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Ergun R, Ozturk NI, Sekerci CA. The effect of duration between sessions on biofeedback treatment in children with dysfunctional voiding. Low Urin Tract Symptoms 2022; 14:387-392. [PMID: 35808986 DOI: 10.1111/luts.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Biofeedback is an effective treatment in children with standard urotherapy-resistant dysfunctional voiding (DV). However, the duration of the session intervals is not standardized. We aimed to compare the effectiveness of daily and weekly sessions of biofeedback treatments. METHODS The data of children who received biofeedback due to DV between March 2018 and May 2019 were retrospectively evaluated. The children were divided into two groups, one with daily and the other with weekly sessions. The voiding patterns in uroflowmetry (UF), maximum flow rate (Qmax), electromyography activity, postvoid residual volume (PVR), the ratio of voided volume to expected bladder capacity (EBC) (%), and Dysfunctional Voiding and Incontinence Scoring System (DVISS) were compared between the two groups. RESULTS A total of 45 children (39 girls [86.6%] and 6 boys [13.3%]) were included in the study. The daily group consisted of 27 (60%) children and the weekly group of 18 (40%). Qmax, PVR, number of abnormal UF patterns, voiding volume/EBC, and DVISS scores were similar between the two groups before treatment. Voiding parameters improved statistically significantly in both groups following biofeedback, but there was no difference between the two groups. A statistical difference was found between the results of DVISS after treatment (P = .03). CONCLUSION Both types of biofeedback treatment (daily and weekly) are effective methods that improve voiding parameters and DVISS values in children with DV. Therefore, the duration between sessions can be determined according to the suitability of the patient and the biofeedback unit.
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Affiliation(s)
- Raziye Ergun
- Pediatric Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Naime Ipek Ozturk
- Pediatric Surgery, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Cagri Akin Sekerci
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey
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Yang SS, Tsai JD, Kanematsu A, Han CH. Asian guidelines for urinary tract infection in children. J Infect Chemother 2021; 27:1543-1554. [PMID: 34391623 DOI: 10.1016/j.jiac.2021.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >105 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B). Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7-14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III-V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).
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Affiliation(s)
- Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan; Buddhist Tzu Chi University, Hualien, Taiwan.
| | - Jeng-Daw Tsai
- Department of Medicine, Mackay Medical College, Taiwan; Department of Pediatric Nephrology, MacKay Children's Hospital, Taiwan; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | | | - Chang-Hee Han
- Department of Urology, Uijeongbu ST. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
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Siregar S, Kurniawan A, Mustafa A. Conservative management of vesicoureteral reflux: A literature review. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ladi-Seyedian SS, Sharifi-Rad L, Amini E, Kajbafzadeh AM. Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical Trial. Appl Psychophysiol Biofeedback 2020; 45:259-266. [DOI: 10.1007/s10484-020-09474-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dossche L, Snauwaert E, Renson C, Van Daele J, Raes A, Dehoorne J, Roels SP, Van Laecke E, Van Herzeele C, Hoebeke P, Vande Walle J. The long-term added value of voiding school for children with refractory non-neurogenic overactive bladder: an inpatient bladder rehabilitation program. J Pediatr Urol 2020; 16:350.e1-350.e8. [PMID: 32147348 DOI: 10.1016/j.jpurol.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/31/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION & BACKGROUND Despite adequate management, 20% of children with overactive bladder (OAB) syndrome fail to improve their bladder function. To approach the need for alternative strategies, an inpatient bladder rehabilitation 'voiding school' program was established. OBJECTIVE The objective of this study was to evaluate the short- and long-term (1-year follow-up) outcome of this voiding school program in children with refractory OAB. In addition, the authors aimed to identify which children achieved the best outcomes with this voiding school program. STUDY DESIGN The charts of all children (n = 357, mean age: 9.7 ± 2.0 years, 63.6% boys) with refractory OAB who attended voiding school between 2000 and 2010 were reviewed. A linear mixed model with random intercept was used to evaluate the incontinence (expressed by enuresis and daytime incontinence voiding scores) and maximal voiding volume (MVV). RESULTS & DISCUSSION This study demonstrated an overall beneficial long-term effect of the inpatient program on day- and night-time incontinence, in which 36.6% of children achieved dryness during day- and night-time. In addition, the mean overall decline in the number of wet nights and days declined with 4 extra dry days and/or nights per week, in comparison with the level of continence before attending the voiding school program. In contrast, only a temporary increase in MVV was seen, however, without relapse incontinence. At last, the authors identified the negative impact of decreasing age, male sex, dysfunctional voiding and nocturnal polyuria on the overall outcome of the inpatient program. CONCLUSION An inpatient rehabilitation 'voiding school' program is a successful and safe treatment modality for children with refractory OAB that results in long-term significant increase of continence, as well as amelioration in degree of severity. The worst outcomes of this voiding school program were detected in children with young age, who were boys, or had associated nocturnal polyuria, dysfunctional voiding, and/or faecal incontinence.
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Affiliation(s)
- L Dossche
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium.
| | - E Snauwaert
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - C Renson
- Department of Pediatric Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - J Van Daele
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - A Raes
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - J Dehoorne
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - S P Roels
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, 9000, Gent, Belgium
| | - E Van Laecke
- Department of Pediatric Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - C Van Herzeele
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - P Hoebeke
- Department of Pediatric Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
| | - J Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, C. Heymanslaan 10, 9000, Gent, Belgium
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Kopru B, Ergin G, Ebiloglu T, Kibar Y. Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective. J Pediatr Urol 2020; 16:38.e1-38.e7. [PMID: 31928898 DOI: 10.1016/j.jpurol.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. OBJECTIVE We studied the biofeedback success in children with LUTD according to parents' expressions. METHODS We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. RESULTS At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. CONCLUSIONS Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD.
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Affiliation(s)
- Burak Kopru
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey.
| | - Giray Ergin
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Turgay Ebiloglu
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
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Dos Reis JN, Mello MF, Cabral BH, Mello LF, Saiovici S, Rocha FET. EMG biofeedback or parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction: A prospective and randomized trial. Neurourol Urodyn 2019; 38:1588-1594. [PMID: 31025397 DOI: 10.1002/nau.24009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 11/09/2022]
Abstract
AIMS Evaluate the efficacy of biofeedback and parassacral electric nerve stimulation (TENS) for the treatment of children with lower urinary tract (LUT) dysfunction. METHODS A prospective, randomized study was approved by our Hospital Ethics Committee. We enrolled 64 children, 43 girls and 21 boys, average age of 9.39 years. The initial evaluation consisted of history, physical examination, urine analyses, voiding diary, uroflow, and ultrasound. Dysfunction voiding symptom score (DVSS) questionnaires were applied pre- and post-treatment. The children were divided into two treatment groups independent of the predominant type of voiding dysfunction (dysfunctional or overactive bladder): biofeedback group and TENS group. The criteria for assessing the effectiveness of the techniques was the resolution of daytime and nighttime symptoms including urinary leakage, improvements in voiding diary, DVSS, and changes in uroflow. After 6 months, the children were reassessed with the same work-up of baseline. RESULTS Regarding daytime symptoms, results for complete response were similar between the two groups (P = 0.483); 54.9% of children treated by the biofeedback group and 60.6% in the TENS group. The same have been observed in the nighttime incontinence with complete resolutions in 29.6% and 25%, respectively ( P = 0.461). Analyzing the voiding diary, uroflow and DVSS questionnaires both groups had significant improvement ( P = 0.001) after treatment. The biofeedback group required fewer sessions than TENS group, 10.9 and 18.1, respectively ( P < 0,001). CONCLUSIONS Both biofeedback and the TENS are equally effective for treating non-neurogenic voiding dysfunction. Biofeedback seems to require a lower number of sessions to obtain similar results of the TENS.
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Affiliation(s)
| | | | | | | | - Samuel Saiovici
- Department Pediatric Urology, Menino Jesus Children's Hospital, Sao Paulo, Brazil
| | - Flavio Eduardo Trigo Rocha
- Department Pediatric Urology, Menino Jesus Children's Hospital, Sao Paulo, Brazil.,Department of Urology, University of Sao Paulo Medical School, São Paulo, Brazil
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Pekbay Y, Ergin O, Topuz B, Sarikaya S, Acar ZZ, Irkilata HC, Dayanç M. The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder. Neurourol Urodyn 2019; 38:1430-1442. [DOI: 10.1002/nau.24007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/07/2019] [Accepted: 04/01/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Yelda Pekbay
- Division of Pediatric UrologyPrivate Dayanc Urology CenterAnkara Turkey
| | - Oguz Ergin
- Department of UrologyPrivate Yasam HospitalAntalya Turkey
| | - Bahadir Topuz
- Department of UrologyGulhane Training and Research HospitalAnkara Turkey
| | - Selçuk Sarikaya
- Department of UrologyGulhane Training and Research HospitalAnkara Turkey
| | | | | | - Murat Dayanç
- Division of Pediatric UrologyPrivate Dayanc Urology CenterAnkara Turkey
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Fuentes M, Magalhães J, Barroso U. Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children. Front Pediatr 2019; 7:298. [PMID: 31404146 PMCID: PMC6673647 DOI: 10.3389/fped.2019.00298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/04/2019] [Indexed: 12/28/2022] Open
Abstract
Normal bladder and urethral sphincter development as well as neural/volitional control over bladder-sphincter function are essential steps for regular lower urinary tract function. These maturational sequences are clinically evident by the age of 5 years. However, in 17-22% of children, symptoms persist beyond that age, characterizing lower urinary tract dysfunction (LUTD). The clinical spectrum is wide and includes overactive bladder, voiding postponement, underactive bladder, infrequent voiding, extraordinary daytime only urinary frequency, vaginal reflux, bladder neck dysfunction, and giggle incontinence. LUTD may lead to vesicoureteral reflux and recurrent urinary tract infections, increasing the likelihood of renal scarring. LUTD is often associated with constipation and emotional/behavioral disorders such as anxiety, depression, aggressiveness, and social isolation, making diagnosis, and treatment imperative. Diagnosis of LUTD is essentially based on clinical history, investigation of bladder storage, voiding symptoms (urinary frequency, daytime incontinence, enuresis, urgency) and constipation. Dysfunctional Voiding Score System (DVSS) is a helpful tool. Physical examination focuses on the abdomen to investigate a distended bladder or palpable fecal mass, the lumbosacral spine, and reflex testing. Bladder diaries are important for recording urinary frequency and water balance, while uroflowmetry is used to assess voided volume, maximum flow, and curve patterns. Bladder ultrasonography to measure post-void residual urine volume and urodynamics are used as supplemental tests. Current first line treatment is urotherapy, a combination of behavioral measures to avoid postponing micturition, and a restricted diet for at least 2 months. Anticholinergics, β3 agonists and neuromodulation are alternative therapies to manage refractory overactive bladder. Cure rates, at around 40%, are considered satisfactory, with daytime symptoms improving in 32% of cases. Furthermore, children who are also constipated need treatment, preferentially with polyethylene glycol at doses of 1-1.5 g/kg in the 1st 3 days and 0.25-0.5 g/kg thereafter until the 2-month period of behavioral therapy is complete. If urotherapy fails in cases of dysfunctional voiding, the next step is biofeedback to teach the child how to relax the external urethral sphincter during micturition. Success rate is around 80%. Children with underactive bladder usually need a combination of clean intermittent catheterization, alpha-blockers, biofeedback and neuromodulation; however, cure rates are uncertain.
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Affiliation(s)
- Mirgon Fuentes
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Juliana Magalhães
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Ubirajara Barroso
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil.,Aliança Hospital, Salvador, Brazil
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Tremback-Ball A, Gherghel E, Hegge A, Kindig K, Marsico H, Scanlon R. The effectiveness of biofeedback therapy in managing Bladder Bowel Dysfunction in children: A systematic review. J Pediatr Rehabil Med 2018; 11:161-173. [PMID: 30223405 DOI: 10.3233/prm-170527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the effects of biofeedback therapy as a non-invasive intervention to treat Bladder Bowel Dysfunction in pediatrics. METHODS Six databases were searched between February 2016 and September 2016. Biofeedback studies for children aged 4-16 with idiopathic urinary or fecal incontinence were included. Articles were excluded on subjects' medical histories, study design, timeline of study, and lacking expert review. Quality was determined using Sackett's Levels of Evidence and the PEDro scale. RESULTS Twelve articles were included in the review. Quality of evidence was moderate, as the average PEDro score of the selected articles was 5.3. The participants' ages ranged from 4-16 years old. Studies demonstrated that a multifactorial approach consisting of biofeedback therapy and behavioral modification can be successful in resolving Bladder Bowel Dysfunction. CONCLUSION Biofeedback is a beneficial treatment for children with dysfunctional voiding and functional fecal incontinence. More conclusive research needs to be completed to explore the effects of biofeedback therapy treatment to make more concrete conclusions. Healthcare professionals should consider biofeedback as an alternative approach in conjunction with traditional treatments. A multidisciplinary approach is best when treating dysfunctional voiding and functional fecal incontinence in the pediatric population.
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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.
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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.
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Ebiloglu T, Kaya E, Köprü B, Topuz B, Irkilata HC, Kibar Y. Biofeedback as a first-line treatment for overactive bladder syndrome refractory to standard urotherapy in children. J Pediatr Urol 2016; 12:290.e1-290.e7. [PMID: 27102986 DOI: 10.1016/j.jpurol.2016.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Overactive bladder syndrome (OAB) and dysfunctional voiding (DV) are subgroups of lower urinary tract dysfunction (LUTD). Standard urotherapy is the first-line treatment option of OAB in children. OBJECTIVES The aim was to investigate the use of biofeedback as a first-line treatment option in OAB refractory to standard urotherapy, and determine the factors affecting efficacy. STUDY DESIGN Between 2005 and 2015, we retrospectively analyzed a total of 136 hospital records of children with OAB who had not previously used any anticholinergics and were refractory to standard urotherapy. Patients with urgency and/or urge incontinence and/or making holding maneuvers to suppress urgency were defined as having OAB symptoms, and resolution of these complaints was defined as successful biofeedback therapy. RESULTS Seventy-three of 136 OAB patients' urgency recovered by biofeedback therapy with the success rate of 53% (p < 0.001). Sixty-two of 101 patients with holding maneuvers (success rate 61%) (p < 0.001), 70 of 101 patients with urgency incontinence (success rate 69%) (p < 0.001), 76 of 114 patients with daytime incontinence (success rate 66%) (p = 0.023), 87 of 97 patients with enuresis (success rate 89%) (p = 0.009), and 27 of 39 patients with dysuria (success rate 69%) (p = 0.007) recovered from their symptoms significantly. The mean lower urinary tract symptom score (LUTSS) was 16.38 and 8.18 before and after biofeedback therapies, respectively (p < 0.001) (Table). Patients without holding maneuvers (p = 0.045), daytime incontinence (p = 0.030), and enuresis (p = 0.045) had better recovery compared to the opposites. DISCUSSION Biofeedback can be thought of as the first-line treatment option when standard urotherapy fails in children with OAB.
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Affiliation(s)
- Turgay Ebiloglu
- Etimesgut Military Hospital, Department of Urology, Ankara, Turkey
| | - Engin Kaya
- Gulhane Military Medical Academy, Department of Urology, Ankara, Turkey
| | - Burak Köprü
- Konya Military Hospital, Department of Urology, Konya, Turkey.
| | - Bahadır Topuz
- Gulhane Military Medical Academy, Department of Urology, Ankara, Turkey
| | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Department of Urology, Ankara, Turkey
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14
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Beksac AT, Koni A, Bozacı AC, Dogan HS, Tekgul S. Postvoidal residual urine is the most significant non-invasive diagnostic test to predict the treatment outcome in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol 2016; 12:215.e1-8. [PMID: 27233211 DOI: 10.1016/j.jpurol.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Uroflowmetry (UF) alone is often inadequate or unreliable to diagnose lower urinary tract dysfunction (LUTD). Therefore, other non-invasive tests, such as ultrasound (US), post-voiding residual volume (PVR) assessment and symptom scales, are used as well for objective definition of the problem. OBJECTIVE The aim of this study was to investigate the possible predictive function of the non-invasive diagnostic tests for the response to treatment. STUDY DESIGN The prospective registry data of 240 patients with LUTD, from November 2006 to September 2013, were retrospectively analyzed. All patients were aged 5-14 years old. Patients with a previous diagnosis of vesicoureteral reflux (VUR), neurogenic bladder, monosymptomatic nocturnal enuresis (NE) were excluded from the study. Uroflowmetry, US, PVR and the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) were performed on every patient at their first visit and follow-ups. A DVISS <9 was considered as the DVISS response; parental opinion was based on International Continence Society criteria of clinical response. Time passed until clinical response was the last outcome parameter. RESULTS Mean age was 8.2 years. Median follow-up was 60.5 months. A total of 62% of patients had complete response, 28.1% had partial response, and 9.7% had no response. Demographic variables were not associated with clinical outcome. Co-existing enuresis nocturna, multiple pharmacotherapy, and increased DVISS were associated with longer time until clinical response. Post-voiding residual volume assessment was the only test to have a prognostic value. DISCUSSION Resolution rates of LUTD ranged from 40 to 90%. High resolution rate could be attributed to the long follow-up period, and the chance of spontaneous resolution. Treatment modalities and co-existing NE were associated with longer time until clinical response. Only PVR was associated with prognosis. This was the first study in literature to report such findings. It was seen that the normalization of pathologic patterns was a good sign for treatment success. The DVISS results showed significantly higher rates of incontinence compared to initial symptoms defined by the patients and/or their parents. This showed the importance of using scoring systems to better define the severity of symptoms. It was hard to establish a standardized cut-off value for bladder wall thickness on US. However, US was a good test for diagnosing additional pathologies. CONCLUSION Increased PVR was the single tool that was associated with prognosis and, therefore, should always be performed after UF. In addition, DVISS can help parents be counseled about their treatment expectations.
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Affiliation(s)
- A T Beksac
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - A Koni
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - A C Bozacı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H S Dogan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Tekgul
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Palmer LS. Evaluation and Targeted Therapy of Voiding Dysfunction in Children. Urology 2016; 92:87-94. [DOI: 10.1016/j.urology.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/12/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
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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.
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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
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Awais M, Rehman A, Baloch NUA, Khan F, Khan N. Evaluation and management of recurrent urinary tract infections in children: state of the art. Expert Rev Anti Infect Ther 2014; 13:209-31. [PMID: 25488064 DOI: 10.1586/14787210.2015.991717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Urinary tract infections (UTIs) represent an important cause of febrile illness in young children and can lead to renal scarring and kidney failure. However, diagnosis and treatment of recurrent UTI in children is an area of some controversy. Guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence and European Society of Paediatric Radiology differ from each other in terms of the diagnostic algorithm to be followed. Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are also areas of considerable debate. In this review, we collate and appraise recently published literature in order to formulate evidence-based guidance for the diagnosis and treatment of recurrent UTI in children.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi 74800, Sindh, Pakistan
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Ladi-Seyedian S, Kajbafzadeh AM, Sharifi-Rad L, Shadgan B, Fan E. Management of non-neuropathic underactive bladder in children with voiding dysfunction by animated biofeedback: a randomized clinical trial. Urology 2014; 85:205-10. [PMID: 25444633 DOI: 10.1016/j.urology.2014.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/09/2014] [Accepted: 09/18/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the efficacy of animated biofeedback and pelvic floor muscle (PFM) exercise in managing children with non-neuropathic underactive bladder (UB). METHODS A total of 50 children with UB without underlying neuropathic disease, aged 5-16 years, were included in this study. They were randomly divided into 2 equal treatment groups comprising standard urotherapy (hydration, scheduled voiding, toilet training, and diet) with (group A) or without (group B) animated biofeedback and PFM exercise. The follow-up period for each participant was 1 year. A complete voiding and bowel habit diary was recorded by participants' parents before and after 2 evaluations. In addition, uroflowmetry with electromyography and bladder ultrasound were performed before, 6 months, and 1 year after treatment. Results were compared between the 2 cohorts. RESULTS Mean number of voiding episodes was significantly increased in group A after biofeedback therapy compared with group B with only standard urotherapy (6.6 ± 1.6 vs 4.5 ± 1 times a day; P <.000). Urinary tract infection did not relapse in 9 of 11 (81%) and 8 of 15 (38%) patients in groups A and B, respectively (P <.02). Postvoid residual volume and voiding time decreased considerably, whereas maximum urine flow increased significantly in group A compared with group B (17.2 ± 4.7 vs 12.9 ± 4.6 mL/s; P <.01). CONCLUSION Combination of animated biofeedback and PFM exercise effectively improves sensation of bladder fullness and contractility in children with UB due to voiding dysfunction.
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Affiliation(s)
- Sanam Ladi-Seyedian
- Pediatric Urology Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
| | - Lida Sharifi-Rad
- Department of Physical Therapy, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Babak Shadgan
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Eileen Fan
- UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland
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Vijverberg MA, Stortelder E, de Kort LM, Kok ET, de Jong TP. Long-term Follow-up of Incontinence and Urge Complaints After Intensive Urotherapy in Childhood (75 Patients Followed Up for 16.2-21.8 Years). Urology 2011; 78:1391-6. [DOI: 10.1016/j.urology.2011.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022]
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Desantis DJ, Leonard MP, Preston MA, Barrowman NJ, Guerra LA. Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review. J Pediatr Urol 2011; 7:342-8. [PMID: 21527216 DOI: 10.1016/j.jpurol.2011.02.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Dysfunctional elimination syndrome is associated with an inability to effectively empty the bladder and may present with UTI, incontinence, intestinal constipation or other voiding symptoms. Biofeedback has emerged as one potentially effective and non-invasive treatment. We sought to analyze if biofeedback is an effective method to treat children less than 18 years of age. METHODS A literature search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Database, AUA, CUA, AAP and ESPU abstracts. Copies of all relevant articles were retrieved for quality assessment and data abstraction by two independent reviewers. Primary outcomes were UTIs and daytime incontinence. RESULTS 27 studies were included (1 RCT and 26 case-series). The pooled estimate showed 83% (95% CI: 79%-86%) and 80% (95% CI: 76%-85%) improvement in UTI and daytime incontinence respectively. I(2) statistic showed "Low" (7%) and "High" (77%) heterogeneity across studies results for UTI and daytime incontinence. The only included RCT favored biofeedback over standard therapy (RR 1.4, 95% CI: 0.98-2.00) but this was not statistically significant. On analysis of all included studies there was also improvement in constipation (18%-100%), frequency (67%-100%), urgency (71%-88%) and VUR (21%-100%). PVR improvement ranged from 26 ml to 99 ml and Q(max) improvement was from 3.1 ml/s-4.7 ml/s. CONCLUSION Based on this review, biofeedback is an effective, non-invasive method of treating dysfunctional elimination syndrome, and approximately 80% of children benefited from this treatment. However, most reports were of low level of evidence and studies of more solid design such as RCT should be conducted.
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Affiliation(s)
- Darren J Desantis
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Yang SSD, Chiang IN, Lin CD, Chang SJ. Advances in non-surgical treatments for urinary tract infections in children. World J Urol 2011; 30:69-75. [PMID: 21614468 DOI: 10.1007/s00345-011-0700-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/07/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With growing antibiotics failure due to emerging resistance of bacteria, non-surgical management of pediatric UTI plays a more important role because of its non-invasive characteristics and little adverse effects. METHODS We searched the Pubmed for management of UTI in children other than surgical correction and antibiotics using terms: risk factor, prepuce/phimosis, steroid cream/steroid, behavioral therapy, urotherapy, biofeedback/pelvic floor exercise, adrenergic antagonist, anticholinergics, diet/dietary, dysfunctional voiding/dysfunctional elimination syndrome, constipation, dietary, clean intermittent catheterization, probiotics/lactobacillus, cranberry, vitamin supplement, breastfeeding, breast milk, with infant/child/children/pediatrics/pediatrics and urinary tract infection. RESULTS The proposed non-surgical management of pediatric UTI included behavioral modification (timed voiding and adequate fluids intake), topical steroid for phimosis, nutrient supplements (breast milk, cranberry, probiotics, and vitamin A), biofeedback training for dysfunctional voiding, anticholinergics for reducing intravesical pressure, alpha-blockers in dysfunctional voiding and neurogenic bladder, and intermittent catheterization for children with large PVR. CONCLUSION The published reports usually included small number of patients and were lacking of randomization and controlled group. Further well-designed studies are warranted to support the concepts of non-operative management for pediatric UTI.
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Affiliation(s)
- Stephen Shei-Dei Yang
- Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, No. 289 Chienkuo Road, Xindian City, Taipei, 231, Taiwan
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