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Michal M, Agata LG, Katarzyna J, Ilona C, Andrzej G, Aleksandra Ż. Immediate and continued results of parasacral transcutaneous electrical nerve stimulation in paediatric patients with overactive bladders. J Pediatr Urol 2024; 20:868-876. [PMID: 39069460 DOI: 10.1016/j.jpurol.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 06/23/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol. OBJECTIVE To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB. STUDY DESIGN 57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48 h frequency/volume (48 h F/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1 h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy). RESULTS After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p < 0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p < 0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p < 0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p < 0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes. DISCUSSION A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS. CONCLUSIONS The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation.
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Affiliation(s)
- Maternik Michal
- Department of Paediatrics, Nephrology and Hypertension Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
| | - Lakomy-Gawryszewska Agata
- Department of Paediatrics, Nephrology and Hypertension Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
| | - Józefowicz Katarzyna
- Division of Physical Therapy Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk Poland.
| | - Chudzik Ilona
- Department of Paediatrics, Nephrology and Hypertension Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
| | - Gołębiewski Andrzej
- Department of Paediatric Surgery and Urology Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk Poland.
| | - Żurowska Aleksandra
- Department of Paediatrics, Nephrology and Hypertension Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
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Hougaard NB, Breinbjerg A, Kamperis K, Skott M. Botulinum Neurotoxin Type A in paediatric non-neurogenic therapy resistant overactive bladder: a cohort study. Int Urol Nephrol 2024:10.1007/s11255-024-04217-z. [PMID: 39327408 DOI: 10.1007/s11255-024-04217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION AND OBJECTIVE Intradetrusor Botulinum Neurotoxin Type A (BoNT-A) is an increasingly applied treatment modality for overactive bladder (OAB) in children with refractory urinary incontinence. Despite that, evidence is sparse, and the potential not fully understood. The aim of this study was to evaluate the effectiveness and safety of intradetrusor injection in children with refractory functional OAB and urinary incontinence. Furthermore, we aimed to identify predictors of efficacy and side effects to BoNT-A treatment. MATERIALS AND METHODS We conducted a cohort study of children with OAB and urinary incontinence who received intradetrusor injection of BoNT-A in the period 01.01.2016 to 31.12.2020 at our centre. All patients were refractory to standard urotherapy, anticholinergics, mirabegron and the combination of these treatments. Patients with neurogenic bladder were excluded. Primary endpoint was the reduction on the frequency of urinary incontinence episodes from baseline. Secondary endpoints included urodynamic parameters and uroflowmetry characteristics as well as side effects. RESULTS Forty-three children (mean age at first treatment 10.7 ± 1.8, 30 males) were included. After first treatment, a reduction of ≥ 50% in incontinence episodes was seen in 58% of patients with daytime urinary incontinence (DUI) and 47% of patients with nocturnal enuresis (NE). Adverse events, mainly urinary tract infections (UTI), were reported by 16% of patients after first treatment. Our analysis identified normal cystometric compliance as a significant predictor of treatment effect We estimated the mean duration of effect to be approximately 7 months. CONCLUSIONS Intradetrusor BoNT-A injection appears to be a safe and effective option in treating refractory urinary incontinent children with overactive bladder. We identified cystometric compliance as a predictor of response. Most children necessitate repeated treatments. Further prospective and controlled studies are necessary in order to fully identify predictors and potential of treatment.
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Affiliation(s)
- Nicklas B Hougaard
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark.
| | - Anders Breinbjerg
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Konstantinos Kamperis
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Martin Skott
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
- Department of Urology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
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van Geen FJ, Nieuwhof-Leppink AJ, Wortel RC, de Kort LMO. Bladder exstrophy-epispadias complex: The effect of urotherapy on incontinence. J Pediatr Urol 2024; 20:645.e1-645.e5. [PMID: 38821732 DOI: 10.1016/j.jpurol.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Achieving urinary continence is a key goal in children born with the bladder exstrophy-epispadias complex (BEEC). Unfortunately, this goal is only moderately achieved despite sometimes extensive surgical treatment. Undergoing repeated hospitalization and operations may consequently have a negative impact on quality of life. We therefore believe that other, conservative treatment options should be explored in an earlier stage of incontinence treatment in BEEC patients. As part of this, an intensive urotherapy program based on was offered to patients with persistent incontinence after reconstructive surgery for BEEC. OBJECTIVE The aim of this study is to evaluate the benefits of intensive urotherapy on incontinence after reconstructive surgery in children with BEEC. STUDY DESIGN A retrospective chart study was performed including all children who were enrolled in an intensive urotherapy program because of persistent incontinence after reconstructive surgery for BEEC. Urotherapy consisted of a ten-day inpatient training program based on cognitive behavioral therapy, with intensive follow-up by experienced urotherapists. Main outcome measurement was continence, expressed as the percentage of children that achieved complete continence (good result; 100% dry) or 50-99% decrease of wet days a week (improved result) after treatment. RESULTS Data of 33 patients with a mean age of 10.6 years were analyzed. In 61% of cases (20/33) an improved or good result was reported on incontinence after urotherapy. Children with classic bladder exstrophy more often achieved a good or improved result (13/16; 81%), compared to children with epispadias (6/16; 38%). The only patient with a cloacal exstrophy completed treatment with an improved result. From the group of patients with persistent incontinence, 75% (12/16) reported that the complaints were socially acceptable at the end of follow-up. DISCUSSION By following our intensive urotherapy program the majority of patients achieved complete continence or improved incontinence. In addition, our results show that the inpatient training program has a positive impact on acceptance in cases of persistent incontinence. The urotherapists offer individualized care and clear guidance, which we deem essential elements of successful treatment. Considering that repeated surgery may impede progress and offers no guarantee of continence, we recommend giving preference to conservative treatment options. CONCLUSION Our results show that 37% (12/33) of patients with BEEC who were enrolled in our intensive urotherapy program because of persistent incontinence after reconstructive surgery, achieved complete continence after urotherapy and 63% (21/33) still experienced some degree of incontinence. 75% of patients who did not achieve complete continence, described the remaining incontinence as socially acceptable. These findings strongly support counselling patients with BEEC to consider conservative treatment before opting for further surgery.
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Affiliation(s)
- Frank-Jan van Geen
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anka J Nieuwhof-Leppink
- Department of Medical Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ruud C Wortel
- Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands
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Li F, Feng L, Yang Y, Ma X, Kang T, Huang W. The effect of biofeedback on nonneurological dysfunctional voiding in children: A meta-analysis and systematic review. J Pediatr Urol 2024; 20:565-580. [PMID: 38997937 DOI: 10.1016/j.jpurol.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE This study was conducted to investigate the effect of biofeedback (BF) on the rehabilitation of children with nonneurological dysfunctional voiding (NDV). METHODS RCTs were retrieved from various databases (published from inception to February 29, 2024). The effects of the BF and non-BF treatments were compared. A random-effects model was used to evaluate the combined data. RESULTS Meta-analysis revealed that BF increased the maximum urinary flow rate (SMD = 3.78, 95% CI 1.33∼6.22), improved urination time (SMD = 5.88, 95% CI 3.75∼8.01), and reduced the postvoid residual (SMD = -19.18, 95% CI -27.03∼-11.33) and urinary tract infection incidence (RR = 0.43, 95% CI 0.21∼0.87). Electromyogram activity (RR = 0.46, 95% CI 0.25∼0.84) and abnormal urination patterns (RR = 0.51, 95% CI 0.35∼0.74) improved, with effects persisting for more than 1 year. However, the effect of BF on the mean urinary flow rate in children with NDV was significant only after 1 year of follow-up (SMD = 1.90, 95% CI 0.87∼2.92). CONCLUSION Existing evidence indicates that BF can enhance urinary parameters and patterns in children with NDV. However, its effectiveness in addressing constipation, daytime urinary incontinence, and nocturnal urinary incontinence is not substantial. High-quality randomized controlled trials can offer additional insights.
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Affiliation(s)
- Fangqin Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Liwei Feng
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Yang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xueping Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Kang
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Wenjiao Huang
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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Casal-Beloy I, Romero Ruíz RM. Letter to the editor re "Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction - A randomized prospective trial". J Pediatr Urol 2024:S1477-5131(24)00294-8. [PMID: 38880669 DOI: 10.1016/j.jpurol.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Infantil Virgen del Rocío, C. Torcuato Luca de Tena, 32, 41013 Sevilla, Spain.
| | - Rosa María Romero Ruíz
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Infantil Virgen del Rocío, C. Torcuato Luca de Tena, 32, 41013 Sevilla, Spain.
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Kopač M. Pediatric Lower Urinary Tract Dysfunction: A Comprehensive Exploration of Clinical Implications and Diagnostic Strategies. Biomedicines 2024; 12:945. [PMID: 38790908 PMCID: PMC11118197 DOI: 10.3390/biomedicines12050945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/03/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, it may cause urinary incontinence, strongly affecting the child's quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity and may be self limiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, neurogenic bladder dysfunction, most often caused by spinal dysraphism, which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. A voiding diary is crucial in the initial evaluation of lower urinary tract function in children.
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Affiliation(s)
- Matjaž Kopač
- Department of Nephrology, Division of Pediatrics, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia
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Warne N, Heron J, von Gontard A, Joinson C. Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study. Eur Child Adolesc Psychiatry 2024; 33:871-879. [PMID: 37095371 PMCID: PMC10894090 DOI: 10.1007/s00787-023-02211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Abstract
Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child's symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.
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Affiliation(s)
- Naomi Warne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carol Joinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Oldenhof AP, Linde JM, Hofmeester I, Steffens MG, Kloosterman-Eijgenraam FJ, Blanker MH. Managing children with daytime urinary incontinence: a survey of Dutch general practitioners. Eur J Gen Pract 2023; 29:2149731. [PMID: 37096586 PMCID: PMC10132240 DOI: 10.1080/13814788.2022.2149731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND In the Netherlands, parents of children with daytime urinary incontinence (UI) first consult general practitioners (GPs). However, GPs need more specific guidelines for daytime UI management, resulting in care and referral decisions being made without clear guidance. OBJECTIVES We aimed to identify Dutch GP considerations when treating and referring a child with daytime UI. METHODS We invited GPs who referred at least one child aged 4-18 years with daytime UI to secondary care. They were asked to complete a questionnaire about the referred child and the management of daytime UI in general. RESULTS Of 244 distributed questionnaires, 118 (48.4%) were returned by 94 GPs. Most reported taking a history and performing basic diagnostic tests like urine tests (61.0%) and physical examinations (49.2%) before referral. Treatment mostly involved lifestyle advice, with only 17.8% starting medication. Referrals were usually at the explicit wish of the child/parent (44.9%) or because of symptom persistence despite treatment (39.0%). GPs usually referred children to a paediatrician (n = 99, 83.9%), only referring to a urologist in specific situations. Almost half (41.4%) of the GPs did not feel competent to treat children with daytime UI and more than half (55.7%) wanted a clinical practice guideline. In the discussion, we explore the generalisability of our findings to other countries. CONCLUSION GPs usually refer children with daytime UI to a paediatrician after a basic diagnostic assessment, usually without offering treatment. Parental or child demand is the primary stimulus for referral.
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Affiliation(s)
| | - J Marleen Linde
- Department of Urology, Isala Hospital, Zwolle, the Netherlands
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ilse Hofmeester
- Department of Urology, Isala Hospital, Zwolle, the Netherlands
| | | | | | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Bladt L, Kashtiara A, Platteau W, De Wachter S, De Win G. First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis. JMIR Form Res 2023; 7:e51019. [PMID: 37847531 PMCID: PMC10618888 DOI: 10.2196/51019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. OBJECTIVE In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). METHODS A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. RESULTS The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was -3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of -19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. CONCLUSIONS Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow.
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Affiliation(s)
- Lola Bladt
- Product Development, Faculty of Design Sciences, University of Antwerp, Antwerp, Belgium
| | - Ardavan Kashtiara
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wouter Platteau
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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10
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Morizawa Y, Hori S, Gotoh D, Nakai Y, Torimoto K, Fujimoto K. Frequency of tethered cord syndrome in pediatric patients with refractory daytime incontinence. Int J Urol 2023; 30:934-935. [PMID: 37431797 DOI: 10.1111/iju.15224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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van Geen FJ, van de Wetering EHM, Nieuwhof-Leppink AJ, Klijn AJ, de Kort LMO. Dysfunctional Voiding: Exploring Disease Transition From Childhood to Adulthood. Urology 2023; 177:60-64. [PMID: 37028523 DOI: 10.1016/j.urology.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To improve our transitional care, we explored how childhood dysfunctional voiding (DV) develops into adulthood. DV is a common condition in both children and adults. However, the long-term course of childhood DV into adulthood is unknown and treatment over the ages differs. METHODS A cross-sectional follow-up was performed in a cohort of 123 females treated from 2000 to 2003 for childhood DV with urinary tract infections (UTIs) and/or daytime urinary incontinence (DUI). The main outcome was a staccato or intermittent urinary flow pattern, possibly indicating persistent or recurred DV according to the International Continence Society criteria. Flow patterns of healthy women were used to compare results. RESULTS Twenty-five patients participated in this study, with a mean duration of 20.8 years after urotherapy. In 10/25 (40%) cases, a staccato or interrupted urinary flow pattern was found on the current measurement, compared to 5/47 (10.6%) in the control group. Around 50% (5/10) of the patients with a dysfunctional flow pattern reported UTIs and 50% (5/10) experienced DUI. In the group with a normal flow pattern, 2/15 (13%) reported UTIs and 9/15 (60%) DUI. The impact of DUI on quality of life was moderate to high in both groups. CONCLUSION Our results show that 40% of females who had extensive urotherapy for DV in childhood, still have DV according to International Continence Society criteria as an adult, 56% still experience DUI, and 28% UTIs. These data should be taken into account in the counseling of patients and for guiding the process of transition into adulthood.
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Affiliation(s)
| | - Eline H M van de Wetering
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands; Department of Urology, Radboudumc, Nijmegen, The Netherlands.
| | - Anka J Nieuwhof-Leppink
- Department of Medical Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Aart J Klijn
- Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Baram M, Zuk L, Stattler T, Katz-Leurer M. The Prevalence of Bladder and Bowel Dysfunction in Children with Cerebral Palsy and its Association with Motor, Cognitive, and Autonomic Function. Dev Neurorehabil 2023; 26:155-162. [PMID: 36943141 DOI: 10.1080/17518423.2023.2193268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE To describe the prevalence of bladder and bowel dysfunction (BBD) in 8-10-year-old children with cerebral palsy and its association with motor, cognitive, and autonomic dysfunction. METHODS A cross-sectional, random sample study of parents of 8-10-year-old children with cerebral palsy. Tools: The Enuresis/Urinary Incontinence Parental Questionnaire, the Functional Independence Measure children's version, the autonomic signs questionnaire, and the Gross Motor Function Classification System. RESULTS 39 out of 59 parents consented to participate, whereas 25.64% reported complete continence. Of the 29 children with BBD, 21 (72.4%) had lower urinary tract symptoms and bowel problems. Only two of the children received conservative and noninvasive treatments. Lastly, motor, cognitive and autonomic impairments were associated with incontinence. CONCLUSIONS BBD is common in 8-10-year-old children with cerebral palsy at all levels of functioning. Most having both lower urinary tract symptoms and bowel problems.
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Affiliation(s)
- Moriah Baram
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Luba Zuk
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tohar Stattler
- ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
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Hyuga T, Tanabe K, Kubo T, Nakamura S, Nakai H, Moriya K. Vibegron shows high efficacy in pediatric patients with refractory daytime urinary incontinence. Neurourol Urodyn 2023; 42:794-798. [PMID: 36840745 DOI: 10.1002/nau.25163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/27/2023] [Accepted: 02/11/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Sparse published reports exist nowadays on vibegron and pediatric overactive bladder, so its usefulness of this agent remains unclear. The purpose of this study was to clarify the effectiveness of vibegron for pediatric cases of daytime urinary incontinence (DUI), including refractory cases. METHODS Participants comprised 57 patients treated with vibegron for DUI from March 2019 to April 2022. To investigate treatment outcomes and risk factors for pediatric patients with refractory DUI, the following factors were evaluated: age at initiatial administration; frequency of DUI; duration of vibegron treatment; presence of neurodevelopmental disorders (NDDs); presence of constipation; and anticholinergic medications before and after initiation of treatment. RESULTS Patients included 38 boys and 19 girls with a median age at initial administration of 111 months (range: 64-202 months) and a median administration term of 6 months (range: 1-33 months). With treatment for 6 months, the response rate (complete response + partial response) was 68.3%. A total of 24 cases with NDD showed a 72.0% response rate at 6 months. As for the relationship between anticholinergic agents and vibegron, 15 cases were treated with vibegron as the first choice without anticholinergics (First-choice cases), and 33 cases were treated with vibegron alone after switching from anticholinergics (Switch cases). Vibegron was used in combination with anticholinergic agents in 9 cases (Add-on cases). Response rates at 6 months were 85.0% in First-choice cases, 66.3% in Switch cases, and 40.7% in Add-on cases. Univariate analyses failed to identify any significant risk factors for refractory cases. CONCLUSIONS Vibegron was effective in pediatric cases of DUI, with efficacy demonstrated within a short time in many cases. Vibegron is expected to play a significant role in the treatment of DUI in pediatric cases.
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Affiliation(s)
- Taiju Hyuga
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuya Tanabe
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Taro Kubo
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shigeru Nakamura
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hideo Nakai
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kimihiko Moriya
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Alarm-assisted urotherapy for daytime urinary incontinence in children: A meta-analysis. PLoS One 2023; 18:e0275958. [PMID: 36735674 PMCID: PMC9897563 DOI: 10.1371/journal.pone.0275958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/27/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Wearable alarm systems are frequently used tools added to urotherapy for children with both daytime and nighttime urinary incontinence. For functional daytime incontinence (DUI) specifically, the effect of alarm interventions has not been systematically reviewed. This study systematically evaluates, summarizes, reviews, and analyzes existing evidence about the effect of wearable alarm systems in urotherapy for children with functional DUI. STUDY DESIGN We completed a comprehensive literature search in August 2022 using MEDLINE/PUBMED, EMBASE, PsycINFO, Cochrane Library, Web of Science, Google Scholar, conference abstracts, and citation tracking. Clinical controlled trials at controlled-trials.com and clinicaltrials.gov were consulted, as was the National health Service Center For Reviews And Dissemination. Eligible studies including the use of noninvasive wearable alarm systems as (part of) treatment for functional DUI in children were included. The main outcome was continence after treatment. Three independent reviewers extracted data. Risk of bias was assessed using Cochrane and National Heart, Lung and Blood Institute quality assessment tools. RESULTS A total of 10 studies out of 1,382 records were included. Meta-analysis revealed a nonsignificant risk ratio of 1.4 (95% CI: 0.8-2.6) for the use of alarm systems. Urotherapy with alarm systems resulted in a 48% (95% CI: 33-62%) continence rate after treatment. CONCLUSIONS Alarm systems might be helpful as part of urotherapy for functional DUI in select cases. Adherence is problematic, and the optimal duration of the use of alarm systems is to be determined. Overall, the risk of bias was high in all studies.
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Sollini ML, Capitanucci ML, Foti C, Nocentini U, Castelli E, Mosiello G. Home pelvic floor exercises in children with non-neurogenic Lower Urinary Tract Symptoms: Is fitball an alternative to classic exercises? Neurourol Urodyn 2023; 42:146-152. [PMID: 36208111 PMCID: PMC10092819 DOI: 10.1002/nau.25060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Biofeedback with home pelvic floor exercises were recommended as non-pharmacologic treatment for non-neurogenic Lower Urinary Tract Symptoms (LUTS) in children. Fitball is recommended to improve all-over flexibility, balance, and coordination, especially for pelvic floor. Aim of the study was to investigate efficacy of standard home pelvic floor exercises versus exercises using fitball. METHODS From April 2021 to February 2022 to all children arrived in our clinic with non-neurogenic LUTS nonresponder at urotherapy, our pelvic floor rehabilitative program was proposed. During the rehabilitation children performed: standard urotherapy, pelvic floor animated biofeedback therapy and pelvic floor exercises in a standard way and using a fitball. After the first session, patients received prescription to repeat at home the same exercises performed at hospital. Children who chose classic exercises were enrolled in group A and they who chose fitball in group B. Continence rate, pelvic floor muscles activity, adherence and satisfaction were evaluated by means of bladder diary, external pubococcygeus test and Likert-type psychometric scale (from 1 = very unsatisfied to 5 = very satisfied) respectively. RESULTS Twenty-six children affected by LUTS were enrolled: 13 in group A and 13 in B. At 4th control urinary incontinence was reduced by 72,5% in A and 71.4% in B. Pubococcygeus test increased in both groups. Adherence at home was 92% in group A and 62% in group B. Satisfaction with the treatment (4 or 5 points) was 95% in both groups. Four patients of group A and all of group B decided to maintain home exercises including fitball. CONCLUSIONS Our preliminary study shows that efficacy of home exercises, with or without fitball, is comparable. Satisfaction with fitball is high, regardless results obtained, because parents and children have learned a new, interesting and stimulating way to manage urinary problems. The opportunity to perform these exercises using fitball, it's an important finding for pediatric population.
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Affiliation(s)
- Maria Laura Sollini
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy.,Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy.,"Santa Lucia" Foundation, I.R.C.C.S., Rome, Italy
| | | | - Calogero Foti
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ugo Nocentini
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy.,"Santa Lucia" Foundation, I.R.C.C.S., Rome, Italy
| | - Enrico Castelli
- Department of Neurorehabilitation, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Mosiello
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
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de Wall LL, Kragt EAM, Van De Wetering EHM, Cobussen-Boekhorst JGL, Mantel-van Stel J, Kortmann BBM, Feitz WF, Bootsma-Robroeks CMHHT. Challenges in e-Health: The effect of digitalisation of frequency voiding charts on compliance in paediatric patients. Randomised controlled trial comparing digital and versus paper frequency voiding charts. Digit Health 2023; 9:20552076231207577. [PMID: 37954691 PMCID: PMC10634267 DOI: 10.1177/20552076231207577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Objective Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents. Methods A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383. Results Ninety-seven patients were randomised to either a digital (N = 53) or paper (N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% (N = 18) for digital and 50% (N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart (p < 0.05). Conclusions In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out frequency voiding charts. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.
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Affiliation(s)
- Liesbeth L de Wall
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Elisabeth AM Kragt
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Eline HM Van De Wetering
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Johanna GL Cobussen-Boekhorst
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Joyce Mantel-van Stel
- Department of Paediatric Urology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara BM Kortmann
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wout F Feitz
- Division of Paediatric Urology, Department of Urology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Charlotte MHHT Bootsma-Robroeks
- Department of Paediatrics, Paediatric Nephrology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kitta T, Chiba H, Kon M, Higuchi M, Kusakabe N, Ouchi M, Togo M, Abe-Takahashi Y, Tsukiyama M, Shinohara N. Urodynamic evaluation of the efficacy of vibegron, a new β3-adrenergic receptor agonist, on lower urinary tract function in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:563-569. [PMID: 35965225 DOI: 10.1016/j.jpurol.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Idiopathic overactive bladder (OAB) is defined as an urgency symptom with or without urge incontinence, which is not due to known neurological abnormalities. Since children present with variable symptoms, pediatric nonneurogenic idiopathic OAB is a condition that is difficult to diagnose and treat. Although there are few reports on bladder function in pediatric patients compared to adult patients, it can be useful for diagnosis. Antimuscarinic therapy is the pharmacological mainstay of OAB management. However, antimuscarinic use is limited by side effects and Insufficient effects. Vibegron, a new drug with a different mechanism of action (β3-adrenoreceptor agonist), was recently introduced for treating OAB in adults but has not been studied in the pediatric population. OBJECTIVE This study aimed to determine the efficacy and tolerability of vibegron in children and adolescents with idiopathic OAB. STUDY DESIGN We conducted a retrospective study enrolling pediatric patients with OAB whose symptoms did not improve with behavioral therapy or pharmaceutical therapy. Efficacy and tolerability were assessed via a question, and patients underwent video-urodynamic testing before and during treatment with once-daily 50 mg vibegron. Statistical differences were evaluated using Wilcoxon matched-pairs signed-rank tests. RESULTS Out of the 17 patients that were recruited, full study with two urodynamic studies were confirmed by 11 patients. OAB symptoms improved in 14 (82.4%) patients, and 3 patients discontinued treatment because of ineffectiveness. No patients discontinued treatment because of intolerance to vibegron. The median (IQR) first desire to void (133 [82-185]-161 [123-227] mL), bladder capacity (158 [136-238]-204 [150-257] mL), and bladder compliance (18.1 [9.1-76.7]-34.0 [30.0-82.3] mL/cm H2O) improved significantly post treatment compared to before treatment. Detrusor overactivity disappeared in one of the eight patients with this condition. The parameters of voiding function did not change significantly after the administration of vibegron. DISCUSSION Treatment with vibegron significantly improved clinical and urodynamic parameters of pediatric OAB with no adverse effects. Little information is available regarding the feasibility of switching drugs when patients discontinue prior pharmacological therapy because of insufficient efficacy or poor tolerability in children. Vibegron may be a promising OAB treatment option with a better balance of efficacy and tolerability. CONCLUSIONS Vibegron is an alternative agent for pediatric patients with idiopathic OAB for improving both subjective symptoms and lower urinary tract function. Future prospective randomized studies with larger sample sizes must be conducted to validate the results of the present study.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naohisa Kusakabe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yui Abe-Takahashi
- Department of Physical Therapy, Faculty of Health Sciences Hokkaido University of Science, Sapporo, Japan
| | - Mayuko Tsukiyama
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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18
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Re: Urodynamic evaluation of the efficacy of vibegron, a new β3-adrenergic receptor agonist, on lower urinary tract function in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:570-571. [PMID: 36210271 DOI: 10.1016/j.jpurol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/03/2022] [Indexed: 12/14/2022]
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de Wall LL, Nieuwhof-Leppink AJ, van de Wetering EHM, Leijn E, Trompetter M, de Kort LMO, Feitz WF, Schappin R. Study protocol for a parallel-group randomized controlled multi-center trial evaluating the additional effect of continuous ultrasound bladder monitoring in urotherapy for children with functional daytime urinary incontinence (SENS-U trial). Trials 2022; 23:648. [PMID: 35964045 PMCID: PMC9375366 DOI: 10.1186/s13063-022-06600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lower urinary tract dysfunction or functional urinary incontinence is a common condition with a prevalence up to 21% between 6 and 8 year-old children. It is associated with an impaired quality of life, lower self-esteem, and social stigmatization. Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined. METHODS/DESIGN This is a multi-center clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6 and 16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice are eligible. Four centers, two academic hospitals, and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups: urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training, or urotherapy with a SHAM device for 3 weeks. The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control (care as usual) group. DISCUSSION To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy. TRIAL REGISTRATION ISRCTN44345202 . Registered on March 2022.
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Affiliation(s)
- L L de Wall
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E H M van de Wetering
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E Leijn
- TOP voor Kinderen Practice, Arnhem, The Netherlands
| | - M Trompetter
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | - L M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W F Feitz
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
| | - R Schappin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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Samijn B, Van den Broeck C, Plasschaert F, Pascal A, Deschepper E, Hoebeke P, Van Laecke E. Incontinence training in children with cerebral palsy: A prospective controlled trial. J Pediatr Urol 2022; 18:447.e1-447.e9. [PMID: 35732572 DOI: 10.1016/j.jpurol.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment. OBJECTIVE To investigate the effectiveness of incontinence training with urotherapy in children with CP. STUDY DESIGN A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis. RESULTS Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p < 0.001), frequency of daytime incontinence (p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct toilet posture (p = 0.034) and fecal incontinence (p = 0.026). DISCUSSION Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended. CONCLUSIONS Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.
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Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | - Frank Plasschaert
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | | | - Piet Hoebeke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Posterior Tibial Nerve Stimulation in Children with Lower Urinary Tract Dysfunction: A Mixed-Methods Analysis of Experiences, Quality of Life and Treatment Effect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159062. [PMID: 35897438 PMCID: PMC9331059 DOI: 10.3390/ijerph19159062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023]
Abstract
Background: Posterior tibial nerve stimulation (PTNS) is one of the treatment modalities for children with therapy-refractory lower urinary tract dysfunction (LUTD). This study used a mixed-methods analysis to gain insight into the experiences of children treated with PTNS and their parents, the effect of treatment on quality of life (QOL) and the effect of PTNS on urinary symptoms. Methods: Quantitative outcomes were assessed through a single-centre retrospective chart analysis of all children treated with PTNS in a group setting between 2016–2021. Voiding parameters and QOL scores before and after treatment were compared. Qualitative outcomes were assessed by an explorative study involving semi-structured interviews transcribed verbatim and inductively analysed using the constant-comparative method. Results: The data of 101 children treated with PTNS were analysed. Overall improvement of LUTD was seen in 42% and complete resolution in 10%. Average and maximum voided volumes significantly increased. QOL improved in both parents and children independent of the actual effect on urinary symptoms. Interviews revealed PTNS to be well-tolerated. Facilitating PTNS in a group setting led to feelings of recognition in both children and parents. Conclusions: PTNS is a good treatment in children with therapy-refractory LUTD and provides valuable opportunities for peer support if given in a group setting.
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22
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Borgström M, Bergsten A, Tunebjer M, Hedin Skogman B, Nevéus T. Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial. Arch Dis Child 2022; 107:570-574. [PMID: 35074830 PMCID: PMC9125372 DOI: 10.1136/archdischild-2021-323488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis. DESIGN Randomised, controlled trial. SETTING Paediatric outpatient ward, regional hospital. PATIENTS Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence. INTERVENTIONS Three groups, each during 8 weeks: (A) basic bladder advice-that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group). MAIN OUTCOME MEASURES Reduction in enuresis frequency during week 7-8 compared with baseline. RESULTS The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls. CONCLUSIONS Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin. TRIAL REGISTRATION NUMBER NCT03812094.
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Affiliation(s)
- Malin Borgström
- Center for Clinical Research Dalarna, Falun, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Amadeus Bergsten
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Tunebjer
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Barbro Hedin Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Institution of Medical and Health Sciences, Örebro University, Örebro, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Deng C, Chen Y, Dai R. Re: Safety and short-term efficacy of mirabegron in children with valve bladder: a pilot study. Pediatr Surg Int 2022; 38:949-950. [PMID: 35362797 DOI: 10.1007/s00383-022-05120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
Overactive bladder (OAB) is a common lower urinary tract dysfunction syndrome. A stepwise approach is a prudent choice. Urotherapy is recommended by the International Children's Continence Society (ICCS) as the first-line treatment for OAB.
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Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Yue Chen
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
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Ramsay S, Lapointe É, Bolduc S. Comprehensive overview of the available pharmacotherapy for the treatment of non-neurogenic overactive bladder in children. Expert Opin Pharmacother 2022; 23:991-1002. [PMID: 35500302 DOI: 10.1080/14656566.2022.2072212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a chronic condition highly prevalent in children and causing bothersome symptoms. It is often associated with deterioration of quality of life and can be devastating for patients and their families. Prompt initiation of conservative measures should be the backbone of treatment. When conservative management fails, pharmacological options must be considered. AREAS COVERED Although antimuscarinics are considered the mainstay of pharmacological treatment for OAB, only two agents are currently approved for the pediatric population. Oxybutynin and propiverine are discussed in this review, as well as other non-approved antimuscarinic agents and β3-agonists with related literature to substantiate their use in children. Dual therapy along with medication adherence and persistence is also discussed. EXPERT OPINION The treatment of OAB in children is demanding and one must rely on a structured, stepwise approach to achieve success. Discussing conservative measures and prescribing medication is not enough. Clinicians should actively involve children and their families in the treatment, set realistic expectations, and closely monitor side effects and medication adherence to ensure maximal efficacy.
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Affiliation(s)
- Sophie Ramsay
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - Élisabeth Lapointe
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
| | - Stéphane Bolduc
- Division of Urology, CHU de Québec - Université Laval Research Center, Québec, Québec, Canada
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Casal-Beloy I, Capdevila-Vilaró B, Pérez-Bertólez S, Martín-Solé O, García González M, Tarrado Castellarnau X, García-Aparicio L. Comentary on "Comparison and characteristics of children successfully treated for daytime urinary incontinence". J Pediatr Urol 2022; 18:247-248. [PMID: 35153147 DOI: 10.1016/j.jpurol.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain; Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
| | - Blanca Capdevila-Vilaró
- Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
| | - Sonia Pérez-Bertólez
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain; Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
| | - Oriol Martín-Solé
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain; Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña, As Xubias, 84, CP: 15006, A Coruña, Spain.
| | - Xavier Tarrado Castellarnau
- Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
| | - Luís García-Aparicio
- Pediatric Urology Unit, Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain; Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2, Esplugues Del Llobregat, Barcelona, 08950, Spain.
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26
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Bladder Training for Individuals with Autism: a Systematic Review Concludes as Empty. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Band ME. It’s Not Just for Kids. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jessen AS, Hagstroem S, Borch L. Comparison and characteristics of children successfully treated for daytime urinary incontinence. J Pediatr Urol 2022; 18:24.e1-24.e9. [PMID: 34930690 DOI: 10.1016/j.jpurol.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Daytime urinary incontinence (DUI) is defined as an involuntary leakage of urine during daytime in children 5 years or older. It is a common disorder in the pediatric population most often caused by an overactive bladder (OAB). A stepwise approach is recommended in the treatment of DUI, with standard urotherapy (SU) being first line treatment followed by pharmacological treatment when SU is unsuccessful. To our knowledge few studies have compared patients achieving continence solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment in the pediatric population. OBJECTIVE The aim of the study was to characterize and compare children suffering from OAB and DUI who became continent solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment. METHODS All children successfully treated for DUI from 2015 to 2020 were retrospectively analyzed and compared using data from patient's records, 48-h flow-volume charts, and uroflowmetry analysis. RESULTS 180 children were successfully treated for DUI. Of these 23 (13%) had bowel dysfunction, 94 (52%) were successfully treated with standard urotherapy (SU) and 64 (35%) needed pharmacological treatment. Children who achieved continence on a combination of SU and pharmacological treatment had a significantly higher baseline voiding frequency (7.6 and 6.5 respectively, p=0.007) and more baseline incontinence episodes during daytime when compared to children who became dry solely on urotherapy (2.2 and 1.1 respectively, p < 0.001). Both groups had a similar baseline age (p=0.96) and received a similar duration of standard urotherapy prior to the eventual pharmacological treatment (p = 0.73). DISCUSSION Most children achieved daytime continence solely on standard urotherapy. We found that children requiring additional pharmacological treatment to achieve continence suffer from a more severe overactive bladder. As such it could be speculated that children with high voiding frequencies and multiple daily incontinence episodes may benefit from adding anticholinergics to SU earlier during the course of treatment, than what is recommended by the International Children's Continence Society (ICCS) today. However prospective interventional studies are needed for safe conclusions. CONCLUSION Our comparison showed that children requiring a combination of SU and pharmacological treatment to achieve continence, had a significantly higher baseline voiding frequency and more baseline incontinence episodes when compared to children requiring only SU to achieve continence.
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Affiliation(s)
- Alexander Slot Jessen
- Department of Pediatric and Adolescent Medicine, NIDO Denmark, Gødstrup Hospital, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Soeren Hagstroem
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Luise Borch
- Department of Pediatric and Adolescent Medicine, NIDO Denmark, Gødstrup Hospital, Gl. Landevej 61, 7400, Herning, Denmark
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Caldwell PHY, Kerr M, Hamilton S, Teixeira-Pinto A, Craig JC. An Alarm Watch for Daytime Urinary Incontinence: A Randomized Controlled Trial. Pediatrics 2022; 149:183834. [PMID: 34907443 DOI: 10.1542/peds.2021-053863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Daytime urinary incontinence is disabling and occurs in 17% of school-aged children. Timed-voiding is part of standard therapy. Can an alarm watch to aid timed-voiding improve treatment response to standard therapy? METHODS The WATCH (Watch with Alarm for Timed-Voiding in Children) study is a randomized controlled trial. Participants were randomly assigned (1:1) to a vibrating alarm or nonalarming watch for 3-months. The primary outcome was the proportion who achieved a complete response (14 consecutive dry days) after 3-months of treatment. Children aged 5 to 13 years who were prescribed timed-voiding for daytime urinary incontinence. RESULTS Overall, 243 children, with a mean age of 8 years, were enrolled, with 62% girls. At 3-months, the complete response rates were similar between the 2 groups (22% alarm versus 17% control; difference: 5%; 95% confidence interval (CI): -5% to 16%; P = .42). In the alarm group, treatment adherence was higher (40% vs 10%; difference: 30%; 95% CI: 20% to 40%; P < .001), frequency of incontinence was lower (25% dry; 40% had 1-3 wet days per week, 24% had 4-6 wet days per week, and 12% had daily wetting, compared with 19%, 30%, 35%, and 16%, respectively; P =.05), and fewer had abnormal postvoid residual urine volumes (12% vs 24%; difference: -12%; 95% CI: -21% to -1%; P = .04) compared with the control group. Improvement was transient and did not persist 6 months beyond the treatment period. CONCLUSIONS Alarm watches do not appear to lead to complete resolution of urinary incontinence in children but did promote treatment adherence, normalization of postvoid residual volumes, and reduction in incontinent episodes while being used.
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Affiliation(s)
- Patrina H Y Caldwell
- The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Marianne Kerr
- The Children's Hospital at Westmead, Sydney, Australia
| | - Sana Hamilton
- The Children's Hospital at Westmead, Sydney, Australia
| | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Nevéus T. Problems with enuresis management-A personal view. Front Pediatr 2022; 10:1044302. [PMID: 36405838 PMCID: PMC9671946 DOI: 10.3389/fped.2022.1044302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Much has happened since the end of the era when enuresis was blamed on the parents or the children themselves. Still, there are large gaps in our knowledge and large parts of modern enuresis management guidelines are (still) not based on firm evidence. In this review I will question the following commonly made assumptions regarding enuresis evaluation and treatment: •It is important to subdivide enuresis according to the presence of daytime symptoms•Voiding charts are crucial in the primary evaluation of the enuretic child•All children with enuresis need to be screened for behavioral or psychiatric issues•Concomittant daytime incontinence needs to be successfully treated before addressing the enuresis•Concomittant constipation needs to be successfully treated before addressing the enuresis•Urotherapy is a first-line treatment against enuresis In this review I will argue that much of what we do with these children is based more on experience and well-meant but poorly supported assumptions than on evidence. Some advice and therapies are probably ineffective whereas for other treatments we lack reliable predictors of treatment response. More research is obviously needed, but awaiting new results enuresis management could be substantially simplified.
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Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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31
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van Geen FJ, Nieuwhof-Leppink AJ, Schappin R, Klijn AJ, de Kort LMO. The effect of meatal correction on daytime urinary incontinence in girls with an anterior deflected urinary stream. J Pediatr Urol 2021; 17:791.e1-791.e5. [PMID: 34538563 DOI: 10.1016/j.jpurol.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Girls with an anterior deflected urinary stream (ADUS) are known to wet the toilet rim and their buttocks while voiding. This deviation may prevent adopting an ideal toileting position and can thus develop into a functional voiding disorder. Although surgical correction of the urinary stream by a meatotomy is part of standard care in girls with ADUS and lower urinary tract symptoms (LUTS) at our center, little is known about the effect of this procedure on daytime urinary incontinence (DUI). OBJECTIVE To assess the effect of meatal correction on incontinence in girls with ADUS and DUI, and to find predictors for therapy success. STUDY DESIGN A retrospective chart study including all girls with ADUS and DUI who underwent a dorsally directed meatal correction at our tertiary referral center between 2005 and 2018 (n = 274). The main outcome measurement was continence according to the International Children's Continence Society criteria, expressed as the percentage of children that were continent at post-surgical follow-up (complete response). Multivariate logistic regression was used to identify predictors of continence. RESULTS In 93% of girls, the direction of the urinary stream was no longer anterior deflected. 29% (n=79) of all girls were continent at post-surgical follow-up. We could not find a convincing predicting factor for achieving continence. DISCUSSION Although meatal correction is successful on normalizing the direction of the urinary stream, less than one-third of girls became continent. In addition, we were unable to indicate which girls will profit from this procedure in terms of continence. Since not every girl with ADUS develops incontinence complaints, it may also be questionable whether ADUS and incontinence are directly related. Since other, less invasive and more effective treatment options for DUI are available, meatal correction should therefore be considered a last-resort option in the treatment of pediatric DUI in girls with ADUS. CONCLUSION Of the 274 girls with ADUS and DUI, 29% did benefit from a meatotomy. No convincing indicator for therapy success could however be found. Therefore, we discourage a meatotomy as standard treatment in girls with ADUS and DUI.
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Affiliation(s)
| | - Anka J Nieuwhof-Leppink
- Department of Medical Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Renske Schappin
- Department of Development and Education of Youth in Diverse Societies, Utrecht University, the Netherlands
| | - Aart J Klijn
- Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands
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32
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Nasution R, Husein A, Adhyatma KP. Efficacy and safety of mirabegron in pediatric population: A systematic review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Whale K, Beasant L, Wright AJ, Yardley L, Wallace LM, Moody L, Joinson C. A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp. JMIR Pediatr Parent 2021; 4:e26212. [PMID: 34779780 PMCID: PMC8663506 DOI: 10.2196/26212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. OBJECTIVE This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. METHODS URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. RESULTS Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. CONCLUSIONS The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.
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Affiliation(s)
- Katie Whale
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Anne J Wright
- Evelina London Children's Hospital, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Lucy Yardley
- School of Psychological Sciences, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Louise M Wallace
- Faculty of Wellbeing, Education, and Language Studies, The Open University, Milton Keynes, United Kingdom
| | - Louise Moody
- Centre for Arts, Memory, and Communities, Faculty of Arts and Humanities, Coventry University, Coventry, United Kingdom
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Casal-Beloy I, García-Novoa MA, García González M, Acea Nebril B, Somoza Argibay I. Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children. J Pediatr Urol 2021; 17:644.e1-644.e10. [PMID: 34176749 DOI: 10.1016/j.jpurol.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays there is still no ideal treatment for paediatric overactive bladder. Initial management measures (urotherapy and constipation control), resolve 40% of cases. The second line of treatment in overactive bladder is anticholinergic drugs, above all oxybutynin. Although most patients improve with these therapies, the complete resolution rate is around 30-40%. Sacral transcutaneous electrical nerve stimulation has recently emerged as a new alternative in the management of patients with refractory paediatric overactive bladder. However, only a few studies have been done to compare the effectiveness of this therapy versus conventional drugs. OBJETIVE The objective of the present study is to compare, in children with overactive bladder, the efficacy of the sacral transcutaneous electrical nerve stimulation versus oxybutynin therapy. MATERIALS AND METHODS We performed a prospective and randomized study of patients with diagnosis of overactive bladder treated with sacral transcutaneous electrical nerve stimulation versus oxybutynin, during the period July 2018-July 2020. Patients refractory to standard urotherapy and constipation management randomly received one of the therapeutic alternatives. Treatment was maintained for 6 months. RESULTS 86 patients were included in the study: 40 patients received electrotherapy (group 1) and 46 patients received oxybutynin (group 2). Before starting the treatment assigned both groups were comparable related to the voiding symptomatology as well as the severity of the overactive bladder. Sacral transcutaneous electrical nerve stimulation was significantly more effective than oxybutynin, with a higher percentage of complete resolution of symptoms in the management of paediatric overactive bladder. VOIDING DIARY All the parameters obtained with the voiding calendar significantly improved in both groups at the end of the treatment. The increase in MaVV was significantly higher in group-1. DVISS (DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM) We observed a progressive decrease in the mean score obtained in the DVISS questionnaire over time in both groups. This decrease was significantly higher in group-1 compared to group-2 (p < 0.005). The mean value obtained in the DVISS questionnaire in group-1 was 6 (interquartile range: 3-9) at the end of the treatment (lower than the diagnostic cut-off point for daytime condition in the DVISS, 8.5). In group-2, the mean value obtained in the DVISS questionnaire was 10 (interquartile range: 8.75-13.25), higher than the cut-off point. COMPLICATIONS A greater number of adverse effects was obtained in group-2 (26.1% versus 15%, p < 0.05). Constipation (n: 6, 10.9%), and abdominal pain (n: 2,4.3%) were the most frequent adverse effects in this group. The adverse events reported in group-1 were contact dermatitis (n: 1.2%) and fecal losses [2] or urgency [5]. CONCLUSION Oxybutynin and sacral transcutaneous electrical nerve stimulation are both effective therapies in the management of paediatric overactive bladder. However, electrotherapy has been shown to be a more effective therapy with a complete clinical resolution rate in a larger number of patients. Furthermore, the rate of adverse effects secondary to electrotherapy is significantly lower than those treated with oxybutynin.
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Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - María Alejandra García-Novoa
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - Benigno Acea Nebril
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Iván Somoza Argibay
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
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Yang SS, Tsai JD, Kanematsu A, Han CH. Asian guidelines for urinary tract infection in children. J Infect Chemother 2021; 27:1543-1554. [PMID: 34391623 DOI: 10.1016/j.jiac.2021.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >105 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B). Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7-14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III-V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).
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Affiliation(s)
- Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan; Buddhist Tzu Chi University, Hualien, Taiwan.
| | - Jeng-Daw Tsai
- Department of Medicine, Mackay Medical College, Taiwan; Department of Pediatric Nephrology, MacKay Children's Hospital, Taiwan; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | | | - Chang-Hee Han
- Department of Urology, Uijeongbu ST. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
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Hussong J, Mattheus H, Wachs S, Equit M, von Gontard A. Evaluation of a bladder and bowel training program for therapy-resistant children with incontinence. J Pediatr Urol 2021; 17:302.e1-302.e8. [PMID: 33593624 DOI: 10.1016/j.jpurol.2021.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common disorders in children. Although standard treatment is highly effective, subgroups of incontinence (combinations of nocturnal enuresis (NE), DUI and/or FI, or with psychological comorbidity) can relapse or take a chronic course. For these complex, therapy-resistant cases, a manualized outpatient bladder and bowel training program was developed. The aim of the study was to evaluate prospectively treatment effects of this training program, including a follow-up assessment. MATERIAL & METHODS The training program was developed for small groups of 2-6 children (of same age and sex) aged 5-12 years with adaptations for 13-16 year-old adolescents. It consists of 7-9 weekly sessions for group training and 3 weekly sessions for individual training. The training comprises information about anatomy/physiology of the urogenital tract, pathophysiology, hygiene and balanced nutrition. Voiding and drinking diaries, stress management, relaxation and emotion regulation techniques are also included. Data of 32 children (mean age 8.6 years, range 5-13 years; 21 boys), who had received standard treatment (and did not reach complete response) are presented. 14 children received group therapy, 18 (younger children) were treated individually. Children were assessed before and after the treatment, as well as at a follow-up of 6 months later. Treatment effects were measured by incontinence frequency and treatment success according to the ICCS (complete response: 100% reduction of symptoms; partial response: 50-99% reduction of symptoms). Psychological symptoms were measured by the Child Behavior Checklist questionnaire (CBCL). RESULTS Frequencies of DUI were significantly reduced from 5.7 wetting episodes/week (before training) to 4.9 (after training) to 2.0 (6 months after training). Frequencies of FI were reduced from 2.9 soiling episodes/week (before training) to 1.9 (after training), but increased to 2.6 (6 months after training). According to the ICCS classification, 11.1% of children with DUI had a complete response after training and 47.6% at follow-up after 6 months. In children with FI, 33.3% reached a complete response at the end of the training and 25% at follow-up. Additionally, psychological symptoms, especially internalizing, decreased significantly during training. Further, in 14 children with comorbid NE, nighttime wetting reduced from 5.9 before training to 1.5 episodes/week at follow-up. CONCLUSIONS This bladder and bowel training program is an effective and successful treatment option for children with therapy-resistant subtypes of incontinence. Symptoms still improved 6 months after training in DUI. Additionally, the training program is helpful to decrease psychological symptoms.
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Affiliation(s)
- J Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - H Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - S Wachs
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - M Equit
- Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - A von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
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S C, Doyle M, Mahon OM, G K. Urinary tract imaging in infants with spina bifida: a selective approach to a baseline DMSA. J Pediatr Urol 2021; 17:396.e1-396.e6. [PMID: 33637457 DOI: 10.1016/j.jpurol.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There is no general agreement among paediatric urologists on how infants with spina bifida (SB) should be investigated after birth. Recently the EUA/ESPU guidelines have been published recommending a baseline DMSA scan in the first year of life and a Voiding Cystourethrogram (VCUG) or Videourodynamic (VUD) between the second and third month of life. OBJECTIVE The aim of this study was to evaluate the outcome of renal investigations in the first year of life in infants with SB to verify if an early DMSA scan is indicated in the management of this group of patients. METHODS All renal imaging, Renal and Bladder Ultrasound (RBUS), VCUGs, VUDs and DMSA were reviewed by two independent assessors to evaluate outcome. RESULTS Seventy patients with spina bifida (40 girls) were enrolled between June 2015 and February 2020. An early VUD detected vesico-ureteral reflux (VUR) in 8/49 (16%) of patients. An early VUD also gave additional information on detrusor under or over activity, bladder trabeculation, end filling detrusor pressure (EFDP) and sphincteric incompetence. DMSA scan detected renal scarring in 4/68 (6%) patients. Three of these 4 patients had significant history of febrile UTIs while the fourth patient had grade 2 left sided VUR. CONCLUSIONS The initial assessment of a newborn with myelodysplasia includes a Renal and Bladder Ultrasound during birth hospitalization. This study confirms the recently published EUA/ESPU guidelines on the management of neurogenic bladder in children and adolescents, which recommend a VUD or VCUG & Cystomanometry with Electromyogram (CMG) (if VUD not available) in the first 6-12 weeks of life. A selective approach to DMSA scan only in infants with SB who either had a febrile UTI or vesico-ureteric reflux would not have missed any scarring or dysplasia and would have saved 58 unnecessary nuclear scans.
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Affiliation(s)
- Cascio S
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland; University College Dublin, Ireland.
| | - M Doyle
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - O Mc Mahon
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Kelly G
- School of Mathematics and Statistics, Ireland; University College Dublin, Ireland
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Nieuwhof-Leppink AJ, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P, Yang S, von Gontard A. Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). J Pediatr Urol 2021; 17:172-181. [PMID: 33478902 DOI: 10.1016/j.jpurol.2020.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Urotherapy is an umbrella term for all non-surgical, non-pharmacological interventions for lower urinary tract disorders (LUTD) in children and adolescents. Urotherapy is a specialized practice, which has become mainstay therapy not only for daytime urinary incontinence, but also for nocturnal enuresis, functional constipation and fecal incontinence. The aim of urotherapy is to achieve the normalization of the micturition and bowel pattern and to prevent further functional disturbances by repeated training. It is well known that in the treatment of adult and childhood incontinence a team approach is best, where there are shared areas of expertise and also discipline-specific expertise available. AIM We present a consensus view from a cross-professional team of experts affiliated with the International Children's Continence Society on definitions, indications and practice of urotherapy. This is a selective, non-systematic review with practical recommendations for the implementation and research on urotherapy. METHODS The document uses the globally accepted ICCS terminology. Evidence-based literature serves as the basis, but in areas lacking in primary evidence, expert consensus is used. Before submission, a full draft was made available to all ICCS members for additional comments. RESULTS Urotherapy uses non-pharmacological, non-surgical methods and focuses on behavioral interventions, largely based on cognitive-behavioral psychotherapy (CBT). Standard urotherapy comprises components such as provision of information, instructions, life-style advice, counselling and registration of symptoms. Specific urotherapy is tailored towards specific disorders and includes alarm treatment, biofeedback training, pelvic floor training, neurostimulation and other interventions. Fig. 1. Urotherapy is a treatment that addresses all aspects of incontinence, leading to the best clinical outcome. This includes somatic, psychosocial, and behavioral problems and quality of life. Therefore urotherapy is recommended by the ICCS as the first-line treatment for most types of LUTD. The document is intended to be clinically useful in primary, secondary and tertiary care.
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Affiliation(s)
- A J Nieuwhof-Leppink
- Department Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
| | - J Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital Homburg, Germany
| | - J Chase
- Victorian Children's Continence Clinic, Paediatric Gastroenterology Victoria, Royal Children's Hospital, Melbourne, Australia
| | - J Larsson
- Section for Paediatric Nephrology, Kristianstad Hospital CSK, Sweden
| | - C Renson
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - S Yang
- Department of Urolgy, Taipei Tzu Chi Hospital and Buddhist Tzu Chi Universtiy, New Taipei, Taiwan
| | - A von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital Homburg, Germany
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Casal-Beloy I, García González M, García-Novoa MA, Somoza Argibay I. Comentary on "The long-term added value of voiding school for children with refractory nonneurogenic overactive bladder: An inpatient bladder rehabilitation program". J Pediatr Urol 2021; 17:126-127. [PMID: 33358302 DOI: 10.1016/j.jpurol.2020.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Division, Pediatric Surgery Department, University Childrens Hospital of A Coruña, As Xubias, 84. CP, 15006, A Coruña, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Childrens Hospital of A Coruña, As Xubias, 84. CP, 15006, A Coruña, Spain.
| | - María Alejandra García-Novoa
- General and Digestive Surgery Department, University Hospital of A Coruña, As Xubias, 84. CP, 15006, A Coruña, Spain.
| | - Ivan Somoza Argibay
- Pediatric Urology Division, Pediatric Surgery Department, University Childrens Hospital of A Coruña, As Xubias, 84. CP, 15006, A Coruña, Spain.
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Casal-Beloy I, García González M, García-Novoa MA, Argibay IS. Comment on: "Device Outcomes in Pediatric Sacral Neuromodulation: A Single Center Series of 187 patients". J Pediatr Urol 2021; 17:73-74. [PMID: 33279433 DOI: 10.1016/j.jpurol.2020.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Division, Pediatric Surgery Department, University Childreńs Hospital of A Coruña, As Xubias, 84, A Coruña, CP: 15006, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Childreńs Hospital of A Coruña, As Xubias, 84, A Coruña, CP: 15006, Spain.
| | - María Alejandra García-Novoa
- General and Digestive Surgery Department, University Hospital of A Coruña, As Xubias, 84, A Coruña, CP: 15006, Spain.
| | - Iván Somoza Argibay
- Pediatric Urology Division, Pediatric Surgery Department, University Children's Hospital of A Coruña, As Xubias, 84, A Coruña, CP: 15006, Spain.
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O'Sullivan H, Kelly G, Toale J, Cascio S. Comparing the outcomes of parasacral transcutaneous electrical nerve stimulation for the treatment of lower urinary tract dysfunction in children: A systematic review and meta-analysis of randomized controlled trials. Neurourol Urodyn 2021; 40:570-581. [PMID: 33410536 DOI: 10.1002/nau.24601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
AIMS Despite published evidence in recent decades suggesting improvement in lower urinary tract symptoms (LUTS) with the use of parasacral transcutaneous electrical nerve stimulation (PTENS), no consensus guidelines for therapy exist. This study systematically reviews the literature to assess the effect of PTENS in children with LUTS. METHODS A database search conducted up to December 2019 included Medline, EMBASE, and the Cochrane Library. From the literature review, 6 randomized controlled studies (234 participants) comparing PTENS and standard treatment (urotherapy/anticholinergics) were considered. From each study, the success rates were available for PTENS and the control group. The ratio of success rates was computed-that is, the risk ratio (RR) and the risk difference (RD). RESULTS The overall success rate with PTENS was 1.92 times that of children undergoing standard urotherapy alone (RR: 1.92, 95% confidence interval [CI: 1.02, 3.61]) and 1.56 for those undergoing either urotherapy alone or with pharmacotherapy (anticholinergics; RR: 1.56, 95% CI [1.04, 2.40]). No difference in the success rate was found when PTENS was used in patients failing previous treatment (urotherapy and pharmacological therapy; RR: 0.175, 95% CI [0.02, 1.45]). CONCLUSIONS Current evidence suggests that PTENS is beneficial in children with LUTS. The chance of success is 1.92 times that of children undergoing standard urotherapy. However, in children who have failed urotherapy and pharmacological therapy, PTENS monotherapy has a limited role and should be an adjunct. Literature shortcomings included small numbers of patients, differing inclusion criteria, and PTENS protocols. A need exists for quality multicenter randomized controlled trials to prove the efficacy of PTENS in children with LUTS.
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Affiliation(s)
- Hugh O'Sullivan
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland
| | - Gabrielle Kelly
- School of Mathematics and Statistics, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - James Toale
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland
| | - Salvatore Cascio
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland.,University College Dublin, Dublin, Ireland
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Transcutaneous electrical nerve stimulation to treat neurogenic bladder due to transverse myelitis. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Morizawa Y, Satoh H, Sato A, Iwasa S, Aoki Y. [TETHERED CORD SYNDROME IN CHILDREN WITH DAYTIME INCONTINENCE]. Nihon Hinyokika Gakkai Zasshi 2021; 112:168-172. [PMID: 36261345 DOI: 10.5980/jpnjurol.112.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
(Introduction) In tethered cord syndrome, the lower end of the spinal cord is moored to the caudal tissue, causing various neuropathies. Bladder dysfunction often appears early. We herein evaluated children with daytime urinary incontinence in whom tethered cord syndrome was eventually diagnosed. (Method) Eighteen children (9 males and 9 females) with daytime urinary incontinence were enrolled between March 2011 and October 2017. The causes of their urinary incontinence were investigated using spinal MRI and changes in clinical symptoms before and after untethering surgery. (Results) The average age at the first visit was 6.3 years (range: 4-9 years). Urodynamic testing and a voiding cystourethrogram (VCUG) were performed in all cases of refractory daytime incontinence, and all patients with abnormal findings on either test underwent spinal MRI. The diagnosis based on spinal MRI findings was filum lipoma in eight, occult tethered cord syndrome in four, low set conus in four, conus lipoma in one, and sacral meningeal cyst in one, patient. The average observation period after untethering surgery was 66.3 months (range: 22-116 months). All the patients achieved a cure postoperatively. Four patients were treated for nocturnal enuresis by oral medication, and three patients required urological management via clean, intermittent catheterization. (Conclusions) When treating children with daytime continence, one should consider the possibility of tethered cord syndrome, the diagnosis of which can be aided by urodynamic assessment of bladder function.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Tokyo Metropolitan Children's Medical Center
| | - Hiroyuki Satoh
- Department of Urology, Tokyo Metropolitan Children's Medical Center
| | - Atsuko Sato
- Department of Urology, Tokyo Metropolitan Children's Medical Center
| | - Shun Iwasa
- Department of Urology, Tokyo Metropolitan Children's Medical Center
- Department of Urology, Keio University School of Medicine
| | - Yujiro Aoki
- Department of Urology, Tokyo Metropolitan Children's Medical Center
- Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University
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Somoza Argibay I, Casal-Beloy I, Seoane Rodríguez S. Neuroestimulación eléctrica transcutánea (TENS) en vejiga neurógena secundaria a mielitis transversa. Neurologia 2021; 36:86-88. [DOI: 10.1016/j.nrl.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/30/2020] [Indexed: 11/25/2022] Open
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Winck-Flyvholm L, Damgaard Pedersen K, Hildorf S, Thorup J. Evaluation of boys with daytime incontinence by combined cystourethroscopy, voiding cystourethrography and urodynamics. Scand J Urol 2020; 55:249-256. [PMID: 33377406 DOI: 10.1080/21681805.2020.1866067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objects: Approximately, 1% of school children have daytime urinary incontinence. The symptoms may be caused by an overactive bladder (OAB). In the evaluation of boys with OAB complaints, one should consider a possible urethral cause. The aim of the study was to evaluate the value of a diagnostic regime with cystourethroscopy, voiding cystourethrography (VCUG) and urodynamic pressure-flow studies in boys with OAB complaints after unsuccessful urotherapy and pharmacological therapy. Materials and Methods: Seventy-five boys (5-14 years old) were investigated with cystourethroscopy and within 24 h thereafter VCUG followed by urodynamic combined cystometry and pressure-flow study. All boys had daytime incontinence and urgency. Results: Sixty-one boys had no suspected urethral valves at cystoscopy or VCUG, and urodynamics showed no obstructed Pdet-Qmax. All 61 boys had detrusor overactivity. Two boys had late diagnosed urethral valves. In four boys, the initial cystourethroscopy was described as normal. The VCUG indicated presence of posterior urethral valves, but urodynamics showed no obstructed Pdet-Qmax. In eight boys, the initial cystourethroscopy was described as normal whereas urodynamics showed obstructed Pdet-Qmax. In four of these boys, VCUG showed abnormalities in the sphincter area but they were not described as suspected urethral valves. At repeat cystourethroscopy, urethral valves could still not be identified. Patient follow-up regarding achievement of continence after investigation guided treatment was in accordance with the literature. Conclusions: Boys can be safely evaluated by cystourethroscopy followed by urodynamics in search for a possible urethral problem. It is our suggestion, that VCUG can be restricted to those boys where urodynamics indicates obstruction or the findings by cystourethroscopy are uncertain.
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Affiliation(s)
- Lilia Winck-Flyvholm
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karen Damgaard Pedersen
- Department of Diagnostic Imaging, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Simone Hildorf
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rakowska-Silska M, Jobs K, Paturej A, Kalicki B. Voiding Disorders in Pediatrician's Practice. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2020; 14:1179556520975035. [PMID: 33293883 PMCID: PMC7705800 DOI: 10.1177/1179556520975035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/22/2020] [Indexed: 01/23/2023]
Abstract
Voiding disorders result usually from functional disturbance. However, relevant
organic diseases must be excluded prior to diagnosis of functional disorders.
Additional tests, such as urinalysis or abdominal ultrasound are required.
Further diagnostics is necessary in the presence of alarm symptoms, such as
secondary nocturnal enuresis, weak or intermittent urine flow, systemic
symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in
the lumbar region, altered sensations in the perineum. Functional micturition
disorders were thoroughly described in 2006, and revised in 2015 by ICCS
(International Children’s Continence Society) and are divided into storage
symptoms (increased and decreased voiding frequency, incontinence, urgency,
nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency,
dysuria), and symptoms that cannot be assigned to any of the above groups
(voiding postponement, holding maneuvers, feeling of incomplete emptying,
urinary retention, post micturition dribble, spraying of the urinary stream).
Functional voiding disorders are frequently associated with constipation.
Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract
symptoms are accompanied by problems with defecation. Monosymptomatic enuresis
is the most common voiding disorder encountered by pediatricians. It is
diagnosed in children older than 5 years without any other lower urinary tract
symptoms. Other types of voiding disorders such as: non-monosymptomatic
enuresis, overactive and underactive bladder, voiding postponement, bladder
outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually
require specialized diagnostics and therapy. Treatment of all types of
functional voiding disorders is based on non-pharmacological recommendations
(urotherapy), and such education should be implemented by primary care
pediatricians.
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Affiliation(s)
- Magda Rakowska-Silska
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Aleksandra Paturej
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
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Prgomet S, Saraga M, Benzon S, Turudić D, Ledina D, Milošević D. Uroflowmetry in Non-Monosymptomatic Nocturnal Enuresis in Children of Coastal Region of Croatia. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:113-118. [PMID: 33002397 DOI: 10.14712/18059694.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the study was to describe clinical characteristics and bladder assessment in children with Non-Monosymptomatic Nocturnal Enuresis (NMNE) in coastal region of Croatia. MATERIALS AND METHODS Records on 85 patients with NMNE were retrospectively reviewed. Bladder assessments were performed in all children. In this research we: (i) compare clinical characteristics and features of bladder assessment: uroflowmetry, post void residuals (PVR) and bladder wall thickness between boys and girls with NMNE and we compare (ii) clinical characteristics and bladder assessment between children with primary and secondary NMNE. RESULTS There were 46 girls and 39 boys. The total of 59 children had primary NMNE and 26 children had secondary NMNE. Uroflow pattern was abnormal in 42% of all children with NMNE. Abnormal uroflow pattern in children with NMNE was more often in girls than in boys (P < 0.05) and in children with secondary than in children with primary NMNE (P < 0.05). Ultrasound evidence of bladder wall thickness was more frequent in boys than in girls. Girls were more likely to have dysfunctional voiding and larger residual urinary volume than boys. CONCLUSIONS Abnormal uroflow pattern in children with NMNE was more often in girls than boys and in children with secondary than in children with primary NMNE.
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Affiliation(s)
- Sandra Prgomet
- Department of Pediatrics, Split University Hospital, University of Split, Split, Croatia
| | - Marjan Saraga
- Department of Pediatrics, Split University Hospital, University of Split, Split, Croatia
| | - Sandra Benzon
- Department of Obstetrics and Gynecology, Split University Hospital, University of Split, Split, Croatia.
| | - Daniel Turudić
- Department of Pediatrics, Zagreb University Hospital, University of Zagreb, Zagreb, Croatia
| | - Dragan Ledina
- Department of Infectology, Split University Hospital, University of Split, Split, Croatia
| | - Danko Milošević
- Department of Pediatrics, Zagreb University Hospital, University of Zagreb, Zagreb, Croatia
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Commentary on "Role of Transcutaneous Electrical Nerve Stimulation in Treating Children With Overactive Bladder From Pooled Analysis of 8 Randomized Controlled Trials". Int Neurourol J 2020; 24:185-186. [PMID: 32615683 PMCID: PMC7332819 DOI: 10.5213/inj.2040164.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/08/2022] Open
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Morizawa Y, Aoki K, Hori S, Gotoh D, Miyake M, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. <p>Is Endoscopic Transurethral Incision Really Effective for Boys with Refractory Daytime Incontinence?</p>. Res Rep Urol 2020; 12:273-277. [PMID: 32766174 PMCID: PMC7381088 DOI: 10.2147/rru.s254159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the clinical efficacy of endoscopic transurethral incision (TUI) for boys with refractory daytime incontinence due to a posterior urethral valve with or without nocturnal enuresis. Patients and Methods A total of 20 boys with daytime incontinence were assessed. Twelve boys underwent TUI (TUI+ group) and eight boys continued receiving oral drugs (TUI- group). The primary endpoint was the cure rate associated with TUI or NE in both groups. Results Only two boys achieved daytime continence 6 months after TUI, but no boys were cured of nocturnal enuresis 6 months after TUI. The median time to daytime continence was significantly longer in the TUI+ than in the TUI- group (52 vs 27 months, respectively; log rank P = 0.041) and the median time to dry nights was significantly longer in the TUI+ than in the TUI- group (56 vs 36 months, respectively; log rank P = 0.021). Conclusion TUI might be not effective in boys with refractory daytime incontinence.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Correspondence: Kiyohide Fujimoto Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara634-8522, JapanTel +81-744-22-3051Fax +81-744-22-9282 Email
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Franco I, Hoebeke P, Baka-Ostrowska M, Bolong D, Davies LN, Dahler E, Snijder R, Stroosma O, Verheggen F, Newgreen D, Bosman B, Vande Walle J. Long-term efficacy and safety of solifenacin in pediatric patients aged 6 months to 18 years with neurogenic detrusor overactivity: results from two phase 3 prospective open-label studies. J Pediatr Urol 2020; 16:180.e1-180.e8. [PMID: 32007426 DOI: 10.1016/j.jpurol.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The standard recommended treatment for neurogenic detrusor overactivity (NDO) is clean intermittent catheterization combined with an antimuscarinic agent. However, the adverse systemic side-effects of oxybutynin, the most widely used agent, are of concern. OBJECTIVE To evaluate the efficacy and safety of solifenacin in pediatric patients with NDO, aged 6 months-<5 years and 5-<18 years. STUDY DESIGN Two open-label, baseline-controlled, phase 3 studies were conducted in pediatric patients with NDO. Patients were treated with sequential doses of solifenacin oral suspension (pediatric equivalent doses 2.5-10 mg) for 12 weeks to determine each patient's optimal dose, followed by a fixed dose ≥40-week treatment period. Primary efficacy endpoint was change from baseline in maximum cystometric capacity (MCC) after 24 weeks. Secondary endpoints included bladder compliance, bladder volume until first detrusor contraction (>15 cmH2O), number of overactive detrusor contractions (>15 cmH2O), maximum catheterized volume (MCV)/24 h, and incontinence episodes/24 h. Safety parameters were treatment-emergent adverse events (TEAEs), serious adverse events, laboratory variables, vital signs, electrocardiograms, and ocular accommodation and cognitive function assessments. RESULTS After 24 weeks, MCC had significantly increased compared with baseline in patients aged 6 months -<5 years and 5-<18 years (37.0 ml and 57.2 ml, respectively; P < 0.001; Fig.). Improvement was also observed after 52 weeks' treatment. Significant changes were observed from baseline to week 24 in all secondary endpoints in both age groups: increase in bladder compliance, increase in bladder volume to first detrusor contraction as a percentage of expected bladder capacity, reduction in the number of overactive detrusor contractions, increase in MCV, and decreased incontinence episodes. TEAEs were mostly mild or moderate, and there were no new drug-related TEAEs compared with adult studies. Age-related improvements were noted in ocular accommodation and cognitive function. DISCUSSION These long-term multicenter investigations demonstrated the efficacy and safety of solifenacin in pediatric patients with NDO. The observed increases in MCC were clinically relevant and demonstrated that an increase in fluid volume can be accommodated in the bladder prior to reaching intravesical pressures that endanger kidney function and/or are associated with leakage or discomfort. Solifenacin was well tolerated with low incidences of constipation and dry mouth (typically associated with antimuscarinics), central nervous system-related side-effects, and facial flushing. CONCLUSION Solifenacin was effective and well tolerated in pediatric patients with NDO, aged 6 months-<18 years, suggesting that it is a viable alternative to oxybutynin, the current standard of care. STUDIES ARE REGISTERED AT CLINICALTRIALS.GOV: NCT01981954 and NCT01565694.
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Affiliation(s)
- Israel Franco
- Yale/New Haven Hospital Section of Pediatric Urology, New Haven, CT, USA.
| | - Piet Hoebeke
- Department of Pediatric Urology, Ghent University Hospital, Ghent, Belgium
| | | | - David Bolong
- Section of Pediatric Nephrology, Philippine Children's Medical Centre, Manila, Philippines
| | - Leon N Davies
- Aston Optometry School, Aston University, Birmingham, UK
| | - Ellen Dahler
- Astellas Pharma Europe B.V., Leiden, the Netherlands
| | | | - Otto Stroosma
- Astellas Pharma Europe B.V., Leiden, the Netherlands
| | | | | | | | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
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