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. 2021 Mar 10;6(2):e383.
doi: 10.1097/pq9.0000000000000383. eCollection 2021 Mar-Apr.

Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction

Martha Pokarowski  1 , Mandy Rickard  1 , Ronik Kanani  2 , Niraj Mistry  3 , Megan Saunders  2 , Rebecca Rockman  4 , Jonathan Sam  5 , Abby Varghese  1 , Jessica Malach  6 , Ivor Margolis  7 , Amani Roushdi  8 , Leo Levin  3   6 , Manbir Singh  1 , Roberto Iglesias Lopes  1 , Walid A Farhat  1 , Martin A Koyle  1 , Joana Dos Santos  1
Affiliations

Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction

Martha Pokarowski et al. Pediatr Qual Saf. .

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.

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Figures

Fig. 1.
Fig. 1.
BBD referral flow diagram.
Fig. 2.
Fig. 2.
Pairwise comparisons of the median (IQR) DVSS scores for BBDN and hospital patients at baseline and follow-up visits.
Fig. 3.
Fig. 3.
Median (IQR) wait times for BBDN and hospital patients at baseline and follow-up visits.
See this image and copyright information in PMC

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