London, 8-10 December 2016

Excellence in Pediatrics

Lower Urinary Tract Symptoms and Urinary Tract Infections in children with functional constipation: A systematic review


JJGT van Summeren, SC van Ommeren,  MY Berger, JH Dekker

University of Groningen, University Medical Centre Groningen, Department of General Practice



Introduction: To date, several reviews were published that concluded to an association of lower urinary tract symptoms (LUTS) or urinary tract infections (UTI) and functional constipation (FC) in children. The underlying pathophysiology is not completely understood. Experts reported it is important for physicians to pay special attention on LUTS in children with bowel dysfunctions. However, no systematic review has been published to evaluate the prevalence and incidence of LUTS or UTIs in children with FC.

Purpose: What is the prevalence and incidence of LUTS and UTI in children (4 to 17 years) with FC?

Methods: A systematic review of the literature was conducted on the electronic databases MEDLINE, EMBASE, PsycINFO and Cochrane library. Data extraction was performed by two independent researchers. Articles with a prevalence or incidence of LUTS or UTI in children (4 to 17 years) with FC were eligible. Studies who included children with an obvious underlying organic or metabolic cause of constipation and articles published before 1990 were excluded. This review considered observational, registry data and epidemiological study designs including case-control, cross-sectional, retrospective, longitudinal or prospective cohort and clinical trials (with pre-intervention information on LUTS). Case-reports (<10 subjects), expert opinions and author replies were excluded. Primary outcome measure was the prevalence and incidence of LUTS and UTI in children with FC. There is a lack of generally used definitions for FC and LUTS and therefore the definitions used in the published studies were described. The Newcastle-Ottowa Quality Assessment Scale was used as a tool to assess the risk of bias.

Results: The initial search strategy included 3001 hits. After screening on title/abstract 58 articles remained. Results are expected in November 2016.

Clinical implications: For physicians it is relevant to know if they have to pay special attention on LUTS and UTI in children with FC.