# Urodynamic characterization in children with lower urinary tract symptoms and comorbid ADHD: a retrospective matched case-control study

## TL;DR

Children with ADHD and urinary issues show worse bladder function compared to those without ADHD, suggesting ADHD may affect bladder control through neurological factors.

## Contribution

This study is the first to systematically investigate urodynamic differences in children with ADHD and lower urinary tract symptoms using a case-control design.

## Key findings

- Children with ADHD had significantly reduced bladder capacity and increased detrusor pressure during filling.
- Detrusor overactivity was more prevalent in children with ADHD and independently predicted urodynamic abnormalities.
- ADHD may influence bladder function through neurobehavioral mechanisms, highlighting the need for early screening in this population.

## Abstract

Lower urinary tract symptoms (LUTS) are common functional urinary disorders in children and can markedly impair quality of life. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition, and emerging evidence suggests that affected children are at increased risk of LUTS. Nevertheless, systematic investigations into the relationship between ADHD and urodynamic characteristics in pediatric LUTS remain limited. This study aimed to evaluate the association between ADHD and urodynamic features in children with LUTS using a case–control design.

We conducted a retrospective case–control study including 144 children with LUTS, of whom 36 were diagnosed with ADHD. All participants underwent standardized urodynamic testing, with assessments of bladder capacity, detrusor pressure at maximum filling, and detrusor overactivity (DO). Children were categorized into ADHD and non-ADHD groups, and intergroup comparisons of urodynamic parameters were performed. Multivariable regression analysis was used to assess the independent association between ADHD and urodynamic abnormalities.

Compared with the non-ADHD group (n = 108), children with ADHD (n = 36) exhibited significantly reduced volumes at first urge, strong urge, and maximum cystometric capacity (all p < 0.05). Conversely, detrusor pressure at maximum filling and the prevalence of DO were significantly higher in the ADHD group (both p < 0.05). Multivariable regression analysis identified DO as an independent predictor of urodynamic abnormalities in children with ADHD (OR = 3.43, 95% CI: 1.32–8.91, p = 0.012).

Children with ADHD display significant functional bladder abnormalities on urodynamic testing, particularly reduced bladder capacity, increased detrusor pressure during filling, and heightened detrusor activity. ADHD may influence bladder function, at least in part, through neurobehavioral mechanisms. These findings provide valuable clinical insights for the management of LUTS in children with ADHD and underscore the importance of early screening and intervention. Further research is needed to elucidate the underlying mechanisms and to develop effective therapeutic strategies.