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Generalized joint hypermobility and voiding dysfunction in children: is there any relationship?

Abstract

Voiding dysfunction is a common entity in pediatric urology. It is believed to have a multifactorial etiology. The aim of this study was to investigate whether there is an increased prevalence of generalized joint hypermobility (GJH) in children with voiding dysfunction compared to normal children. Moreover, the prevalence of voiding complaints in patients with and without GJH was assessed. A total of 226 children—aged 5 to 14 years—including 113 patients diagnosed with voiding dysfunction and 113 sex/age/body mass index-matched normal children were recruited. GJH was evaluated in both groups using the Beighton score (4 or more = hypermobile). In the patient’s group, GJH was significantly more frequent than in controls: 51/113 (45 %) versus 19/113 (17 %) (P = 0.001). In addition, in both groups, GJH was more prominent in girls than boys (P < 0.05). Urinary tract infection was the most frequent features in children with voiding dysfunction (64 %). In the subgroup of positive GJH, urinary tract infection remained the most common manifestation among the girls (P = 0.003), while constipation was the most prevalent manifestation among the boys (P = 0.001). Conclusion: Our findings suggest that children with voiding dysfunction have significantly higher prevalence of GJH compared to normal children. Further studies are needed to determine the cause and effect of these two common presentations and will help to develop a multidisciplinary approach in understanding and management of voiding dysfunction in children.

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Fig. 1

Abbreviations

GJH:

Generalized joint hypermobility

UTI:

Urinary tract infection

VUR:

Vesicoureteral reflux

UF/EMG:

Uroflowmetry with electromyography

BMI:

Body mass index

ROM:

Range of motion

ICCS:

International Children’s Continence Society

STC:

Slow transit constipation

References

  1. 1.

    Beighton P (1988) Hypermobility scoring. Br J Rheumatol 27(2):163

  2. 2.

    Benninga M, Candy DC, Catto-Smith AG, Clayden G, Loening-Baucke V, Di Lorenzo C, Nurko S, Staiano A (2005) The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr 40(3):273–275

  3. 3.

    Chase J, Austin P, Hoebeke P, McKenna P (2010) The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children’s Continence Society. J Urol 183(4):1296–1302

  4. 4.

    Child AH (1986) Joint hypermobility syndrome: inherited disorder of collagen synthesis. J Rheumatol 13(2):239–243

  5. 5.

    de Kort LM, Verhulst JA, Engelbert RH, Uiterwaal CS, de Jong TP (2003) Lower urinary tract dysfunction in children with generalized hypermobility of joints. J Urol 170(5):1971–1974. doi:10.1097/01.ju.0000091643.35118.d3

  6. 6.

    Engelbert RH, Bank RA, Sakkers RJ, Helders PJ, Beemer FA, Uiterwaal CS (2003) Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics 111(3):e248–254

  7. 7.

    Grahame R (1999) Joint hypermobility and genetic collagen disorders: are they related? Arch Dis Child 80(2):188–191

  8. 8.

    Grahame R (2000) Heritable disorders of connective tissue. Baillieres Best Pract Res Clin Rheumatol 14(2):345–361. doi:10.1053/berh.1999.0069

  9. 9.

    Hansson S, Hjalmas K, Jodal U, Sixt R (1990) Lower urinary tract dysfunction in girls with untreated asymptomatic or covert bacteriuria. J Urol 143(2):333–335

  10. 10.

    Hoebeke P, Van Laecke E, Van Camp C, Raes A, Van De Walle J (2001) One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 87(6):575–580

  11. 11.

    Hogeweg J, Langereis M, Bernards A, Faber J, Helders P (1994) Goniometry-variability in the clinical practice of a conventional goniometer in healthy subjects. Eur J Physical Med Rehab 4(1):2–7

  12. 12.

    Horton WA, Collins DL, DeSmet AA, Kennedy JA, Schimke RN (1980) Familial joint instability syndrome. Am J Med Genet 6(3):221–228. doi:10.1002/ajmg.1320060306

  13. 13.

    Jha S, Arunkalaivanan AS, Situnayake RD (2007) Prevalence of incontinence in women with benign joint hypermobility syndrome. Int Urogynecol J Pelvic Floor Dysfunct 18(1):61–64. doi:10.1007/s00192-006-0096-8

  14. 14.

    Juul-Kristensen B, Rogind H, Jensen DV, Remvig L (2007) Inter-examiner reproducibility of tests and criteria for generalized joint hypermobility and benign joint hypermobility syndrome. Rheumatology (Oxford) 46(12):1835–1841. doi:10.1093/rheumatology/kem290

  15. 15.

    Keane DP, Sims TJ, Abrams P, Bailey AJ (1997) Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence. Br J Obstet Gynaecol 104(9):994–998

  16. 16.

    Kirby A, Davies R (2007) Developmental Coordination Disorder and Joint Hypermobility Syndrome—overlapping disorders? Implications for research and clinical practice. Child Care Health Dev 33(5):513–519. doi:10.1111/j.1365-2214.2006.00694.x

  17. 17.

    Larsson LG, Baum J, Mudholkar GS (1987) Hypermobility: features and differential incidence between the sexes. Arthritis Rheum 30:1426–30

  18. 18.

    Loening-Baucke V (1997) Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 100(2 Pt 1):228–232

  19. 19.

    Mastoroudes H, Giarenis I, Cardozo L, Srikrishna S, Vella M, Robinson D, Kazkaz H, Grahame R (2013) Lower urinary tract symptoms in women with benign joint hypermobility syndrome: a case–control study. Int Urogynecol J. doi:10.1007/s00192-013-2065-3

  20. 20.

    Mastoroudes H, Giarenis I, Cardozo L, Srikrishna S, Vella M, Robinson D, Kazkaz H, Grahame R (2013) Prolapse and sexual function in women with benign joint hypermobility syndrome. BJOG 120(2):187–192. doi:10.1111/1471-0528.12082

  21. 21.

    Mishra MB, Ryan P, Atkinson P, Taylor H, Bell J, Calver D, Fogelman I, Child A, Jackson G, Chambers JB, Grahame R (1996) Extra-articular features of benign joint hypermobility syndrome. Br J Rheumatol 35(9):861–866

  22. 22.

    Murray KJ (2006) Hypermobility disorders in children and adolescents. Best Pract Res Clin Rheumatol 20(2):329–351. doi:10.1016/j.berh.2005.12.003

  23. 23.

    Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, Jorgensen TM, Rittig S, Walle JV, Yeung CK, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 176(1):314–324. doi:10.1016/S0022-5347(06)00305-3

  24. 24.

    Reilly DJ, Chase JW, Hutson JM, Clarke MC, Gibb S, Stillman B, Southwell BR (2008) Connective tissue disorder—a new subgroup of boys with slow transit constipation? J Pediatr Surg 43(6):1111–1114. doi:10.1016/j.jpedsurg.2008.02.041

  25. 25.

    Russek LN (1999) Hypermobility syndrome. Phys Ther 79(6):591–599

  26. 26.

    Schulman SL (2004) Voiding dysfunction in children. Urol Clin North Am 31(3):481–490. doi:10.1016/j.ucl.2004.04.019, ix

  27. 27.

    Smits-Engelsman B, Klerks M, Kirby A (2011) Beighton score: a valid measure for generalized hypermobility in children. J Pediatr 158(1):119–123. doi:10.1016/j.jpeds.2010.07.021, 123 e111-114

  28. 28.

    Ulmsten U, Ekman G, Giertz G, Malmstrom A (1987) Different biochemical composition of connective tissue in continent and stress incontinent women. Acta Obstet Gynecol Scand 66(5):455–457

  29. 29.

    van Eerde AM, Verhoeven VJ, de Jong TP, van de Putte EM, Giltay JC, Engelbert RH (2012) Is joint hypermobility associated with vesico-ureteral reflux? An assessment of 50 patients. BJU Int 109(8):1243–1248. doi:10.1111/j.1464-410X.2011.10469.x

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Correspondence to Abdol-Mohammad Kajbafzadeh.

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Kajbafzadeh, A., Sharifi-Rad, L., Ladi Seyedian, S.S. et al. Generalized joint hypermobility and voiding dysfunction in children: is there any relationship?. Eur J Pediatr 173, 197–201 (2014). https://doi.org/10.1007/s00431-013-2120-6

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Keywords

  • Connective tissue disorder
  • Generalized joint hypermobility
  • Lower urinary tract dysfunction
  • Voiding dysfunction