Prevalência de sintomas do Trato Urinário Inferior em crianças e adolescentes com diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade

Abstract

Recent studies show that psychiatric disorders are very common in children and adolescents with symptoms of lower urinary tract (LUT). The aim of this study was to investigate the prevalence of symptoms of LUT in 90 children and adolescents aged 5-17 years diagnosed with Attention Deficit and Hyperactivity Disorder (ADHD). Methods: Symptoms were assessed using questionnaires already translated and adapted to Brazilian culture, called Portuguese Brazilian version of the Dysfunctional Voiding Symptom Score (DVSS) and MTA-SNAP-IV in Portuguese for use in Brazil. Results: Symptoms of LUT were detected in 25 (27.8%) children and adolescents with ADHD. 41.1% had urgency, 33.3% daytime urinary incontinence alone or with enuresis, 8.9% fecal incontinence, 7.8% holding maneuvers, 5.6% voiding postponement, 3.3% urinary tract infection and 82.2% constipation. There was no significant difference between genders with regard to the symptoms analyzed. When the median DVSS values were compared among patients with and without symptoms of LUT, p <0.001 was observed. Boys had 3.7 times more symptoms of ADHD than girls (p <0.001). LUT symptoms were more frequent in girls (p <0.05). Children with daytime urinary incontinence alone or with enuresis had more symptoms of oppositional defiant disorder (ODD) associated with ADHD (p <0.05). Discussion: Comorbidity of psychological disorders is higher in children with LUT symptoms. Externalizing disorders can be seen as symptoms of behavior (conduct disorder, ADHD) and internalizing disorders such as emotional symptoms (anxiety, depression). In this study, we used the ICCS classification and it was found that all patients with enuresis had other symptoms of LUT named nonmonosymptomatic enuresis. We detected positive association between ODD and daytime urinary incontinence alone or with enuresis. In children with ODD, temperament factors may favor an increase in the rate of incontinence problems. Conclusions: An association of psychiatric disorders such as ADHD and ODD was detected with symptoms of TUI. Children with ODD have higher rates of daytime urinary incontinence with or without enuresis than ADHD. The investigation of symptoms of the TUI should be performed in all children and adolescents with psychiatric disorders, including externalizing and internalizing disorders, as well as psychiatric symptoms should be investigated in all children with symptoms of TUI.