ESPU Meeting on Saturday 6, September 2025, 11:30 - 12:15
11:30 - 11:33
S38-1 (OP)
Konrad SZYMANSKI 1, Benjamin WHITTAM 2, Hannah DILLON 2, Shelly KING 2, Joshua ROTH 2, Martin KAEFER 2, Brandon COCKRUM 1, Pankaj DANGLE 1, Kirstan MELDRUM 1, Richard RINK 2, Mark CAIN 2 and Rosalia MISSERI 2
1) Riley Children's Health at IU Health, Pediatric Urology, Indianapolis, USA - 2) Riley Children's Health at IU Health, Indianapolis, USA
PURPOSE
Existing health-related quality of life (HRQOL) questionnaires used for children with lower urinary tract dysfunction (LUTD) were developed without children's input and lack LUTD specificity and sensitivity to changing symptoms. We aimed to develop and validate a child-centered bladder-specific HRQOL questionnaire.
MATERIAL AND METHODS
We drafted an 18-question pilot questionnaire using a comprehensive item generation/refinement process with children with LUTD, parents and providers. It was administered to children 8-17 years old attending LUTD clinics and healthy controls (2023-2024). Final questions were determined by clinical relevance, high factor loadings and psychometrics. At baseline and at 3 months, children also completed the 13-item symptom questionnaire (Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire, VQ), 20-item Pediatric Incontinence Questionnaire (PinQ, physician-developed bladder-specific HRQOL) and 10-item Kidscreen-10 questionnaire (generic quality of life). Non-parametric tests, factor analysis and linear regression were used.
RESULTS
Median age of 172 children was 12 years old (44% males), similar to the 32 controls (p>=0.12). Face and content validity of the 10-question Riley Bladder Quality of Life Questionnaire (RIBQQ) were established by children, parents, and experts. Internal consistency and test-retest reliability were high (Cronbach's alpha=0.85, ICC=0.80). Correlations were moderate with VQ (r=-0.45), strong with PinQ (r=-0.81) and low with Kidscreen (r=0.29). Individuals would appreciate RIBQQ differences of >=10/100 points. RIBQQ scores were lower among children with LUTD than controls (medians: 50 vs. 100, p<0.0001) and correlated with LUTD severity (very mild: 66, mild: 57.5, moderate: 37.5, p<0.0001).
For 89 children providing 3-month follow-up data (20 implemented LUTD therapies), VQ improved by a median 1 point (p=0.01) and RIBQQ by 2.5 (p=0.03), without significant changes in PinQ and Kidscreen (p>=0.22). After adjusting for baseline symptom severity and their impact on HRQOL (baseline RIBQQ), RIBQQ scores increased with symptom improvement at 3 months (RR=2.63, p=0.01).
CONCLUSIONS
RIBQQ is a short, valid HRQOL questionnaire for children with LUTD and may be the preferred method of assessing clinical change.
11:33 - 11:36
S38-2 (OP)
Anna LEIJON 1, Terese NILSSON 2, Ulla SILLÉN 3, Anna-Lena HELLSTRÖM 4, Linda VIXNER 5 and Barbro HEDIN SKOGMAN 2
1) Faculty of Medical Sciences, Örebro University, Örebro, Sweden, Center for Clinical Research Dalarna , Falun, Sweden, Falun, SWEDEN - 2) Faculty of Medical Sciences, Örebro University, Örebro, Sweden, Center for Clinical Research Dalarna, Falun, Sweden, Falun, SWEDEN - 3) Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Göteborg, SWEDEN - 4) Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden, Göteborg, SWEDEN - 5) School of Health and Welfare, Dalarna University, Falun, Sweden, Falun, SWEDEN
PURPOSE
The ongoing BABITT study (Bowel and Bladder function in Infant Toilet Training) is a randomized controlled trial investigating whether assisted infant toilet training reduces the prevalence of functional bowel and bladder disorders in children up to 4 years of age. The aim of this present observational study is to construct, assess content validity and evaluate feasibility of the questionnaire used in the BABITT study.
MATERIAL AND METHODS
The questionnaire was developed in three consecutive steps. Step 1, outlining based on literature review and expert panel discussions. Step 2, validation for relevance and simplicity by content validity index (CVI) using 4-point Likert scales. With dichotomized data, an index level more than or equal to 0.78 was considered as acceptable. Step 3, the respondent burden was analysed and a pilot phase allowed for evaluation of feasibility.
RESULTS
In Step 1, the Rome IV criteria and ICCS frameworks were selected for items comprising the primary outcomes in the BABITT study. After the final assessment round in Step 2, the item-level content validity index (I-CVI) was excellent, ranging from 0.88 to 1.00 in most items, in all domains, for both relevance and simplicity. In the pilot phase Step 3, the response rate was 95% and the parents' acceptance of replying to the questionnaire was satisfactory.
CONCLUSIONS
A web-based questionnaire was developed to evaluate parent-reported bladder and bowel function in children who are introduced to assisted infant toilet training. The BABITT questionnaire emerged as valid and feasible in its context.
11:47 - 11:50
S38-3 (OP)
Aurora J. GRUTMAN 1, Mohammad Elmojtaba GUMMA 2, Nicole PAGE 2, Andrew T. GABRIELSON 3, Marisa CLIFTON 3 and Heather DICARLO 3
1) Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Maryland, USA - 2) Johns Hopkins School of Medicine, Baltimore, USA - 3) The James Buchanan Brady Urological Institute, Urology, Baltimore, USA
PURPOSE
To investigate whether cannabis use disorder (CUD) is associated with the diagnosis of lower urinary tract symptoms (LUTS) in pediatric patients.
MATERIAL AND METHODS
This retrospective cohort study queried the TriNetX Research Network, a claims database with records from over 140 million patients and 100 healthcare organizations, for previously healthy male and female patients under 18 years of age with or without a diagnosis of CUD. Propensity-score matching was conducted matching for demographic factors and comorbidities associated with LUTS. The primary outcomes were new diagnoses of all-cause LUTS, pelvic pain, overactive bladder (OAB), dysuria, or urinary tract infection (UTI) among patients with prior CUD compared to controls without CUD.
RESULTS
We identified 4,859,819 male (12,099 with CUD, 4,847,720 without) and 4,274,461 female (12,349 with CUD, 4,262,112 without) patients for inclusion. After propensity-score matching, there was 11,840 male and 11,810 female patients in each arm with median ages of 15.6 and 15.5 years, respectively.
At 5 year follow up, significant increases in new diagnoses of pelvic pain (OR 2.3 [95% CI 1.8-2.9], p<0.01), OAB (OR 1.6 [95% CI 1.9-2.7], p<0.01), dysuria (OR 1.2 [95% CI 1.1-1.5], p=0.01), and UTI (OR 1.8 [95% CI 1.5-2.1], p<0.01) were observed among female patients with CUD compared to controls.
At 5 years follow up, significant increases in new diagnoses of pelvic pain (OR 3.8 [95% CI 2.4-5.9], p<0.01), dysuria (OR 1.4 [95% CI 1.1-1.8], p=0.02), and UTI (OR 1.7 [95% CI 1.2-2.6], p<0.01) were observed in male patients with CUD compared to controls.
CONCLUSIONS
We observed significant increases in first-time LUTS diagnoses in pediatric patients with CUD compared to matched controls. Further investigation of how cannabinoids impact the urinary tract and pelvic floor is warranted.
11:50 - 11:53
S38-4 (OP)
Britt BORG 1, Betina TRABJERG 2, Julie Werenberg DREIER 2, Søren RITTIG 1, Anders BREINBJERG 1, Jakob CHRISTENSEN 2, Kristian JUUL 3, Per Hove THOMSEN 4 and Konstantinos KAMPERIS 1
1) Aarhus University Hospital, Child and Adolescent Medicine, Aarhus N, DENMARK - 2) Aarhus University, National Centre for Register-Based Research, Business and Social Sciences, Aarhus V, DENMARK - 3) Ferring Pharmaceuticals, R&D, TA Urology, Kastrup, DENMARK - 4) Aarhus University Hospital, Child and Adolescent Psychiatry, Aarhus N, DENMARK
PURPOSE
To investigate whether fecal incontinence in children is associated with performance on standardized school tests.
MATERIAL AND METHODS
In a register-based nationwide matched cohort study of children born in Denmark between 1997 and 2008, we identified 3413 children with fecal incontinence (ICD-10 codes from health registers) and matched on sex and age with 34130 reference children.
Mean difference (△) in test scores between children with fecal incontinence and children without fecal incontinence on standardized National School Tests in language and mathematics were estimated applying multiple linear regression adjusting in for relevant confounders. In sub-analyses, we investigated the influence of mental disorders.
RESULTS
We identified 3,413 children with fecal incontinence (70 % boys), median age at treatment onset was 7.0 years [IQR 5.9 to 8.5]). Children with fecal incontinence had lower test scores than matched reference children, e.g., 6th grade mathematics △basic adjusted -9.3 [95% CI -10.4 to -8.3], △fully adjusted −4.9 [95% CI −5.9 to −4.0]. Prevalence of psychiatric disorder was high in children with fecal incontinence e.g., 23.7 % in 8th grade compared to 5.9 % of reference children. Children with fecal incontinence and most types of psychiatric disorder scored substantially lower than the reference children, most notably was ADHD, e.g., in 6th grade mathematics tests △fully adjusted -13.2, [95% CI -16.4 to -10.0].
CONCLUSIONS
In this nationwide register-based study, children with fecal incontinence scored lower in tests of school performance compared to matched reference children even after adjustment for confounders. The prevalence of clinically diagnosed MD was high in children with fecal incontinence, and highly associated with low school performance. Healthcare professionals, teachers and parents need to be extra mindful of children with fecal incontinence, and are urged to acquire the right support for children with fecal incontinence, including referral for evaluation of psychiatric disorder even at small suspicion, as the prevalence is immense.
11:53 - 11:56
S38-5 (OP)
Turker ALTUNTAS 1, Mehmet Umut KUTUKOGLU 1, Onur Can OZKAN 1, Cagri Akin SEKERCI 2, Kamil CAM 1, Tufan TARCAN 1 and Selcuk YUCEL 3
1) MARMARA UNIVERSITY SCHOOL OF MEDICINE, UROLOGY, Istanbul, TÜRKIYE - 2) Marmara University Pendik Training and Research Hospital, Paediatric Urology, Pendik Istanbul, TÜRKIYE - 3) MARMARA UNIVERSITY SCHOOL OF MEDICINE, Peadiatric Urology, Istanbul, TÜRKIYE
PURPOSE
Urinary CA19-9 is associated with hydronephrosis and renal pelvis diameter and may indicate kidney damage in obstructive uropathies. This study hypothesized that urinary CA19-9 could serve as a biomarker for neurological deficits in children with LUT symptoms. The aim was to compare CA19-9 levels in children with neurogenic and non-neurogenic LUT dysfunction.
MATERIAL AND METHODS
50 children (25 neurogenic, 25 non-neurogenic) with LUT dysfunction and 15 healthy controls were prospectively included. Urinary CA19-9 was analyzed using ELISA, and creatinine levels were measured in spot urine samples. For the neurogenic group, DMSA, USG, VCUG, and UD parameters were recorded. UUT damage (VUR, hydronephrosis, or renal scarring) was assessed.
RESULTS
The mean age was 9.26 years (range: 1-17). Urinary CA19-9 levels were 77.34 U/ml cre in the neurogenic group, 58.63 U/ml cre in the non-neurogenic group, and 48.21 U/ml cre in controls (p<0.001). No significant differences were found in subgroup analyses of the neurogenic group. Similarly, no correlations were observed between CA19-9 levels and voiding frequency, bladder capacity, Qmax, or symptom scores in the non-neurogenic group.
Evaluation of Parameters of the Neurogenic Group
|
Ca19-9 U/ml cre Median (min-max) |
P value | |
| UUT Damage | 0,27 | |
| Present (n:13) | 70,05 (44,21-102,15) | |
| Absent (n:12) | 80,74 (41,73-107,84) | |
|
DLPP (cm H2O) |
0,174 | |
| > 20 (n:9) | 77,66 (57,3-107,84) | |
| ≤ 20 (n:7) | 61,29 (41,73-83,52) | |
|
Compliance (ml/cm H2O) |
0,117 | |
| < 10 (n:17) | 75,78 (41,73-107,84) | |
| ≥ 10 (n:6) | 91,79 (60,96-102,15) |
Correlation Analyses of the Neurogenic Group
| (n:25) | Ca19-9 U/ml cre |
| Voiding Frequency | 0,533 |
| Bladder capacity (ml) | 0,691 |
| Qmax (ml/s) | 0,936 |
| Symptom Score | 0,858 |
| Quality of Life Score | 0,110 |
CONCLUSIONS
CA19-9 levels were significantly higher in children with neurogenic LUT dysfunction. Further studies are required to explore its role in assessing UUT damage and UD parameters.
11:56 - 11:59
S38-6 (OP)
Isabel PLANAS DÍAZ 1, Isabel CASAL BELOY 2, Cristina MARIN RODRIGUEZ 3, Laura DIAZ MENENDEZ 3, Maria Jose MOYA JIMENEZ 3, Rocio GRANERO CENDON 3 and Rosa ROMERO RUIZ 2
1) Hospital Infantil Virgen del Rocío, Pediatric Surgery Department, Sevilla, SPAIN - 2) Hospital Infantil Virgen del Rocio, Pediatric Urology, Sevilla, SPAIN - 3) Hospital Infantil Virgen del Rocio, Pediatric Surgery Department, Sevilla, SPAIN
PURPOSE
Traditionally, patients with high anorectal malformations are considered to have a worse associated urological functional prognosis and are actively managed in pediatric urology units. This study aimed to evaluate lower urinary tract (LUT) function in patients with ARM.
MATERIAL AND METHODS
We conducted a retrospective cohort study of ARM patients followed by the Multidisciplinary URIMAR clinic (Pediatric Colorectal and Urology) from 2017 to 2024. Demographic and clinical data, as well as current bladder function, were collected from medical records. Patients with cloacal malformations were excluded.
Patients were divided into groups according to the presence of dysraphism and ARM height. Bivariate analyses were performed using LUT symptom variables (DVISS), urodynamic tests (both invasive and non-invasive), and treatment requirements.
RESULTS
Out of 108 children with ARM followed at our centre, 72 (66.7%) were assessed in the URIMAR clinic: 23 high, 18 medium, 14 low, 3 unknown height, and 14 with cloacal malformations. No significant differences were found among the study groups regarding the prevalence of LUT symptoms, urodynamic abnormalities, or treatment requirements (Table 1).
Table 1.
|
|
Dysraphism(15) |
Non -dysraphism(23) |
p (X2) |
||
|
AbnormalDVISS Yes No |
46,7% (7) |
|
0,552
|
||
|
Urodinamicabnormalities Yes No |
|
|
0,616 |
||
|
Need for pharmacological treatment Yes No |
33,3% (5) |
|
0,069
|
||
|
|
Low ARM |
IntermediateARM |
High ARM |
p (X2) |
|
|
AbnormalDVISS Yes No |
|
|
|
|
|
|
Urodinamicabnormalities Yes No |
54,5% (6) |
|
|
|
|
|
Need for pharmacological treatment Yes No |
|
|
|
0,512 |
|
CONCLUSIONS
All patients with ARM are at risk of lower urinary tract dysfunction. Therefore, urological follow-up is required regardless of the type of malformation or associated spinal anomalies.