Abstract General Information

Title

ASSOCIATION OF TOILET TRAINING AGE WITH LOWER URINARY TRACT SYMPTOMS DEVELOPMENT: A CASE-CONTROL STUDY

Introduction and objective

Lower urinary tract symptoms (LUTS) are a set of symptoms that affect 7-10% of the pediatric population. Some studies have divergent findings regarding the association of late toilet training, defined as training conducted after the age of 2, with the development of these dysfunctions. Therefore, the objective of this study is to determine whether there is an association between toilet training after the age of 2 and the development of LUTS.

Method

A case-control study was conducted based on medical record data of patients who initiated treatment for lower urinary tract symptoms and monosymptomatic enuresis at the Center between 2007 and 2023. The patients were divided into two groups: cases, who were diagnosed with LUTS, and controls, who did not have LUTS. Furthermore, they were further divided into exposed individuals, who underwent toilet training after the age of 2, and unexposed individuals, who underwent toilet training by the age of 2. The exposed and unexposed groups were also compared in terms of urgency, daytime incontinence, infrequent urination, "potty dance’’, enuresis, and constipation. Additionally, the patients symptoms were analyzed for severity using Dysfunctional Voiding Symptom Score - DVSS.

Results

A total of 1,118 patients were included in the study, with 562 (50.3%) being male and a median age of 9 (IQR 7-11) years. Among the patients, 496 (44.3%) were diagnosed with LUTS, with 215 (43.3%) being exposed - toilet trained after the age of 2 - and 281 (56.7%) being unexposed, toilet trained by the age of 2, yielding an odds ratio of 1.35 with a 95% confidence interval of 1.06-1.7 and p=0.015. Patients who underwent toilet training after the age of 2 had statistically significant values higher for daytime incontinence, enuresis, and constipation (p<0.01 for these variables). The median DVSS was higher in the exposed group (p<0.01).

Conclusion

Delayed toilet training, conducted after the age of 2, has been associated with a higher chance of developing lower urinary tract dysfunction.