1
|
Cai T, Yao Y, Sun W, Lei P. Desmopressin in combination with anticholinergic agents in the treatment of nocturnal enuresis: a systematic review and meta-analysis. Front Pediatr 2023; 11:1242777. [PMID: 37928358 PMCID: PMC10620680 DOI: 10.3389/fped.2023.1242777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Background The desmopressin combined with anticholinergic agents for the treatment of nocturnal enuresis (NE) remains controversial. This meta-analysis assesses the efficacy and safety of desmopressin compared with desmopressin plus anticholinergic agents for the treatment of NE. Methods We searched MEDLINE, Embase, and Cochrane Controlled Trials Register databases for RCTs published for the treatment of NE. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. This meta-analysis used RevMan v.5.1.0 to analyze data. Results Eight studies involving 600 patients (293 in the combination group and 307 in the desmopressin group) contained meaningful data. The results were as follows: after one month of treatment, compared with the desmopressin monotherapy group, the combination group was significantly better in treating NE in FR (full responders, P = 0.003), FR + PR (partial responders) (P < 0.0001), and the mean number of wet nights (P = 0.004); also, the combination group had a better effect in FR (P < 0.00001), FR + PR (P = 0.02) and the mean number of wet nights (P = 0.04) after 3 months' treatment. For side effects, combination therapy does not cause more adverse events in treating NE (P = 0.42). Conclusions This study elucidates that desmopressin combined with the anticholinergic agent was demonstrated to be more effective in treating NE than desmopressin monotherapy, and the anticholinergic agent does not increase the risk of adverse events (AEs).
Collapse
Affiliation(s)
- Tong Cai
- Department of Urology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yi Yao
- Department of Paediatrics, Yantai Yuhuangding Hospital, Yantai, China
| | - Weigui Sun
- Department of Urology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Peipei Lei
- Department of Endocrinology, Yantai Yuhuangding Hospital, Yantai, China
| |
Collapse
|
2
|
Oktay C, Işık G. Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting: A Single-Center Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1327-1332. [PMID: 36478362 DOI: 10.1002/jum.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) is a frequent cause of admission to pediatric nephrology outpatient clinics. The aim of this study was to determine whether anatomical changes in lower urinary tract structures (retrovesical angulation [RVA] and bladder neck position [BNP]) are associated with UI in pediatric patients with daytime-wetting in comparison to healthy children. METHODS In this prospective study, patients with daytime UI diagnosed using the Dysfunctional Voiding Symptom Score of the International Children's Continence Society and 3-day-voiding/bowel diary were compared with an age- and sex-matched control group without incontinence. In addition to routine clinical evaluation, RVA and BNP were measured at rest using transabdominal ultrasound (TA-US). Intra-rater agreement was estimated. RESULTS A total of 88 children were included in the study, with 44 children (22 boys, 22 girls) each in patient and control groups. RVA was significantly greater and BNP was significantly lower in the patient group versus control group (RVA: 134.30 ± 10.05 vs 127.94 ± 13.15, P = .013; BNP: 11.88 ± 4.53 vs 17.20 ± 5.55, P < .001, respectively). Irrespective of the presence of incontinence, girls had a significantly greater RVA than boys (P < .001). However, there was no difference between sexes in BNP values (P = .630). Intra-rater agreement was very strong for RVA (P < .001, r = .897), and strong for BNP (P < .001, r = .774). CONCLUSIONS TA-US imaging is a non-invasive and practical procedure routinely performed in pediatric patients presenting with UI complaints. Our study demonstrated anatomical changes in lower urinary tract structures in pediatric patients with UI. These changes should be considered in the diagnosis, follow-up, and treatment of patients with UI.
Collapse
Affiliation(s)
- Cemil Oktay
- Department of Radiology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Güneş Işık
- Department of Pediatric Nephrology, Adıyaman University Medical Faculty, Adıyaman, Turkey
| |
Collapse
|
3
|
Ziaei E, Dorreh F, Yousefichaijan P, Sarmadian R, Sajjadi N, Kahbazi M. Evaluation of the association between asthma and non-neurogenic urinary incontinence in children; a case-control study. BMC Pediatr 2023; 23:141. [PMID: 36997891 PMCID: PMC10061945 DOI: 10.1186/s12887-023-03958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Asthma is the most common chronic disease in children. Asthma can lead to sleep disorders and psychiatric issues, which are often accompanied by urinary incontinence in children. Furthermore, several studies have shown a relationship between allergic diseases and urinary incontinence. This study aims to examine the association between asthma and non-neurogenic urinary incontinence. MATERIALS AND METHODS This case-control study included 314 children over three years old referred to Amir Kabir Hospital; 157 with asthma and 157 without asthma. After explaining each urinary disorder in accordace with the International Children's Continence Society's definitions, parents and children were asked about their presence. The disorders included monosymptomatic nocturnal enuresis(MNE), nonmonosymptomatic nocturnal enuresis (NMNE), vaginal reflux (VR), pollakiuria, infrequent voiding, giggle incontinence (GI), and overactive bladder (OAB). The analysis was performed using Stata 16. RESULTS The average age of the children was 8.19 ± 3.15 years. Patients with asthma (p = 0.0001) and GI (p = 0.027) had a considerably lower average age than patients without these disorders. Asthma and urinary incontinence, including NMNE, Infrequent voiding, and OAB, were significantly correlated (p = 0.017, 0.013, and 0.0001, respectively). Moreover, the association between MNE and asthma was significant in males (p = 0.047). CONCLUSION Due to the relationship between asthma and urinary incontinence, children with asthma must be evaluated for the presence of urinary disorders and, if present, receive the proper treatment in order to improve their quality of life.
Collapse
Affiliation(s)
- Elaheh Ziaei
- Faculty of medicine, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Dorreh
- Department of Pediatrics, Arak university of medical sciences, Arak, Iran
| | | | - Roham Sarmadian
- Infectious disease research center(IDRC), Arak university of medical sciences, Arak, Iran.
| | - Nooshin Sajjadi
- Department of Pediatrics, Arak university of medical sciences, Arak, Iran
| | - Manijeh Kahbazi
- Department of Pediatrics, Arak university of medical sciences, Arak, Iran
| |
Collapse
|
4
|
Baram M, Zuk L, Stattler T, Katz-Leurer M. The Prevalence of Bladder and Bowel Dysfunction in Children with Cerebral Palsy and its Association with Motor, Cognitive, and Autonomic Function. Dev Neurorehabil 2023; 26:155-162. [PMID: 36943141 DOI: 10.1080/17518423.2023.2193268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE To describe the prevalence of bladder and bowel dysfunction (BBD) in 8-10-year-old children with cerebral palsy and its association with motor, cognitive, and autonomic dysfunction. METHODS A cross-sectional, random sample study of parents of 8-10-year-old children with cerebral palsy. Tools: The Enuresis/Urinary Incontinence Parental Questionnaire, the Functional Independence Measure children's version, the autonomic signs questionnaire, and the Gross Motor Function Classification System. RESULTS 39 out of 59 parents consented to participate, whereas 25.64% reported complete continence. Of the 29 children with BBD, 21 (72.4%) had lower urinary tract symptoms and bowel problems. Only two of the children received conservative and noninvasive treatments. Lastly, motor, cognitive and autonomic impairments were associated with incontinence. CONCLUSIONS BBD is common in 8-10-year-old children with cerebral palsy at all levels of functioning. Most having both lower urinary tract symptoms and bowel problems.
Collapse
Affiliation(s)
- Moriah Baram
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Luba Zuk
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Tohar Stattler
- ALYN Hospital Pediatric and Adolescent Rehabilitation Center, Jerusalem, Israel
| | | |
Collapse
|
5
|
Karamaria S, Dossche L, Delens V, Degraeuwe E, Raes A, Mauel R, Vande Walle C, Everaert K, Vande Walle J. Circadian rhythm of water and solute excretion in nocturnal enuresis. Pediatr Nephrol 2023; 38:771-779. [PMID: 35748940 DOI: 10.1007/s00467-022-05645-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nocturnal polyuria (NP) due to a suppressed vasopressin circadian rhythm is a well-documented pathogenetic mechanism in enuresis, mainly studied in monosymptomatic enuresis. A substantial percentage of patients do not respond to desmopressin. This suggests that NP may not only be related to vasopressin, but that other kidney components play a role. Solute handling and osmotic excretion have been investigated in the past, especially in refractory patients. Nevertheless, data in treatment-naïve populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naïve patients with or without NP, with emphasis on circadian rhythms. METHODS Retrospective analysis of 403 treatment-naïve children 5-18 years with severe enuresis (> 8 nights/2 weeks). Circadian rhythms were evaluated by a 24-h urine collection in 8 timed portions (4 day, 4 nighttime) at in-home settings. Urine volume, osmolality, and creatinine were measured. Patients were subdivided into three groups according to nocturnal diuresis (ND) and Expected Bladder Capacity (EBCage) ratio: (a) < 100%, (b) 100-129%, (c) > 130%. RESULTS All groups maintained circadian rhythm for diuresis and diuresis rates. Patients with higher ND (100-129% and > 130% EBCage) had higher daytime volumes and less pronounced circadian rhythm. In the ND group > 130% EBCage, the ND rate was higher during the first night collection and osmotic excretion was significantly higher overnight. CONCLUSIONS Overall 24-h fluid intake (reflected by 24-h diuresis) and nutritional intake (24-h osmotic excretion) might play a role in enuresis. Increased diuresis rate early in the night can be important in some patients, whereas the total night volume can be important in others. A higher resolution version of the Graphical abstract is available as Supplementary Information.
Collapse
Affiliation(s)
- Sevasti Karamaria
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Vincent Delens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Eva Degraeuwe
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium
| | | | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
6
|
Daniel M, Szymanik-Grzelak H, Sierdziński J, Podsiadły E, Kowalewska-Młot M, Pańczyk-Tomaszewska M. Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation. J Pers Med 2023; 13:jpm13010138. [PMID: 36675799 PMCID: PMC9865477 DOI: 10.3390/jpm13010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Urinary tract infections (UTIs) are one of childhood’s most common bacterial infections. The study aimed to determine the clinical symptoms, laboratory tests, risk factors, and etiology of different UTIs in children admitted to pediatric hospitals for three years. Methods: Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. Results: We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5−48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in children with APN than with CYS. The risk factors of UTIs were presented in 46.6% of patients, of which 35.6% were children with APN and 61.7% with CYS. The main risk factor was CAKUT, more frequently diagnosed in children with CYS than APN, mainly in children <2 years. The most commonly isolated bacteria were Escherichia coli (74%). There was a higher percentage of urine samples with E. coli in girls than in boys. Other bacteria found were Klebsiella species, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus species. Conclusions: Patients with APN were younger and had higher inflammatory markers. Often, fever is the only symptom of UTI in children, and other clinical signs are usually non-specific. The most common UTI etiology is E. coli, regardless of the clinical presentation and risk factors.
Collapse
Affiliation(s)
- Maria Daniel
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence: ; Tel.: +48-317-97-35
| | - Hanna Szymanik-Grzelak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Edyta Podsiadły
- Department of Pharmaceutical Microbiology, Centre for Preclinical Research, Faculty of Pharmacy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | | |
Collapse
|
7
|
Akkary R, Guérin F, Chargari C, Jochault L, Audry G, Pio L, Minard-Colin V, Haie-Meder C, Martelli H. Long-term urological complications after conservative local treatment (surgery and brachytherapy) in children with bladder-prostate rhabdomyosarcoma: A single-team experience. Pediatr Blood Cancer 2022; 69:e29532. [PMID: 35739611 DOI: 10.1002/pbc.29532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Outcome of children with bladder-prostate rhabdomyosarcoma (RMS) has improved with multimodal therapies, including surgery and/or radiotherapy for local treatment. Our aim was to report long-term urological complications after a conservative approach combining conservative surgery and brachytherapy. PATIENTS AND METHODS Eighty-six patients, free of disease, were retrospectively reviewed. Symptoms related to urinary tract obstruction, incontinence, infection, and lithiasis were reported and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) classification. Only symptomatic patients underwent urodynamic studies. Risk factors for complications were analyzed. RESULTS There were 76 males and 10 females. The median follow-up was 6.3 years (18 months to 24 years). Complications occurred after a median follow-up of 5 years (0-21). Twenty-two patients (26%) had long-term urological complications. Urinary tract obstruction was found in 15 patients (17%) and urinary incontinence in 14 patients (16%). Recurrent urinary tract infection occurred in four patients and urinary lithiasis in four (5%). The underlying physiopathology included bladder dysfunction in 15 patients (17%), urethral stenosis in six (7%), and ureterovesical junction stenosis in five (6%). On univariate analysis, posterior bladder wall dissection (p = .001), bladder neck trigone dissection (p = .010), and partial prostatectomy (p = .023) were significantly associated with an increased risk of bladder dysfunction; on multivariate analysis, only age ≤2 years (p = .028) at operation and posterior bladder wall dissection (p = .006) were found to be significant. CONCLUSION The conservative surgical approach combined with brachytherapy for bladder-prostate RMS leads to long-term urological complications in 26% of survivors. Optimizing brachytherapy doses for young children and establishing a clear and long-term follow-up protocol could help to reduce these complications.
Collapse
Affiliation(s)
- Rezkalla Akkary
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Cyrus Chargari
- Brachytherapy Unit, Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Loic Jochault
- Department of Biostatistics, Hôpitaux Civils, Colmar, France
| | - Georges Audry
- Department of Pediatric Surgery, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Luca Pio
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | | | - Christine Haie-Meder
- Brachytherapy Unit, Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| |
Collapse
|
8
|
Berg-Poppe P, Christensen M, Koskovich N, Stephenson C. Pelvic Floor Muscle Resting Tone in Children With Dysfunctional Voiding Symptomology Following Simple Gross Motor Exercises. Pediatr Phys Ther 2022; 34:28-35. [PMID: 34873121 DOI: 10.1097/pep.0000000000000842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aimed to understand the effects of a set of simple gross motor exercises on pelvic floor muscle (PFM) resting tone (RT) in children with dysfunctional voiding symptomology. METHODS The study compared PFM RT for a single-sample before and after 2 protocols: exercise versus relaxation (metric standard). RESULTS Participants included 27 children ages 5.00 to 10.92 years. Preintervention PFM RT was similar between the interventions: 63% (exercise) and 78% (relaxation) of children decreased PFM RT following intervention. Between-intervention post-minus-prechanges in PFM RT were compared. Between-intervention differences were similar. CONCLUSIONS Exercise and relaxation protocols were comparable in lowering PFM RT in children with voiding dysfunction. Findings are clinically worthy in that either exercises or relaxation prior to toileting may assist with more complete emptying in children with symptoms.
Collapse
Affiliation(s)
- Patti Berg-Poppe
- Department of Physical Therapy (Dr Berg-Poppe), University of South Dakota, Vermillion, South Dakota; Rehabilitation Services Department (Drs Berg-Poppe, Christensen, and Koskovich), LifeScape, Sioux Falls, South Dakota; Rehabilitation Services Department (Dr Stephenson), LifeScape, Rapid City, South Dakota
| | | | | | | |
Collapse
|
9
|
Chanchlani N, Hodes D. Fifteen-minute consultation: Vulval soreness in the prepubertal girl. Arch Dis Child Educ Pract Ed 2021; 106:333-340. [PMID: 33246924 DOI: 10.1136/archdischild-2019-316905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Neil Chanchlani
- Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK .,Exeter IBD Pharmacogenetics, Exeter, UK
| | - Deborah Hodes
- Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Parents' expectations of the outpatient care for daytime urinary incontinence in children: A qualitative study. J Pediatr Urol 2021; 17:473.e1-473.e7. [PMID: 34176751 DOI: 10.1016/j.jpurol.2021.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/05/2021] [Accepted: 05/28/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Daytime urinary incontinence (UI) can have an enormous impact on a child's life, lowering both self-esteem and quality of life. Although most children start therapy after their first visit to our outpatient clinic, no studies have reported on parents' or patients' expectations of care for daytime UI in this setting. OBJECTIVE We aimed to explore the expectations of the parents of children referred to an outpatient clinic for daytime UI. STUDY DESIGN This was a qualitative study that involved performing semi-structured interviews with the parents of children who had been referred for daytime UI (with or without nocturnal enuresis). Interviews took place between July 2018 and October 2018 and continued until saturation was reached. The results were transcribed verbatim and analyzed according to Giorgi's strategy of phenomenological data analysis. RESULTS Nine parents of children, aged 5-12 years old, were interviewed, revealing "(Experienced) Health," Self-management," and "Social Impact" as the main themes that influenced parental expectations. All parents wanted to know if there was a medical explanation for UI, some were satisfied when diagnostics revealed no underlying condition, and others wanted treatment. Parents expressed no preferences about diagnostics or the content and duration of treatment, but they hoped that any previously attempted ineffective steps would not be repeated. Some parents defined treatment success as their child becoming completely dry, but most stated that learning coping strategies was more important. DISCUSSION This is the first study to explore the expectations of parents when attending outpatient care for children with daytime UI. We employed a strong theoretical framework with a clear interview guide. The main limitations are that we only interviewed parents and that this was a qualitative study, precluding the drawing of firm conclusions. Nevertheless, our results point to the need for quantitative evaluation. CONCLUSION Expectations seem to be influenced by (experienced) health, efforts at self-management, and the social impact of UI, making it critical that these themes are addressed. It was interesting to note that parents do not always attend outpatient departments with the goal of completely resolving daytime UI. Instead, some only want to know if there is an underlying medical condition or want to reduce the social impact by learning coping mechanisms. Excluding underlying medical conditions may therefore stimulate acceptance of watchful waiting without the need to start treatment.
Collapse
|
11
|
Brigden A, Shaw A, Crawley E. "it's a medical condition … you need to support as much as possible": a qualitative analysis of teachers' experiences of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME). BMC Pediatr 2021; 21:6. [PMID: 33397331 PMCID: PMC7780629 DOI: 10.1186/s12887-020-02461-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background An increasing number of children with complex health needs are being educated in mainstream classes. CFS/ME is a complex and disabling condition, and there is little guidance on how primary school teachers can support younger children with this condition. To improve care, it is important to understand what these children need in the school setting, and the barriers and facilitators to teachers providing this support. The aims for this qualitative study were to explore teachers’ views about CFS/ME, their experiences of supporting a pupil with CFS/ME and their perspectives on the barriers and facilitators to providing support. Methods We recruited families from an NHS specialist paediatric CFS/ME service and families were eligible if the child was aged between 5 and 11 years and had a diagnosis of CFS/ME. We gained written consent/assent from families to invite the child’s teacher to participate in a qualitative interview. We contacted these teachers, gained written consent and then carried out semi-structured qualitative interviews. Interviews were audio-recorded, transcribed, anonymised and analysed thematically. Interviews took place between July 2018 and December 2018. Results We interviewed 11 teachers; their pupil’s age ranged from 5 to 11 years and school attendance ranged from 0 to 80%. Theme 1: Most teachers provided rich descriptions of their pupil’s CFS/ME; they consistently described cognitive dysfunction and significant fatigue, but beyond this the symptoms varied from one account to the next (from mobility problems, to aches and pains, digestive problems, headaches, nausea and hypersensitivity). These teachers noted the ripple effects on their pupil’s social, emotional and academic functioning. Two of the eleven teachers said that they did not observe symptoms of CFS/ME, expressing a degree of scepticism about the diagnosis. Theme 2: Teachers described a close relationship with their pupil. They said they understood the individual needs of the child and portrayed positive and proactive attitudes towards providing support. The type of support provided included facilitating rest breaks and limiting strenuous activities; using practical strategies to address cognitive, physical, social and emotional difficulties; maintaining a connection with the child during their absences from school; and encouraging the child to talk about their health and wellbeing. Teachers noted that receiving formal confirmation of the child’s diagnosis enabled them to put this support in place. Theme 3: The adaptations they described were often intuitive, rather than being based on a knowledge of CFS/ME. Teachers wanted more resources to increase their understanding of the condition and its management. Conclusions Primary school teachers want to provide effective support for children with CFS/ME. Clinical services should consider working in collaboration with teachers to equip them with evidence-based strategies for CFS/ME management in the primary school setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-020-02461-7.
Collapse
Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Alison Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| |
Collapse
|
12
|
Mohajerzadeh L, Tabari AK, Atqiaee K, Vosoughi A, Lotfollahzadeh S. The effects of botulinum toxin injection on urodynamic changes in pediatric population with neurospastic bladder: First trial in Iran. J Pediatr Surg 2020; 55:2517-2520. [PMID: 32019705 DOI: 10.1016/j.jpedsurg.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurogenic bladder is one of the serious, disturbing problems referred to pediatric urologic clinics. The increase in bladder pressure may damage the upper urinary tract. Anticholinergic medications have been used as the first line of complementary treatment. Regardless can be omitted, botulinum toxin (BT) was introduced as an alternative method for increasing bladder compliance. BT is a neurotoxic poison that can interfere with acetylcholine release, leading to reduced external sphincter pressure and detrusor activity. This study was established to assess urodynamic changes following BT injection among Iranian pediatric population, for the first time. METHODS This clinical trial was conducted at Shahid Beheshti University of Medical Sciences (SBUM), Tehran, Iran, from November 2018 to January 2019 as a medical graduation dissertation. Twenty patients, previously as followings with a neurogenic bladder who met the eligibility criteria, underwent BT injection with general anesthesia using a rigid cystoscope and an endoscopic needle. Demographic data, history of anticholinergic consumption, side effects or intolerance, and the dosage of the injected BT were all recorded. The urodynamic variables during our study included: flow rate in second two, the flow time of diuresis, time of peak flow, average flow, discharged volume, maximum detrusor muscle filling pressure, maximum flow, acceleration, post-void residual volume, compliance, and cystometric bladder capacity. SPSS software version 22 was used to analyze data. The significance level was considered less than 0.05. RESULTS Twenty patients who did not respond to anticholinergic medications or could not tolerate the side effects were entered the study. The mean age was 7.7 ± 2.02 years (range 5-13), and 13 (65%) of them were male. All patients received anticholinergic medications before BT injection. Discharge volume and maximum detrusor muscle filling pressure showed the most significant changes after injection (p < 0.005). However, there was no significant effect of the baseline characteristics on post-injection improvement in urodynamic results (p > 0.05). CONCLUSION In this study, maximum detrusor filling pressure and discharge volume were both significantly improved. These findings motivate additional studies towards selecting better indexes for defining the clinical improvement and its relation with specific urodynamic results. LEVEL OF EVIDENCE Treatment study, level III.
Collapse
Affiliation(s)
- Leily Mohajerzadeh
- Pediatric Surgery Research Center, Research Institute for Children's Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Khaleghnejad Tabari
- Pediatric Surgery Research Center, Research Institute for Children's Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Khashayar Atqiaee
- Pediatric Surgery Research Center, Research Institute for Children's Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Armin Vosoughi
- Pediatric Surgery Research Center, Research Institute for Children's Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran; Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saran Lotfollahzadeh
- Pediatric Surgery Research Center, Research Institute for Children's Health, ShahidBeheshti University of Medical Sciences, Tehran, Iran; Renal Section, Department of Medicine, Boston University School of Medicine, Boston, USA.
| |
Collapse
|
13
|
Body-Worn Versus Bell-and-Pad Alarm Device for the Management of Monosymptomatic Nocturnal Enuresis in Children: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2020; 47:507-512. [PMID: 32970035 DOI: 10.1097/won.0000000000000678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness of bell-and-pad alarm therapy to body-worn alarm therapy for the management of monosymptomatic enuresis in children 6 to 16 years of age. DESIGN A prospective, randomized, adaptive clinical control trial. SUBJECTS AND SETTING The sample comprised 86 children who attended a continence clinic for treatment of monosymptomatic enuresis and met the criteria for enuresis alarm therapy as per International Children's Continence Society (ICCS) guidelines. Subjects were randomly allocated to an experimental group (body-worn alarm, n = 41) or a control group (bell-and-pad alarm, n = 45). The study setting was a single-site specialist continence service in regional Victoria, Australia. Treatment was administered in the child's home. METHODS Alarm therapy was administered by the child and/or parent for an initial period of 8 weeks at which time the child underwent a review with the continence nurse specialist. If the child had achieved 14 consecutive dry nights, the therapy was deemed successful and ceased. Children who had not become dry continued therapy for a further 8 weeks up to a maximum of 16 weeks, with a final review was instituted. Each child kept a diary for the duration of alarm therapy to report on frequency of wet/dry nights, times of alarm, response to alarm, and response to sensation to void (without alarm). The 2 types of alarm devices were compared with respect to categorical variables using dichotomous cross-tabulations and χ tests of independence based on the most positive outcome versus the other outcomes. RESULTS Dryness in accordance with the criteria outlined by the ICCS guidelines was achieved in 18 children (43.9%) in the body-worn alarm group versus 29 children (64.4%) in the routine (bell-and-pad) group (P = .056). The bell-and-pad alarm performed better on 7 out of the 9 indicators, including the primary outcome measure of the child attained dryness for 14 nights or more, nightly alarm use, alarm woke child, alarm woke parent (P = .022), false (positive) alarms (P = .039), child turned alarm off and went back to sleep (P = .003), and child was compliant with alarm use. The body-worn device produced higher proportions of the most positive outcomes for 2 of the 9 indicators: relapse (P = .076) and false (negative) nonalarms (P = .066). CONCLUSIONS Study findings suggests that the bell-and-pad alarm is preferable to the body-worn alarm. Additional research is recommended using other body-worn alarm devices across a larger population in order to establish the more definitive findings needed for clinical decision-making.
Collapse
|
14
|
Fazeli MS, Pourrahmat MM, Collet JP, Afshar K. The effects of antimuscarinic agents on the activity of the cardiac autonomic nervous system in children with functional overactive bladder. J Pediatr Urol 2019; 15:642.e1-642.e6. [PMID: 31526515 DOI: 10.1016/j.jpurol.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Functional overactive bladder disorder is one of the most prevalent presentations of bladder and bowel dysfunction in children, and it is associated with lower overall cardiac autonomic and parasympathetic activity. Antimuscarinics are the most frequently used pharmacological agents for treatment of children with functional overactive bladder disorder; however, there is a gap in the literature in describing the effect of antimuscarinics on the autonomic profile of this population. OBJECTIVE The aim of the study was to assess the cardiac parasympathetic activity before and after 12 weeks of oxybutynin treatment in children with overactive bladder. METHODS This was a single-institution prospective cohort study. Cardiac autonomic activity was assessed during storage and voiding phases of the bladder function via spectral analysis of heart rate variability and impedance cardiography. The primary outcome measure was high frequency, a proxy for parasympathetic nervous system activity. Parameters of uroflow study, severity of symptoms, and quality of life outcomes were also assessed. RESULTS Ten children (7 females) diagnosed with overactive bladder with a median age of 10 years (range = 6-14) were followed up for a median treatment duration of 11.8 weeks (range = 6-19.4). After treatment, there was a significant reduction in high frequency during the storage phase (median change = -24.17%, p = 0.047). No change was observed in the other outcome measures except for the overall Symptom Score for Dysfunctional Elimination Syndrome after treatment (5-point decrease, p = 0.034) (Summary Table). DISCUSSION The findings of the present follow-up study suggest that the use of oxybutynin in children with overactive bladder is associated with a significant reduction in the activity of the parasympathetic nervous system. The clinical implications of this finding are important because similar autonomic profiles (as markers of chronic stress) have been shown to be associated with increased inflammation and are found in major chronic diseases. The authors caution making a clinical connection between the heart rate variability profile of the patients in this study and patients with chronic diseases because oxybutynin is usually not administered as long-term treatment for overactive bladder. CONCLUSION Use of oxybutynin was associated with reduction in cardiac parasympathetic activity of children with functional overactive bladder. Further investigation into the role of the autonomic nervous system as a treatment target in the management of these children is warranted.
Collapse
Affiliation(s)
- Mir Sohail Fazeli
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Evidinno Outcomes Research Inc, Vancouver, Canada
| | - Mir-Masoud Pourrahmat
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jean-Paul Collet
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Beijing Tiantan Hospital, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Kourosh Afshar
- British Columbia Children's Hospital Research Institute, Vancouver, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
15
|
Bastos JM, Rondon AV, de Lima GRM, Zerati M, Schneider-Monteiro ED, Molina CAF, Calado ADA, Barroso U. Brazilian consensus in enuresis-recomendations for clinical practice. Int Braz J Urol 2019; 45:889-900. [PMID: 31408290 PMCID: PMC6844333 DOI: 10.1590/s1677-5538.ibju.2019.0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/06/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
Collapse
Affiliation(s)
- José Murillo Bastos
- Universidade Federal de Juiz de Fora (UFJF) e Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil
| | - Atila Victal Rondon
- Universidade do Estado do Rio de Janeiro (UERJ) e Hospital Federal Cardoso Fontes (HFCF), Rio de Janeiro, RJ, Brasil
| | | | - Miguel Zerati
- Instituto de Urologia e Nefrologia de São José do Rio Preto (IUN) e Faculdade Regional de Medicina(FAMERP), Hospital de Base, São José do Rio Preto, SP, Brasil
| | | | - Carlos Augusto F Molina
- Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil
| | | | - Ubirajara Barroso
- Universidade Federal da Bahia (UFBA) e Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil
| |
Collapse
|
16
|
Dombek K, Costa Monteiro LM, Fontes JM, Ramos EG. Immediate effect of transcutaneous electrical nerve stimulation on urodynamic parameters of children with myelomeningocele. Neurourol Urodyn 2019; 38:2351-2358. [PMID: 31486143 DOI: 10.1002/nau.24155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/18/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the immediate response of electrical stimulation in children with neurogenic bladder (NB) due to myelomeningocele, using the urodynamic study (UDS). METHODS This is a nonrandomized intervention study with 26 children with neurogenic overactive bladder and low bladder compliance due to myelomeningocele, aged 5 to 15 years. Each child performed a routine UDS and then a second UDS, during which the electrical stimulation was applied in the parasacral region. The main outcome was the difference in the maximum bladder pressure observed between the two urodynamic studies, analyzed from the paired t test. RESULTS We found that 77% of the patients had a lower maximum bladder pressure in the test with electrostimulation compared with the ones without electrostimulation. On average, the pressure reduction after stimulation was 7.24 cmH2 O (95% confidence interval [CI], 0.35-14.14; P = .04). The reduction was even higher in children under 12 years of age, compared with the children above 12 years (11.29 cmH2 O, 95% CI, 3.47-19.12; P = .01). CONCLUSION The use of transcutaneous electrical nerve stimulation had a significant immediate effect on reducing the maximum bladder pressure during the urodynamic studies among the tested pediatric patients with NB. The results were more significant among children under 12 years of age.
Collapse
Affiliation(s)
- Kathiussa Dombek
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Lucia M Costa Monteiro
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Juliana Marin Fontes
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Eloane G Ramos
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:492-501. [DOI: 10.1016/s2352-4642(19)30113-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 01/21/2023]
|
18
|
Abstract
Enuresis is a frequent complaint not always volunteered by parents or patients. The pediatric clinician has to inquire about enuresis to break the secrecy surrounding this symptom that could be related to a more serious underlying renal, endocrine, or psychosocial disease. Determining the type of enuresis is crucial to offer optimal treatment. We present a review for the pediatric clinician to optimize their care of the child with monosymptomatic enuresis. [Pediatr Ann. 2018;47(10):e390-e395.].
Collapse
|
19
|
Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:949-964. [PMID: 28948380 DOI: 10.1007/s00787-017-1051-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
According to the International Children's Continence Society (ICCS) guidelines for the treatment of daytime urinary incontinence (DUI) in children and adolescents, the first-line intervention for all types of DUI is standard urotherapy (SU). Despite this recommendation there is still no meta-analysis available on the effectiveness of SU. The aim of this study is to provide a meta-analytic evaluation of the intervention. This meta-analysis is based on Odds Ratios (OR) and consists of 26 patient samples out of 19 studies (N = 1609), collected from well-established medical databases. Remission rates after SU are compared to spontaneous remission rates, which are matched to the individual follow-up period. The meta-analysis shows that SU is an effective treatment of DUI. Compared to a spontaneous remission rate of 15.40% per year, urotherapy increases the probability to recover by a factor of 7.27 (6.57 if corrected for publication bias). After exclusion of three outlying samples this effect can be generalized for all types of SU and all patient populations. Moderator analyses cannot identify variables which significantly influence the variance of effect sizes. However, RCTs seem to be associated with lower effects, even when the control group is not considered for effect size calculation. Based on the present meta-analysis, SU is an effective intervention for treating DUI in children and adolescents. Of 100 patients in 1 year, approximately 56 patients (54 if corrected for publication bias) remit after being treated with SU, while only 15 out of 100 remit spontaneously. However, to further quantify the effect size of SU in comparison to spontaneous remission rates and other treatments, additional RCTs are still needed.
Collapse
|
20
|
Kuwertz-Bröking E, von Gontard A. Clinical management of nocturnal enuresis. Pediatr Nephrol 2018; 33:1145-1154. [PMID: 28828529 DOI: 10.1007/s00467-017-3778-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 01/14/2023]
Abstract
Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful.
Collapse
Affiliation(s)
- Eberhard Kuwertz-Bröking
- Pediatric Nephrology, University Children's Hospital Münster, Waldeyerstrasse 22, 48149, Muenster, Germany.
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| |
Collapse
|
21
|
Fernandes L, Martin D, Hum S. A case of the giggles: Diagnosis and management of giggle incontinence. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:445-447. [PMID: 29898935 PMCID: PMC5999241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lisa Fernandes
- Clinical pharmacist at the Family Practice Health Centre at Women's College Hospital in Toronto, Ont.
| | - Danielle Martin
- Family physician and Vice President for Medical Affairs and Health System Solutions at Women's College Hospital and Associate Professor in the Department of Family and Community Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Susan Hum
- Research Associate in the Department of Family and Community Medicine at Women's College Hospital
| |
Collapse
|
22
|
Saarikoski A, Koppeli R, Taskinen S, Axelin A. Voiding school as a treatment for daytime incontinence or enuresis: Assessing the effectiveness of intervention by measuring changes in wetting episodes. J Pediatr Urol 2018; 14:256.e1-256.e7. [PMID: 29452905 DOI: 10.1016/j.jpurol.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most urotherapy interventions are planned for children with daytime incontinence or symptoms, and are based on individual education. This study conducted a voiding school (VS) program with groups of 4-6 children with daytime incontinence or enuresis with or without daytime symptoms. OBJECTIVE The aim of this quasi-experimental study with a one-group pretest-posttest design was to assess the effectiveness of the VS intervention for treating children's daytime incontinence or enuresis. MATERIALS AND METHODS Sixty-nine 6-12-year-old children with incontinence classified as treatment resistant participated in the VS at an outpatient clinic. Based on a power analysis, a sample of 52 participants was required. The VS involved two whole-day group visits 2 months apart. The educational content of the intervention was based on the International Children's Continence Society's standards for urotherapy, and was delivered with child-oriented teaching methods, including group discussions with peers. The primary outcome measure was the number of dry days and nights. The amount of wetting was also estimated, and the frequency of voiding measured. Data were collected with 1-week voiding diaries before and after each visit. Changes in dependent variables between four measurement points was measured by using repeated measures variance analysis. The long-term effectiveness was evaluated from patient records concerning 3-month follow-up phone calls or other contacts 8-18 months after the VS. RESULTS Fifty-eight children, 34 girls and 24 boys, completed the study. Twelve children had daytime incontinence, 18 had enuresis, and 28 had both. The number of dry days increased from a mean of 3.5-5.3 (P < 0.001), and the number of dry nights increased from a mean of 2.4-3.9 (P < 0.001) (Summary table). Thirteen (22%) children became completely dry. Three of them had daytime incontinence, five enuresis, and five both. Twenty-four out of 40 (60%) children with daytime incontinence, and 23 out of 46 (50%) children with enuresis showed ≥50% decrease in wetting episodes. The amount of wetting reduced, but the voiding frequency remained unchanged based on the voiding diaries. Twenty-two (45%) of the children were completely dry (six had daytime incontinence, nine enuresis, and seven both), and 16 (39%) showed further improvement, but eight (16%) children remained unchanged 8-18 months after the VS. CONCLUSIONS Voiding school (VS) was an effective intervention for treating both daytime incontinence and nocturnal enuresis in children who had not benefited from standard treatment and were classified as treatment resistant.
Collapse
Affiliation(s)
- A Saarikoski
- Children's Hospital, Helsinki University Central Hospital, Finland; Department of Nursing Science, University of Turku, Finland.
| | - R Koppeli
- Children's Hospital, Helsinki University Central Hospital, Finland
| | - S Taskinen
- Children's Hospital, Helsinki University Central Hospital, Finland
| | - A Axelin
- Department of Nursing Science, University of Turku, Finland
| |
Collapse
|
23
|
Adam A, Claassen F, Coovadia A, de Maayer T, Fockema M, Fredericks J, Gottlich E, Grindell L, Haffejee M, Lazarus J, Levy C, Mathabe K, McCulloch M, Moonsamy G, Moshokoa E, Mutambirwa S, Patel H, van der Merwe A, Van Heerden I, Van Vijk F, Deshpande A, Smith G, Hoebeke P. The South African guidelines on Enuresis—2017. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
24
|
Franco I, Arlen AM, Collett-Gardere T, Zelkovic PF. Imipramine for refractory daytime incontinence in the pediatric population. J Pediatr Urol 2018; 14:58.e1-58.e5. [PMID: 29100969 DOI: 10.1016/j.jpurol.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE Lower urinary tract (LUT) and voiding dysfunction constitute a large percentage of pediatric urology referrals. Children with urinary incontinence unresponsive to behavioral modifications and traditional pharmacotherapy including anticholinergics and alpha blockers remain a challenge. We evaluated the impact of imipramine on treatment outcomes in children with refractory incontinence. STUDY DESIGN Children ≤18 years of age with refractory non-neurogenic daytime incontinence prescribed imipramine were identified. Patient demographics and baseline testing were assessed, as well as medication dosing and side effects of all patients. The Vancouver Symptom Score (VSS) was completed at the initial consultation and each subsequent clinic visit. The questionnaire was self-administered and completed by patients and/or parents. Treatment success was defined as per the International Children's Continence Society (ICCS). RESULTS One hundred and three patients (55 males and 48 females) met the inclusion criteria. The intention-to-treat response rate was 65% (complete 44, partial response 23). Sixteen (15.6%) patients were non-responders and 20 (19.4%) were lost to follow-up. There was no statistical difference between all groups with regards to age, baseline VSS, and dose. Of those children with complete follow-up (n = 83), 44 (53%) experienced complete treatment response. Pre- and post-VSS were statistically different in both complete and partial response groups (complete 19.5-9.5; p < 0.0001; partial 19.7-13; p = 0.0002) (Table). Side effects were reported by 11 out of 83 (13.3%) patients; partial responders experienced a higher likelihood of side effects (26.1%; p = 0.03). DISCUSSION The mainstay of LUT dysfunction management in children is implementation of a bowel program and timed voiding regimen, with additional treatment modalities and pharmacotherapy added depending upon prevailing symptomatology. Daytime incontinence refractory urotherapy, anticholinergics, and/or non-selective alpha blockers can be difficult to treat, and can be unresponsive to parasacral transcutaneous electrical nerve stimulation (TENS) and percutaneous tibial nerve stimulation (PTNS). We observed that over half of children with refractory daytime incontinence reported complete resolution of daytime accidents with imipramine. Limitations of the study include the retrospective nature, relatively small sample size and lack of control group. CONCLUSIONS Two-thirds of children with refractory daytime incontinence experienced treatment response to imipramine, adding a valuable tool to the pediatric urologist's armamentarium in managing select, challenging patients.
Collapse
Affiliation(s)
- Israel Franco
- Department of Urology, Yale University, New Haven, CT, USA.
| | - Angela M Arlen
- Department of Urology, Yale University, New Haven, CT, USA
| | | | - Paul F Zelkovic
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
25
|
Saarikoski A, Koppeli R, Salanterä S, Taskinen S, Axelin A. Voiding school as a treatment of daytime incontinence or enuresis: Children's experiences of the intervention. J Pediatr Urol 2018; 14:56.e1-56.e7. [PMID: 29037865 DOI: 10.1016/j.jpurol.2017.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/10/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Daytime incontinence and enuresis are common problems in otherwise healthy children, and negatively influence their social lives and self-esteem. Motivation for treatment is often a real clinical problem. Children's experiences of their incontinence treatments have not been previously described. OBJECTIVE The aim of this study was to describe children's experiences of the Voiding School intervention as a treatment for their incontinence. STUDY DESIGN A qualitative, descriptive focus-group study with a purposive sample was conducted at a Finish university hospital in 2014. Children aged 6-12 years participated in the Voiding School at an outpatient clinic. The intervention included two 1-day group visits 2 months apart. The educational content was based on the International Children Continence Society's standards for urotherapy. The education was delivered with child-oriented teaching methods. At the end of the second visit, 19 children were interviewed in five groups. Data were analysed with inductive content analysis. RESULTS The children described incontinence as an embarrassing problem, which they had to hide at any cost. They had experienced bullying and social isolation because of it. Normal outpatient visits emphasized adult-to-adult communication, which made the children feel like outsiders. The children perceived the Voiding School as a nice and child-oriented experience. Making new friends was especially important to younger boys who felt that the Voiding School day was too long and issue-oriented. In the Voiding School, videos and 'learning by doing' helped the children to understand the basis of given advice, and they were able to learn new habits, which gave them control over the incontinence; this helped them to become 'the boss of the bladder'. Sharing experiences and improvements in their incontinence with their peers supported the children's self-esteem and encouraged them to do new things, such as staying overnight with friends. These experiences helped them to acquire control over the problem (Summary Figure). DISCUSSION According to the children's experiences, normal outpatient visits were only appointments for adults, and not very useful for children. In the Voiding School, they were respected as being the main person, and their views were listened to. The results underlined the importance of a child-oriented approach to patient education with regard to children, and provided encouragement to further develop the intervention. CONCLUSION Child orientation, peer support, learning by doing, and understanding the cause and effect helped children to gain control over their bladders. Based on the children's experiences, this could be achieved by a voiding school.
Collapse
Affiliation(s)
- A Saarikoski
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland; Department of Nursing Science, University of Turku, Turku, Finland.
| | - R Koppeli
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - S Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
| | - S Taskinen
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - A Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
26
|
Whale K, Cramer H, Joinson C. Left behind and left out: The impact of the school environment on young people with continence problems. Br J Health Psychol 2017; 23:253-277. [PMID: 29228510 PMCID: PMC5900927 DOI: 10.1111/bjhp.12284] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 10/27/2017] [Indexed: 11/30/2022]
Abstract
Objectives To explore the impact of the secondary school environment on young people with continence problems. Design In‐depth qualitative semi‐structured interviews. Methods We interviewed 20 young people aged 11–19 years (11 female and nine male) with continence problems (daytime wetting, bedwetting, and/or soiling). Interviews were conducted by Skype (n = 11) and telephone (n = 9). Transcripts were analysed using inductive thematic analysis. Results We generated five main themes: (1) Boundaries of disclosure: friends and teachers; (2) Social consequences of avoidance and deceit; (3) Strict and oblivious gatekeepers; (4) Intimate actions in public spaces; and (5) Interrupted learning. Conclusion Disclosure of continence problems at school to both friends and teachers was rare, due to the perceived stigma and fears of bullying and social isolation. The lack of disclosure to teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. Young people with continence problems require unrestricted access to private and adequate toilet facilities during the school day. There is a need for inclusive toilet access policies and improved toilet standards in schools. Addressing the challenges faced by young people with continence problems at school could help to remove the barriers to successful self‐management of their symptoms. It is particularly concerning that young people with continence problems are at higher risk of academic underachievement. Increased support at school is needed to enable young people with continence problems to achieve their academic potential. Statement of Contribution What is already known on this subject? Continence problems are among the most common paediatric health problems Self‐management of continence problems requires a structured schedule of fluid intake and bladder emptying Inadequate toilet facilities and restricted access make it difficult for young people to manage their incontinence
What does this study add? Improvement is needed in teacher understanding of the needs of young people with continence problems Young people are reluctant to disclose continence problems due to perceived stigma and fear of social isolation Young people with continence problems may be at increased risk of academic underachievement
Collapse
Affiliation(s)
- Katie Whale
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | - Carol Joinson
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| |
Collapse
|
27
|
Tkaczyk M, Maternik M, Krakowska A, Wosiak A, Miklaszewska M, Zachwieja K, Runowski D, Jander A, Ratajczak D, Korzeniecka-Kozyrska A, Mader-Wołyńska I, Kiliś-Pstrusińska K. Evaluation of the effect of 3-month bladder basic advice in children with monosymptomatic nocturnal enuresis. J Pediatr Urol 2017. [PMID: 28634090 DOI: 10.1016/j.jpurol.2017.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Advice (BBA) into the standards of patients' care in both monosymptomatic and non-monosymptomatic nocturnal enuresis. Although the idea of this recommendation was clear and reflects clinical experience, duration and efficacy have not been definitely established. Recent data have demonstrated the lack of efficacy of BBA and a fierce discussion has ensued. The present study was aimed to assess the efficacy of BBA in a group of previously untreated children with primary monosymptomatic nocturnal enuresis (MNE). STUDY DESIGN The study was a prospective interventional multicenter trial in a cohort of previously untreated MNE patients. Forty-nine children (36 males, 13 females, mean age 7.2 years) were included in the analysis. The treatment efficacy was assessed at the 30th, 60th, and 90th days of BBA. RESULTS We discovered that the mean number of wet nights decreased significantly (p < 0.001) only after 3 months of BBA from 8.9 to 5.9 episodes every 2 weeks. BBA was fully successful in 2% o the children after 30 day, 12% after 60 days, and 18% after 90 days (Figure). Partial response (by ICCS) was assessed for 8%, 20%, and 34% of the patients. We noted a relatively high rate of non-responders that decreased from 90% to 47% after 90 days. We detected no differences in BBA efficacy between children with night-time polyuria or decreased maximal voided volume. A lower number of wet nights initially predicted the response to the BBA. DISCUSSION Our study confirmed rather limited efficacy of BBA, similarly to previous observations, but provided more information on isolated MNE, because of a more specific study group and longer period of observation. The limitation of the study was lack of randomization. CONCLUSION Our study revealed that in treatment-naïve children with monosymptomatic enuresis basic bladder training had a low (18%) and late effect, mostly pronounced after the third month of therapy. It seems that only if the patient presents with a favorable profile of bedwetting, occasionally and with a high maximum voided volume, it is worth maintaining BBA for a longer period of up to 3 months before initiating second-line therapy. In an unfavorable initial profile desmopressin or an alarm may be introduced much earlier.
Collapse
Affiliation(s)
- Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland; IV Chair of Pediatrics, Medical University of Lodz, Lodz, Poland.
| | - Michał Maternik
- Department of Nephrology and Hypertension of Children and Adolescents, Medical University of Gdansk, Gdańsk, Poland
| | - Anna Krakowska
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Agnieszka Wosiak
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
| | - Monika Miklaszewska
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Zachwieja
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Runowski
- Department of Nephrology, Transplantation and Hypertension, Child's Health Memorial Hospital Research Institute, Warszawa, Poland
| | - Anna Jander
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | | | | | | | | |
Collapse
|
28
|
Whale K, Cramer H, Wright A, Sanders C, Joinson C. 'What does that mean?': a qualitative exploration of the primary and secondary clinical care experiences of young people with continence problems in the UK. BMJ Open 2017; 7:e015544. [PMID: 29042374 PMCID: PMC5652505 DOI: 10.1136/bmjopen-2016-015544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/14/2017] [Accepted: 07/27/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To explore the clinical care experiences of young people with continence problems. DESIGN In-depth semistructured qualitative interviews were conducted by Skype and telephone, with the addition of art-based participatory research techniques. Transcripts were analysed using inductive thematic analysis. SETTING Primary and secondary care in the UK. PARTICIPANTS We interviewed 20 participants (9 females, 11 males) aged 11-20 years. There were six participants with bedwetting alone, five with daytime wetting alone, five with combined (day and night) wetting and four with soiling. RESULTS We identified four themes: appointment experiences, treatment experiences, engagement with treatment and internalisation and externalisation of the continence problem. Patient-focused appointments using age-appropriate language were highly desirable. Continuity of care was highlighted as an important aspect of positive clinical experiences; however, this was found to be rare with many participants seeing a different person on each visit. Participants had tried a wide range of treatments for their continence problems with varying degrees of success. Relapse and treatment failure were common. Experiencing relapse was distressing and diminished participants' belief in the success of future treatments and undermined adherence. Participants would be seen to adopt two opposing coping strategies for dealing with their continence problem- internalisation and externalisation. CONCLUSION Incontinence in young people is challenging to manage. Young people may need to try a range of treatments before their symptoms improve. Due to challenges in treatment, there is an increased risk of poor adherence. During patient-focused appointments, clinicians should work to build rapport with patients and use age-appropriate language. Involving young people in their own care decisions is important. The way in which young people understand their continence problem can influence their coping strategies and adherence to treatment regimes.
Collapse
Affiliation(s)
- Katie Whale
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Anne Wright
- Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Carol Joinson
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
29
|
Thomas DT, Yener S, Kalyoncu A, Uluc K, Bayri Y, Dagcinar A, Dagli T, Tugtepe H. Somatosensory evoked potentials as a screening tool for diagnosis of spinal pathologies in children with treatment refractory overactive bladder. Childs Nerv Syst 2017; 33:1327-1333. [PMID: 28342118 DOI: 10.1007/s00381-017-3393-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the usefulness of somatosensory evoked potential as a screening tool for spinal pathologies in patients with treatment refractory overactive bladder. METHODS This prospective study was performed between January 2011 and January 2014. Children >5 years old with treatment refractory overactive bladder were enrolled after exclusion of anatomical and neurological causes of incontinence. All patients underwent urodynamic studies, spinal MRI, and somatosensory evoked potential (SEP). Sensitivity, specificity, PPV, and NPV were calculated for SEP. RESULTS Thirty-one children (average age 8.3 ± 2.9 years) were included in the study. SEP was abnormal in 13 (41.9%), and MRI was abnormal in 8 (25.8%) patients. SEP was found to have a sensitivity of 87.5%, a specificity of 73.9%, positive predictive value of 53.85%, and negative predictive value (NPV) of 94.4%. CONCLUSION In patients with treatment refractory OAB, SEP is an important tool for the screening of tethered cord/spinal pathologies. Our results suggest that a child with a normal SEP study in this group of patients may not require further investigation with MRI.
Collapse
Affiliation(s)
- David Terence Thomas
- Department of Pediatric Surgery, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Sevim Yener
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Aybegum Kalyoncu
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga Dagli
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Tugtepe
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey.
| |
Collapse
|
30
|
|
31
|
Sinha R, Raut S. Management of nocturnal enuresis - myths and facts. World J Nephrol 2016; 5:328-338. [PMID: 27458562 PMCID: PMC4936340 DOI: 10.5527/wjn.v5.i4.328] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/28/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of
treatment.
Collapse
|
32
|
Current Treatment Options for Nonneurogenic Overactive Bladder in Children. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback. J Pediatr Urol 2015; 11:137.e1-5. [PMID: 25824876 DOI: 10.1016/j.jpurol.2014.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/17/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE While there are many options for children with treatment refractory urinary incontinence, there is no single accepted method. This study's aim was to prospectively evaluate the effect of transcutaneous electrical nerve stimulation in children with urinary incontinence resistant to standard medical, urological therapy and/or biofeedback. PATIENTS & METHODS This study was performed at a university hospital. For inclusion, patients >5 years of age first underwent evaluation with urinary ultrasonography, uroflow-electromyogram and voiding diaries. Treatment with biofeedback, alpha adrenergic blockers, anticholinergics and/or urotherapy was commenced according to uroflow-EMG and voiding diary findings. Patients with partial or no response to this standard therapy were then included in this study, performed between April 2012 and February 2014. Patients with anatomical or neurological causes for urinary incontinence were excluded. TENS was performed on S3 dermatome, every day for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated pulse of 350 μs. Intensity was determined by the child's sensitivity threshold. Medical treatment and urological therapy was continued during TENS. Uroflow parameters (voiding volume as percentage of expected bladder capacity, Qmax, Qave, flow and voiding time, postvoiding residual urine) and urinary system symptoms (presence of urinary tract infection, frequency, urge incontinence, fractionated voiding and constipation) were compared immediately before commencement and immediately after the completion of 3 months of TENS. RESULTS Twenty-seven patients were included in this study (4 males, 23 females). Patients' average age was 7.2 years, 11 had overactive bladder and 16 had dysfunctional voiding. Comparison of urinary system symptoms and uroflow parameters before and after TENS are shown in Table. After 3 months of TENS; a statistically significant decrease was observed in the number of patients with frequency, urge incontinence, urinary tract infections and constipation. There was a decrease in the number of patients with fractionated voiding, although this change was not statistically significant. Similarly, for uroflow-EMG parameters; bladder capacity, Qmax, Qave and flow time increased while voiding time and PVR decreased. Changes seen in bladder capacity, Qmax and PVR were statically significant, while other changes were not. Patients' response rates after 3 months of TENS were; complete response in 70.4%, partial response in 22.2% and no response in 7.4%. CONCLUSION This study has shown that transcutaneous electrical nerve stimulation is a promising treatment option for standard-treatment refractory children with urinary incontinence.
Collapse
|
34
|
Tugtepe H, Thomas DT, Ergun R, Abdullayev T, Kastarli C, Kaynak A, Dagli TE. Comparison of biofeedback therapy in children with treatment-refractory dysfunctional voiding and overactive bladder. Urology 2015; 85:900-4. [PMID: 25669732 DOI: 10.1016/j.urology.2014.12.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate and compare the effectiveness of biofeedback therapy (BF) in children with treatment refractory overactive bladder (OAB) and dysfunctional voiding (DV). METHODS This study was performed between April 2012 and March 2014. Patients with treatment refractory OAB and DV were included. All patients had 3 months of BF. Patients' urologic system symptoms and uroflow parameters before BF and 3 months after BF and response rates were compared. RESULTS Forty-five patients completed the study. Significant improvement was seen in urinary tract infections, urge incontinence, fractionated voiding, constipation, voided volume, maximum flow rate (Qmax), average flow rate (Qave), and postvoiding residue for patients with DV and in urinary tract infection, frequency, urge incontinence, Qmax, Qave, voiding time, and postvoiding residue for patients with OAB. Overall, better results were observed in patients with DV. CONCLUSION BF is an effective treatment modality in children with treatment refractory OAB and DV; however, patients with DV show better improvement.
Collapse
Affiliation(s)
- Halil Tugtepe
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey.
| | | | - Raziye Ergun
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tural Abdullayev
- Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Kastarli
- Pediatric Urodynamics and Biofeedback Unit, Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayten Kaynak
- Pediatric Urodynamics and Biofeedback Unit, Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga E Dagli
- Division of Pediatric Urology, Department of Pediatric Surgery, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|