Abstract
The combination of the functional disorders of urination and defecation constitutes the Dys-functional Elimination Syndrome (DES). DES refers to an abnormal pattern of elimination of unknown etiology characterized by bowel and bladder incontinence and withholding, with no underlying anatomic or neurologic abnormalities. Essential precondition for a child to be subsumed under this entity is the exclusion of either anatomical or neurological causative factors. In the present review study the individual entities of dysfunctional filling, such as the unstable or lazy bladder, or dysfunctional urination, such as the detrusor sphincter dyssynergia and the functional constipation are being described comprehensively. Subsequently, the analysis of the pathophysiological effects of the dysfunctional elimination syndrome such as incontinence, urinary tract infections and the conservation or the deterioration of vesicoureteric reflux, is being accentuated. With the documentation of DES, the therapeutic strategy should aim at treating both the functional disorder of the vesicourethral unit and the functional constipation. The first part does not specify depending on the type of this disorder. Rarely, surgical treatment of functional urinary disorders may be required.
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Bibliography
1. Shaikh N., Hoberman A., Wise B., et al.: Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life? Pediatrics. 2003 Nov; 112 (5): 1134–1137.
2. Halachmi S., Farhat W.A.: Interactions of constipation, dysfunctional elimination syndrome, and vesicoureteral reflux. Adv Urol. 2008; 2008: 828275.
3. Aydoğdu O., Burgu B., Teber S., et al.: A challenging review of childhood incontinence: rare complications of dysfunctional elimination syndrome in an epileptic boy. Turk J Pediatr. 2011 Jan– Feb; 53 (1): 100–103.
4. Von Gontard A., Hollmann E.: Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations. J Urol. 2004 Jun; 171 (6 Pt 2): 2644–2647.
5. Curran M.J., Kaefer M., Peters C., Logigian E., Bauer S.B.: The overactive bladder in childhood: long- term results with conservative management. J Urol. 2000 Feb; 163 (2): 574–577.
6. Hadjizadeh N., Motamed F., Abdollahzade S., Rafiei S.: Association of voiding dysfunction with functional constipation. Indian Pediatr. 2009 Dec; 46 (12): 1093–1095. Epub 2009 Apr 1.
7. Klijn A.J., Asselman M., Vijverberg M.A., et al.: The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding. J Urol. 2004 Nov; 172 (5 Pt 1): 1986–1988.
8. Wein A.J., Kavoussi L.R., Campbell M.F.: Urology Cambell-Walsh, 10th ed. Saunders Elsevier: 2012; 3418–3420.
9. O’Regan S., Yazbeck S.: Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children. Med Hypotheses. 1985 Aug; 17 (4): 409–413.
10. O’Regan S., Yazbeck S., Schick E.: Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. 1985 Mar; 23 (3): 152–154.
11. Ab E., Schoemaker M., Van Empelen R.: Paradoxical movement of the pelvic floor in dysfunctional voiding and the results of biofeedback training. Br J Urol Int. 2002; 89: 48.
12. Patoulias I.: Voiding disturbance in childhood. 1st ed. Parisianos, Athens: 2011; 58– 59. ISBN 978- 960-394-723-3.
13. Loening-Baucke V.: Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997 Aug; 100 (2 Pt 1): 228–232.
14. Chase J., Austin P., Hoebeke P., McKenna P.: International Children's Continence Society. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2010 Apr; 183 (4): 1296–1302.
15. Hoebeke P., Van Laecke E., Van Camp C., Raes A., Van De Walle J.: One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int. 2001 Apr; 87 (6): 575–580.
16. Herndon C.D., Decambre M., McKenna P.H.: Interactive computer games for treatment of pelvic floor dysfunction. J Urol. 2001 Nov; 166 (5): 1893–1898.
17. Hansson S., Hjalmas K., Jodal U., Sixt R.: Lower urinary tract dysfunction in girls with untreated asymptomatic or cover bacteriuria. J Urol. 1990; 143: 333–336.
18. Issenman R.M., Filmer R.B., Gorski P.A.: A review of bowel and bladder control development in children: how gastrointestinal and urologic conditions relate to problems in toilet training. Pediatrics 1999; 103: 1346–1352.
19. Regan S.O., Schick E., Hamburger B., Yazbeck S.: Constipation associated with vesicoureteral reflux. Urol. 1986; 28: 394–396.
20. Chen J.J., Mao W., Homayoon K., Steinhardt G.F.: A multivariate analysis of dysfunction elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol. 2004; 171: 1907–1910.
21. Naseer S.R., Steinhardt G.F.: New renal scars in children with urinary tract infections, vesicoureteral reflux and voiding dysfunction: a prospective evaluation. J Urol. 1997 Aug; 158 (2): 566–568.
22. Mulders M.M., Cobussen-Boekhorst H., de Gier R.P., Feitz W.F., Kortmann B.B.: Urotherapy in children: quantitative measurements of daytime urinary incontinence before and after treatment according to the new definitions of the International Children’s Continence Society. J Pediatr Urol. 2011 Apr; 7 (2): 213–218.
23. Nevéus T., Von Gontard A., Hoebeke P., et al.: The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006 Jul; 176 (1): 314–324.
24. Farhat W., Bägli D.J., Capolicchio G., et al.: The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000 Sep; 164 (3 Pt 2): 1011–1015.
25. Bower W.F., Yip S.K., Yeung C.K.: Dysfunctional elimination symptoms in childhood and adulthood. J Urol. 2005 Oct; 174 (4 Pt 2): 1623–1627; discussion 1627–1628.
26. Vereecken R.L., Proesmans W.: Urethral instability as an important element of dysfunctional voiding. J Urol. 2000; 163: 585–588.
27. Dede O., Sakellaris G.: Daytime urinary incontinence. Essentials in Pediatr Urol. 2012; 57–68.
28. Desantis D.J., Leonard M.P., Preston M.A., Barrowman N.J., Guerra L.A.: Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol. 2011 Jun; 7 (3): 342–348.
29. Dyer L.L., Franco I.: Botulinum Toxin-A Therapy in pediatric Urology: Indications for the Neurogenic and Non-Neurogenic Neurogenic Bladder. Scientific World J. 2009; 9: 1300–1305.
30. Kroll P., Jankowski A., Soltysiak J., et al.: Botulinum toxin-A injections in children with neurogenic bladder. Nephroourol. 2011; 3: 125–128.
31. Carr L.K.: Botulinum toxin A should not be first-line therapy for overactive bladder. Can Urol Assoc J. 2011 Jun; 5 (3): 204–205.
32. Steele S.S.: Botulinum toxin A: First-line therapy for idiopathic detrusor over activity. Can Urol Assoc J. 2011; 5: 207–209.
33. Barroso U. Jr, Tourinho R., Lordêlo P., Hoebeke P., Chase J.: Electrical stimulation for lower urinary tract dysfunction in children: a systematic review of the literature. Neurourol Urodyn. 2011 Nov; 30 (8): 1429–1436.
34. Lordêlo P., Soares P.V., Maciel I., Macedo A. Jr, Barroso U. Jr.: Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results. J Urol. 2009 Dec; 182 (6): 2900–2904.
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