Pediatric overactive bladder and lower urinary tract dysfunctions: diagnosis and treatment

摘要

The most common lower urinary tract (LUT) dysfunction in children is overactive bladder syndrome (OAB). This has been known by numerous other names such as urge syndrome, urgency frequency syndrome, hyperactive bladder syndrome, persistent infantile bladder and detrusor hypertonia. Recently, the International Children’s Continence Society has been attempting to standardize the nomenclature; OAB is the accepted terminology today. OAB is defined by the presence of one or all the following symptoms: urgency, frequency, urge incontinence and nocturia, which is less common in children than in the adults. This constellation of symptoms in general represents what the International Children’s Continence Society defines as storage symptoms. Until recently, the concepts that had been used to dictate the management of this problem in children were based on the foundation that this was primarily a bladder problem (small bladder capacity) and/or a delay in maturation in the nervous system of children. The expectation that children would outgrow their problems led many pediatric urologists and other practitioners to tell parents that “they would not be wetting themselves on their wedding day”. However, recent studies in adult patients with OAB have shown that they had symptoms as children. Recent findings of associations between LUT symptoms and sexual dysfunction, as well as between LUT dysfunction and neuropsychiatric problems, have opened up a new frontier into the possible mechanisms of OAB in children. These findings point to OAB as a symptom of a more centrally located dysfunction that affects multiple systems. This review presents a brief review of the neurophysiology of voiding as well as a how to evaluate and treat the child with OAB symptoms. In conclusion, the movement away from a vesicocentric way of thinking to a more corticocentric mode of thinking, along with new imaging modalities that can examine the brain as it works, will be of great value in determining future treatments of OAB. Medications generated from these evidence-based studies will hopefully treat the underlying disease process and not just the symptoms.