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The Iowa VIP Experience: Early Observations with a Collaborative Pediatric Psycho-Urologic Bladder and Bowel Dysfunction Clinic
Background: Some difficult to treat children with bladder and bowel dysfunction have an underlying psychologic component either contributing to or caused by their urologic issue. We reviewed our initial experience involving a multidisciplinary clinic where children with difficult to treat urologic issues and concomitant psychological problems are seen jointly with a pediatric psychologist and a pediatric urology provider.
Methods: We performed a retrospective review of all patients seen in our collaborative clinic. We evaluated patient demographics, type of visit and underlying diagnosis and outcomes.
Results: Since 2013, 63 individual patients were seen in the clinic with 97 total visits. Mean patient age was 8.2 years (4– 16 years) and 51% were male. Urologic diagnosis included daytime urinary incontinence (89%), nocturnal enuresis (41%), voiding dysfunction (22%), recurrent urinary tract infections (25%) and constipation (52%). Psychologic diagnosis included Attention Deficit Hyperactivity Disorder (38%), Anxiety (17%), Autism spectrum (5%), Oppositional Defiant Disorder (13%), Obsessive Compulsive Disorder (3%) and intellectual disabilities (3%). 28 patients (44%) were already established with psychological services prior to our collaborative evaluation, while 12 patients (19%) were referred for further psychological evaluation. Average initial validated Iowa bowel/bladder questionnaire score was 28 (47-10), which changed to a mean score of 25 (47-12) (p=0.2) during return visits.
Conclusions: With coordination of pediatric psychology and urology, establishing such a multidisciplinary clinic is viable and is beneficial for these difficult to treat patients. Such a clinic may reveal other psychological issues, resulting in further sub-specialty evaluation. In our early experience, children with concomitant psychological and urological problems and their families do need and benefit from the focused psycho-urologic therapy that our multidisciplinary clinic can offer.