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

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Objective: The aim of this study is to find out if there is 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. Follow up was from three months to five years. Included: Children with hydronephrosis associated with undiagnosed chronic functional constipation. Excluded: children known to have constipation. The medical records were checked for history of stool habits and 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 fulfill the Rome III criteria, but whose complaints, including hydronephrosis,  resolved with  laxative treatment.

Results: Out of 93 patients with urologic presentations, nine were excluded because of the previous diagnosis of constipation. Out 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 nine cases post laxative treatment. The hydronephrosis was intermittent in 2/9 cases coinciding with noncompliance with the management. Associated urinary findings included abdominal pain, flank pain, LUTS, and urinary tract infection (UTI) 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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