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Occult Chronic Functional Constipation: An Overlooked Cause of Reversible Hydronephrosis in Childhood

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Objective: To find out if there was any relationship between occult chronic functional constipation and transient hydronephrosis.

Methods: A retrospective study of patients referred to the renal service at Jordan University Hospital from January 2011 to December 2014 because of urological complaints and found to have hydronephrosis associated with undiagnosed constipation. The follow-up was from 3 months to 5 years. Children with hydronephrosis associated with undiagnosed chronic functional constipation were included. Children known to have constipation were excluded. The medical records were checked for the patients’ history of stool habits and their physical examination findings, urine analysis, urine culture, and renal ultrasonography. Occult constipation was defined as the existence of constipation without the knowledge of the parents or the referring physician in patients who did not fulfil the Rome III criteria, but whose complaints, including hydronephrosis, were resolved with laxative treatment.

Results: Out of 93 patients with urologic presentations, 9 were excluded because of the previous diagnosis of constipation. Of the remaining patients, 84 were diagnosed to have occult chronic functional constipation. Renal ultrasonography was done for 43 patients. Hydronephrosis was found in 9/43 (21.0%) patients. Hydronephrosis resolved in all the nine cases after laxative treatment. The hydronephrosis was intermittent in 2/9 cases coinciding with noncompliance with the management. The associated urinary findings included abdominal pain, flank pain, lower urinary tract symptoms and urinary tract infection found in 3/43, 11/43, 39/43 and 15/43 patients, respectively.

Conclusion: Occult chronic functional constipation is an overlooked cause of reversible hydronephrosis in children.

11 Sep, 2015
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e-Published: 15 Mar, 2016
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