title: Impact of an interdisciplinary approach in children and adolescents with lower urinary tract dysfunction (LUTD).
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Roberta Vasconcellos Menezes
authors.initials: RV
authors.lastname: de Azevedo
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Eduardo Araújo
authors.initials: EA
authors.lastname: Oliveira
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Monica Maria de Almeida
authors.initials: MM
authors.lastname: Vasconcelos
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Breno Augusto Campos
authors.initials: BA
authors.lastname: de Castro
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Fabiana Resende
authors.initials: FR
authors.lastname: Pereira
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Nathalia Filgueiras Vilaça
authors.initials: NF
authors.lastname: Duarte
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Patricia Moraes Resende
authors.initials: PM
authors.lastname: de Jesus
authors.affiliation: Faculdade de Ciencias Médicas.
authors.forename: Giovana Teixeira Branco
authors.initials: GT
authors.lastname: Vaz
authors.affiliation: Universidade Federal de Minas Gerais.
authors.forename: Eleonora Moreira
authors.initials: EM
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D008297:Male; D010348:Patient Care Team; D012189:Retrospective Studies; D011795:Surveys and Questionnaires