Urologic symptoms in pediatric patients with Postural Orthostatic Tachycardia Syndrome
Joseph Scales, MD, Marcelino Rivera, MD, Stephanie Kimmes, CNP, Anna Strand, CNP, Suzanne Rathbun, RN, Philip Fischer, MD, Candace Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: Children with postural orthostatic tachycardia syndrome (POTS) present with a constellation of symptoms involving multiple systems. To date, few reports exist characterizing urologic symptoms at presentation in pediatric patients with POTS. Here, we describe the incidence and spectrum of urologic symptoms in this population.
METHODS: We reviewed consecutive patients, age 9-18 years, presenting with symptoms concerning for autonomic dysfunction (AD) from 01/2010-05/2016. Urologic symptoms were noted. Patients with AD not meeting criteria for POTS (change in heart rate [delta HR] <40 beats per minute [bpm], during tilt table testing) but referred to Pediatric Urology with urologic symptoms were included. Urologic symptoms were categorized as storage-related (incontinence, urgency, frequency), elimination-related (dysuria, incomplete bladder emptying, hesitancy), and other.
RESULTS: We identified 35 patients (27 female, 8 male) with POTS/AD and urologic symptoms. Median age was 15 years (IQR 12-17). Median delta HR was 43bpm (IQR 33-50); 19 patients with POTS had delta HR >40bpm, while 7 with delta HR 30-39bpm and 6 with delta HR <30bpm were diagnosed with AD. Most common POTS-related symptoms were abdominal/other pain (35/35, 100%), headache (24/35, 69%), dizziness/ presyncope (21/35, 60%), and fatigue (20/35, 57%). Urologic symptoms included storage (24/35, 69%), elimination (13/35, 37%), and other (13/35, 37%) - hematuria (3), pelvic pain (5), recurrent urinary tract infections (5). Thirteen (37%) presented with urologic symptoms in more than one category. Recommended treatment program consisted of education and multidisciplinary rehabilitation programs including exercise, with rare use of medications for refractory symptoms. Of patients with follow-up, 82% (9/11) noted significant improvement in urinary symptoms with treatment program, at median follow-up of 17 months (IQR 9-20) without requiring ancillary urologic medications.
CONCLUSIONS: Patients with POTS/AD may present with multiple urologic symptoms. Primary treatment should consist of multidisciplinary rehabilitation and management of POTS rather than urologic medications, as symptoms can improve or resolve similar to improvement noted in autonomic symptoms.
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