Monica Maria de Almeida Vasconcelos

Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction

AbstractRisk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by 99mtechnetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P  = 0.07). Although UTI was not a risk factor, it was associated with VUR (P  = 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.

Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study

Fifty-six patients 5.9–15.2 years old with dysfunctional elimination syndrome (DES) unimproved by previous therapies were randomly distributed into two voiding training programs: group 1 contained 26 patients submitted to 24 training sessions over a 3-month period; group 2 contained 30 patients submitted to 16 sessions over a 2-month period. Both groups adhered to a voiding and drinking schedule, received instruction on adequate toilet posture, were reinforced through the maintenance of voiding diaries, and went through proprioceptive and pelvic floor muscle training (Kegel exercises). Group 2 patients also received biofeedback therapy. Clinical evaluation was carried out before each program’s initiation and 1, 6, and 12 months after each program’s termination. All patients were submitted to renal ultrasonography and dynamic ultrasonography before and 6 months after each program’s conclusion. Millivoltage recordings of pelvic floor muscles were compared before and after training. Urinary continence was improved after completion of either training program. Only those patients who received biofeedback training showed a significant decrease in postvoiding residual (PVR) urine as detected by dynamic ultrasonography. Our results show that either training regime can reduce episodic urinary incontinence and urinary tract infection but that further study is required to identify the optimal training duration.

Prevalence of lower urinary tract symptoms in school-age children.

Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6–12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p < 0.001), children aged 6–8 (p < 0.028), and attended the school with the lowest social level (p < 0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.

Impacto de uma abordagem interdisciplinar em crianças e adolescentes com disfunção do trato urinário inferior (DTUI)

INTRODUCTION The lower urinary tract dysfunction (LUTD) corresponds to changes in the filling or emptying of urine caused by neurogenic, anatomical and functional alterations. OBJECTIVE To evaluate the impact of treatment in children and adolescents with LUTD. METHODS Historical cohort of 15 year follow-up with the participation of 192 patients (123F, 69M), aged 0.1 to 16.8 years, analyzed at admission (T0) and at final follow-up (T1). Most patients belong to a neurologic bladder dysfunction group (60.4%). The treatment was uroterapy with behavioral and cognitive intervention, timed voiding, oral hydration, laxative diet, biofeedback, sacral nerve stimulation, clean intermittent catheterization (CIC), anticholinergic therapy, rectal enema, treatment of urinary tract infection (UTI) and, in refractory cases, surgical procedures such as continent and incontinent urinary diversion (vesicostomy), bladder augmentation and conduit for performing antegrade colonic enema. RESULTS The main symptoms were daytime urinary incontinence (82.3%), the non-monosymptomatic nocturnal enuresis (78.6%), fecal incontinence (54.2%) and constipation (47.9%). There was a significant reduction of urinary tract infection (p = 0.0027), daytime urinary incontinence (p < 0.001), nocturnal enuresis (p < 0.001), fecal incontinence (p = 0.010) and of vesicoureteral reflux (p = 0.01). There was significant increase in the use of CIC (p = 0.021), of anticholinergic therapy (p < 0.001) and decrease of chemoprophylaxis (p < 0.001). CONCLUSION This study showed that treatment of LUTD in children must be individualized, and requires constant monitoring of clinical, laboratory and imaging to minimize the risk of kidney damage.

Percepción de monitores del PET-Salud respecto a su formación y trabajo en equipo interdisciplinario.

Buscou-se identificar e analisar as representacoes sociais de monitores do PET-Saude da Universidade Federal de Minas Gerais (UFMG), Brasil, que atuam na linha de pesquisa Saude na Escola, concernente a influencia dessa vivencia na sua formacao e no seu olhar sobre o trabalho em equipe interdisciplinar. O trajeto metodologico delineou as representacoes sociais dos monitores apos vivenciarem o projeto. As respostas dos relatorios dos monitores foram digitalizadas e importadas para o programa NVivo10, categorizadas e analisadas por meio do discurso do sujeito coletivo. Levantaram-se dados de 33 monitores do PET-Saude na Escola, que constituiram 16 componentes representacionais positivamente relacionados a sua formacao (n=9) e ao trabalho em equipe interdisciplinar (n=7). Verificou-se que a vivencia no referido projeto promoveu diferenciais relevantes na formacao desses futuros profissionais de saude, com percepcoes favoraveis ao trabalho em equipe interdisciplinar, atentas as demandas sociais do Sistema Unico de Saude (SUS).This study aimed to identify and analyze social representations of PET-Health monitors at the Minas Gerais Federal University (UFMG), Brazil, which participate in the School Healthcare research area, with respect to the influence of this experience on their professional education and their outlook toward interdisciplinary teamwork. The methodology sought to delineate their social representations. Their responses were assessed, entered into a database, and imported to the NVivo.10 software. The data were categorized and evaluated using collective subject discourse analysis. Data from 33 monitors of PET-Saude were gathered, and these formed 16 representational components: nine related to the monitors’ education and seven related to interdisciplinary teamwork. The experience made a relevant difference to the education of professionals, with favorable perceptions toward interdisciplinary teamwork focusing on the social demands of the Brazilian Health System (SUS).

Percepção de monitores do PET-Saúde sobre sua formação e trabalho em equipe interdisciplinar

Buscou-se identificar e analisar as representacoes sociais de monitores do PET-Saude da Universidade Federal de Minas Gerais (UFMG), Brasil, que atuam na linha de pesquisa Saude na Escola, concernente a influencia dessa vivencia na sua formacao e no seu olhar sobre o trabalho em equipe interdisciplinar. O trajeto metodologico delineou as representacoes sociais dos monitores apos vivenciarem o projeto. As respostas dos relatorios dos monitores foram digitalizadas e importadas para o programa NVivo10, categorizadas e analisadas por meio do discurso do sujeito coletivo. Levantaram-se dados de 33 monitores do PET-Saude na Escola, que constituiram 16 componentes representacionais positivamente relacionados a sua formacao (n=9) e ao trabalho em equipe interdisciplinar (n=7). Verificou-se que a vivencia no referido projeto promoveu diferenciais relevantes na formacao desses futuros profissionais de saude, com percepcoes favoraveis ao trabalho em equipe interdisciplinar, atentas as demandas sociais do Sistema Unico de Saude (SUS).This study aimed to identify and analyze social representations of PET-Health monitors at the Minas Gerais Federal University (UFMG), Brazil, which participate in the School Healthcare research area, with respect to the influence of this experience on their professional education and their outlook toward interdisciplinary teamwork. The methodology sought to delineate their social representations. Their responses were assessed, entered into a database, and imported to the NVivo.10 software. The data were categorized and evaluated using collective subject discourse analysis. Data from 33 monitors of PET-Saude were gathered, and these formed 16 representational components: nine related to the monitors’ education and seven related to interdisciplinary teamwork. The experience made a relevant difference to the education of professionals, with favorable perceptions toward interdisciplinary teamwork focusing on the social demands of the Brazilian Health System (SUS).

Lower urinary tract dysfunction - a common diagnosis in the pediatrics practice

Lower urinary tract dysfunction indicates an abnormal function of the lower urinary tract to the childs age, which can lead to loss of coordinated capacity storage and elimination of urine. It is a common entity in children, although under-diagnosed in clinical practice, and that, besides representing a risk to the upper urinary tract, causes an emotional embarrassment to parents and children, due to urinary incontinence and frustration in dealing with the problem. The acquisition of daytime urinary continence occurs in most children until age 4 and night, until 5 years of age. After this age, urinary incontinence becomes a social problem. Despite the clinical importance often parents are unaware of the symptoms of this dysfunction. This article aims to address the key issues related to the diagnosis of this dysfunction.

Prevalence of lower urinary tract symptoms in children and adolescents diagnosed with attention deficit hyperactivity disorder

Introduction: There is evidence that psychiatric disorders are common in children and adolescents with symptoms of lower urinary tract (LUT). Objective: To investigate the prevalence of LUT’s symptoms in children and adolescents with Attention Deficit Disorder and Hyperactivity Disorder (ADHD). Methods: 90 patients aged 5-17 years with ADHD who were attended at a specialized clinic at the Hospital das Clínicas, UFMG. LUT Symptoms were assessed with questionnaires translated and adapted to the Brazilian culture, called Portuguese Brazilian version of the Dysfunctional Voiding Symptom Score (DVSS) and the behavior symptoms with MTA-SNAP-IV in Portuguese for use in Brazil. Results: Symptoms of LUT were detected in 25 (27.8%) of the ADHD patients; 41.1% presented urgency, 33.3% urinary incontinence (UI) daytime isolated or associated with enuresis, 8.9% fecal incontinence, 7.8% holding maneuvers, 5.6% low voiding frequency, 3.3% urinary tract infection and Prevalence of lower urinary tract symptoms in children and adolescents diagnosed with attention deficit hyperactivity disorder Fabiane Ramos de Araújo1, Mônica Maria de Almeida Vasconcelos2, Arthur Melo Kummer3, Eduardo Araujo de Oliveira4, Eleonora Moreira Lima5 Prevalência de sintomas do trato urinário inferior em crianças e adolescentes com diagnóstico de transtorno de déficit de atenção e hiperatividade DOI: 10.5935/2238-3182.20160051

Mental disorders in children and adolescents with lower urinary tract dysfunction

Lower urinary tract dysfunction (LUTD) affects about 2-25% of the pediatric population and is associated with the presence of emotional and behavioral disorders. The purpose of this literature review was to identify studies focusing on mental disorders in children and adolescents with LUTD. The prevalence of these disorders is high - ranging from about 20 to 40% - in children with symptoms of LUTD and comorbidities. The presence of emotional and behavioral symptoms impact in the treatment of the dysfunction, self-esteem of patients and caregivers. Despite the association between mental/behavioral disorders and LUTD be well documented in the literature, the investigation of psychiatric symptoms in clinical practice is still not common and should be stimulated.

PET-Health monitors perceptions regarding their education and interdisciplinary teamwork.

Buscou-se identificar e analisar as representacoes sociais de monitores do PET-Saude da Universidade Federal de Minas Gerais (UFMG), Brasil, que atuam na linha de pesquisa Saude na Escola, concernente a influencia dessa vivencia na sua formacao e no seu olhar sobre o trabalho em equipe interdisciplinar. O trajeto metodologico delineou as representacoes sociais dos monitores apos vivenciarem o projeto. As respostas dos relatorios dos monitores foram digitalizadas e importadas para o programa NVivo10, categorizadas e analisadas por meio do discurso do sujeito coletivo. Levantaram-se dados de 33 monitores do PET-Saude na Escola, que constituiram 16 componentes representacionais positivamente relacionados a sua formacao (n=9) e ao trabalho em equipe interdisciplinar (n=7). Verificou-se que a vivencia no referido projeto promoveu diferenciais relevantes na formacao desses futuros profissionais de saude, com percepcoes favoraveis ao trabalho em equipe interdisciplinar, atentas as demandas sociais do Sistema Unico de Saude (SUS).This study aimed to identify and analyze social representations of PET-Health monitors at the Minas Gerais Federal University (UFMG), Brazil, which participate in the School Healthcare research area, with respect to the influence of this experience on their professional education and their outlook toward interdisciplinary teamwork. The methodology sought to delineate their social representations. Their responses were assessed, entered into a database, and imported to the NVivo.10 software. The data were categorized and evaluated using collective subject discourse analysis. Data from 33 monitors of PET-Saude were gathered, and these formed 16 representational components: nine related to the monitors’ education and seven related to interdisciplinary teamwork. The experience made a relevant difference to the education of professionals, with favorable perceptions toward interdisciplinary teamwork focusing on the social demands of the Brazilian Health System (SUS).