LOWER URINARY TRACT DYSFUNCTION IN CHILDREN: FOCUS ON OVERACTIVE BLADDER

Abstract

Lower urinary tract (LUT) dysfunction in childhood presents a high prevalence, which can lead to urinary urgency, urinary incontinence, urinary tract infection, vesicoureteral reflux, renal damage, and psychological and emotional impacts. The overactive bladder (OAB) is the most common kind of LUT dysfunction. It is characterized as a change in the bladder storage phase, combined with urinary symptoms typical of this phase, but with a normal urinary flow pattern and without post-void residual. Its pathophysiology is still controversial, and includes possibilities of alterations of central origin, of triggering uncontrolled detrusor contractions due to constipation, or the possibility of being caused by the urinary tract infection. There are three main treatments available for children with OAB: drugs, urotherapy and electrical stimulation. Of these, drug therapy is still the most widespread in the world, despite having several side effects and low cure rate. Urotherapy is based on micturition and food guidelines and should be indicated as the first therapeutic line. Electrical stimulation still presents diversity in relation to the position of the electrode, time and frequency of the application and different parameters in relation to the therapeutic current. Despite this variability, the combined therapies of urotherapy with electrostimulation have better clinical results according to literature.