Bladder Bowel Dysfunction Scoring System A novel, illustrated questionnaire for evaluation of voiding dysfunction in children

INTRODUCTION: We sought to evaluate the reliability and validity of a new, illustrated questionnaire, the Bladder Bowel Dysfunction Scoring System (BBDSS) in the assessment of overactive bladder (OAB) and bladder bowel dysfunction (BBD). METHODS: The BBDSS questionnaire consisted of 12 structured questions. This pilot study was designed with two principal groups of questions: one group to assess bladder symptoms and the other to assess bowel dysfunction during the preceding month. Each question had three possible answers, with each answer being assigned a severity score. We prospectively collected previously untreated patients referred to our voiding dysfunction clinic for the first time. A control group of healthy children was recruited to assess the reliability of the BBDSS questionnaire. The provisional diagnosis was collected from patients' charts at the time of presentation. RESULTS: The questionnaire was administered to 92 children (44 in the affected group and 48 in the control group). The age at presentation was similar in both groups (17 months or nine years, nine months). The mean total score for the affected group was 8.7 (3-14), while it was 1.19 (0-5) for the control group (p<0.001). There was a strong correlation, between the total BBDSS score and both groups (r=0.88, p<0.001). Using the receiver operating characteristic (ROC) curve, the BBDSS was found to be an excellent tool in differentiating normal from affected patients (area under the curve [AUC]=0.98, p<0.001). When the total BBDSS score was >= 6, the positive predictive value was 1, with a negative predictive value of 0.89. The defecation part of the BBDSS was a good tool in differentiating OAB from BBD patients (AUC=0.89, p<0.001). No patient with OAB had a bowel score >3. CONCLUSIONS: The BBDSS is a reliable and valid instrument in the diagnosis of voiding dysfunction. The questionnaire was easily administered by parents or children. Moreover, it can differentiate between OAB and BBD.