Lower urinary tract symptoms (LUTS) in children is very common in clinical practice; however, the factors affecting these symptoms are still unclear. We hypothesized that many factors such as the delay in elimination communication (EC) and toilet training (TT) time, and urinary tract infection (UTI) in infants and young children may affect the prevalence  of LUTS in older children and adolescents. Therefore, the  aim of present study was to investigate the prevalence of LUTS and their risk factors in children and adolescents in Mainland China.

From December 2019 to January 2020, five primary and middle schools in Henan China were selected to survey the children and adolescents( 6-16 years old). A total of 4000 anonymous questionnaires were distributed to collect information of LUTS [frequency, urgency, daytime urinary incontinence（DUI）, nocturnal enuresis], and their related factors including age, gender, history of using diapers after birth, UTI, EC and or TT, etc. The exclusion criteria are obvious organic diseases, such as neurological diseases and hormone metabolism disorders. Chi-square test and multivariate Logistic regression was used to analyse the risk factors that related to LUTS, and their correlation.

A total of 3885 questionnaires were qualified for statistical analysis and 19.67% (764/3885) cases were found to have one or more symptoms. The prevalence of LUTS in 6-year-old children was 35.21% (125/355), and that of 16-year-old children dropped to 10.29% (36/350). Of which. urgency 14.18% (551/3885);frequent 8.29%(322/3885);DUI 4.68%(182/3885) [urge incontinence 66.48%(121/182), stress urinary incontinence 33.52%(61/182)], and nocturnal enuresis 2.96%(115/3885). The prevalence of UTI is 15.62%(607/3885).The prevalence of frequent urination and urgency together  was 6.07%(236/3885);the prevalence of frequent urination, urgency and DUI together was 1.75%(68/3885); frequent urination, urgency, DUI and nocturia appeared simultaneously in 0.39%(15/3885). With the increase of age, the rate of urinary frequency, urgency, DUI and nocturnal enuresis showed a significant decrease (P<0.05) gradually. As shown in Table 1,diapers usage last for more than 1 year and begun voiding training after 1 year old, UTI, refuse TT shown a significant impact on the prevalence of LUTS (P<0.05).

With the increase of economic level, the use of diapers has increased, and the delay of EC/TT has led to LUTS increased significantly in children and adolescents. The study suggests that children and adolescents have a higher prevalence of LUTS. Use diapers for more than 1 year after birth, UTI and no TT are risk factors for LUTS. Urinary training before 1 year old is a protective factor for LUTS. The younger the age, the higher the prevalence of LUTS, and the care of children with LUTS should be paid more attention to. School-age children suffer from LUTS was found to be as high as 35.21%,and therefore, more attention should be paid to the health care of these children.

The study suggests that children and adolescents have a higher prevalence of LUTS. Use diapers for more than 1 year after birth, UTI and no EC/TT are risk factors for LUTS. Initiated EC/TT before 1 year old is a protective factor for LUTS.