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’t Hoen LA, Korfage IJ, Verhallen JT, van Ledden-Klok MJ, van den Hoek J, Blok BF, Scheepe JR. Vancouver Symptom Score for Dysfunctional Elimination Syndrome: Reliability and Validity of the Dutch Version. J Urol 2016; 196:536-41. [DOI: 10.1016/j.juro.2016.02.2973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Lisette A. ’t Hoen
- Department of Urology and Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ida J. Korfage
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Joop van den Hoek
- Department of Urology and Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F.M. Blok
- Department of Urology and Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen R. Scheepe
- Department of Urology and Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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102
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Goknar N, Oktem F, Demir AD, Vehapoglu A, Silay MS. Comparison of Two Validated Voiding Questionnaires and Clinical Impression in Children With Lower Urinary Tract Symptoms: ICIQ-CLUTS Versus Akbal Survey. Urology 2016; 94:214-7. [DOI: 10.1016/j.urology.2016.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/01/2016] [Accepted: 05/03/2016] [Indexed: 11/26/2022]
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103
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Kakizaki H, Kita M, Watanabe M, Wada N. Pathophysiological and Therapeutic Considerations for Non-Neurogenic Lower Urinary Tract Dysfunction in Children. Low Urin Tract Symptoms 2016; 8:75-85. [PMID: 27111618 DOI: 10.1111/luts.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/17/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children.
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Affiliation(s)
- Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masaki Watanabe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Asgari SA, Asl AS, Safarinejad MR, Ghanaei MM. High success rate with new modified endoscopic treatment for high-grade VUR: A pilot study with preliminary report. J Pediatr Urol 2016; 12:100.e1-4. [PMID: 26549873 DOI: 10.1016/j.jpurol.2015.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/03/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Despite the benefits of the minimally invasive endoscopic treatment for vesicoureteral reflux (VUR) it has a major drawback which is low success rate in high grade VUR. For overcoming this problem, we introduce a new modified technique of endoscopic treatment called periureteral injection technique (PIT). MATERIALS AND METHODS In a prospective study a total of 37 ureters in 19 boys and 14 girls were treated, including 3 bilateral cases. Of 37 units, 30 (81.1%) had grade IV and 7 (18.9%) had grade V primary VUR (18 right, 13 left and 3 bilateral units). Subureteral injection of Vantris(®) was done at the 5-o'clock and 7-o'clock positions in which the direction of injecting needles were almost parallel. Pre- and post-operative evaluation included urinalysis, urinary tract ultrasonography, voiding cystourethrography (VCUG), dimercaptosuccinic acid scan and urodynamic studies. RESULTS The median age was 38 months (range 8-125). At 6 months follow up period confirmed with VCUG, the VUR has been disappeared in 34 (91.8%) units and 3 units [2 (5.4%) grade II and 1 (2.7%) had grade III)] had downgraded VUR. Complications included early fever due to urinary tract infection in 1 children, transient dysuria in 2 patients and low back pain in one patient (Summary Table). CONCLUSION The success rate of PIT for treatment of high grade VUR is high. However, further studies with more patients and longer follow up periods are needed to draw final conclusion.
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Affiliation(s)
- S A Asgari
- Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - A S Asl
- Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - M R Safarinejad
- Clinical Center for Urological Disease Diagnosis and Private Clinic Specializing in Urological and Andrological Genetics, Tehran, Iran.
| | - M M Ghanaei
- Urology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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105
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Martins G, Minuk J, Varghese A, Dave S, Williams K, Farhat WA. Non-biological determinants of paediatric bladder bowel dysfunction: A pilot study. J Pediatr Urol 2016; 12:109.e1-6. [PMID: 26586295 DOI: 10.1016/j.jpurol.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Children with bladder and bowel dysfunction (BBD) constitute a significant proportion of referrals at paediatric urology clinics worldwide, presenting with a wide range of symptom severity that may significantly affect quality of life. Non-biological factors may play a key role in triggering BBD severity, but these underpinning causes of BBD during childhood are still unknown. The aim of this study was to identify the effects of personal, family related and environmental variables on the severity of BBD symptoms in school-aged children. STUDY DESIGN A pilot, prospective, observational study was conducted on 53 children diagnosed with BBD, and their legal guardian(s), on their first referred visit to a paediatric BBD clinic led by nurse practitioners. Upon receiving consent, patients and their legal guardian(s) completed three study questionnaires, with the guidance of research coordinators. The first questionnaire was the Dysfunctional Voiding Scoring System (DVSS); the second, a three-part questionnaire used to collect demographic information and data on the patient, their family and environmental characteristics; and the third gathered a detailed history of the child's lifestyle regimen, focusing on their bowel and bladder function. RESULTS Most of the children were female (66%), with an average age of 8.35 years. Most children attended public schools (74%) and none reported failing a grade. The mean parental age was 41.4 years (SD = 4.9 years), 62% of the families had two children and 53% were Caucasian. The mean DVSS score for this sample was 9.9 (SD = 4.2, range 2-21). Daycare attendance, school problems and unplanned pregnancy showed statistically significant influences on the severity of BBD and were associated with higher DVSS scores according to the Table below. CONCLUSIONS Children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school problems. These findings suggest that interventions aimed at decreasing BBD severity, or preventing its onset in school-aged children, should focus on the environment surrounding them, specifically on the interaction between personal, familial and environmental factors. These factors seem to have an important effect on paediatric continence, as children grow and develop under numerous societal influences and social interactions.
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Affiliation(s)
- G Martins
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Nursing, Faculty of Health Sciences, University of Brasilia, SQN 214, Bloco K, Suite 613, Brasilia, Federal District, 70873-110, Brazil.
| | - J Minuk
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - A Varghese
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - S Dave
- London Health Sciences Centre (LHSC), Pediatric Urology, Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada.
| | - K Williams
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - W A Farhat
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
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106
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Tarhan H, Ekin RG, Can E, Cakmak O, Yavascan O, Mutlubas Ozsan F, Helvaci M, Zorlu F. C-reactive protein levels in girls with lower urinary tract symptoms. J Pediatr Urol 2016; 12:105.e1-4. [PMID: 26497919 DOI: 10.1016/j.jpurol.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. OBJECTIVE This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. STUDY DESIGN Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. RESULTS There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). DISCUSSION Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. CONCLUSION The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.
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Affiliation(s)
- H Tarhan
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - R G Ekin
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - E Can
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - O Cakmak
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - O Yavascan
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - F Mutlubas Ozsan
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - M Helvaci
- Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - F Zorlu
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey.
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107
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Johnston DL, Qureshi AH, Irvine RW, Giel DW, Hains DS. Contemporary Management of Vesicoureteral Reflux. ACTA ACUST UNITED AC 2016; 2:82-93. [PMID: 27570729 DOI: 10.1007/s40746-016-0045-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD) when present, are the foundation of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe the benefits outweigh the risks and costs for many patients. Careful observation can be considered in patients with a single medical home, parental understanding of what UTI signs and symptoms are, low grade VUR, no history of complicated UTIs and close follow-up. Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.
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Affiliation(s)
- Derrick L Johnston
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Aslam H Qureshi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
| | - Rhys W Irvine
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Dana W Giel
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
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108
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Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Mathews R, Bhatnagar S, Ivanova A, Mattoo TK, Moxey-Mims M, Carpenter MA, Pohl HG, Greenfield S. Recurrent Urinary Tract Infections in Children With Bladder and Bowel Dysfunction. Pediatrics 2016; 137:peds.2015-2982. [PMID: 26647376 PMCID: PMC4702025 DOI: 10.1542/peds.2015-2982] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Little generalizable information is available on the outcomes of children diagnosed with bladder and bowel dysfunction (BBD) after a urinary tract infection (UTI). Our objectives were to describe the clinical characteristics of children with BBD and to examine the effects of BBD on patient outcomes in children with and without vesicoureteral reflux (VUR). METHODS We combined data from 2 longitudinal studies (Randomized Intervention for Children With Vesicoureteral Reflux and Careful Urinary Tract Infection Evaluation) in which children <6 years of age with a first or second UTI were followed for 2 years. We compared outcomes for children with and without BBD, children with and without VUR, and children with VUR randomly assigned to prophylaxis or placebo. The outcomes examined were incidence of recurrent UTIs, renal scarring, surgical intervention, resolution of VUR, and treatment failure. RESULTS BBD was present at baseline in 54% of the 181 toilet-trained children included; 94% of children with BBD reported daytime wetting, withholding maneuvers, or constipation. In children not on antimicrobial prophylaxis, 51% of those with both BBD and VUR experienced recurrent UTIs, compared with 20% of those with VUR alone, 35% with BBD alone, and 32% with neither BBD nor VUR. BBD was not associated with any of the other outcomes investigated. CONCLUSIONS Among toilet-trained children, those with both BBD and VUR are at higher risk of developing recurrent UTIs than children with isolated VUR or children with isolated BBD and, accordingly, exhibit the greatest benefit from antimicrobial prophylaxis.
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Affiliation(s)
| | | | - Ron Keren
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nathan Gotman
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven G. Docimo
- Urology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Ranjiv Mathews
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | | | - Anastasia Ivanova
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tej K. Mattoo
- Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Marva Moxey-Mims
- National Institute of Diabetes, and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Myra A. Carpenter
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hans G. Pohl
- Division of Urology, Children’s National Medical Center, George Washington University School of Medicine, Washington, District of Columbia; and
| | - Saul Greenfield
- Division of Pediatric Urology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
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109
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Queiroz Machado V, Monteiro A, Peçanha A, Garcez da Fonseca E. Slow transit constipation and lower urinary tract dysfunction. J Pediatr Urol 2015; 11:357.e1-5. [PMID: 26302830 DOI: 10.1016/j.jpurol.2015.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/21/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Many theories have been proposed for the coexistence of constipation and lower urinary tract dysfunction (LUTD), such as bladder compression from a distended rectum and stimulation of sacral reflexes from a full rectum. In these cases, successful treatment of constipation should result in resolution of bladder symptoms. Some children have refractory constipation and others respond well to treatment, but once treatment is discontinued most children relapse back into their constipation. This may indicate the existence of a defect in colon motility, with a persistent peristalsis problem. The existence of a common neuromuscular disorder should be the base for both bladder and bowel dysfunction (BBD). OBJECTIVE To study colonic transit time (CTT) in children and adolescents with refractory constipation and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS A total of 15 children (mean age 9.7 years) with refractory constipation and LUTS were evaluated with: standardized medical history; physical examination; bladder and bowel diaries; Bristol stool scale; Rome III criteria; Dysfunctional Voiding Scoring System (DVSS); ultrasound examination of the kidneys and urinary tract, and measurement of rectal diameter; urodynamic evaluation; and a CTT study using radiopaque markers. RESULTS Urodynamic features were abnormal in 13 out of 15 children: 10 (66.7%) presented with detrusor overactivity (DO) and voiding dysfunction (VD), two (16.7%) had isolated DO, and one (8.3%) had a VD. The CTT study was abnormal in 12 out of 15 children: nine (60%) presented with slow transit constipation, three (20%) had outlet obstruction, and three (20%) had a normal CTT study. When comparing CTT and LUTD, nine (100%) children with slow transit constipation (STC) and three (50%) with no STC had DO (P = 0.04). Seven (77.8%) children with STC and three (50%) with no STC had VD (P = 0.29). The DVSS scores ranged from 6 to 21. The subgroup with STC had a DVSS score that was significantly higher than that of the subgroup with noF STC (Figure). DISCUSSION The present study showed a high prevalence of STC in children and adolescents with refractory constipation and LUTS. This was in accordance with previous studies that have demonstrated a rate of 50-60% of STC in children with refractory constipation. In addition, DO was found to be associated with STC, which raises the chance for the existence of a common neuromuscular disorder to be the base for both bladder and bowel dysmotility. The limitation of this study was the number of participants. CONCLUSIONS The present study demonstrated an association between DO and STC.
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Affiliation(s)
- V Queiroz Machado
- Department of Pediatrics, The School of Medical Sciences, The University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 Vila Isabel, 20 551-030, Rio de Janeiro, Brazil.
| | - A Monteiro
- Department of Radiology, The School of Medical Sciences, The University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 Vila Isabel, 20 551-030, Rio de Janeiro, Brazil.
| | - A Peçanha
- Department of Radiology, The School of Medical Sciences, The University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 Vila Isabel, 20 551-030, Rio de Janeiro, Brazil.
| | - E Garcez da Fonseca
- Department of Pediatrics, The School of Medical Sciences, The University of the State of Rio de Janeiro, Boulevard 28 de Setembro, 77 Vila Isabel, 20 551-030, Rio de Janeiro, Brazil.
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110
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Hidas G, Billimek J, Nam A, Soltani T, Kelly MS, Selby B, Dorgalli C, Wehbi E, McAleer I, McLorie G, Greenfield S, Kaplan SH, Khoury AE. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux. J Urol 2015; 194:1396-401. [DOI: 10.1016/j.juro.2015.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Guy Hidas
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - John Billimek
- School of Medicine, University of California, Irvine, Irvine, California
| | - Alexander Nam
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Tandis Soltani
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Maryellen S. Kelly
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Blake Selby
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Crystal Dorgalli
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Elias Wehbi
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Irene McAleer
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Gordon McLorie
- Department of Urology, Children’s Hospital of Orange County, Orange, California
| | - Sheldon Greenfield
- School of Medicine, University of California, Irvine, Irvine, California
| | - Sherrie H. Kaplan
- School of Medicine, University of California, Irvine, Irvine, California
| | - Antoine E. Khoury
- Department of Urology, Children’s Hospital of Orange County, Orange, California
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111
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de Carvalho Mrad FC, de Bessa J, de Figueiredo AA, Netto JMB. About the article: Prevalence of lower urinary tract symptoms in individuals with down syndrome. J Pediatr Urol 2015; 11:230-1. [PMID: 26148436 DOI: 10.1016/j.jpurol.2015.06.004] [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: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 11/15/2022]
Affiliation(s)
| | - José de Bessa
- State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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112
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Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A. Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring. Pediatrics 2015; 136:e13-21. [PMID: 26055855 PMCID: PMC4485012 DOI: 10.1542/peds.2015-0409] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09-3.93]) and presence of renal scarring on the baseline (99m)Tc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22-6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86-4.87]). CONCLUSIONS VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD.
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Affiliation(s)
- Ron Keren
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Pediatrics and Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Nader Shaikh
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Hans Pohl
- Division of Urology, Children’s National Health System, Washington, DC; and
| | | | - Anastasia Ivanova
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa Zaoutis
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa Patel
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel deBerardinis
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison Parker
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sonika Bhatnagar
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Mary Ann Haralam
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Marcia Pope
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Diana Kearney
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Bruce Sprague
- Division of Urology, Children’s National Health System, Washington, DC; and
| | - Raquel Barrera
- Division of Urology, Children’s National Health System, Washington, DC; and
| | - Bernarda Viteri
- Division of Urology, Children’s National Health System, Washington, DC; and
| | - Martina Egigueron
- Division of Urology, Children’s National Health System, Washington, DC; and
| | - Neha Shah
- Division of Urology, Children’s National Health System, Washington, DC; and
| | - Alejandro Hoberman
- University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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113
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Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P. International Children's Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn 2015; 34:640-7. [DOI: 10.1002/nau.22783] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Stuart B. Bauer
- Harvard Medical School; Boston Children's Hospital; Boston MA
| | - Rien J.M. Nijman
- Department of Urology and Pediatric Urology; University Medical Centre Groningen; Groningen the Netherlands
| | - Beth A. Drzewiecki
- Albert Einstein College of Medicine; Montefiore Medical Center; Children's Hospital at Montefiore; Bronx NY
| | - Ulla Sillen
- Department of Pediatrics; University of Gothenberg; Gothenberg Sweden
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114
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Quintiliano F, Veiga ML, Moraes M, Cunha C, de Oliveira LF, Lordelo P, Bastos Netto JM, Barroso Júnior U. Transcutaneous parasacral electrical stimulation vs oxybutynin for the treatment of overactive bladder in children: a randomized clinical trial. J Urol 2015; 193:1749-53. [PMID: 25813563 DOI: 10.1016/j.juro.2014.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE We determined the effectiveness of 2 methods to treat overactive bladder in children using intragroup and intergroup comparisons in a randomized clinical trial. MATERIALS AND METHODS Nine boys and 19 girls with a mean ± SD age of 6.4 ± 2.18 years were randomly divided into group 1-parasacral transcutaneous electrical stimulation with placebo drug and group 2-oxybutynin with sham scapular electrical therapy. Success was assessed by 1) the rate of complete symptom resolution, 2) a visual analog scale of 0 to 10, 3) the dysfunctional voiding score system, 4) voiding diary records, 5) Rome III criteria and 6) side effect frequency in each group. RESULTS A total of 13 and 15 patients were randomized to groups 1 and 2, respectively. Symptoms completely resolved in 6 patients in group 1 (46%) and 3 in group 2 (20%) (p = 0.204). A statistically significant improvement was found in the 2 groups in the dysfunctional voiding score system and voiding diary records. However, no statistically significant difference was found between the groups in the visual analog scale score, voiding frequency, and maximum and mean voided volume (p = 0.295, 0.098, 0.538 and 0.650, respectively). Constipation improved in 100% of group 1 patients but in only 55% in group 2 (p = 0.031 vs 0.073). Group 1 showed no side effects while dry mouth, hyperthermia and hyperemia developed in 58%, 25% and 50% of group 2 patients (p = 0.002, 0.096 and 0.005, respectively). Treatment was discontinued by 13.3% of patients in group 2. CONCLUSIONS Parasacral transcutaneous electrical stimulation was as effective as oxybutynin to treat overactive bladder in children. However, transcutaneous parasacral electrical stimulation was more effective against constipation and showed no detectable side effects. Oxybutynin was more effective for decreasing voiding frequency.
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Affiliation(s)
- Fábio Quintiliano
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Maria Luiza Veiga
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Marília Moraes
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Carolina Cunha
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Liliana Fajardo de Oliveira
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Patrícia Lordelo
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - José Murillo Bastos Netto
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil
| | - Ubirajara Barroso Júnior
- Division of Pediatric Urology, Department of Urology, Bahia School of Medicine, Salvador, Bahia, Brazil; Divisions of Urology, Departments of Surgery, Federal University of Juiz de Fora and School of Health and Medical Sciences of Juiz de Fora, Juiz de Fora (LFdO, JMBN), Minas Gerais, Brazil.
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115
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Paye-Jaouen A, Pistolesi F, Botto N, Enezian G, Grapin-Dagorno C, Peycelon M, El-Ghoneimi A. Long-Term Bladder Function after Ureterocele Decompression in Children. J Urol 2015; 193:1754-9. [DOI: 10.1016/j.juro.2014.10.115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Filippo Pistolesi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Goharig Enezian
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Christine Grapin-Dagorno
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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116
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Hubert KC, Sideridis G, Sherlock R, Rosoklija I, Kringle G, Johnson K, Bauer SB, Nelson CP. Urinary incontinence in spina bifida: Initial instrument validation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 40:42-50. [PMID: 25841183 DOI: 10.1016/j.ridd.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to perform a psychometric assessment of the Incontinence Symptom Index-Pediatric (ISI-P) in a cohort of adolescents with spina bifida (SB) and neuropathic urinary incontinence (UI) to test its validity and reliability. The ISI-P, an 11-item instrument with domains for symptom severity and impairment, was self-administered by subjects 11-17 years old with SB and UI. Controls were 11-17 years old, with nephrolithiasis and no history of UI. Formal psychometric assessment included an evaluation of internal consistency, test re-test reliability and factor analysis. Of 78 study-eligible subjects we attempted to contact, 33 (66.7% female) with a median age of 13.1 years completed the ISI-P (42.3% response rate). 21 control patients also completed the ISI-P. Cronbach's alpha was 0.936 and 0.792 for the severity and bother factors respectively. The delta Chi-square test for the two-factor (vs. one-factor) model was significantly [χ(2)(89) = 107.823, p < 0.05] in favor of the former model with descriptive fit indices being excellent (e.g., comparative fit index = 0.969). Furthermore, category information analysis showed that all categories were associated with different threshold values, namely that each category contributed unique information for the measurement of the latent trait. In conclusion, the ISI-P has desirable psychometric properties for the measurement of UI symptom severity and impairment in adolescents with SB.
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MESH Headings
- Adolescent
- Child
- Cohort Studies
- Cross-Sectional Studies
- Diurnal Enuresis/diagnosis
- Diurnal Enuresis/etiology
- Diurnal Enuresis/psychology
- Factor Analysis, Statistical
- Female
- Humans
- Male
- Psychometrics
- Quality of Life
- Reproducibility of Results
- Severity of Illness Index
- Social Participation/psychology
- Spinal Dysraphism/complications
- Surveys and Questionnaires
- Urinary Bladder, Neurogenic/diagnosis
- Urinary Bladder, Neurogenic/etiology
- Urinary Bladder, Neurogenic/psychology
- Urinary Incontinence/diagnosis
- Urinary Incontinence/etiology
- Urinary Incontinence/psychology
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/psychology
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/etiology
- Urinary Incontinence, Urge/psychology
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Affiliation(s)
- Katherine C Hubert
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Georgios Sideridis
- Clinical Research Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Rebecca Sherlock
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Ilina Rosoklija
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Greta Kringle
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Kathryn Johnson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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117
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Attention deficit-hyperactivity disorder symptoms and daytime voiding symptoms in children with primary enuresis: an observational study to evaluate the effectiveness of desmopressin treatment. ScientificWorldJournal 2015; 2015:356121. [PMID: 25866838 PMCID: PMC4381655 DOI: 10.1155/2015/356121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/25/2015] [Accepted: 02/24/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the effectiveness of presence of desmopressin in treating primary enuresis (PE) for children with attention deficit-hyperactivity disorder (ADHD) symptoms. Materials and Methods. Children aged from 5 to 12 years with the chief complaint of PE treated with desmopressin were enrolled in pediatric urology clinics. The parent-reported SNAP-IV questionnaire was used to evaluate ADHD symptoms (cut-off value: 90th percentile). Voiding symptoms were assessed by the Dysfunctional Voiding Scoring System (DVSS) questionnaire. The responses to desmopressin were analyzed in children with and without ADHD symptoms. Results. The study sample comprised 68 children; 27 (39.7%) presented with ADHD symptoms and 41 (60.3%) with non-ADHD symptoms. The children collected from a tertiary referral center may explain the high prevalence of ADHD symptoms in the present study. The total DVSS score in the ADHD symptoms group was significantly higher than in the non-ADHD symptoms group (7.72 versus 5.65, P = 0.05). In the ADHD symptoms group, there were significantly higher score in the “pee 1-2 times/day” and “can't wait” subscales of DVSS and lower sleep quality based on the Pediatric Sleep Quality questionnaire, as well as significantly lower peak flow rate and voided volume. The responses to desmopressin for enuresis were comparable between children with ADHD and non-ADHD symptoms. Conclusions. Approximately 39.7% of PE children presented with ADHD symptoms at urologic clinics. PE children with ADHD symptoms had higher risk of daytime LUTS and comparable response to desmopressin treatment for PE. To evaluate ADHD symptoms and daytime voiding symptoms is important in children with PE.
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118
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Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn 2015; 35:471-81. [PMID: 25772695 DOI: 10.1002/nau.22751] [Citation(s) in RCA: 530] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/21/2015] [Indexed: 11/07/2022]
Abstract
AIM The impact of the original International Children's Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function. METHODS A variety of worldwide experts from multiple disciplines within the ICCS leadership who care for children with LUT dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. Additionally, contributions and feedback from the multidisciplinary ICCS membership were solicited. RESULTS Following a review of the literature over the last 7 years, the ICCS experts assembled a new terminology document reflecting current understanding of bladder function and LUT dysfunction in children using the resources from the literature review, expert opinion and ICCS member feedback. CONCLUSIONS The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of LUT function in children. Neurourol. Urodynam. 35:471-481, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Paul F Austin
- From the Division of Urology, Washington University in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri
| | - Stuart B Bauer
- Department of Urology, Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wendy Bower
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Janet Chase
- The Children's Centre, Cabrini Hospital, Melbourne, Australia
| | | | - Piet Hoebeke
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Johan Vande Walle
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Germany
| | - Anne Wright
- Pediatrics, Evelina Children's Hospital, St. Thomas' Hospital, London, England
| | - Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Section of Paediatric Nephrology, Uppsala University, Uppsala, Sweden
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119
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Mota DM, Barros AJD, Matijasevich A, Santos IS. Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil. J Pediatr (Rio J) 2015; 91:52-8. [PMID: 25193596 DOI: 10.1016/j.jped.2014.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management.
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Affiliation(s)
- Denise M Mota
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil.
| | | | - Alicia Matijasevich
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil; Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil
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120
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Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2014.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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121
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Ooi SM, Kane N, Khosa J, Barker A, Samnakay N. Lower urinary tract dysfunction in children after intravesical ureteric reimplantation surgery under one year of age. J Pediatr Urol 2014; 10:1139-44. [PMID: 24953546 DOI: 10.1016/j.jpurol.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 05/21/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report the results of a study conducted on voiding function in children who have undergone intravesical trans-trigonal Cohen ureteric reimplantation surgery before the age of one year. SUBJECTS Twenty-eight children (18 males, 10 females) had surgery at a mean age of 4.9 months (range 8-352 days). METHODS Bladder function was assessed at a mean age of 7.3 years using questionnaires, the dysfunctional voiding scoring system, PinQ quality of life tool, uroflowmetry and post-void residuals. RESULTS Of the total children, 72% had normal lower urinary tract (LUT) function. Eight children (28%) had evidence of LUT dysfunction, two had urge incontinence, two had giggle incontinence, two had voiding postponement, one had dysfunctional elimination syndrome and one had evidence of dysfunctional voiding. Five of the eight children were managed with continence physiotherapy (urotherapy) and one required ongoing anticholinergic therapy. CONCLUSION When compared to the published rates of LUT dysfunction in the general paediatric community, no evidence was found to suggest an increased incidence of bladder dysfunction in children undergoing intravesical Cohen ureteric reimplantation surgery under one year of age.
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Affiliation(s)
- S M Ooi
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia.
| | - N Kane
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia.
| | - J Khosa
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia.
| | - A Barker
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia.
| | - N Samnakay
- Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia; University of Western Australia, Nedlands, Western Australia 6009, Australia.
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Yüksel S, Yurdakul AÇ, Zencir M, Çördük N. Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study. J Pediatr Urol 2014; 10:1181-6. [PMID: 25001292 DOI: 10.1016/j.jpurol.2014.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/07/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim was to determine the prevalence of voiding dysfunction and its related risk factors in Turkish schoolchildren. MATERIALS AND METHODS A randomly selected, cross-sectional study was conducted using a self-administered and previously validated questionnaire. The questionnaire consisted of two parts. The first part included personal demographic and familial information, and the second part included the Dysfunctional Voiding and Incontinence Scoring System (DVISS). The questionnaires were given to 4668 children between 6 and 15 years of age, which were completed by the parents and children together. The children with a score of ≥9 were accepted as having lower urinary tract dysfunction (LUTD). RESULTS The data were collected from 4016 children (the response rate was 86.0%), including 48.6% boys and 51.4% girls. The mean age was 10.5±2.2 years. The overall frequency of LUTD was 9.3%. While the 6-year-old children had the highest frequency (23.1%) of LUTD, this rate was 7.9% at the age of 10, and the children aged 14 years had the lowest frequency (4.9%), (p<0.001). Lower urinary tract symptoms were significantly more common in girls (7.6%) than in boys (3.2%) only for the older age group (between 12 and 15 years of age). Compared with normal children, those with LUTD (with a score of ≥9) had the following risk factors: less educated parents, a parent that had lower urinary tract symptoms when he or she was a child, more persons per room (≥2 persons), more siblings (≥4 siblings) at home, past medical history of urinary tract infections, and squatting position (in girls). CONCLUSIONS Lower urinary tract problems are one of the most important and ongoing health problems in childhood. Determining the prevalence of lower urinary tract problems in children and their related risk factors is the first step to managing and reducing the number of children suffering from voiding problems.
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Affiliation(s)
- Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey.
| | - Ayşe Çolpan Yurdakul
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Mehmet Zencir
- Department of Public Health, Pamukkale University School of Medicine, Denizli, Turkey
| | - Nergül Çördük
- Department of Pediatric Surgery, Pamukkale University School of Medicine, Denizli, Turkey
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123
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Factor analysis of the pediatric symptom checklist in a population of children with voiding dysfunction and/or nocturnal enuresis. J Clin Psychol Med Settings 2014; 21:72-80. [PMID: 24158241 DOI: 10.1007/s10880-013-9375-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The research objective was to identify the factor structure of the pediatric symptom checklist (PSC) in children with voiding dysfunction and/or nocturnal enuresis who were seen in a pediatric urology clinic. Retrospective chart reviews were conducted for 498 consecutive patients, ages 6-16, who were seen over a 13-month period. The PSC, a 35-item measure used to screen for psychosocial difficulties, was completed by the patient's caregiver. Confirmatory factor analyses using three previous models were conducted. A four factor model comprised of internalizing, externalizing, attention problems, and chronic illness factors represented the best fit to the data. Within this population, the PSC appears to capture internalizing and externalizing problems, difficulties with attention, and possible side effects of a medical condition. This information could aid clinicians in assessing adjustment difficulties within this population and concurrently allow researchers to examine whether these specific factors are related to other relevant outcomes.
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124
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Combined functional pelvic floor muscle exercises with Swiss ball and urotherapy for management of dysfunctional voiding in children: a randomized clinical trial. Eur J Pediatr 2014; 173:1347-53. [PMID: 24844352 DOI: 10.1007/s00431-014-2336-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 04/17/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED We report the clinical results of two types of urotherapy programs in children with dysfunctional voiding (DV). Sixty children with a median age of 8 (range, 5-14) diagnosed with DV were randomly allocated to one of two groups, each made up of 30 patients. Patients in group A underwent behavioral urotherapy (hydration, scheduled voiding, toilet training, and high-fiber diet) combined with pelvic floor muscle (PFM) exercises, whereas group B only received behavioral urotherapy. All parents completed a voiding and bowel habit diary chart. Uroflowmetry with pelvic floor surface electromyography (EMG) and bladder ultrasound were performed on all patients at the beginning and the end of the 1-year study. Abnormal voiding pattern normalized to a bell shape in 21/30 of patients in group A and 8/30 of patients in group B (P < 0.000). EMG activity during voiding disappeared significantly in 23/30 patients in group A compared to 15/30 patients in group B (P < 0.02). Episodes of urgency resolved in 12/14 of patients in group A and 3/11 of patients in group B (P < 0.01). Daytime wetting improved in 15/17 and 4/11 of patients in groups A and B, respectively. In addition, reduction in post-void residue (PVR) was significant in group A (P < 0.003). CONCLUSION Functional PFM exercises with Swiss ball combined with behavioral urotherapy proved as a safe and effective therapeutic modality, reducing the frequency of urinary incontinence, PVR, and the severity of constipation in children with DV.
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de Carvalho Mrad FC, de Bessa J, de Rezende Duarte AMB, Vieira AAP, Araujo FCC, de Sá Camargo ML, Tibiriça SHC, de Figueiredo AA, de Bastos Netto JM. Prevalence of lower urinary tract symptoms in individuals with Down syndrome. J Pediatr Urol 2014; 10:844-9. [PMID: 24726199 DOI: 10.1016/j.jpurol.2014.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Down syndrome (DS), which is caused by the trisomy of chromosome 21, is the most frequent of all genetic syndromes. The current study aims to estimate the prevalence of lower urinary tract symptoms (LUTS) in individuals with DS buy using the Dysfunctional Voiding Symptom Score (DVSS) and correlate with functional constipation, age, and gender, as well as determine the most sensitive and specific factors associated with LUTS. METHODS LUTS was assessed in individuals with DS using a cross-sectional study through the application of a validated and adapted version of the DVSS for the Brazilian population. The presence of functional constipation was evaluated according to the Rome III criteria. RESULTS Of the 114 individuals assessed, 84 were included in the study (median age 16 ± 5.0 years, 66.7% female). The prevalence of LUTS was 27.3%. The symptoms were more frequent in males (OR 3.0, 95% CI 1.1-8.3, p = 0.03) and in individuals younger than 10 years of age (OR 5.2, 95% CI 1.8-14, p = 0.001). Functional constipation was observed in 50% of subjects. It was detected in 95.65% of the individuals with LUTS and 32.78% without LUTS (OR 45.1, 95% CI 5.66-301, p = 0.001). The symptom listed in question 8 ("push to pee") was the most specific indicator. When present, this symptom indicated a higher probability of LUTS (LR+ = 6.3), while the symptom listed in question 4 ("push for bowel movements to come out") showed high sensitivity and, when absent, indicated a lower probability of LUTS (LR- = 0.1). CONCLUSIONS LUTS was more prevalent in young males with DS and appeared to improve with age. Functional constipation was strongly associated with LUTS. These findings will contribute to raising the awareness of professionals involved in the follow-up of individuals with DS regarding the clinical manifestations and the need for a standardized investigation of LUTS.
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Affiliation(s)
- Flávia Cristina de Carvalho Mrad
- Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medical Sciences and Health, Juiz de Fora, Minas Gerais, Brazil.
| | - José de Bessa
- State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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Bulum B, Özçakar ZB, Kavaz A, Hüseynova M, Ekim M, Yalçınkaya F. Lower urinary tract dysfunction is frequently seen in urinary tract infections in children and is often associated with reduced quality of life. Acta Paediatr 2014; 103:e454-8. [PMID: 24974882 DOI: 10.1111/apa.12732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/23/2014] [Accepted: 06/26/2014] [Indexed: 11/30/2022]
Abstract
AIM Previous studies suggest that 6-46% of children suffer from lower urinary tract dysfunction (LUTD). This study evaluated the prevalence of LUTD in children with a urinary tract infection (UTI) and assessed the impact of standard urotherapy on patients with LUTD. METHODS We enrolled 228 patients who were 4 years of age or older with at least one episode of UTI, together with a control group of 100 children. All the children were evaluated using the Pediatric Lower Urinary Tract Symptom Score (PLUTSS), and the intervention group were re-assessed after therapy to gauge their response. RESULTS Lower urinary tract dysfunction was detected in 134 (59%) patients. Their mean PLUTSS was 15.9 ± 5.3, and 78% of these patients had a reduced quality of life (QOL). After 5 ± 2.7 months of behavioural therapy, 105 (78%) patients with LUTD were evaluated for the second time. This showed that LUTD was ameliorated in 69% of the patients and improved in 26%, with a mean post-treatment PLUTSS of 6.6 ± 5.6. Two control group children had LUTD. CONCLUSION Lower urinary tract dysfunction was frequently seen in patients with UTIs, but standard urotherapy was usually successful. Most of the patients in our study with LUTD also had an impaired QOL.
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Affiliation(s)
- Burcu Bulum
- Department of Paediatric Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Zeynep Birsin Özçakar
- Department of Paediatric Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Aslı Kavaz
- Department of Paediatric Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Mehriban Hüseynova
- Department of Paediatrics; Ankara University School of Medicine; Ankara Turkey
| | - Mesiha Ekim
- Department of Paediatric Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Fatoş Yalçınkaya
- Department of Paediatric Nephrology; Ankara University School of Medicine; Ankara Turkey
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Berry A, Rudick K, Richter M, Zderic S. Objective versus subjective outcome measures of biofeedback: what really matters? J Pediatr Urol 2014; 10:620-6. [PMID: 25070936 DOI: 10.1016/j.jpurol.2014.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical epidemiologic studies suggest that once established, voiding dysfunction can become a lifelong condition if not treated correctly early on in life. Biofeedback is one component of a voiding retraining program to help children with voiding dysfunction. Our goal was to compare objective non-invasive urodynamic data obtained during office biofeedback sessions with patient reported voiding symptom scores. METHODS Charts of 55 children referred in 2010 for pelvic floor muscle biofeedback therapy for urinary incontinence were retrospectively reviewed. Patients with any anatomic diagnoses were excluded. Forty-seven (86%) females and eight males (14%) with a mean age of 8.2 years made up the cohort. Uroflow curves, voided volumes, and post-void residuals were recorded at each visit and served as objective data. Volumes were normalized as a percentage of expected bladder capacity according to age. The patient reported symptom score and patient reported outcome (improved, no change or worse) served as subjective measures of intervention. RESULTS The primary referral diagnoses were day and night wetting in 37 (67%) and daytime incontinence in 18 (33%) children. A history of urinary tract infection (UTI) was noted in 32 (64%) patients, and 25% were maintained on antibiotic prophylaxis during the study period. Twenty-nine percent were maintained on anticholinergic medication. Patients attended an average of 2.5 biofeedback sessions. Voided volumes and post void residual volumes were unchanged, 50% of the abnormal uroflow curves normalized over the course of treatment (p < 0.05). Patient reported symptom score decreased from 12.8 ± 5.6 to 8.0 ± 6.5 (p < 0.002) over an average follow-up time of 276 days reflecting fewer daytime voiding symptoms. There was no significant change in the patient symptom score component for the night-time wetting. Patient-reported outcomes at the final session of biofeedback were rated an improved in 26 (47%), no change in 15 (27%), worse in three (5%) patients, and not rated in 11 patients (21%). CONCLUSIONS Pelvic floor muscle biofeedback is associated with patient-reported improvement in symptoms, reduction in voiding symptom score, and normalization of uroflow curves, but these improvements are not correlated with objective parameters of voided volumes and post-void residual urine obtained during office visits for biofeedback. It is important to identify the most relevant outcome measures for BFB, as insurance coverage for medical interventions that cannot offer outcomes analysis that demonstrates a benefit for the patient will eventually be eliminated.
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Affiliation(s)
- Amanda Berry
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Kristen Rudick
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meg Richter
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Zderic
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Imamura M, Usui T, Johnin K, Yoshimura K, Farhat W, Kanematsu A, Ogawa O. [Cross-cultural validated adaptation of dysfunctional voiding symptom score (DVSS) to Japanese language and cognitive linguistics in questionnaire for pediatric patients]. Nihon Hinyokika Gakkai Zasshi 2014; 105:112-121. [PMID: 25158553 DOI: 10.5980/jpnjurol.105.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Validated questionnaire for evaluation of pediatric lower urinary tract symptoms (LUTS) is of a great need. We performed cross-cultural validated adaptation of Dysfunctional Voiding Symptom Score (DVSS) to Japanese language, and assessed whether children understand and respond to questionnaire correctly, using cognitive linguistic approach. METHODS We translated DVSS into two Japanese versions according to a standard validation methodology: translation, synthesis, back-translation, expert review, and pre-testing. One version was written in adult language for parents, and the other was written in child language for children. Pre-testing was done with 5 to 15-year-old patients visiting us, having normal intelligence. A specialist in cognitive linguistics observed the response by children and parents to DVSS as an interviewer. When a child could not understand a question without adding or paraphrasing the question by the parents, it was defined as 'misidentification'. RESULTS We performed pretesting with 2 trial versions of DVSS before having the final version. The pre-testing for the first trial version was done for 32 patients (male to female ratio was 19 : 13). The pre-testing for the second trial version was done for 11 patients (male to female ratio was 8 : 3). In DVSS in child language, misidentification was consistently observed for representation of time or frequency. We completed the formal validated translation by amending the problems raised in the pre-testing. CONCLUSION The cross-cultural validated adaptation of DVSS to child and adult Japanese was completed. Since temporal perception is not fully developed in children, caution should be taken for using the terms related with time or frequency in the questionnaires for children.
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Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 2014; 370:2367-76. [PMID: 24795142 PMCID: PMC4137319 DOI: 10.1056/nejmoa1401811] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with febrile urinary tract infection commonly have vesicoureteral reflux. Because trial results have been limited and inconsistent, the use of antimicrobial prophylaxis to prevent recurrences in children with reflux remains controversial. METHODS In this 2-year, multisite, randomized, placebo-controlled trial involving 607 children with vesicoureteral reflux that was diagnosed after a first or second febrile or symptomatic urinary tract infection, we evaluated the efficacy of trimethoprim-sulfamethoxazole prophylaxis in preventing recurrences (primary outcome). Secondary outcomes were renal scarring, treatment failure (a composite of recurrences and scarring), and antimicrobial resistance. RESULTS Recurrent urinary tract infection developed in 39 of 302 children who received prophylaxis as compared with 72 of 305 children who received placebo (relative risk, 0.55; 95% confidence interval [CI], 0.38 to 0.78). Prophylaxis reduced the risk of recurrences by 50% (hazard ratio, 0.50; 95% CI, 0.34 to 0.74) and was particularly effective in children whose index infection was febrile (hazard ratio, 0.41; 95% CI, 0.26 to 0.64) and in those with baseline bladder and bowel dysfunction (hazard ratio, 0.21; 95% CI, 0.08 to 0.58). The occurrence of renal scarring did not differ significantly between the prophylaxis and placebo groups (11.9% and 10.2%, respectively). Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group. CONCLUSIONS Among children with vesicoureteral reflux after urinary tract infection, antimicrobial prophylaxis was associated with a substantially reduced risk of recurrence but not of renal scarring. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; RIVUR ClinicalTrials.gov number, NCT00405704.).
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Lee LC, Koyle MA. The Role of Bladder and Bowel Dysfunction (BBD) in Pediatric Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Naseri M. Lower Urinary Tract Urological Abnormalities and Urodynamic Findings of Physiological Urinary Incontinence Versus Non-mono Symptomatic Nocturnal Enuresis in Children. Nephrourol Mon 2014; 6:e15360. [PMID: 24783173 PMCID: PMC3997942 DOI: 10.5812/numonthly.15360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/26/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although 98% of children attain daytime bladder control by three years of age, urinary incontinence is regarded physiological up to the fifth year of life. OBJECTIVES This study aimed to assess whether lower urinary tract urological abnormalities and abnormal urodynamic findings are infrequent in children with physiological urinary incontinence in contrast to those with non-monosymptomatic nocturnal enuresis (NMNE). PATIENTS AND METHODS During a three-year period (2007-2009), 66 neurologically normal children including 51 children (34 girls, 17 boys) older than five years of age with NMNE and intermittent daytime incontinence, and 15 children with physiological urinary incontinence (eight girls and seven boys) aged four to five years of age without any known urological abnormalities were enrolled in the study. Patients with neurologic deficits or known urological anomalies were excluded from the study. Kidney-bladder ultrasonography, voiding cystourethrography (VCUG), and urodynamic studies were performed to evaluate the anatomy of urinary tract and bladder function. RESULTS Urinary tract infection was found in 23 (34.8%) children, 17 (33.3%) and 6 (40%) patients with NMNE and physiological urinary incontinence, respectively. Out of 48 patients who underwent VCUG, vesicoureteral reflux (VUR) was found in seven and eight children younger and older than five years of age, respectively. Abnormal urodynamic findings were reported in 5 (62.5%) of eight children younger than five-year-old, and 14 (63.6%) of 22 patients older than 5-year-old. CONCLUSIONS VUR might be more frequent in children with physiological urinary incontinence than the normal population, and might be as common as NMNE with intermittent daytime incontinence.
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Affiliation(s)
- Mitra Naseri
- Pediatric Nephrology Department, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mitra Naseri, Pediatric Nephrology Department, Dr Sheikh Children Hospital, Mashhad University of Medical Sciences, Naderi Avenue, Taabodi Street, Mashhad, IR Iran. Tel: +98-5117269021; Ext: 25, Fax: +98-5117273943, E-mail:
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Pediatric urinary incontinence: Classification, evaluation, and management. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Lee HE, Farhat W, Park K. Translation and linguistic validation of the korean version of the dysfunctional voiding symptom score. J Korean Med Sci 2014; 29:400-4. [PMID: 24616590 PMCID: PMC3945136 DOI: 10.3346/jkms.2014.29.3.400] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 11/23/2022] Open
Abstract
Although studies on pediatric dysfunctional voiding are increasing, there have not been enough efforts to validate the Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Therefore, we aimed to translate and validate the DVSS into Korean. The DVSS questionnaire was validated between January and October, 2013. Two bilinguals independently translated the English version of the DVSS questionnaire into Korean, and then reconciled the forward translation of the Korean version. The original DVSS was back-translated into English, then assessed for equivalence to the original. Cognitive debriefing interviews with 5 patients to test the interpretation of the translation were made, then modified and distributed to 48 patients for re-evaluation. A statistical analysis of inter-scale correlation, and test re-test consistency was performed with the Cronbach's alpha coefficient. The changes from patient interviews were reflected in the final version. In an intra-class correlation, the Cronbach's alpha was high in all of the questions (0.97, P < 0.001). Test re-test Cronbach's alpha analysis of reproducibility was higher than 0.8 for all of the 10 questions (P < 0.001). Translation and linguistic validation of Korean version of the DVSS questionnaire was completed by a proper process, with high reliability and validity.
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Affiliation(s)
- Hahn-Ey Lee
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Walid Farhat
- The Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kwanjin Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Akbal C, Şahan A, Şener TE, Şahin B, Tinay I, Tarcan T, Şimşek F. Diagnostic value of the pediatric lower urinary tract symptom score in children with overactive bladder. World J Urol 2013; 32:201-8. [PMID: 24362911 DOI: 10.1007/s00345-013-1224-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/05/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aims were (1) to assess the pediatric lower urinary tract symptom score (SS) prior to treatment as a means of determining severity of overactive bladder (OAB) and (2) to investigate relationships between SS results and those of standard diagnostic modalities. MATERIALS AND METHODS Symptom scores were recorded pre- and 6 months SS for 294 children with OAB unrelated to neurological disorder. Uroflowmetry-electromyography data, total bladder capacity, and a 2-day bladder diary were also recorded, and upper urinary tract deterioration was investigated as indicated. Overactive bladder was treated with standard approaches. No response to treatment was defined as 0-49% reduction in OAB-related symptoms based on SS results. Non-responders underwent additional evaluations as indicated. RESULTS Two hundred forty-one patients (97%; mean age 9.8 ± 2.8 years; mean follow-up 11 months; range 6-18 months) completed the study. One hundred thirteen (47%) required ultrasonography (USG), and those with abnormal USG had a significantly higher pre- and 6 months SS (p = 0.016). All non-responders (n = 38; 16%) underwent urodynamics evaluation, 34 underwent spinal magnetic resonance imaging (MRI), 34 underwent voiding cystourethrography (VCUG), and 34 underwent dimercaptosuccinic acid scanning (DMSA). Non-responders with terminal detrusor hyperactivity had significantly lower SS after therapy (p = 0.09). Non-responders with abnormal MRI had higher pre- and 6 months SS than those with normal MRI. Thirteen (38%) of the non-responders who required VCUG had vesicoureteral reflux (VUR), and this subgroup had higher pre-treatment SS (p = 0.030). Seven (21%) of the non-responders who required DMSA had scarring, and all 7 had VUR. The subgroup with scarring had higher pre-treatment SS (p = 0.030). CONCLUSION Pediatric OAB patients with high 6 months SS have a higher incidence of additional upper urinary tract pathology. Those with low pre-treatment SS require fewer laboratory tests and other assessments. The SS tool can reduce the number of urodynamics evaluations, and other tests required to diagnose renal damage in children with OAB.
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Affiliation(s)
- Cem Akbal
- Pediatric Urology Division, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey,
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Veiga ML, Lordêlo P, Farias T, Barroso C, Bonfim J, Barroso U. Constipation in children with isolated overactive bladders. J Pediatr Urol 2013; 9:945-9. [PMID: 23462384 DOI: 10.1016/j.jpurol.2013.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/07/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the prevalence of constipation in children with isolated overactive bladder (IOAB) and no micturition complaints. MATERIALS AND METHODS A questionnaire was used to evaluate constipation in 51 children with IOAB, as well as in a control group of 74 children between the ages of 4 and 14 years. The Rome III criteria for children were used to assess constipation. IOAB was defined as the presence of symptoms such as urgency with or without daytime incontinence or frequency, a bell-shaped uroflow, and no post-residual urine. RESULTS Mean patient ages were 7.94 (±2.8) and 8.28 (±3.4) years in the OAB and control group, respectively (p = 0.54). Twenty-eight (54.9%) of the OAB group were girls, and 34 (45.9%) were girls in the control group (p = 0.32). More of the children with IOAB had constipation than those without urinary symptoms (54.9% vs. 29.7%, p = 0.005; or 2.87, 95% CI: 1.3-6.0). The results were statistically significant regarding the following Rome III criteria: "history of stool retention", "presence of painful or hard bowel movements", "the presence of a large fecal mass in the rectum" and "large diameter stools which may obstruct the toilet". Within the group with OAB, constipation was more common among males (p = 0.05). There was no association between the type of OAB symptoms and constipation. The average dysfunctional voiding symptom score was 9.76 (±4.1). Eleven children (21.6%) presented alterations on ultrasound. Girls with OAB presented more frequently with UTI than boys (18 vs. 10, p = 0.13). CONCLUSION This was the first comparative study with respect to constipation in children with IOAB and without urinary symptoms. Children with IOAB have a greater risk of having constipation compared to those with no urinary symptoms.
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Affiliation(s)
- Maria Luiza Veiga
- CEDIMI, (Center for Childhood Urinary Disorders), Department of Urology and Physiotherapy, Bahiana School of Medicine, Bahia, Brazil
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Urinary dysfunction in children is associated with exposure to environmental tobacco smoke. J Pediatr Urol 2013; 9:1116-21. [PMID: 23702349 DOI: 10.1016/j.jpurol.2013.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/03/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Environmental tobacco smoke (ETS) is known to cause significant morbidity across a wide variety of organ systems. The purpose of this study was to examine the relationship of ETS exposure with pediatric urinary dysfunction. PATIENTS AND METHODS Participants were drawn from a university-based pediatric urology practice throughout the first half of 2011. All patients who presented with a chief complaint of urinary dysfunction were approached to participate (N = 184). Exclusion criteria eliminated all but 71 subjects. Of these, 68 subjects and their parents completed age-appropriate questionnaires on ETS exposure and symptom severity. Data were analyzed using descriptive statistics and relationship between exposure and outcome was evaluated via Spearman correlation analysis. RESULTS A total of 68 children with no known etiology for their urinary dysfunction were evaluated for symptom severity and ETS exposure. Participants demonstrated a significant positive correlation (rho = 0.592 for those 4-10 years; rho = 0.415 for those 11-17 years) between ETS exposure and severity of their urinary symptoms. CONCLUSIONS These data indicate a positive relationship between ETS exposure and urinary dysfunction among children with no other obvious etiology for their symptoms. Physicians should inform parents of the potential dangers of childhood ETS exposure, including the possible relationship with urinary dysfunction.
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Chang SJ, Chiang IN, Lin CD, Hsieh CH, Yang SSD. Obese children at higher risk for having overactive bladder symptoms: A community-based study. Neurourol Urodyn 2013; 34:123-7. [DOI: 10.1002/nau.22532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - I-Ni Chiang
- Department of Urology; National Taiwan University Hospital; Taipei Taiwan
| | - Chia-Da Lin
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
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Abstract
Vesicoureteral reflux (VUR) is a significant risk factor for clinical pyelonephritis and renal scarring. In 2010, the American Urological Association (AUA) reported that bladder and bowel dysfunction (BBD), which is common in patients with VUR, increases the risk of breakthrough UTI in children receiving antibiotic prophylaxis, reduces the success rate for endoscopic injection therapy, and increases the risk of postoperative UTI, irrespective of the surgical success rate for VUR. Accordingly, physicians are strongly recommended to investigate BBD in their patients with VUR. Symptoms and signs of BBD include urinary frequency and urgency, prolonged voiding intervals, daytime wetting, perineal and penile pain, holding manoeuvres (posturing to prevent wetting), constipation, and encopresis. Primary assessment tools include the Pediatric Symptom Checklist, urinalysis, urine culture, bladder diary, measurement of the postvoid residual urine volume, Dysfunctional Voiding Symptom Score, uroflow with electromyography, and Bristol Stool Form Score. The Rome III criteria can also be used for diagnostic assessment of bowel function. Treatment of BBD should be individualized, directed at symptomatic and objective improvement, and can include behavioural modification, biofeedback, selective use of anticholinergics and α-blockers, and bowel management.
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Affiliation(s)
- Jack S Elder
- Vattikuti Urology Institute, Henry Ford Hospital, Department of Pediatric Urology, Children's Hospital of Michigan, 2799 West Grand Boulevard, K-9, Detroit, MI 48202, USA
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Barroso U, Viterbo W, Bittencourt J, Farias T, Lordêlo P. Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children. J Urol 2013; 190:673-7. [PMID: 23422257 DOI: 10.1016/j.juro.2013.02.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. MATERIALS AND METHODS We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly. RESULTS A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant. CONCLUSIONS We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence.
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Affiliation(s)
- Ubirajara Barroso
- Center for Voiding Disorders in Children (CEDIMI), Section of Pediatric Urology, Division of Urology, Bahiana School of Medicine, Salvador, Bahia, Brazil
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140
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Carpenter MA, Hoberman A, Mattoo TK, Mathews R, Keren R, Chesney RW, Moxey-Mims M, Greenfield SP. The RIVUR trial: profile and baseline clinical associations of children with vesicoureteral reflux. Pediatrics 2013; 132:e34-45. [PMID: 23753091 PMCID: PMC3691529 DOI: 10.1542/peds.2012-2301] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Vesicoureteral reflux (VUR) is diagnosed in ∼30% to 40% of children who have imaging studies after urinary tract infections (UTIs). Our goal is to characterize children enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial and to compare our study cohort with those from previously published studies. METHODS RIVUR investigators from 19 pediatric sites in the United States recruited 607 children with grade I through IV VUR. Children were enrolled after a first or second UTI. This cross-sectional report of baseline data includes extensive clinical, parental report, and imaging study results. RESULTS RIVUR recruited 607 children (558 girls, 49 boys) with grade I (11%), II (42%), III (38%), or IV (8%) reflux. The median age was 12 months, and most children (91%) were enrolled after their first UTI. The UTI leading to enrollment was both febrile and symptomatic for 323 children, febrile only in 197 children, and symptomatic only in 86. Renal involvement at baseline as documented by a (99m)Tc dimercaptosuccinic acid scan was uncommon with cortical defects identified in 89 (15%) children. Bladder and bowel dysfunction was identified in 71 (56%) of 126 toilet-trained subjects assessed. CONCLUSIONS RIVUR is the largest prospective, randomized trial for children with primary VUR to date, comparing prophylaxis with placebo. The study sample comprises patients from 19 pediatric clinical sites in the United States, whose demographic and clinical characteristics may differ from those of children enrolled in previous trials from other countries.
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Affiliation(s)
- Myra A. Carpenter
- Department of Biostatistics, The University of North Carolina, Chapel Hill, North Carolina
| | - Alejandro Hoberman
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tej K. Mattoo
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan
| | - Ranjiv Mathews
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ron Keren
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Russell W. Chesney
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and
| | - Saul P. Greenfield
- Department of Pediatric Urology, Women & Children’s Hospital of Buffalo, Buffalo, New York
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141
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Baek M, Kang MY, Lee HE, Park K, Choi H. Clinical value of persistent but downgraded vesicoureteral reflux after dextranomer/hyaluronic acid injection in children. J Korean Med Sci 2013; 28:1060-4. [PMID: 23853490 PMCID: PMC3708078 DOI: 10.3346/jkms.2013.28.7.1060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/23/2013] [Indexed: 11/20/2022] Open
Abstract
We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 ± 0.39 per year and 0.07 ± 0.32 per year in VUR resolved children (P < 0.001), and 0.76 ± 1.18 per year and 0.20 ± 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
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Affiliation(s)
- Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Young Kang
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hahn-Ey Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwanjin Park
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hwang Choi
- Department of Urology, Armed Forces Capital Hospital, Seongnam, Korea
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142
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Evaluation of functional lower urinary tract dysfunction in children: are the physicians complying with the current guidelines? ScientificWorldJournal 2013; 2013:341606. [PMID: 23737714 PMCID: PMC3655648 DOI: 10.1155/2013/341606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/04/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To elucidate whether the diagnostic and treatment approaches of the physicians for functional lower urinary tract dysfunction (LUTD) in children is complying with the current guidelines. MATERIAL AND METHODS We have conducted an internet-based national survey for the physicians from different departments randomly sampled from the database of Turkish Paediatric Urology Society. Participants were asked to answer two-page questionnaire consisting of 4 main sections: "demography," "working conditions," "daily practice," and "scientific knowledge." Kruskal Wallis and multiple logistic regression were used for statistical analyses. RESULTS Of the 117 departments a total of 93 have completed the survey (n: 58 urology; n: 35 paediatric nephrology). Routine use of a questionnaire with validated symptom scoring system was found to be 13.9%. Of the participants, only 38.7% were asking all of the patients to fill the bladder diary. During treatment, only 24.7% were applying standard urotherapy for every patient. Almost half of the clinicians (45.1%) believed that they were personally insufficient during the evaluation of those children. Finally, 86% reported that children with LUTD were not adequately approached. CONCLUSIONS Evaluation of LUTD in children is not complying with the current guidelines. General approach for those children needs to be revisited by the clinicians.
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143
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Barber T. Is History Enough to Rule Out Significant Constipation? J Urol 2013; 189:1196-7. [DOI: 10.1016/j.juro.2013.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Theodore Barber
- Department of Pediatric Urology, Helen DeVos Children's Hospital, Grand Rapids, Michigan
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144
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Long-term prospective evaluation of an inpatient voiding reeducation program for lower urinary tract conditions in children. Int Urol Nephrol 2013; 45:299-306. [PMID: 23381501 DOI: 10.1007/s11255-012-0348-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Our aim was to evaluate the efficacy of our treatment program for children with lower urinary tract conditions, developed at the Department of Pediatric Nephrology of the University Children's Hospital in Ljubljana. METHODS Sixty-four patients with lower urinary tract conditions were randomly allocated to two groups. Group A received treatment immediately, whereas patients of group B received no treatment for a period of 3 months-the amount of time it takes to complete our program. No child in group B experienced spontaneous regression of their symptoms in the 3-month delay period, while the patients of group A were already being treated and were achieving results. Thus, all the patients of group B then entered the program in exactly the same way as patients of group A. RESULTS The final success rate in both groups did not differ significantly (p = 0.706-1.000) and ranged from 86.2 % for group A and 86.7 to 90 % for group B. Long-term follow-up showed statistically identical success rates (p = 1.000). CONCLUSION This prospective controlled study with long-term follow-up (48 months) shows that our treatment program, applied as an inpatient voiding school program, is an effective method, with durable results.
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145
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Thibodeau BA, Metcalfe P, Koop P, Moore K. Urinary incontinence and quality of life in children. J Pediatr Urol 2013; 9:78-83. [PMID: 22236468 DOI: 10.1016/j.jpurol.2011.12.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 12/07/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Urinary incontinence (UI) negatively affects children's quality of life (QOL). It is not known if parents are reliable informants on impact and QOL nor if lower urinary tract symptoms (LUTS) are related to QOL. We wished to determine the association between LUTS measured by the Dysfunctional Voiding Symptom Score (DVSS) and QOL measured by the Pediatric Urinary Incontinence QOL tool (PIN-Q), and to test the relationship between parent and patient's responses. SUBJECTS AND METHOD Forty children (10 males, 30 females), aged 5-11 years with non-neurogenic daytime wetting, and their parents completed DVSS and PIN-Q as well as responding to open-ended questions about the effect of incontinence. RESULTS Child DVSS: mean 12.6 (3 (very mild) to 21 (severe)); parent DVSS: mean 12.8 (3-20). Child PIN-Q: mean 37.6 (8 (no effect) to 70 (severe effect)); parent PIN-Q: mean 38.7 (15-61). Parents indicated a major effect of UI on family function and dynamics, as well as on the child. CONCLUSIONS UI has a major effect on the child and the family. The PIN-Q and DVSS are complementary and provide a clinically appropriate picture of LUTS and impact on QOL. Parents understood the effect of incontinence and could act as proxy for the child.
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146
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Primary severe hypospadias: comparison of reoperation rates and parental perception of urinary symptoms and cosmetic outcomes among 4 repairs. J Urol 2012; 189:1508-13. [PMID: 23154207 DOI: 10.1016/j.juro.2012.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE We compared complication rates, urinary symptoms and cosmetic outcomes as perceived by parents of patients undergoing 1 of 4 repairs for proximal hypospadias associated with ventral curvature. MATERIALS AND METHODS A total of 93 patients underwent hypospadias repair between 2004 and 2010. In patients requiring no urethral plate transection the repair consisted of tubularized incised plate urethroplasty (26 patients) or onlay island flap urethroplasty (31). In patients requiring urethral plate transection the repair consisted of onlay island flap on albuginea (18 patients) or 2-stage repair (18). Complications were assessed by chart review. A customized questionnaire and the Pediatric Penile Perception Score were administered to parents to evaluate their perception of urinary symptoms and cosmetic outcomes, respectively. RESULTS After a median followup of 4.5 years (range 2.2 to 8.4) complications developed in 21 patients (23%) without any difference among procedures or between patients who did and did not require urethral plate transection. Parents of 75 patients (80%) participated in the survey without differences among repairs (p = 0.35). Reported urinary symptoms were not different among repairs. For Pediatric Penile Perception Score the only difference concerned the question about penile length (p = 0.03), with the score being significantly better for the techniques requiring urethral plate transection (p = 0.05). The 2-stage repair had a significantly better score for the question about penile length and overall Pediatric Penile Perception Score than all other techniques. CONCLUSIONS Overall complication rates were comparable among repairs and did not increase after urethral plate transection. Urinary symptoms as reported by parents were comparable among the procedures. Perceived penile length was significantly better after urethral plate transection. The 2-stage repair yielded the best cosmetic results.
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147
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Drzewiecki BA, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting. J Urol 2012; 188:1578-83. [DOI: 10.1016/j.juro.2012.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Beth A. Drzewiecki
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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148
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Exploratory factory analysis and predicted probabilities of a Chinese version of Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Neurourol Urodyn 2012; 31:1247-51. [DOI: 10.1002/nau.22254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 03/13/2012] [Indexed: 11/07/2022]
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149
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Neuropathic Bladder Caused by Caudal Regression Syndrome without Any Other Neurogenic Symptoms. Case Rep Med 2012; 2012:982418. [PMID: 22761628 PMCID: PMC3384936 DOI: 10.1155/2012/982418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 04/30/2012] [Indexed: 11/17/2022] Open
Abstract
Caudal regression syndrome (CRS) is a rare congenital vertebral anomaly, which occurs most often in combination with spinal cord malformations and morphologic dysfunctions of the lower extremities; these signs are useful for both patients and clinicians in the diagnosis of this syndrome. However, in certain cases, clinicians have failed to identify the syndrome due to the lack of apparent anomalies, resulting in the progression of renal dysfunction caused by neuropathic bladder when CRS is eventually identified. Here, we report a case of a 2-year-old girl who was referred to our hospital for vesicoureteral reflux. At examination, she presented no neurological symptoms; however, on cystourethrography and CT scanning we found that the sacral bone was absent, through which CRS was diagnosed. A urodynamic study indicated detrusor-sphincter dyssynergia, and clean intermittent catheterization was initiated. In the present report, we describe a case of CRS with no neurologic symptoms other than a neuropathic bladder. The lack of outward signs can result in delayed diagnosis. Thus, urological examinations, including a urodynamic study, might be the only clue for identifying an underlying neurologic injury involving the lower spinal cord.
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150
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Relationship among bacterial virulence, bladder dysfunction, vesicoureteral reflux and patterns of urinary tract infection in children. J Urol 2012; 188:236-41. [PMID: 22595065 DOI: 10.1016/j.juro.2012.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE We hypothesized that virulence levels of Escherichia coli isolates causing pediatric urinary tract infections differ according to severity of infection and also among various uropathies known to contribute to pediatric urinary tract infections. We evaluated these relationships using in vitro cytokine interleukin-6 elicitation. MATERIALS AND METHODS E. coli isolates were cultured from children presenting with urinary tract infections. In vitro cytokine (interleukin-6) elicitation was quantified for each isolate and the bacteria were grouped according to type of infection and underlying uropathy (neurogenic bladder, nonneurogenic bowel and bladder dysfunction, primary vesicoureteral reflux, no underlying etiology). RESULTS A total of 40 E. coli isolates were collected from children with a mean age of 61.5 months (range 1 to 204). Mean level of in vitro cytokine elicitation from febrile urinary tract infection producing E. coli was significantly lower than for nonfebrile strains (p = 0.01). The interleukin-6 response to E. coli in the neurogenic bladder group was also significantly higher than in the vesicoureteral reflux (p = 0.01) and no underlying etiology groups (p = 0.02). CONCLUSIONS In vitro interleukin-6 elicitation, an established marker to determine bacterial virulence, correlates inversely with clinical urinary tract infection severity. Less virulent, high cytokine producing E. coli were more likely to cause cystitis and were more commonly found in patients with neurogenic bladder and nonneurogenic bowel and bladder dysfunction, whereas higher virulence isolates were more likely to produce febrile urinary tract infections and to affect children with primary vesicoureteral reflux and no underlying etiology. These findings suggest that bacteria of different virulence levels may be responsible for differences in severity of pediatric urinary tract infections and may vary among different underlying uropathies.
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