title: Bullying has a potential role in pediatric lower urinary tract symptoms.
abstract: OBJECTIVE
  National statistics estimate that a quarter of American school children are regularly bullied, making this issue the main parental concern and the leading form of school violence. To our knowledge no study in the literature has examined the association of bullying with lower urinary tract symptoms. We evaluated the relationship between being bullied and lower urinary tract symptoms in the pediatric population.
  
  
  METHODS
  We accrued 100 patients from a pediatric urology practice in prospective case-control fashion. The degree of lower urinary tract symptoms was determined by the voiding severity score obtained by a single pediatric urologist. Using the Peer Relations Questionnaire and a thermometer scale we surveyed participants for evidence of victimization from bullying and school related anxiety. We then correlated voiding symptom severity with the degree of bullying.
  
  
  RESULTS
  After applying our study exclusion criteria we examined and analyzed data on 38 control children without lower urinary tract symptoms and on 38 children with lower urinary tract symptoms. Mean age was similar in the 2 groups. There were more females in the group with lower urinary tract symptoms (22 vs 13). Mean case voiding severity score was 3.82 (range 2 to 5). As measured by Bullied Index Score the degree of being bullied was significantly higher in the case group (4.76 vs 1.95, p <0.001), as was the anxiety level estimated by the thermometer score (3.68 vs 0.97, p <0.001). We also found that physical forms of bullying accounted for worse voiding severity scores (4.56 vs 3.67, p <0.01).
  
  
  CONCLUSIONS
  To our knowledge our study is the first to show that 1) bullying is significantly associated with pediatric lower urinary tract symptoms and 2) physical forms of bullying accompany worsened symptoms.
authors.affiliation: Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey. Electronic address: philiptzhao@hotmail.com.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Zhao
authors.affiliation: Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Danielle
authors.initials: D
authors.lastname: Velez
authors.affiliation: Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Izak
authors.initials: I
authors.lastname: Faiena
authors.affiliation: Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Creenan
authors.affiliation: Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Barone
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D058445:Bullying; D002648:Child; D004775:Enuresis / Q000523:psychology; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D011795:Surveys and Questionnaires
keywords: anxiety; bullying; lower urinary tract symptoms; questionnaires; urinary bladder