Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS), leading them to seek medical attention at pediatric urology clinics due to urinary dysfunction. Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. The symptoms seriously reduce the quality of life of children. LUTS is among the most common reasons for hospitalization in adulthood for individuals with CP. Therefore, it is extremely important to detect LUTS in CP at an early age, to create appropriate treatment programs and to protect the upper urinary systems.
 The aim of this study is to determine the severity of LUTS, which is common in children with CP; It is examined according to quality of life, toilet training age, CP type and gross motor functional classification system (GMFCS).

54 (29 girls; 25 boys) children with CP were included in the study. 
Urinary symptoms of the children included in the study evaluated with the Voiding Disorders Symptom Score (DVISS), 
Quality of life of the children included in the study evaluated with the Pediatric Incontinence Quality of Life Scale (PINQ).
Evaluated from bladder diary data (bladder usage capacity, frequency of voiding )
It was examined how children's urinary symptoms,  quality of life and toilet trainiing age  differ according to the type of CP and GMFCS.
Inclusion Criteria;
5-18 years old
Diagnosed with cerebral palsy
Lower urinary tract complaints and symptoms
Children in levels I-II-III or IV according to the GMFCS were included in the study.
Exclusion criteria;
At level V according to the GMFCS
Epileptic seizures
Cognitively impaired 
Children with anatomical or congenital malformations of the urinary system were not included in the study.

According to the CP type  results were as follows;

The IBSS scores for hemiplegic (HP) , diplegic(DP) , quadriplegic (QP) and ataxic(AT)  CP were as follows, respectively: (HP:13, DP:15,32 , QP:16, AT:13,17), p=0,145
The PINQ scores for HP, DP, QP and AT  CP were as follows, respectively: (HP: 30,62, DP: 32,03, QP: 33,5, AT: 29,17), p=0,462
The toilet training age  for HP, DP, QP and AT  CP were as follows, respectively: (HP: 4,12, DP: 5,21, QP: 9,25,5, AT: 5,17), p=0,001

According to the GMFCS level  results were as follows;

The IBSS scores for according to GMFCS level I-II-III-IV  were as follows, respectively;
(Level-I: 13,63, Level-II:16,5, Level-III: 14,77, Level-IV: 18,2), p=0,075

The PIN-Q scores for according to GMFCS level I-II-III-IV  were as follows, respectively;
(Level-I: 31,38, Level-II:31,5, Level-III: 30,62, Level-IV: 34,4), p=0,677

The toilet training age for according to GMFCS level I-II-III-IV  were as follows, respectively;
(Level-I: 4,73, Level-II:5,46, Level-III: 5,63, Level-IV: 7,46), p=0,002

In the literature, studies examining the urinary symptoms of children with CP were generally conducted at all levels (I-II-III-IV-V) according to GMFCS, and children with cognitive impairment were not excluded. Since voluntary urination is an action that requires mobilization and cognitive control together, these two factors should be taken into consideration when evaluating LUTS in children with CP. 
In the literature, in studies where all levels of GMFCS are included; It has been observed that as the GMFCS level increases, the quality of life decreases (1) and symptoms increase (2). In our study, in children with CP who had GMFS scores between I and IV and did not have cognitive impairment; There is no statistical significance between CP type and quality of life, symptoms, and bladder use capacity.  
In the literature, in a study conducted in GMFCS I-V groups, it was found that quadriplegic type CP was the slowest to gain continence (3). In our study, consistent with the literature, toilet training age was found to be statistically significant only in the level IV and quadriplegic groups. As the GMFCS level increases, the age of toilet training is delayed.

In our study, consistent with the literature, toilet training age was found to be statistically significant only in the level IV and quadriplegic groups. As the GMFCS level increases, the age of toilet training is delayed.
Since voluntary urination is an action that requires mobilization and cognitive control together, we recommend that the GMFCS V group should not be included or evaluated separately when evaluating LUTS in children with CP.

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