ARE BEHAVIORAL AND EMOTIONAL PROBLEMS PROGNOSTIC PREDICTORS FOR TREATMENT FAILURE OF OVERACTIVE BLADDER IN CHILDREN?
Herbert Leão Santos, Medicine Student1, Glicia Estevam Abreu, PhD1, Ana Aparecida Braga, PhD1, Maria Luiza Veiga, PhD1, Patrina Caldwell, PhD2, Justine Hussong, PhD3, Alexander Von Gontard, PhD4, Sana Hamilton, PhD2, Aniruddh Deshpande, PhD5, José Bessa, PhD6, Ubirajara Barroso Jr., PhD1.
1Bahiana School of Medicine and Public Health, Salvador, Brazil, 2The Children's Hospital at Westmead, Sydney, Australia, 3Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany, 4Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland, 5The Children's Hospital at Westmead and John Hunter Children's Hospital,, Newcastle, Australia, 6State university of Feira de Santana, Feira de Santana, Brazil.
BACKGROUNG: Overactive Bladder (OAB) is a clinical diagnosis that leads many children and their caregivers to visit the physician. It is known that behavioral and emotional aspects may be associated with a higher prevalence of Lower Urinary Tract Symptoms (LUTS) in this group of patients. Due to this great epidemiological relationship between them, it is possible that children more affected by psychological problems are also related to a higher failure rate in the treatment of OAB. The aim of the present study is to assess whether the Strength and Difficulty Questionnaire (SDQ) score is a prognostic predictor of treatment failure for OAB. METHODS: This is an international, multicenter, prospective cohort study involving children between 6 and 16 years of age under Parasacral TENS with a diagnosis of OAB. The study was carried out in four centers in three different countries: two in Oceania, one in Europe and one in South America, between June 2016 and December 2019. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after treatment, being Dysfunctional Urination Symptom Score (DVSS) and the International Consultation Questionnaire on Incontinence - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS) to assess LUTS intensity and the SDQ for assessment of emotional and behavioral aspects. Treatment failure was considered in patients who had a reduction in the symptom intensity score below 50% after treatment, as recommended by International Children's Continence Society (ICCS). RESULTS: Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Data were expressed as median. The correlation between baseline SDQ score and the variation in the severity of LUTS was -0.34; p = 0.04. The area under the ROC curve (AUC) was 0,681 (95% CI 0,53 to 0,81; p=0,026), demonstrating the accuracy of the SDQ in identifying patients more likely to fail in treatment with Parasacral TENS. A score greater or equal 20 was found to be the better cut-off point, with the highest levels of sensitivity and specificity in combination. The sensitivity of SDQ score of 20 was 93%. CONCLUSION: The present study represents favorable evidence to the accurate use of the SDQ score in the prediction of failure in the treatment of OAB.
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