Hypothesis / aims of study
Overactive bladder (OAB) is common in clinical practice. Many risk factors have been reported related to its prevalence, but whether urinary tract malformation in boys is a risk factor for this abnormality and the OAB impact on children's mental psychology is still unclear. We assume that the boy's urinary tract malformation is an additional OAB risk factor and the disease can influence children's psychological behaviour. The aims of the present study were to investigate the risk factors of OAB in Chinese boys and to evaluate the psycho-behavioral status of OAB patients.
Study design, materials and methods
A total of 3000 boys (aged 6-15 year) from five primary schools and junior high school in Henan were included and the survey was conducted by using an anonymous questionnaire to collect the following information: ①gender, date of birth, inhabitation; ②Lower Urinary Symptoms(LUTS);③Overactive Bladder Scale (OABSS);④Child Sleep Questionnaire (PSQ); ⑤Strengths and Difficulties Questionnaire (SDQ). The OAB criterion in this study was urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease, which is in accordance with the OAB definition from ICS .The exclusion criteria were obvious organic diseases, such as lower bladder urinary tract obstruction, neurological diseases, and incomplete questionnaires.
A total of 2650 questionnaires were collected, and 2333(77.8%) qualified for statistical analysis. The prevalence of OAB was 6.0% (143/2333). One-way analysis of variance showed that the prevalence of OAB was related to BMI, nocturnal enuresis(NE), UTI, constipation, prolong the usage of diapers, phimosis, redundant prepuce, concealed penis(2=10.833，39.983，75.954，116.301，30.280，70.258，446.589，respectively, P＜0.05）.There was no statistically significant difference of their residence (2=1.191,P＞0.05).Multivariate analysis of the influencing factors for the prevalence of OAB in boys: NE, UTI, constipation,use of diapers, and combined with phimosis, redundant prepuce and concealed penis were risk factors for OAB in boys (OR >1), while BMI was not a risk factor (OR < 1). The difficulty problem score (30.26±6.48) in OAB group was higher than that in the normal group (27.1±7.52), and the difference was statistically significant (P < 0.05). U test was conducted on children's sleep questionnaire scores and difficulty scores, and the results showed that the sleep score of OAB group was significant higher than that of normal group ((4.45±3.39 vs. 2.88±2.78, P < 0.05).
Interpretation of results
The significant relationship between OAB and BMI, NE, constipation, and the use of diapers in boys was consistent with other reports, The prevalence of OAB in boys related to phimosis, redundant prepuce and occult penis has not been reported in the literature. Phimosis and redundant prepuce has been reported related to UTI, which might be way to induce OAB. However, the mechanism of OAB induced by these risk factors needs to be further studied in the future. The difficulty score of boys with OAB was higher than that of normal children indicating that OAB affects the psychological behavior of patients. Similarly, the sleep score of boys with OAB was higher than that of normal boys, suggesting that the sleep quality of boys with OAB was affected.
OAB in boys is common and affects mental health and sleep quality. Meanwhile, NE, UTI, constipation, use of diapers, combined with phimosis, redundant prepuce and concealed penis are the risk factors of OAB.