Disfunção vesical e intestinal em crianças e adolescentes

Autores

  • Vera Q. Machado Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
  • Eliane Maria G. O. da Fonseca Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.

DOI:

https://doi.org/10.12957/rhupe.2016.28240

Resumo

A presente revisão tem por objetivo apresentar e discutir as particularidades da disfunção vesical e intestinal (DVI) na infância. A associação de constipação intestinal com a disfunção do trato urinário inferior foi descrita inicialmente em 1998. Ambas são condições de alta prevalência na população pediátrica. A origem embrionária comum do reto e da bexiga na cloaca, sua inervação simpática (L1-L3) e parassimpática (S2-S4) similares, a representação afim em regiões supra espinhais, a proximidade anatômica, são diferentes teorias propostas para explicar essa associação. A melhora dos sintomas urinários está relacionada ao sucesso terapêutico para a constipação. Entretanto, muitas crianças com DVI apresentam constipação refratária ou respondem inicialmente ao tratamento, mas quando este é descontinuado, apresentam recidivas tanto dos sintomas de constipação, quanto dos sintomas do trato urinário inferior. Embora, história clínica e exame físico completos, associados ao diário das eliminações, sejam os pilares do diagnóstico da DVI, nos casos refratários, testes diagnósticos adicionais são necessários. O manejo terapêutico da DVI envolve: educação e desmistificação, adequação de hábitos intestinal e miccional e acompanhamento regular e prolongado. A dificuldade na abordagem terapêutica de crianças com DVI ainda é pouco explorada na literatura. A cronicidade dos sintomas intestinais e urinários interfere de forma significativa no desenvolvimento emocional desses pacientes. Estudos atuais chamam a atenção para a possibilidade da existência de uma desordem neuromuscular comum, responsável tanto pela dismotilidade vesical, quanto pela colônica. Esses achados poderão servir de base para o desenvolvimento de novas modalidades terapêuticas envolvendo ambos os sistemas.

Descritores: Disfunção vesical; Disfunção  intestinal; Constipação crônica; Disfunção do trato urinário inferior.

Biografia do Autor

Vera Q. Machado, Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.

Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.

Eliane Maria G. O. da Fonseca, Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.

Departamento de Pediatria. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.

Referências

Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adult: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25(1):3-18. http://dx.doi.org/10.1016/j.bpg.2010.12.010

Vaz GT, Vasconcelos MM, Oliveira EA, et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol. 2012; 27(4):597-603. http://dx.doi.org/10.1007/s00467-011-2028-1

Chase JW, Homsy Y, Siggaard C, et al. Functional constipation in children. J Urol. 2004; 171:2641-3.

Mugie SM, Di Lorenzo C, Benninga MA. Constipation in childhood. Nat Rev Gastroenterol Hepatol. 2011;8(9):502-11. http://dx.doi.org/10.1038/nrgastro.2011.130

Fernandes E, Vernier R, Gonzalez R. The unstable bladder in children. J Pediatr. 1991;118(6):831-7.

Austin PF, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescent: update report from the Standardization Committee of the International Children’s Continence Society). J Urol. 2014; 191(6):1863-5. http://dx.doi.org/10.1016/j.juro.2014.01.110

Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. 1998; 160(3 Pt 2):1019-22.

Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997; 100(2 Pt 1): 228-32.

Borch L, Hagstroem S, Bower WF, et al. Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr. 2013;102(5):e215-20. http://dx.doi.org/10.1111/apa.12158

Malykhina A, Wyndaele JJ, Anderson KE, et al. Do the Urinary Bladder and Large Boxel Interact, in sickness or in health? ICS-RS 2011. Neurourol Urodynam. 2012;31(3):352-8. http://dx.doi.org/10.1002/nau.21228

Woo LL, Thomas JC, Brock JW. Cloacal exstrophy: a comprehensive review of an uncommon problem. J Pediatr Urol. 2010;6(2):102-11. http://dx.doi.org/10.1016/j.jpurol.2009.09.011

Franco I. Overactive bladder in children. Part I: Pathophysiology. J Urol. 2007; 178(3 Pt 1):761-8. http://dx.doi.org/10.1016/j.juro.2007.05.014

Kern MK, Arndorfer RC, Hyde JS, et al. Cerebral cortical representation of external anal sphincter contraction: effect of effort. Am J Physiol Gastrointest Liver Physiol. 2004; 286(2):304-11. http://dx.doi.org/10.1152/ajpgi.00201.2003

Lioa KK, Chen JT, Lai KL, et al. Effect of sacral-root stimulation on the motor cortex in patients with overactive bladder syndrome. Neurophysiol Clin. 2008;38(1):39-43. http://dx.doi.org/10.1016/j.neucli.2007.09.004

Di Lorenzo C. Pediatric anorectal disorders. Gastroenterol Clin North Am. 2001;30(1):269-87.

da Fonseca EM, Santana PG, Gomes FA, et al. Dysfunction elimination syndrome: is age toilet training a determinant? J Pediatr Urol 2011;7(3):332-5. http://dx.doi.org/10.1016/j.jpurol.2011.03.004

Machado VQ, Monteiro A, Peçanha A, et al. Slow transit constipation and lower urinary dysfunction. J Pediatr Urol. 2015;11(6): 357.e1-5. http://dx.doi.org/10.1016/j.jpurol.2015.05.032

Lucanto C, Bauer SB, Hyman PE, et al. Function of hollow viscera in children with constipation and voiding difficulties. Dig Dis Scie. 2000;45(7):1274-80.

Benninga MA, Buller HA, Tytgat GN, et al. Colonic transit time in constipated children: does pediatric slow-transit constipation exist? J Pediatr Gastroenterol Nutr. 1996;23(3):241-51.

Griffiths DM. The physiology of continence: idiopathic fecal constipation and soiling. Semin in Pediatr Surg. 2002; 11(2):67-74.

Mostafa RM, Moustafa YM, Hamdy H. Interstitial cells of Cajal, the maestro in health and disease. World J Gastroenterol. 2010;16(26):3239-48.

McCloskey KD. Bladder interstitial cells: an updated review of current knowledge. Acta Physiol (Oxf). 2013;207(1):7-15. http://dx.doi.org/10.1111/apha.12009

Tabbers MM, Di Lorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258-74. http://dx.doi.org/10.1097/MPG.0000000000000266

Hyams JS, Di Lorenzo C, Saps M, et al. Childhood functional gastrointestinal disorders: child /adolescent. Gastroenterology. 2016;150(6):1456-1468. http://dx.doi.org/10.1053/j.gastro.2016.02

Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-4. http://dx.doi.org/10.3109/00365529709011203

Anderson B, Thimmersch I, Aardsma N, et al. The prevalence of abnormal genital findings, vulvovaginitis, enuresis and encopresis in children who present with allegation of sexual abuse. J Pediatr Urol. 2014;10(6):1216-21. http://dx.doi.org/10.1016/j.jpurol.2014.06.011

Singh SJ, Gibbons NJ, Vincent MV, et al. Use of pelvic ultrasound in the diagnosis of megarectum in children with constipation. J Pediatr Surg.2005;40(12):1941-4. http://dx.doi.org/10.1016/j.jpedsurg.2005.08.012

Modin L, Dalby K, Walsted AM, et al. Transabdominal ultrasound measurement of rectal diameter is dependent on time to defecation in constipated children. J Paediatr Child Health. 2015;51(9):875-80. http://dx.doi.org/10.1111/jpc.12881

Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, et al. Diagnostic value of abdominal radiography in constipated children: a systematic review. Arch Pediatr Adolesc Med. 2005;159:671-8. http://dx.doi.org/10.1001/archpedi.159.7.671

Tarcan T, Tinay I, TemizY, et al. The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination. J Pediatr Urol. 2012;8:55-8. http://dx.doi.org/10.1016/j.jpurol.2010.11.002

Southwell BR, King SK, Hutson JM. Chronic constipation in children: organic disorders are a major cause. J Paediatr Child Health. 2005;41(1-2):1-15. http://dx.doi.org/10.1111/j.1440-1754.2005.00527.x

Kann MA. Idiopathic constipation: any movement? Scand J Gastroenterol Suppl. 1992;192:106-9.

Gordon M, Naidoo K, Akoberg AK, et al. Osmotic and stimulant laxatives for the management of childhhod constipation. Cochrane Database Syst Rev. 2012;7:CD009118. http://dx.doi.org/10.1002/14651858.CD009118.pub2

Borgers ME, van der Berg MM, Reistsma JB, et al. A randomized controlled trial of enemas in combination with oral laxative therapy for children with chronic constipation. Clin Gastroenterol Hepatol. 2009;7:1069-74. http://dx.doi.org/10.1016/j.cgh.2009.06.018

Maternik M, Krzeminska K, Zurowska A. The management of childhood urinary incontinence. Pediatr Nephrol. 2015;30(1):41-50. http://dx.doi.org/10.1007/s00467-014-2791-x

Clarke MC, Chase JW, Gibb S, et al. Decreased colonic transit time after transcutaneous interferencial stimulation in children with slow transit constipation. J Pediatr Surg. 2009;44(2):408-12. http://dx.doi.org/10.1016/j.jpedsurg.2008.10.100

Ismail K, Chase J, Gibb S, et al. Daily transabdominal electrical stimulation at home increased defecation in children with slow-transit constipation: a pilot study.J Pediatr Surg. 2009;44:2388-92. http://dx.doi.org/10.1016/j.jpedsurg.2009.07.063

Tugtepe H, Thomas DT, Ergun R, et al. Comparison of biofeedback therapy in children with treatment-refractory dysfunctional voiding and overactive bladder. Urology. 2015;85(4):900-4. http://dx.doi.org/10.1016/j.urology.2014.12.031

Fitzgerald MP, Thom DH, Wassel-Fyr, C et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol. 2006; 175:989-93. http://dx.doi.org/10.1016/S0022-5347(05)00416-7

Pijpers MA, Bongers ME, Benninga MA, et al. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr. 2010;50(3):256-68. http://dx.doi.org/10.1097/MPG.0b013e3181afcdc3

Downloads

Publicado

2016-06-19

Edição

Seção

Artigos