Sunday, May 20, 2012 3:30 PM-5:30 PM
Pediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis
597: The Pediatric Bladder Is Not Immune to the Effects of Environmental Tobacco Smoke
Introduction and Objectives
Cigarette smoke contains known bladder irritants and is associated with the development of bladder cancer in adults. European studies show an elevated risk of bladder cancer among adults exposed to environmental tobacco smoke (ETS) during childhood. There is no current literature addressing the urologic effects of ETS in children. This study asked whether ETS may act as a bladder irritant for children, perhaps serving as a risk factor for irritative storage symptoms (SS): urinary urgency, increased urinary frequency and incontinence.
Forty-five children ages 4–17 years presenting with SS were included in the study. Parents of children 4–10 years completed surveys on ETS exposure and SS. Children ages 11–17 years completed the surveys independently. All questions on ETS exposure were validated by the Harvard Children’s Health and the Children’s Neurotoxicant Exposure Studies. Questions on SS severity came from the Dysfunctional Voiding Scoring System. SS severity was quantified by clinical exam and classified as very mild, mild, moderate, or severe. Statistical analyses included descriptive statistics, ANOVA, and t-tests.
Subject exposure to ETS was 28%, a rate 13% higher than the NJ statewide average. Twenty-one subjects presented with very mild/mild SS scores and 24 had moderate/severe ones. None of the subjects with very mild/mild scores had mothers who smoked or were subjected to ETS in an automobile. In contrast, 23% of those with moderate/severe scores had mothers who smoked; 50% had exposure to ETS in an automobile on a regular basis. On various measures of ETS exposure, subjects with greater exposure had higher symptom severity scores compared to those who were not exposed. For children 4–10 years, the relationship between increasing SS severity and ETS exposure was particularly striking [t-test (p=0.014); ANOVA (p = 0.008)].
Exposure to ETS is associated with worsening of SS in children, especially those 4–10 years. Clinicians should inquire about ETS exposure when children present with a chief complaint of urinary frequency, urgency, or urge incontinence. As appropriate, they should offer parents information about smoking cessation.