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MacNeily AE. The role of uroflowmetry in the diagnosis of lower urinary tract disorders in children. J Urol 2012; 187:1960-1. [PMID: 22503024 DOI: 10.1016/j.juro.2012.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Arlen AM, Boyt MA, Cooper CS. School nurse perceptions and knowledge of pediatric toileting. J Pediatr Urol 2012; 8:205-8. [PMID: 21377426 DOI: 10.1016/j.jpurol.2011.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We surveyed school nurses on toileting conditions in schools, their level of understanding related to normal toileting patterns in school-age children, and whether they are in need of additional resources to promote healthy toilet habits for their students. MATERIALS AND METHODS An Institutional Review Board approved web-based survey with 34 questions was employed; 562 nurses completed the survey and 97% were currently employed as school nurses. Participants were invited via email blasts through national school nursing associations and the Iowa Department of Education. RESULTS Only 48% and 33% of respondents suspected an underlying health problem in children with frequent urination and bladder or bowel accidents, respectively. Despite 61% reporting never receiving information about children's normal elimination patterns, 43% had been asked to provide such information to teachers. Only 42% felt they had adequate resources to respond to such requests. School nurses requested information about treatment of dysfunctional elimination (67%), health effects of childhood toileting habits (65%), fluid intake guidelines (44%) and improvement of bathroom facilities (39%); 70% were unaware of local providers specially trained to treat children with these problems. CONCLUSIONS Our survey results suggest that school nurses need additional information and resources in order to promote healthy elimination patterns in school children.
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Vaz GT, Vasconcelos MM, Oliveira EA, Ferreira AL, Magalhães PG, Silva FM, Lima EM. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol 2012; 27:597-603. [PMID: 21969094 DOI: 10.1007/s00467-011-2028-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 08/26/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6-12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p < 0.001), children aged 6-8 (p < 0.028), and attended the school with the lowest social level (p < 0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.
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Affiliation(s)
- Giovana T Vaz
- Pediatric Nephrology Unit, Hospital das Clinicas, Federal University of Minas Gerais (UFMG), Rua Piauí, 933 apt 502, Belo Horizonte, MG 30150-320, Brazil
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154
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Salvatore S, Serati M, Origoni M, Candiani M. Is overactive bladder in children and adults the same condition?: ICI-RS 2011. Neurourol Urodyn 2012; 31:349-51. [PMID: 22422704 DOI: 10.1002/nau.22223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
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Thom M, Campigotto M, Vemulakonda V, Coplen D, Austin PF. Management of lower urinary tract dysfunction: a stepwise approach. J Pediatr Urol 2012; 8:20-4. [PMID: 21377425 DOI: 10.1016/j.jpurol.2011.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate management patterns of lower urinary tract (LUT) dysfunction and establish a treatment algorithm to guide pediatric healthcare providers. METHODS 390 children with non-neurogenic LUT dysfunction were followed over 7 months; 115 patients were excluded due to incomplete data. Children were categorized based on presenting complaints and pelvic ultrasound into three groups: daytime urinary incontinence (UI) with complete emptying (CE), UI with incomplete emptying (IE), or IE without UI. Every child underwent behavioral modification (BM) including timed voiding, double voiding, deep breathing, and treatment of constipation if present. BM failures received secondary treatment including medications (alpha blockers, anticholinergics), physical therapy, and/or botulinum toxin type A injection of the external sphincter at a dose of 100 units. RESULTS BM improved symptoms in 152 (55%): 68% (46% dry), 49% (27% dry), and 59% (29% dry) from the three groups, respectively. Of the 45% who showed no change in symptoms, 98 (80%) improved with addition of medication, the majority (89) after starting alpha blocker therapy. Children with IE responded better to alpha blockers, 83 (77%) compared to 38% with CE, whereas those with CE demonstrated more symptom resolution with anticholinergics, 6 (38%) compared to 13% of those with IE. Only 6 (2%) patients were refractory to non-operative treatment with all showing improvement after injection of botulinum toxin type A, 4 (67%) of whom became completely dry. CONCLUSION Diagnosis of UI and/or IE with stratification of children into particular symptom groups appears beneficial in determining the appropriate therapy for children with LUT dysfunction.
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Affiliation(s)
- Matthew Thom
- Pediatric Urology, Washington University in St Louis, St. Louis Children's Hospital, 4990 Children's Place, Suite 1120, Box 8242, St. Louis, MO 63110, USA.
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Correlation between symptoms of voiding dysfunction and attention deficit disorder with hyperactivity in children with lower urinary tract symptoms. J Urol 2011; 187:656-61. [PMID: 22177910 DOI: 10.1016/j.juro.2011.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE We clarified correlations between symptoms of attention deficit disorder with hyperactivity and voiding dysfunction in children. MATERIALS AND METHODS The study sample consisted of 92 boys and 38 girls 4 to 14 years old who presented at pediatric urology clinics with untreated lower urinary tract symptoms. Parents completed the Swanson, Nolan and Pelham-IV scale. Each subject with a combined score in the first 2 subscales (inattention, hyperactivity/impulsivity) at or above the 90th percentile was classified as having symptoms of attention deficit disorder with hyperactivity. All other cases were classified as nonattention deficit disorder. Voiding dysfunction symptoms were assessed by the Dysfunctional Voiding Symptom Scale. Sleep quality was assessed by the Pediatric Sleep Questionnaire. We then analyzed correlations between Dysfunctional Voiding Symptom Scale and symptoms of attention deficit disorder with hyperactivity. RESULTS The group with symptoms of attention deficit disorder with hyperactivity had significantly higher scores on the Dysfunctional Voiding Symptom Scale overall and in the "cannot wait" subscale compared to the group without attention deficit disorder, as well as poorer sleep quality and lower voiding volumes. Overall Dysfunctional Voiding Symptom Scale scores were significantly correlated with overall Swanson, Nolan and Pelham-IV scale scores and also significantly correlated with each of the 3 Swanson, Nolan and Pelham-IV subscales (inattention, hyperactivity/impulsivity and oppositional defiant). Overall Dysfunctional Voiding Symptom Scale scores and scores on the "cannot wait" and "hurt when pee" subscales were significantly higher for males than for females. CONCLUSIONS Boys with higher scores of attention deficit disorder with hyperactivity symptoms tend to have higher Dysfunctional Voiding Symptom Scale scores. Lower urinary tract symptoms were significantly correlated with overall Swanson, Nolan and Pelham-IV scores and significantly correlated with each of the 3 subscales. Evaluation of concomitant symptoms of attention deficit disorder with hyperactivity in children with lower urinary tract symptoms is an important clinical concern.
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157
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Chang SJ, Hsieh CH, Yang SSD. Constipation is associated with incomplete bladder emptying in healthy children. Neurourol Urodyn 2011; 31:105-8. [DOI: 10.1002/nau.21225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/05/2011] [Indexed: 01/19/2023]
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158
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High Risk of Sleep Disordered Breathing in the Enuresis Population. J Urol 2011; 186:1710-3. [DOI: 10.1016/j.juro.2011.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 11/21/2022]
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159
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Factors Influencing Quality of Life in Children With Urinary Incontinence. J Urol 2011; 186:1048-52. [DOI: 10.1016/j.juro.2011.04.104] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 11/23/2022]
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Lower Urinary Tract Dysfunction: A Childhood Problem in Adults? CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Calado AA, Araujo EM, Barroso U, Netto JMB, Filho MZ, Macedo A, Bagli D, Farhat W. Cross-cultural adaptation of the dysfunctional voiding score symptom (DVSS) questionnaire for Brazilian children. Int Braz J Urol 2011; 36:458-63. [PMID: 20815952 DOI: 10.1590/s1677-55382010000400009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To translate and culturally adapt the Dysfunctional Voiding Symptom Score (DVSS), questionnaire into Brazilian Portuguese. MATERIALS AND METHODS The 10-item Dysfunctional Voiding Symptom Score (DVSS) was translated into Brazilian Portuguese according to a standard methodology: translation, synthesis, back-translation, Expert Committee, and pre-testing. After the translation process the final version was pre-tested and patient responses were analyzed to identify necessary modifications. Reliability was evaluated using the test-retest method, and internal consistency was assessed using Cronbach's alpha. RESULTS The Cronbach's alpha coefficient was calculated in the test and retest phases. Internal consistency was found to be satisfactory, as confirmed by a Cronbach's alpha coefficient of 0.76 for the test and 0.77 for the retest. A high degree of stability was found in the test/retest, with an intraclass correlation coefficient (ICC) of 0.960 (p < 0.001; 95% CI: 0.943-0.972). CONCLUSIONS The cross-cultural adaptation process of the Dysfunctional Voiding Symptom Score questionnaire to be used on Brazilian children was successfully completed following internationally accepted methodologies.
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Affiliation(s)
- Adriano A Calado
- Division of Pediatric Urology, Pernambuco State University, Recife, Pernambuco, Brazil.
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162
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Abstract
Constipation remains a frequent presentation to paediatricians, with significant health resource implications. We present a practical guide to the management of paediatric constipation and evaluate the current evidence for treatment regimens, to help the clinician in treating a condition that can be distressing and has a significant impact on affected families.
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Affiliation(s)
- Nadeem A Afzal
- Paediatric Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Rd, Southampton, Hants, SO16 6YD, England.
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163
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Schneider D, Yamamoto A, Barone JG. Evaluation of consistency between physician clinical impression and 3 validated survey instruments for measuring lower urinary tract symptoms in children. J Urol 2011; 186:261-5. [PMID: 21600599 DOI: 10.1016/j.juro.2011.03.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Since many children with lower urinary tract symptoms are treated based on history and physical, it is important to know which symptom survey correlates best with the physician clinical impression. We evaluated 3 tools that have been demonstrated to predict severity of lower urinary tract symptoms, the Dysfunctional Voiding Symptom Score, the Akbal survey and the Nelson survey. Total scores from each survey were compared to clinical impression. MATERIALS AND METHODS Participants consisted of 36 males and 35 females referred to our pediatric urology center for lower urinary tract symptoms. A total of 37 children 4 to 10 years old completed the Dysfunctional Voiding Symptom Score with the help of their parents, and 34 of these parents completed the Akbal survey. A total of 35 children 11 to 17 years old completed the Nelson survey. Scores from the 3 instruments were compared to the clinical impression of a pediatric urologist using rank correlation (Kendall's tau-b test). RESULTS Mean total symptom scores were increased relative to physician rating for all 3 surveys. Symptoms reported by younger children using the Dysfunctional Voiding Symptom Score correlated better with physician rating of symptom severity (tau-b 0.43) compared to symptoms reported by parents using the Akbal survey (tau-b 0.41). Older children reporting symptoms using the Nelson survey had the strongest correlation with physician clinical impression (tau-b 0.48). CONCLUSIONS All 3 surveys were statistically significantly correlated with the physician impression of severity for lower urinary tract symptoms, with the Nelson survey being the most accurate.
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Affiliation(s)
- Dona Schneider
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University (DS), New Jersey, USA
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164
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Hooman N, Hallaji F, Mostafavi SH, Mohsenifar S, Otukesh H, Moradi-Lakeh M. Correlation between Lower Urinary Tract Scoring System, Behavior Check List, and Bladder Sonography in Children with Lower Urinary Tract Symptoms. Korean J Urol 2011; 52:210-5. [PMID: 21461287 PMCID: PMC3065135 DOI: 10.4111/kju.2011.52.3.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/10/2011] [Indexed: 11/24/2022] Open
Abstract
Purpose The Pediatric Lower Urinary Tract Scoring System (PLUTSS) is a standardized questionnaire used for screening and evaluation of the response of children with lower urinary tract symptoms (LUTS) to therapy. We presumed that adding the Child Behavior Check List (CBCL) and bladder volume wall index (BVWI) to the PLUTSS would increase its validity in the detection of children with LUTS. Materials and Methods One hundred twenty-two children aged 5 to 15 years with LUTS were enrolled in the study. Seventy-two healthy, age-matched children without urinary complaints were considered as controls. The PLUTSS and CBCL were filled out for all children. Sonography was performed to measure BVWI. Chi-square test and likelihood ratio were used to compare frequencies, receiver operating curve (ROC) analysis was used to evaluate the correlation, and Cohen's kappa was used to measure the agreement between variables. p-values <0.05 were considered significant. Results Behavior problems were significantly more common in children with LUTS than in healthy children (p<0.05). The frequency of thick, thin, and normal BVWIs did not differ significantly in the two groups (p>0.05). ROC analysis showed that there was no correlation between PLUTSS, CBCL, and BVWI in either the LUTS subgroup or in the controls (p>0.05). The PLUTSS had the highest sensitivity and specificity, and adding the two other tests decreased its validity for the diagnosis of children with LUTS. Conclusions The PLUTSS by itself was the best predictor of LUTS. The CBCL and BVWI were not helpful in making a diagnosis; however, the CBCL was useful in the detection of behavior problems in children with non-monosymptomatic enuresis.
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Affiliation(s)
- Nakysa Hooman
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
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165
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Yang SSD, Zhao LL, Chang SJ. Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurourol Urodyn 2011; 30:1253-7. [PMID: 21394761 DOI: 10.1002/nau.20982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/11/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners. PATIENTS AND METHODS In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations. RESULTS Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU. CONCLUSION Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction.
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Affiliation(s)
- Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan
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166
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Childhood dysfunctional voiding is differentially associated with urinary incontinence subtypes in women. World J Urol 2011; 30:111-5. [DOI: 10.1007/s00345-011-0665-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/21/2011] [Indexed: 01/23/2023] Open
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Castagnetti M, Zhapa E, Berrettini A, Ghirardo G, Murer L, Zanon GF, Rigamonti W. Lower urinary tract symptoms (LUTS) after renal transplant in non-urologic anuric patients. Pediatr Transplant 2010; 14:859-62. [PMID: 20825573 DOI: 10.1111/j.1399-3046.2010.01390.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We assessed LUTS at least 12 months after RTx in patients without evidence of lower urinary tract dysfunction (non-urologic) that had been anuric for at least six months before RTx. No bladder recycling was performed before RTx. LUTS were evaluated using a questionnaire. Clinical records were also reviewed. LUTS in anuric patients were compared with those in non-anuric patients. Fourteen anuric patients fulfilled the inclusion criteria. Median age at RTx was 11 (5-21) yr, median duration of anuria before RTx 24 (7-46) months, and median post-RTx follow-up 2.7 (1.9-10.2) yr. Daytime symptoms were exceptional. Nocturia was the most common symptom (10 patients). Only one patient reported symptoms to affect her quality of life. One patient experienced a febrile UTI and none graft failure. LUTS (nocturia) proved unrelated to duration of anuria, length of follow-up, and presence of (nocturnal) polyuria. LUTS were not statistically different in patients anuric and non-anuric before RTx. Non-urologic patients suffer from long-term storage symptoms, particularly nocturia. LUTS, however, do not seem to increase the risks of urinary infections or graft failure and appear to occur irrespective of the presence of anuria before RTx. Bladder recycling before RTx seems unnecessary.
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Affiliation(s)
- Marco Castagnetti
- Section of Paediatric Urology, Urology Unit, Department of Oncological and Surgical Sciences, University Hospital of Padova, Padua, Italy.
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170
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Lordêlo P, Benevides I, Kerner EG, Teles A, Lordêlo M, Barroso U. Treatment of non-monosymptomatic nocturnal enuresis by transcutaneous parasacral electrical nerve stimulation. J Pediatr Urol 2010; 6:486-9. [PMID: 20837326 DOI: 10.1016/j.jpurol.2009.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 11/17/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of transcutaneous parasacral electrical stimulation (TCPSE) in the treatment of non-monosymptomatic nocturnal enuresis (NMNE). Also, we evaluated possible pretreatment predictors of TCPSE failure. MATERIALS AND METHODS Nineteen children diagnosed with NMNE who underwent TCPSE were studied prospectively. There were 6 boys and 13 girls with a mean age of 9.05 ± 3.153 years (range 5-17 years). The sessions were performed three times per week for a maximum of 20 sessions, for 20 min each and at a frequency of 10 Hz. RESULTS For eight children (42%) the nocturnal enuresis resolved, four (21%) presented a reduction in nocturnal episodes to less than one a week, six (32%) presented no change and one (5%) had increased frequency of NMNE. Symptoms present before treatment, such as daytime incontinence, frequency, constipation and occurrence of urinary tract infection, were not predictors of failure after TCPSE. CONCLUSION TCPSE can be an effective treatment for NMNE, but about a third of patients will need another kind of treatment. No pretreatment factor was determined that predicted TCPSE failure.
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Affiliation(s)
- Patrícia Lordêlo
- Department of Urology and Physical Therapy, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
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171
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De Gennaro M, Niero M, Capitanucci ML, von Gontard A, Woodward M, Tubaro A, Abrams P. Validity of the International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms: A Screening Questionnaire for Children. J Urol 2010; 184:1662-7. [DOI: 10.1016/j.juro.2010.03.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Mario De Gennaro
- Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Mauro Niero
- Department of Methodology, University of Verona, Verona, Italy
| | - Maria Luisa Capitanucci
- Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alexander von Gontard
- Department of Pediatric Neuropsychiatry, Saarland University Hospital, Homburg, Germany
| | - Mark Woodward
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol, United Kingdom
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | - Paul Abrams
- Department of Urology, Southmead Hospital, Bristol, United Kingdom
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5-Year Prospective Results of Dimercapto-Succinic Acid Imaging in Children With Febrile Urinary Tract Infection: Proof That the Top-Down Approach Works. J Urol 2010; 184:1703-9. [DOI: 10.1016/j.juro.2010.04.050] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 11/21/2022]
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Silva JAF, Gonsalves MDCD, Saverio AP, Oliveira IC, Carrerette FB, Damião R. Lower Urinary Tract Dysfunction and Ultrasound Assessment of Bladder Wall Thickness in Children With Cerebral Palsy. Urology 2010; 76:942-5. [DOI: 10.1016/j.urology.2010.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 04/06/2010] [Accepted: 04/06/2010] [Indexed: 11/28/2022]
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Lordêlo P, Teles A, Veiga ML, Correia LC, Barroso U. Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial. J Urol 2010; 184:683-9. [PMID: 20561643 DOI: 10.1016/j.juro.2010.03.053] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children. We designed a prospective randomized trial with sham control for this evaluation. MATERIALS AND METHODS We prospectively randomized 25 girls and 12 boys with an average age of 7.6 years (range 4 to 12) into the test (active treatment) or sham (superficial scapular electrical stimulation) group. A total of 20 sessions, 20 minutes each (10 Hz) were performed 3 times weekly. The criteria used to evaluate the rate of success were 1) self-reported cure, or significant, mild or no improvement; 2) visual analogue scale (level of success 0 to 10); 3) percent improvement; 4) modified Toronto score; and 5) maximum voided volume, average voided volume and number of voids daily based on bladder diary entries. After completion of the 20 sessions controls who were not cured underwent active treatment. RESULTS A total of 21 patients in the test group and 16 in the sham group underwent treatment. Among the active treatment group 61.9% of parents reported cure. In the sham group no parent reported cure (p <0.001). Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group, while 1 parent in the sham group indicated a score of 9 (p = 0.002). Additionally 100% improvement was reported by 12 parents in the test group and no parent in the sham group. Toronto score improved significantly in the test group (p <0.001) and sham group (p = 0.008). However, the score was reduced more significantly in the test group compared to the sham group (p = 0.011). In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased. After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured. CONCLUSIONS This is the first known randomized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder.
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Affiliation(s)
- Patrícia Lordêlo
- Department of Urology and Physical Therapy, Section of Pediatric Urology, Bahiana School of Medicine, Salvador, Bahia, Brazil
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175
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Abstract
Lower urinary tract syndrome is common in children. Incontinence, urinary tract infection, vesicoureteral reflux, and constipation are commonly associated with this syndrome. Examining the clinical history of the afflicted patient plays a major role in the accurate diagnosis and treatment of lower urinary tract disorder. Along with pharmacologic treatment, pelvic floor muscle retraining, biofeedback therapy, and adaptation of a healthy lifestyle are advocated for rapid recovery of patients.
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177
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Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, Kim HG, Moon DG, Park KH, Park YH, Pai KS, Suh HJ, Lee JW, Cho WY, Ha TS, Han SW. An Epidemiologic Study of Voiding and Bowel Habits in Korean Children: A Nationwide Multicenter Study. Urology 2010; 76:215-9. [PMID: 20163840 DOI: 10.1016/j.urology.2009.12.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/08/2009] [Accepted: 12/15/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
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178
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Brandström P, Esbjörner E, Herthelius M, Holmdahl G, Läckgren G, Nevéus T, Sillén U, Sixt R, Sjöberg I, Stokland E, Jodal U, Hansson S. The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol 2010; 184:274-9. [PMID: 20478580 DOI: 10.1016/j.juro.2010.01.055] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. MATERIALS AND METHODS Children 1 to younger than 2 years with grade III-IV reflux were recruited into this prospective, open, randomized, controlled, multicenter study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercapto-succinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. RESULTS During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. CONCLUSIONS Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.
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Affiliation(s)
- Per Brandström
- Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden
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179
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Kaye JD, Palmer LS. Characterization and management of voiding dysfunction in children with attention deficit hyperactivity disorder. Urology 2010; 76:220-4. [PMID: 20350758 DOI: 10.1016/j.urology.2010.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 12/24/2009] [Accepted: 01/18/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate whether voiding dysfunction (VD) in children with attention deficit hyperactivity disorder (ADHD) could be treated successfully using individualized therapy. We also sought to describe the spectrum of voiding symptoms experienced by children with ADHD. ADHD is diagnosed in 3-5% of children. These children have a greater incidence of VD than non-ADHD controls, and it is less amenable to treatment. METHODS A comprehensive history assessed the nature of the voiding disorder. A physical examination, screening urologic ultrasonography, and urinalysis were routinely performed, with electromyography combined with uroflowmetry performed for certain cases. Treatment was individualized to include behavioral modification, bowel and diet management, biofeedback, pharmacotherapy, and close follow-up. RESULTS A total of 75 children with ADHD were referred because of VD. The 75 children (39 boys and 36 girls) were 5-16 years old. Of the 75 children, 60 were taking medication for ADHD. All the children had daytime wetting (>1/d, 5-7 d/wk) and urgency. In addition, 88% had frequency and 87% had sleep enuresis. Of the 75 families, 56 proceeded with our prescribed program. Of the 56 children, 47 (83.9%) had complete resolution or improvement of the daytime symptoms. Of the 17 patients (30.4%) with complete resolution, 9 responded to behavior modification and anticholinergics and 8 needed biofeedback. Of the 30 patients with a partial response (53.6%), 9 responded to behavior modification alone, 15 to behavior modification and anticholinergics, and 6 required all 3 modalities. Of the 56 children, 9 failed to respond to any of the 3 modalities. CONCLUSIONS Diurnal symptoms constituted the most common referred complaint in children with ADHD. VD can be successfully treated if the treatment is individualized. Multimodal treatment, including behavior modification combined with anticholinergic agents and/or biofeedback, appears to be effective in managing VD in most of these challenging cases.
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Affiliation(s)
- Jonathan D Kaye
- Division of Urology, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, Long Island, New York 11042, USA
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180
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Chase J, Austin P, Hoebeke P, McKenna P. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children's Continence Society. J Urol 2010; 183:1296-302. [PMID: 20171678 DOI: 10.1016/j.juro.2009.12.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE We present a consensus view of members of the International Children's Continence Society on the management of dysfunctional voiding in children. MATERIALS AND METHODS Discussions were held by the board of the International Children's Continence Society and a multi-disciplinary core group of authors was appointed. The draft document review process was open to all International Children's Continence Society members via the web site. Feedback was considered by the core authors and, by agreement, amendments were made as necessary. RESULTS Guidelines on the assessment, and nonpharmacological and pharmacological management of dysfunctional voiding are presented. CONCLUSIONS The final document is not a systematic literature review. It includes relevant research when available as well as expert opinion on the current understanding of dysfunctional voiding in children.
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Affiliation(s)
- Janet Chase
- Monash Medical Centre Paediatric Continence Clinic, Melbourne, Australia
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181
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Hoebeke P, Bower W, Combs A, De Jong T, Yang S. Diagnostic Evaluation of Children With Daytime Incontinence. J Urol 2010; 183:699-703. [DOI: 10.1016/j.juro.2009.10.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Indexed: 01/19/2023]
Affiliation(s)
- P. Hoebeke
- Department of Pediatric Urology, Ghent University Hospital, Ghent, Belgium
| | - W. Bower
- Department of Surgery, Chinese University Hong Kong, Hong Kong, China
| | - A. Combs
- Department of Pediatric Urology, Columbia University, New York, New York
| | - T. De Jong
- Pediatric Renal Centre WKZ, University Children's Hospital, Utrecht, The Netherlands
| | - S. Yang
- Division of Urology, Buddhist Tzu Chi University, Taipei, Taiwan
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182
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Rivers CL. School Nurse Interventions in Managing Functional Urinary Incontinence in School-Age Children. J Sch Nurs 2010; 26:115-20. [DOI: 10.1177/1059840509356776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Uncomplicated urinary incontinence (UI) in school-age children is a prevalent yet underrecognized problem that has remained in the shadow of other concerns commonly perceived as more prominent or urgent. There is good evidence that functional UI in children can be treated and managed effectively. When there is no structural or neurologic abnormality and the underlying cause of the UI is related to either the storage or voiding phase of the bladder cycle then it is considered functional. School nurses are in an ideal position to identify, manage, and help children with functional UI cope effectively while maintaining healthy psychosocial well-being and educational success.
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183
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184
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Predicting success in the endoscopic management of pediatric vesicoureteral reflux. Urology 2009; 76:195-8. [PMID: 19931896 DOI: 10.1016/j.urology.2009.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 09/02/2009] [Accepted: 09/05/2009] [Indexed: 11/22/2022]
Abstract
Vesicoureteral reflux is a common cause of pediatric morbidity. Though traditionally managed using a limited number of therapeutic modalities, the last decade has witnessed countless surgical innovations for treating reflux. A major force behind this innovation is the increasing use of endoscopic injection, which currently constitutes nearly half of all anti-reflux procedures performed in the United States. However, published success rates for injection vary dramatically. Despite a relative lack of comparative data, multiple studies have attempted to define the most important prognostic factors for injection success. This article is an attempt to summarize these findings.
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185
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Intractable voiding dysfunction in children with normal spinal imaging: predictors of failed conservative management. Urology 2009; 75:161-5. [PMID: 19854476 DOI: 10.1016/j.urology.2009.06.100] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/31/2009] [Accepted: 06/13/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To identify the factors that might predict which individuals ultimately fail to resolve voiding symptoms by analyzing their presenting symptoms and video-urodynamic findings. Older children with intractable voiding dysfunction and no evidence of neurologic abnormality, who are recalcitrant to medical treatment, pose a management challenge. METHODS The charts of neurologically normal children with intractable voiding dysfunction, who had fluorourodynamic studies and normal lumbosacral magnetic resonance imaging, were reviewed. A database was created that included the urodynamics, presenting urinary symptoms, presence of soiling or constipation, age at onset of symptoms, cystogram and bladder ultrasound findings, and treatments given. Long-term follow-up was determined from chart review (all patients) or by a mailed survey (15 patients). Patients without symptoms and off medication were defined as normal. RESULTS A total of 50 children met the criteria mentioned earlier in the text, presented at a mean age of 9.4 years (range, 3.8-17.3) and were followed up for a mean of 4 years (range, 1-11) from their initial urodynamic evaluation. Of them, 33 (66%) remained symptomatic and 1 (34%) normalized. A total of 31 were found to have uninhibited bladder contractions (UBCs) with daytime wetting, of which 24 (77.4%) failed to normalize (P = .037). All 9 with UBCs and detrusor-sphincter dyssynergia remained symptomatic (P = .02). CONCLUSIONS The majority failed to resolve their voiding symptoms. Children who presented with daytime wetting, UBC, and detrusor-sphincter dyssynergia were the most likely to remain symptomatic. Patients with these characteristics might be considered for more aggressive alternative therapies, after a period of medical management.
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186
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Development of a Symptom Score for Dysfunctional Elimination Syndrome. J Urol 2009; 182:1939-43. [DOI: 10.1016/j.juro.2009.03.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Indexed: 11/21/2022]
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187
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Butrick CW. Pelvic Floor Hypertonic Disorders: Identification and Management. Obstet Gynecol Clin North Am 2009; 36:707-22. [DOI: 10.1016/j.ogc.2009.08.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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188
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Chertin B, Natsheh A, Fridmans A, Shenfeld OZ, Farkas A. Renal scarring and urinary tract infection after successful endoscopic correction of vesicoureteral reflux. J Urol 2009; 182:1703-6. [PMID: 19692032 DOI: 10.1016/j.juro.2009.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE We evaluated renal function and the incidence of urinary tract infection after successful endoscopic correction of vesicoureteral reflux. MATERIALS AND METHODS From 1988 to 2007, 169 male and 338 female patients (696 refluxing renal units) with a median age of 3.7 years underwent successful endoscopic correction of primary vesicoureteral reflux using polytetrafluoroethylene and dextranomer/hyaluronic acid copolymer. Reflux was grades I to V in 36 (5.2%), 178 (25.6%), 298 (42.7%), 163 (23.4%) and 21 refluxing renal units (3.1%), respectively. Renal ultrasound and (99m)technetium-dimercaptosuccinic acid scan were performed in all patients preoperatively, and in all patients and in 509 of 696 refluxing renal units (73%) postoperatively, respectively. All patients were followed 1 to 20 years (median 13). RESULTS Preoperatively (99m)technetium-dimercaptosuccinic acid scan revealed scarring in 543 of 696 refluxing renal units (78%). Reflux resolved after 1 injection in 473 refluxing renal units (68%), in 161 (23%) after 2 and in 25 ureters (3.6%) after 3. In 37 refluxing renal units (5.4%) reflux improved to grade I, which required no further treatment. Renal deterioration was noted in 11 of 26 refluxing renal units with initially severe renal scarring (less than 20% uptake on (99m)technetium-dimercaptosuccinic acid scan). The remaining refluxing renal units in this group showed an insignificant 2.3% change in relative function after successful reflux correction (p >0.005). Patients with vesicoureteral reflux downgrading did not show new renal scars. Of the remaining 446 refluxing renal units 27 (6.1%) showed a greater than 5% decrease in relative function without new scarring. Eight children in the polytetrafluoroethylene group and 3 in the dextranomer/hyaluronic acid copolymer group (overall 2.2%) had febrile urinary tract infection after successful endoscopic correction, leading to reevaluation that resulted in the diagnosis of recurrent reflux in 8 (72.7%). A total of 28 children (5.6%) had afebrile urinary tract infection without recurrent vesicoureteral reflux. CONCLUSIONS Our data show that successful endoscopic correction of vesicoureteral reflux is accompanied by a low incidence of new renal scarring and febrile urinary tract infection. Patients who initially have corrected reflux but who have a febrile urinary tract infection at long-term followup require prompt revaluation to rule out recurrent reflux.
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Affiliation(s)
- Boris Chertin
- Division of Pediatric Urology, Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel.
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189
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Rizzini M, Donatti TL, Bergamaschi DP, Brunken GS. Equivalência conceitual, de itens e semântica da versão brasileira do instrumento Dysfunctional Voiding Scoring System (DVSS) para avaliação de disfunção do trato urinário inferior em crianças. CAD SAUDE PUBLICA 2009; 25:1743-55. [DOI: 10.1590/s0102-311x2009000800010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 04/06/2009] [Indexed: 11/22/2022] Open
Abstract
Investiga-se a equivalência conceitual, de itens e semântica entre o instrumento Dysfunctional Voiding Scoring System (DVSS), utilizado para avaliar a disfunção funcional do trato urinário inferior em crianças, concebido em inglês e uma versão em português. Na primeira etapa realizou-se a avaliação da equivalência conceitual e de itens, seguida de duas traduções do instrumento original para o português. Na segunda etapa foram realizadas 63 entrevistas, com crianças de 3 a 10 anos e responsáveis, e modificação de itens segundo dificuldades de interpretação. Na terceira etapa foi realizada a retradução do instrumento em português para o inglês e avaliação da equivalência semântica. Na quarta etapa, a versão pré-teste foi aplicada em vinte duplas de crianças de 3 a 10 anos e responsáveis. Apresenta-se o instrumento em português com equivalência conceitual, de itens e semântica. Sugere-se que a aplicação do DVSS seja realizada por meio de entrevista por profissional treinado e não baseada em autopreenchimento como proposto no instrumento original.
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190
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Ritchey M, Ferrer F, Shearer P, Spunt SL. Late effects on the urinary bladder in patients treated for cancer in childhood: a report from the Children's Oncology Group. Pediatr Blood Cancer 2009; 52:439-46. [PMID: 18985721 PMCID: PMC2917580 DOI: 10.1002/pbc.21826] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Childhood cancer survivors who have had pelvic or central nervous system surgery or have received alkylator-containing chemotherapy or pelvic radiotherapy as part of their cancer therapy may experience urinary bladder late effects. This article reviews the medical literature on long-term bladder complications in survivors of childhood cancer and outlines the Children's Oncology Group Long-Term Follow-up (COG LTFU) Guidelines related to bladder function. An overview of the treatment of bladder late effects and recommended counseling for survivors with these complications are presented.
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Affiliation(s)
| | | | - Patricia Shearer
- Cancer Survivor Program University of Florida Shands Cancer Center Gainesville, FL
| | - Sheri L. Spunt
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics University of Tennessee, Memphis, TN
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191
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Kistner M. Dysfunctional elimination behaviors and associated complications in school-age children. J Sch Nurs 2009; 25:108-16. [PMID: 19233931 DOI: 10.1177/1059840509331442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lack of privacy, risk of bullying, limited access, lack of essential products for good hygiene, and dirty bathrooms can all contribute to encouraging a child to withhold urine and stool while in school. Withholding behaviors over time can create a condition known as dysfunctional elimination syndrome (DES). DES is any pattern of voiding or stooling that varies from the developmental norm. These abnormal patterns of elimination can eventually lead to complications of urinary tract infection, vesicoureteral reflux, and incontinence of urine and/or stool. School officials (teachers, school nurses, and school administrators) can help in the prevention of learned behaviors that lead to DES in school-age children. School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule. In addition, school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate. School nurses can be a powerful force in protecting children's health by participating in research and developing evidence-based guidelines to improve bathroom access and conditions.
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Affiliation(s)
- Mary Kistner
- General Surgery Department at Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, Texas, USA
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192
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Chesney RW, Carpenter MA, Moxey-Mims M, Nyberg L, Greenfield SP, Hoberman A, Keren R, Matthews R, Matoo TK. Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR): background commentary of RIVUR investigators. Pediatrics 2008; 122 Suppl 5:S233-9. [PMID: 19018047 PMCID: PMC4336951 DOI: 10.1542/peds.2008-1285c] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Because of the frequency of urinary tract infections in children, off-label use of antimicrobial prophylaxis is often the usual treatment of children with vesicoureteral reflux, and such use is increasingly being called into question; hence, a definitive study to determine the value of antimicrobial prophylaxis with regard to the recurrence of urinary tract infection and the incidence of renal scarring is essential. The currently recommended follow-up procedures (repeated urine cultures, renal and genitourinary imaging, antimicrobial therapy and prophylaxis, as well as other factors including cleanliness, adequate bladder and bowel emptying, and compliance with protocols) are expensive (in terms of time, attention to detail, and cost) and cumbersome. Such recommendations should be evidence-based.
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Affiliation(s)
- Russell W. Chesney
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Myra A. Carpenter
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Leroy Nyberg
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Alejandro Hoberman
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ron Keren
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ron Matthews
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Tej K. Matoo
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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193
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Keren R, Carpenter MA, Hoberman A, Shaikh N, Matoo TK, Chesney RW, Matthews R, Gerson AC, Greenfield SP, Fivush B, McLurie GA, Rushton HG, Canning D, Nelson CP, Greenbaum L, Bukowski T, Primack W, Sutherland R, Hosking J, Stewart D, Elder J, Moxey-Mims M, Nyberg L. Rationale and design issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study. Pediatrics 2008; 122 Suppl 5:S240-50. [PMID: 19018048 PMCID: PMC2842127 DOI: 10.1542/peds.2008-1285d] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal is to determine if antimicrobial prophylaxis with trimethoprim/sulfamethoxazole prevents recurrent urinary tract infections and renal scarring in children who are found to have vesicoureteral reflux after a first or second urinary tract infection. DESIGN, PARTICIPANTS, AND METHODS The Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study is a double-blind, randomized, placebo-controlled trial. Six hundred children aged 2 to 72 months will be recruited from both primary and subspecialty care settings at clinical trial centers throughout North America. Children who are found to have grades I to IV vesicoureteral reflux after the index febrile or symptomatic urinary tract infection will be randomly assigned to receive daily doses of either trimethoprim/sulfamethoxazole or placebo for 2 years. Scheduled follow-up contacts include in-person study visits every 6 months and telephone interviews every 2 months. Biospecimens (urine and blood) and genetic specimens (blood) will be collected for future studies of the genetic and biochemical determinants of vesicoureteral reflux, recurrent urinary tract infection, renal insufficiency, and renal scarring. RESULTS The primary outcome is recurrence of urinary tract infection. Secondary outcomes include time to recurrent urinary tract infection, renal scarring (assessed by dimercaptosuccinic acid scan), treatment failure, renal function, resource utilization, and development of antimicrobial resistance in stool flora. CONCLUSIONS The RIVUR study will provide useful information to clinicians about the risks and benefits of prophylactic antibiotics for children who are diagnosed with vesicoureteral reflux after a first or second urinary tract infection. The data and specimens collected over the course of the study will allow researchers to better understand the pathophysiology of recurrent urinary tract infection and its sequelae.
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Affiliation(s)
- Ron Keren
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Myra A. Carpenter
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Alejandro Hoberman
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nader Shaikh
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tej K. Matoo
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Russell W. Chesney
- Department of Pediatrics, Le Bonheur Children's Medical Center, Memphis, Tennessee
| | - Ranjiv Matthews
- Department of Urology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arlene C. Gerson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Saul P. Greenfield
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Barbara Fivush
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gordon A. McLurie
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - H. Gil Rushton
- Department of Urology, Children's National Medical Center, Washington, DC
| | - Douglas Canning
- Department of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Caleb P. Nelson
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Lawrence Greenbaum
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy Bukowski
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - William Primack
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Richard Sutherland
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - James Hosking
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Dawn Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Jack Elder
- Department of Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive Kidney Disease, National Institutes of Health, Bethesda, Maryland
| | - Leroy Nyberg
- National Institute of Diabetes and Digestive Kidney Disease, National Institutes of Health, Bethesda, Maryland
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194
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Chertin B, Natsheh A, Fadeev D, Shenfeld OZ, Farkas A. Unilateral Vesicoureteral Reflux and History of Contralateral Vesicoureteral Reflux Warranting Routine Bilateral Endoscopic Correction. J Urol 2008; 180:1601-3; discussion 1604. [DOI: 10.1016/j.juro.2008.03.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alaeddin Natsheh
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dmitry Fadeev
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ofer Z. Shenfeld
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amicur Farkas
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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195
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Won Kwak K, Park KH. Clinical Inconsistency of Lower Urinary Tract Symptoms Between Questionnaire and Bladder Diary in Children With Nocturnal Enuresis. J Urol 2008; 180:1085-9; discussion 1089-90. [PMID: 18639291 DOI: 10.1016/j.juro.2008.05.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Indexed: 10/21/2022]
Affiliation(s)
- Kyung Won Kwak
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Hyun Park
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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196
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Interactions of constipation, dysfunctional elimination syndrome, and vesicoureteral reflux. Adv Urol 2008:828275. [PMID: 18604297 PMCID: PMC2441926 DOI: 10.1155/2008/828275] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 04/16/2008] [Indexed: 11/17/2022] Open
Abstract
Vesicoureteral reflux (VUR) is simply described as incompetence of the unidirectional valve at the ureterovesical junction (UVJ), leading to backflow of urine to the kidney. Today, it is clear that VUR is not only related to the UVJ function but also to a combination of processes including immunity, bladder and pelvic floor function, dysfunctional voiding, and constipation. Although our surgical aims directed towards improving the valve coaptation at the UVJ, we understand today the importance of the diagnosis and treatment of constipation and dysfunctional voiding adjunctively.
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Non-invasive evaluation of voiding function in asymptomatic primary school children. Pediatr Nephrol 2008; 23:1115-22. [PMID: 18335255 DOI: 10.1007/s00467-008-0776-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 01/04/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
This study aimed to evaluate the voiding characteristics of primary school children by using questionnaires and non-invasive diagnostic tools. The voiding characteristics of 212 healthy children in two primary schools were evaluated with ultrasound for bladder wall thickness (BWT) in association with the Pediatric Lower Urinary Tract Symptom Score (PLUTSS), familial questionnaire, uroflowmetry (UF) and urinalysis. Most of the children (70%) had achieved urinary and fecal continence between the ages of 18 months and 36 months. Twenty-five per cent of healthy children void fewer than four times or more than seven times per day. Ninety percent of children had a PLUTSS within normal ranges (< 9). Fifteen percent of patients had a uroflowmetric pattern other than bell-shaped. The peak and average flow rates were higher in girls. Enuresis nocturna was detected in 10% of children. None of the children had documented urinary tract infection. The average BWT from posterior wall at full bladder in healthy children was 1.1 mm. The anterior and posterior BWT measurements before and after micturition were found to be thicker in boys. Regarding the UF pattern, in post-voiding measurements in children with abnormal UF pattern, the bladder walls were thicker. Non-invasive tests in non-symptomatic children showed a range of variability, and these deviations should be kept in mind during the evaluation of voiding characteristics of a child. The symptom scoring system, with the high sensitivity and specificity rates it possesses, is one of the promising tools for this purpose.
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Therapy for vesicoureteral reflux: Antibiotic prophylaxis, urotherapy, open surgery, endoscopic injection, or observation? Curr Urol Rep 2008; 9:143-50. [DOI: 10.1007/s11934-008-0026-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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199
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Pharmacotherapy in the management of voiding and storage disorders, including enuresis and encopresis. J Am Acad Child Adolesc Psychiatry 2008; 47:491-498. [PMID: 18438186 DOI: 10.1097/chi.0b013e31816774c5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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200
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Quantifying demographic, urological and behavioral characteristics of children with lower urinary tract symptoms. J Pediatr Urol 2008; 4:127-33. [PMID: 18631908 DOI: 10.1016/j.jpurol.2007.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/22/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This project examines the voiding and behavioral characteristics of children referred to a specialty voiding clinic, including the impact of incontinence on the child and family. PATIENTS AND METHODS A total of 351 new patients (aged 5-17 years) referred to our specialty voiding clinic completed background information, including demographics and medical history, a standardized voiding questionnaire, school history, and questions about child and family quality of life, prior to their first appointment. RESULTS Patients are primarily female (53%) and Caucasian (70%) with a mean age of 9.5 years (range 5-17; SD=3.5). Of the patients, 25% were diagnosed with a mental or behavioral health problem. Mean urological symptom score was 12 (range 0-29). Higher symptom scores are associated with younger age, ethnic minority status, a mental health diagnosis, being on psychotropic medications, and a poor child and family quality of life. Families of children who are wet day and night reported a poorer quality of life as compared to the families of children who were daytime wetters or bedwetters only. CONCLUSION Symptom scores are associated with type of incontinence, social and quality of life variables. Collecting this baseline data will enable ongoing monitoring of progress for these complex patients.
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