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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1134-1137

Dysfunctional Elimination Syndrome: Is It Related to Urinary Tract Infection or Vesicoureteral Reflux Diagnosed Early in Life?

Nader Shaikh, MD, MPH*, Alejandro Hoberman, MD*, Barbara Wise, CRNP, PhD{ddagger}, Marcia Kurs-Lasky, MS§, Diana Kearney, RN*, Stephanie Naylor, RN*, Mary Ann Haralam, CRNP*, D. K. Colborn, BS* and Steven G. Docimo, MD{ddagger}

* Departments of Pediatrics
{ddagger} Urology, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
§ University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania

Objective. It has been suggested that urinary tract infections (UTIs) early in life predispose to dysfunctional elimination syndrome (DES). This study evaluated the relationship between early UTI, vesicoureteral reflux (VUR), and DES by comparing two cohorts of school-aged children.

Methods. The UTI cohort (n = 123) included children previously enrolled in a prospective treatment trial conducted between 1992 and 1997. All were diagnosed with a febrile UTI before 2 years of age. The comparison cohort (n = 125) included children who were evaluated for fever in the emergency department between 1992 and 1997, whose urine culture was negative. Dysfunctional elimination symptoms were compared in the two cohorts by having families complete a revised version of the Dysfunctional Voiding Scoring System.

Results. Completed questionnaires were received from 248 children. There were no significant differences in selected demographic or clinical characteristics between the two cohorts. DES was present in 22% and 21% of children with and without a history of early UTI, respectively. Among children with UTIs, 18% of those with VUR and 25% of those without VUR had DES.

Conclusions. Dysfunctional elimination is common in a general pediatric population. Neither UTI nor VUR diagnosed before 2 years of age was associated with DES in school-aged children.

Key Words: dysfunctional elimination • voiding dysfunction • dysfunctional voiding • vesicoureteral reflux • urinary tract infection

Abbreviations: DES, dysfunctional elimination syndrome • UTI, urinary tract infection • VUR, vesicoureteral reflux • CI, confidence interval • OR, odds ratio

Received for publication Nov 12, 2002; Accepted Apr 9, 2003.


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