Female sex and dilating vesicoureteral reflux (VUR) are independent risk factors for the development of bladder and bowel dysfunction (BBD) in children, according to study findings published online in Pediatrics.

In a secondary analysis of 2 prospective trials (the Careful Urinary Tract Infection Evaluation trial [CUTIE] and the Randomized Intervention for Children with Vesicoureteral Reflux [RIVUR] trial), a team led by Hillary L. Copp, MD, MS, of the University of California San Francisco, found that girls had 12.7-fold increased odds of BBD compared with boys, and the presence of dilating VUR, compared with its absence, was associated with 2-fold increased odds of BBD, after adjusting for age. BBD was not associated with body mass index or antibiotic prophylaxis.

The researchers noted that patients with VUR and concomitant BBD are at high risk for febrile urinary tract infection (UTI).

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“The results of this study should be interpreted within a clinical context,” the investigators wrote. “We believe that inquiring about a child’s bladder and bowel symptoms should take place for all patients with a previous UTI. Prompt medical management should be considered before any surgical treatment in patients with BBD.”

The study included 318 patients with median age of 21 months at baseline. Of these, 83 (26%) had no VUR, 126 (40%) had non-dilating VUR, and 108 (34%) had dilating VUR. BBD developed in 111 patients (35%): 1 (5%) of 19 boys and 110 (37%) of 299 girls.

“The reasons as to why girls develop BBD overwhelmingly more than boys are not well understood,” the investigators wrote. “Others have observed increased dysfunctional voiding in girls versus boys in this age group.”

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Gaither TW, Cooper CS, Kornberg Z, et al. Risk factors for the development of bladder and bowel dysfunction. Pediatrics. 2018;11(1):e20172797.