Pediatric Urology Urinary Retention in Children Amihay Nevo, Roy Mano, Pinhas M. Livne, Bezalel Sivan, and David Ben-Meir OBJECTIVE METHODS
RESULTS
CONCLUSION
To describe the causes and outcome of urinary retention in children and assess its prevalence by gender and age. The medical records of all children (aged 12 hours in the presence of a palpable bladder or a urine volume greater than expected for age ([age in years þ 2] [30 cc]).3 The cause is identified only on completion of all diagnostic testing. Urinary retention secondary to behavioral disturbances is diagnosed after exclusion of other possible etiologies and a psychological evaluation. Dysfunctional voiding was defined according to the International Children’s Continence Society terminology based on urodynamic studies or repeated uroflowmetry measurements.5 Fecal impaction was defined according to the Paris Consensus on Childhood Constipation Terminology Group as severe constipation with a large fecal mass in the rectum, which is unlikely to be passed on demand.6 For the present study, findings at initial presentation and treatment were retrieved from the emergency room’s medical database. Data on patient age and gender, medical history, http://dx.doi.org/10.1016/j.urology.2014.08.020 0090-4295/14
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Table 1. Etiologies of urinary retention stratified by patient gender Girls Etiology Mechanical Urethral stone Urethral stricture Urethral polyp Bladder diverticulum Phimosis Rhabdomyosarcoma Neuroblastoma Bladder neck polyp Infection and inflammation Cystitis Vaginitis HSV genitalis Meatitis Periappendicular abscess Infected urachal cyst Missed testicular torsion Fecal impaction Neurologic Dysfunctional voiding Myelitis Gynecologic Hematocolpos Labial adhesion Labial hematoma Behavioral Idiopathic Total
Total No. of Patients (%)
No. of Patients (%)
Boys Median Age (Range), y
14 (25)
10 (18)
2 (14)
15.8 (15-16.5)
1 (7) 1 (7)
16.5 15
7 (13) 6 (11)
3 (21) 2 (14) 2 (14)
4 (7)
4 1 2 1 1 2
3 (5) 12 (21) 56
(29) (7) (14) (7) (7) (14) 14
10 (3.8-11) 15 (13.9-16) 15 (13.9-16) 4 (3.8-15.5) 15.5 3.9 (3.8-4) 4 12.1 8.5 (2-15) 11.6 (15-16.5)
No. of Patients (%)
Median Age (Range), y
14 1 3 1 2 1 4 1 1 8 4
(33) (2) (7) (2) (5) (2) (10) (2) (2) (19) (10)
4.2 (0.6-16.2) 7 13 (13-16.2) 5 2.6 (0.6-4.5) 3 2.9 (0.8-3.8) 1.4 4.5 11.4 (2.5-16) 11.4 (2.5-14.5)
1 1 1 1 4 4 3 1
(2) (2) (2) (2) (10) (10) (7) (2)
4 11.6 3.2 16 8 (3.1-12.1) 9.6 (0.8-11.3) 8.5 (0.8-11.3) 11
2 (5) 10 (24) 42
12 (10-14) 11.5 (2.2-17) 10 (0.6-17)
HSV, herpes simplex virus.
duration of urinary retention, residual volume, diagnostic workup, final diagnosis, treatment, and follow-up were collected from the patients’ medical records. When follow-up information was lacking, the parents or guardians were contacted and interviewed with a telephone questionnaire. Clinical data were reported using descriptive statistics. The median and range were used for continuous variables. The chisquare test was used to analyze between-group differences in categorical variables. One-year intervals were used for analysis of age distribution. All statistical analyses were 2 sided and performed with SPSS Statistics, version 21.0 (IBM Corp., Armonk, NY). A P value
RESULTS
CONCLUSION
To describe the causes and outcome of urinary retention in children and assess its prevalence by gender and age. The medical records of all children (aged 12 hours in the presence of a palpable bladder or a urine volume greater than expected for age ([age in years þ 2] [30 cc]).3 The cause is identified only on completion of all diagnostic testing. Urinary retention secondary to behavioral disturbances is diagnosed after exclusion of other possible etiologies and a psychological evaluation. Dysfunctional voiding was defined according to the International Children’s Continence Society terminology based on urodynamic studies or repeated uroflowmetry measurements.5 Fecal impaction was defined according to the Paris Consensus on Childhood Constipation Terminology Group as severe constipation with a large fecal mass in the rectum, which is unlikely to be passed on demand.6 For the present study, findings at initial presentation and treatment were retrieved from the emergency room’s medical database. Data on patient age and gender, medical history, http://dx.doi.org/10.1016/j.urology.2014.08.020 0090-4295/14
1475
Table 1. Etiologies of urinary retention stratified by patient gender Girls Etiology Mechanical Urethral stone Urethral stricture Urethral polyp Bladder diverticulum Phimosis Rhabdomyosarcoma Neuroblastoma Bladder neck polyp Infection and inflammation Cystitis Vaginitis HSV genitalis Meatitis Periappendicular abscess Infected urachal cyst Missed testicular torsion Fecal impaction Neurologic Dysfunctional voiding Myelitis Gynecologic Hematocolpos Labial adhesion Labial hematoma Behavioral Idiopathic Total
Total No. of Patients (%)
No. of Patients (%)
Boys Median Age (Range), y
14 (25)
10 (18)
2 (14)
15.8 (15-16.5)
1 (7) 1 (7)
16.5 15
7 (13) 6 (11)
3 (21) 2 (14) 2 (14)
4 (7)
4 1 2 1 1 2
3 (5) 12 (21) 56
(29) (7) (14) (7) (7) (14) 14
10 (3.8-11) 15 (13.9-16) 15 (13.9-16) 4 (3.8-15.5) 15.5 3.9 (3.8-4) 4 12.1 8.5 (2-15) 11.6 (15-16.5)
No. of Patients (%)
Median Age (Range), y
14 1 3 1 2 1 4 1 1 8 4
(33) (2) (7) (2) (5) (2) (10) (2) (2) (19) (10)
4.2 (0.6-16.2) 7 13 (13-16.2) 5 2.6 (0.6-4.5) 3 2.9 (0.8-3.8) 1.4 4.5 11.4 (2.5-16) 11.4 (2.5-14.5)
1 1 1 1 4 4 3 1
(2) (2) (2) (2) (10) (10) (7) (2)
4 11.6 3.2 16 8 (3.1-12.1) 9.6 (0.8-11.3) 8.5 (0.8-11.3) 11
2 (5) 10 (24) 42
12 (10-14) 11.5 (2.2-17) 10 (0.6-17)
HSV, herpes simplex virus.
duration of urinary retention, residual volume, diagnostic workup, final diagnosis, treatment, and follow-up were collected from the patients’ medical records. When follow-up information was lacking, the parents or guardians were contacted and interviewed with a telephone questionnaire. Clinical data were reported using descriptive statistics. The median and range were used for continuous variables. The chisquare test was used to analyze between-group differences in categorical variables. One-year intervals were used for analysis of age distribution. All statistical analyses were 2 sided and performed with SPSS Statistics, version 21.0 (IBM Corp., Armonk, NY). A P value
