ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

RESUMO CONTEXTO: Recentemente foi demonstrada associação entre sintomas do trato urinário inferior entre mães e filhos. No entanto, o papel da constipação funcional neste binômio não é claro. OBJETIVO: Avaliar a disfunção vésico-intestinal entre mães e filhos. MÉTODOS: Estudo transversal de base populacional. As mães e os filhos responderam a um questionário de autorresposta, composto pelos critérios de Roma IV, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System e perguntas sociodemográficas. RESULTADOS: Foram estudados 441 pares mãe-filho. A idade média dos filhos foi de 9,1±2,7 anos, sendo 249 (56,5%) do sexo feminino. A idade média das mães foi de 35,7±6,1 anos. A constipação sem sintomas do trato urinário inferior estava presente em 35 (7,9%) crianças e 74 (16,8%) mães. Sintomas do trato urinário inferior isolados estavam presentes em 139 (31,5%) crianças e 92 (20,9%) mães e a disfunção vésico-intestinal ocorreu em 51 (11,6%) crianças e 78 (17,7%) mães. Não houve associação entre sintomas isolados do trato urinário inferior em crianças e sintomas isolados do trato urinário inferior em mães (P=0,31). Na análise univariada, houve associação entre disfunção vésico-intestinal em crianças e disfunção vésico-intestinal em mães (OR=4,8 IC 95% 2,6-9,6; P<0,001) e constipação isolada em crianças e constipação isolada em mães (OR=3,0 IC 95 % 1,4-6,4; P=0,003). Na análise multivariada, mães com disfunção vésico-intestinal foi o único fator de associação independente para disfunção vésico-intestinal em crianças (OR=5,4 IC 95% 2,5-11,6; P<0,001). CONCLUSÃO: Mães com disfunção vésico-intestinal têm maior probabilidade de ter filhos com disfunção vésico-intestinal. A associação entre constipação e sintomas do trato urinário inferior desempenha um papel importante nesta apresentação familiar.

ABSTRACT BACKGROUND: Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE: To evaluate bladder and bowel dysfunction between mothers and children. METHODS: A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS: A total of 441 mother-child pairs was obtained. Children’s mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers’ mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn’t any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION: Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

ABSTRACT Purpose To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. Materials and Methods A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. Results Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. Conclusions These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.