Martha Pokarowski1, Mandy Rickard1, Ronik Kanani2, Niraj Mistry3, Megan Saunders2, Rebecca Rockman4, Jonathan Sam5, Abby Varghese1, Jessica Malach6, Ivor Margolis7, Amani Roushdi8, Leo Levin3,6, Manbir Singh1, Roberto Iglesias Lopes1, Walid A Farhat1, Martin A Koyle1, Joana Dos Santos1. 1. Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Department of Pediatrics, North York General Hospital, North York, Ontario, Canada. 3. Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada. 4. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Department of Pediatrics, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada. 6. Department of Pediatrics, Markham Stouffville Hospital, Markham, Ontario, Canada. 7. Department of Pediatrics, William Osler Health Centre-Brampton Civic Hospital, Brampton, Ontario, Canada. 8. Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Abstract
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care. METHODS: We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients. RESULTS: Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction. CONCLUSIONS: Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care. METHODS: We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients. RESULTS: Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction. CONCLUSIONS: Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
Authors: N Brownrigg; L H Braga; M Rickard; F Farrokhyar; B Easterbrook; A Dekirmendjian; K Jegatheeswaran; J DeMaria; A J Lorenzo Journal: J Pediatr Urol Date: 2017-07-04 Impact factor: 1.830
Authors: Nader Shaikh; Alejandro Hoberman; Ron Keren; Nathan Gotman; Steven G Docimo; Ranjiv Mathews; Sonika Bhatnagar; Anastasia Ivanova; Tej K Mattoo; Marva Moxey-Mims; Myra A Carpenter; Hans G Pohl; Saul Greenfield Journal: Pediatrics Date: 2015-12-08 Impact factor: 7.124