipation, using the Rome III criteria [3]. Of these 11 patients, 54.54% (6/11) were male and 45.46% (5/11) female, and all of them were older than 10 years of age at the time of re-evaluation. Therefore, in this reassessment, we observed a reduction in symptoms with an increase in age. These findings are compatible with those of Rihtman et al. [4] who showed that in individuals with DS aged from 6 to 16 years, there is an improvement in motor and cognitive skills, which could therefore lead to a better voiding pattern. Although all families were instructed to seek a pediatric urologist for evaluation and treatment of dysfunctional voiding after the first assessment, none of them did so. Despite this advice, when responding to the DVSS for the second time, many caregivers stated that after participation in the study they began to pay more attention and were more aware of their child’s urinary problem. This was
different from the first assessment, when we noted that a great portion of caregivers felt that needing assistance during micturition would be normal for DS patients. An improvement in constipation was found in 45.45% (5/11) of the individuals who showed improved LUTS. This was probably because after the first evaluation these patients were counseled regarding diet and also trained to use the toilet. Three of them also received drug treatment with polyethylene glycol (PEG 4000) at 0.5 g/kg/day. This finding reinforces the need to approach the issue of constipation in children with DS and LUTS [5]. It is important to emphasize that the DS is a genetically determined condition and highlights human diversity; all the actions described in this study aim to improve the quality of life of these people and their families. The process of rehabilitation and inclusion into society should include treatment of urinary and bowel symptoms to improve and achieve a better quality of life.
Acknowledgments Again we are grateful to all the participants for their dedication and the Ambulatory Interdisciplinary Team of Down Syndrome of the Department of Health of Children and Adolescents (Unified Health System-SUSBrazil).
References [1] Farhat W, Bagli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A, et al. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol 2000;164:1011e5. [2] Calado AA, Araujo EM, Barroso Jr U, Netto JM, Filho MZ, Macedo Jr A, et al. Cross-cultural adaptation of the dysfunctional voiding score symptom (DVSS) questionnaire for Brazilian children. Int Braz J Urol 2010;36:458e63. [3] Rasquim A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders:
DOI of original article: http://dx.doi.org/10.1016/j.jpurol.2014.02.011. The institution at which the work was performed: Center for Interdisciplinary Research in Urology Federal University of Juiz de Fora, Minas Gerais, Jose ¸o Kelm8er s/n e Campus Universitario, 36036900, Brazil. Tel.: þ55 (32) 21023978. Email: [email protected]. ´ Lourenc *
http://dx.doi.org/10.1016/j.jpurol.2015.06.004 1477-5131/ª 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Letter to the Editor children/adolescents. Gastroenterology 2006;130:1527e37. [4] Rihtman T, Tekuzener E, Parush S, Tenenbaum A, Bachrach SJ, Ornoy A. Are the cognitive functions of children with Down syndrome related to their participation? Dev Med Child Neurol 2010;52:72e8. [5] Burguers RE, Mugie SM, Chase J, Cooper CS, Von Gontard A, Ritting CS, et al. Management of functional constipation in children with lower urinary tract symptoms: report from the Standardization Committee of the International Children’s Continence Society. J Urol 2013;190:29e36 [Review].
Fla ´via Cristina de Carvalho Mrad* Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
231 Jose ´ de Bessa Jr. State University of Feira de Santana, Feira de Santana, Bahia, Brazil Andre ´ Avarese de Figueiredo Jose ´ Murillo Bastos Netto Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil *Correspondence to: F.C. de Carvalho Mrad, Ludwig Van Beethoven 80, Juiz de Fora, 36036634, MG, Brazil, Tel.: þ55 (32) 88526360 E-mail addresses: [email protected], fonsecamreis@ terra.com.br (F.C. de Carvalho Mrad) 10 June 2015 Available online 24 June 2015