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Singh GK, Deshpande AV, Schlegel G, Starkey MR, Taghavi K. The rationale for bladder washouts in children with neurogenic bladder. Neurourol Urodyn 2024; 43:1019-1024. [PMID: 38516982 DOI: 10.1002/nau.25450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non-antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.
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Affiliation(s)
- Gopal-Krsna Singh
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Aniruddh V Deshpande
- Department of Urology, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Center for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- School of Public Health, Westmead, New South Wales, Australia
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Schlegel
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Ronald Starkey
- Bladder and Kidney Health Discovery Program, Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kiarash Taghavi
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Victoria, Australia
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Severe kidney dysfunction in a child who presented with constipation: Answers. Pediatr Nephrol 2021; 36:4079-4082. [PMID: 34331130 DOI: 10.1007/s00467-021-05189-3] [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: 06/09/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
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Hacıislamoğlu A, Ekşi M, Özlü DN, Yavuzsan AH, Evren İ, Karadağ S, Polat H, Kargı T, Taşçı Aİ. Evaluation of the efficacies of methylphenidate and biofeedback treatments in giggle incontinence: One-year follow-up study. J Pediatr Urol 2021; 17:646.e1-646.e5. [PMID: 34417132 DOI: 10.1016/j.jpurol.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/27/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Giggle incontinence is a type of urinary incontinence (GI) that occurs with laughing due to the urinary bladder's involuntary contraction leading to complete emptying. There are studies in the literature that biofeedback therapy or methylphenidate can be effective in the treatment of this condition. OBJECTIVE This study aimed to compare the efficacies of biofeedback therapy and methylphenidate treatment in patients with GI. STUDY DESIGN In this non-randomized observational study, children aged 5-18 years who were diagnosed with GI between January 2014 and December 2019 were included in the study. Patients who were treated by biofeedback were assigned to Group 1, while patients who were given methylphenidate treatment were placed in Group 2. Patients in Group 1 were treated with biofeedback, which was planned once a week for four weeks and once a month for the following two months. They continued their pelvic floor strengthening exercises at home for the following nine months. Patients in Group 2 were prescribed 5 mg oral methylphenidate qid for three months. Patients in both groups were followed up with 3-month intervals within a year. The results were classified as complete response, partial response or no response as per The International Children's Continence Society (ICCS) recommendations. RESULTS The study population consisted of 38 patients with GI. Mean age of the patients was 7.7 (5-11). Among these patients, 31 (81.5%) were female, while 7 (18.4%) were male. Two groups were similar regarding mean patient age and gender distribution. There was no difference between the two groups regarding treatment responses evaluated during the 1st, 3rd, and 6th-month outpatient clinic encounters (p > 0.05). However, treatment responses assessed during the 12th-month outpatient clinic encounter revealed 15 (94.1%) patients with complete response in Group 1, while there were 10 (55.6%) patients who showed complete response in Group 2, with a significant difference (p = 0.03). DISCUSSION Our study showed that treatment responses were reduced after discontinuation of methylphenidate. We achieved high complete response rates in the first, third, sixth, and twelfth-month assessments by biofeedback treatment. CONCLUSIONS Significantly more favorable treatment outcomes were achieved with biofeedback therapy than methylphenidate treatment after completion of 1-year. Multi-center, randomized studies are needed to evaluate efficacy and safety.
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Affiliation(s)
- Ahmet Hacıislamoğlu
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Mithat Ekşi
- Arnavutköy State Hospital, İstanbul, Turkey.
| | - Deniz Noyan Özlü
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Abdullah Hızır Yavuzsan
- University of Health Sciences, Sisli Hamidiye Etfal Training & Research Hospital, Department of Urology, Istanbul, Turkey.
| | - İsmail Evren
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Serdar Karadağ
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Hakan Polat
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Taner Kargı
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
| | - Ali İhsan Taşçı
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, İstanbul, Turkey.
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Tas D, Ekinci S, Akgül S, Düzçeker Y, Derman O, Kanbur N. Bladder and voiding dysfunction in adolescents with anorexia nervosa: a novel finding and potential causes. Eat Weight Disord 2020; 25:1755-1762. [PMID: 31813115 DOI: 10.1007/s40519-019-00827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/02/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aimed to investigate the bladder capacity (BC) and bladder dynamics of adolescents with anorexia nervosa (AN). METHODS The participants consisted of 15 adolescents newly diagnosed with AN according to the DSM 5 criteria and in the acute weight loss period who were questioned about the symptoms of lower urinary tract (LUT) dysfunction. Functional bladder capacity (FBC) and voided volume with uroflowmetry were measured for each subject; the larger volume of the two was chosen for the bladder capacity. Uroflowmetry was used to obtain uroflow curves for the participants whose patterns were labeled as pathologic if they were outside the bell-shape. RESULTS Fourteen (93.3%) of the patients exhibited at least one of the LUT dysfunction symptoms (pathologic voiding symptom/urinary incontinence/pathologic uroflow pattern). BC was observed to increase in 86.6% (n = 13) of the patients. Eighty% of the patients (n = 12) showed pathological uroflow patterns. In patients with pathological uroflow patterns, which showed insufficiency of bladder contraction, assistance of abdominal muscles was needed during voiding. CONCLUSION The novel findings presented in this study are the increase of BC in adolescents with AN, the presence of at least one type of voiding or bladder dysfunction, and the pathology of uroflow patterns of most patients show that the bladder dynamics is affected in AN. The most important contribution of this study to the literature is that impaired bladder dynamics was determined to be a medical complication of AN. LEVEL OF EVIDENCE Case-control analytic study, Level III.
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Affiliation(s)
- Demet Tas
- Children Hospital Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Yasemin Düzçeker
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Orhan Derman
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
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Mannemuddhu SS, Bayne CE, Tufan Pekkucuksen N, Shoemaker LR. Attention to detail: not simple bed wetting-Hinman-Allen syndrome. J Nephrol 2020; 34:247-250. [PMID: 32720135 DOI: 10.1007/s40620-020-00810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Sai Sudha Mannemuddhu
- Division of Nephrology, Department of Pediatrics, University of Florida-College of Medicine, 1600 SW Archer Rd, HD-214, Gainesville, FL, 32610, USA.
| | - Christopher E Bayne
- Division of Pediatric Urology, Department of Urology, University of Florida-College of Medicine, Gainesville, FL, 32610, USA
| | - Naile Tufan Pekkucuksen
- Division of Nephrology, Department of Pediatrics, University of Florida-College of Medicine, 1600 SW Archer Rd, HD-214, Gainesville, FL, 32610, USA
| | - Lawrence R Shoemaker
- Division of Nephrology, Department of Pediatrics, University of Florida-College of Medicine, 1600 SW Archer Rd, HD-214, Gainesville, FL, 32610, USA
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Middleton T, Ellsworth P. Pharmacologic therapies for the management of non-neurogenic urinary incontinence in children. Expert Opin Pharmacother 2019; 20:2335-2352. [PMID: 31644331 DOI: 10.1080/14656566.2019.1674282] [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] [Indexed: 01/30/2023]
Abstract
Introduction: Non-neurogenic urinary incontinence in children is a common condition that affects the quality of life for both patients and parents. Symptoms may occur in the daytime, nighttime, or both and may be the result of structural and functional anomalies. Evaluation and management of associated co-morbidities, such as constipation is critical to management. Behavioral therapy is a fist line therapy in most cases of non-neurogenic urinary incontinence and pharmacologic therapy a second-line therapy.Areas covered: In this review, the authors cover the pharmacologic agents, FDA approved and commonly used non-FDA approved, available for the treatment of four non-structural etiologies of non-neurogenic urinary incontinence in children. These include nocturnal enuresis, overactive bladder, giggle incontinence, and dysfunctional voiding.Expert opinion: Non-neurogenic causes of urinary incontinence in children represent a complicated medical condition that requires both pharmacologic and non-pharmacologic management. Limited FDA-approved therapies as well as suboptimal results with approved therapies due to a lack in the understanding of the underlying pathophysiology and patient selection may lead to the use of alternative non-FDA approved therapies.
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Affiliation(s)
- Tiernan Middleton
- Class of 2020, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Pamela Ellsworth
- Pediatric Urology, Nemours Children's Hospital, Orlando, FL, USA.,Urology, Central Florida College of Medicine, Orlando, FL, USA
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Buckley BS, Sanders CD, Spineli L, Deng Q, Kwong JSW. Conservative interventions for treating functional daytime urinary incontinence in children. Cochrane Database Syst Rev 2019; 9:CD012367. [PMID: 31532563 PMCID: PMC6749940 DOI: 10.1002/14651858.cd012367.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In children, functional daytime urinary incontinence is the term used to describe any leakage of urine while awake that is not the result of a known underlying neurological or congenital anatomic cause (such as conditions or injuries that affect the nerves that control the bladder or problems with the way the urinary system is formed). It can result in practical difficulties for both the child and their family and can have detrimental effects on a child's well-being, education and social engagement. OBJECTIVES To assess the effects of conservative interventions for treating functional daytime urinary incontinence in children. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains studies identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 11 September 2018). We also searched Chinese language bibliographic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang. No language restrictions were imposed. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised, multi-arm studies, cross-over studies and cluster-randomised studies that included children aged between 5 and 18 years with functional daytime urinary incontinence. DATA COLLECTION AND ANALYSIS Two review authors independently screened records and determined the eligibility of studies for inclusion according to predefined criteria. Where data from the study were not provided, we contacted the study authors to request further information. Two review authors assessed risk of bias and processed included study data as described in the Cochrane Handbook for Systematic Reviews of Interventions. Where meta-analysis was possible, we applied random-effects meta-analysis using the Mantel-Haenszel method for dichotomous outcomes. MAIN RESULTS The review included 27 RCTs involving 1803 children. Of these, six were multi-arm and one was also a cross-over study. Most studies were small, with numbers randomised ranging from 16 to 202. A total of 19 studies were at high risk of bias for at least one domain. Few studies reported data suitable for pooling due to heterogeneity in interventions, outcomes and measurements.Individual conservative interventions (lifestyle, behavioural or physical) versus no treatmentTranscutaneous electrical nerve stimulation (TENS) versus sham (placebo) TENS. More children receiving active TENS may achieve continence (risk ratio (RR) 4.89, 95% confidence interval (CI) 1.68 to 14.21; 3 studies; n = 93; low-certainty evidence).One individual conservative intervention versus another individual or combined conservative interventionPelvic floor muscle training (PFMT) with urotherapy versus urotherapy alone. We are uncertain whether more children receiving PFMT with urotherapy achieve continence (RR 2.36, 95% CI 0.65 to 8.53, 95% CI 25 to 100; 3 studies; n = 91; very low-certainty evidence).Voiding education with uroflowmetry feedback and urotherapy versus urotherapy alone. Slightly more children receiving voiding education with uroflow feedback and urotherapy may achieve continence (RR 1.13, 95% CI 0.87 to 1.45; 3 studies; n = 151; low-certainty evidence).Urotherapy with timer watch versus urotherapy alone. We are uncertain whether urotherapy plus timer watch increases the number of children achieving continence compared to urotherapy alone (RR 1.42, 95% CI 1.12 to 1.80; 1 study; n = 58; very low-certainty evidence).Combined conservative interventions versus other combined conservative interventionsTENS and standard urotherapy versus PFMT with electromyographic biofeedback and standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.11, 95% CI 0.73 to 1.68; 1 study; n = 78; very low-certainty evidence).PFMT with electromyography biofeedback and standard urotherapy versus PFMT without feedback but with standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.05, 95% CI 0.72 to 1.52; 1 study; n = 41; very low-certainty evidence).Individual conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)PFMT versus anticholinergics. We are uncertain whether more children receiving PFMT than anticholinergics achieve continence (RR 1.92, 95% CI 1.17 to 3.15; equivalent to an increase from 33 to 64 per 100 children; 2 studies; n = 86; very low-certainty evidence).TENS versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 0.81, 95% CI 0.05 to 12.50; 2 studies; n = 72; very low-certainty evidence).Combined conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)Voiding education with uroflowmetry feedback versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportion of children achieving continence (RR 1.02, 95% CI 0.58 to 1.78; 1 study; n = 64; very low-certainty evidence). AUTHORS' CONCLUSIONS The review found little reliable evidence that can help affected children, their carers and the clinicians working with them to make evidence-based treatment decisions. In this scenario, the clinical experience of individual clinicians and the support of carers may be the most valuable resources. More well-designed research, with well-defined interventions and consistent outcome measurement, is needed.
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Affiliation(s)
- Brian S Buckley
- University of the PhilippinesDepartment of SurgeryManilaPhilippines
| | - Caroline D Sanders
- University of Northern British ColumbiaSchool of Nursing3333 University WayPrince GeorgeBritish ColumbiaCanadaV7M 2A9
| | - Loukia Spineli
- Hannover Medical SchoolDepartment of Obstetrics, Gynecology and Reproductive Medicine, Midwifery Research UnitCarl‐Neuberg‐Straße 1HannoverGermany30625
| | - Qiaoling Deng
- Zhongnan Hospital of Wuhan UniversityClinical Laboratory169 Donghu RoadWuhanHubei ProvinceChina430071
| | - Joey SW Kwong
- United Nations Population FundAsia and the Pacific Regional Office4th Floor, United Nations Service BuildingRajdamnern Nok AvenueBangkokThailand10200
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Logan BL, Blais S. Giggle incontinence: Evolution of concept and treatment. J Pediatr Urol 2017; 13:430-435. [PMID: 28673794 DOI: 10.1016/j.jpurol.2017.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Giggle incontinence is a sudden and involuntary episode of urinary incontinence that is provoked by an episode of laughter. Decades of case studies and small research studies have formed the basis of what is known about giggle incontinence; however, much remains unknown about this type of incontinence, leaving the recommendations for clinical management somewhat unguided. METHODS A systematic review of 22 articles on the topic of "giggle incontinence" and related terms was conducted, including all published articles and commentaries since the term was first seen in print in 1959. RESULTS This review provides a historical context for the diagnosis, a summary of what is known about its etiology, and a summary of current treatments. CONCLUSIONS There is disagreement about the pathophysiology of laughter incontinence, with two differing explanations. The first emphasizes the neurologic origin of the cascade of events during laughter and urination, and draws a likeness to cataplexy and other CNS disorders, and emphasizes treatment with methylphenidate. The second emphasizes urologic dysfunction, with biofeedback and bladder retraining as the recommended therapy. Comprehensive treatment of children with laughter incontinence requires an appreciation of both concepts. Since inception of the concept there has been question about the appropriateness of the term "giggle incontinence." This review encourages discussion among readers/clinicians about the term and the essential qualities of the diagnosis.
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Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trial. J Pediatr Urol 2017; 13:263.e1-263.e6. [PMID: 28089606 DOI: 10.1016/j.jpurol.2016.11.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/15/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, and its main manifestation is urinary urgency. In general, urotherapy and anticholinergics are the first choices of treatment. Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative for the treatment of detrusor overactivity in children, but treatment protocols described to date require several sessions per week or long-lasting sessions, making it difficult for the child to adhere to the treatment. Thus, this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children. STUDY DESIGN This prospective, randomized controlled trial included 16 children with OAB. Children were divided into two groups: CG (urotherapy and electrical stimulation placebo) and EG (urotherapy and PTENS). For both groups, therapy was delivered in 20 weekly sessions, of duration 20 min each. Placebo electrical stimulation was done in the scapular area. The children were evaluated prior to treatment (T1), at the end of the 20 sessions (T2), and 60 days after the completion of treatment (T3), with a 3-day voiding diary, visual analogue scale (VAS), Rome III diagnostic criteria, and the Bristol Scale. RESULTS The groups were similar in age, gender, and ethnicity. In the initial assessment, all children, in both groups, had urgency and incontinence, 50% in each group had constipation, and enuresis was present in seven children (87.5%) in the EG and six (75%) in the CG. No differences were found between the groups regarding the volumetric measurements made in the voiding diary, urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale. Sixty days after treatment, a significant improvement was found in the EG group (p = 0.03) regarding urgency (Table), as well as an increase in dry nights in those presenting with enuresis (p = 0.03). No difference was noted regarding urinary incontinence (Table). At the end of 20 sessions and after 60 days of treatment, those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS (p = 0.05 and 0.04, respectively). CONCLUSIONS Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis, and in the perception of those responsible for the children. Further studies with larger populations are needed to corroborate these results.
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Sampaio C, Sousa AS, Fraga LGA, Veiga ML, Bastos Netto JM, Barroso U. Constipation and Lower Urinary Tract Dysfunction in Children and Adolescents: A Population-Based Study. Front Pediatr 2016; 4:101. [PMID: 27752507 PMCID: PMC5046079 DOI: 10.3389/fped.2016.00101] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between constipation and lower urinary tract dysfunction (LUTD) and nocturnal enuresis in a population-based study. MATERIAL AND METHODS This is a cross-sectional study. The criteria for inclusion were children and adolescents of between 5 and 17 years and who agreed to sign the informed consent form. The study excluded students with neurological problems or who had documented abnormalities of the urinary tract. To identify the presence and severity of LUTD, we used the Voiding Dysfunction Symptom Score (DVSS). To evaluate the presence of constipation, Rome III questionnaire was used. RESULTS We interviewed 829 children and adolescents, of which 416 (50.18%) were male. The mean (SD) age was 9.1 (±2.9) years. The overall prevalence of LUTD was 9.1%, predominantly in girls (15 versus 3.1%, p < 0.001). Constipation was found in 9.4% of boys and 12.4% of girls (p = 0.169). Constipated children were 6.8 times more likely to have LUTD than those not constipated (p < 0.001, coefficient and correlation of 0.411). Constipation was found in 8.2% of children without LUTD and in 35.2% of children with LUTD. We performed multivariate analysis to identify urinary symptoms that are independent predictors of the presence of constipation. The presence of infrequent urination (p = 0.004) and holding maneuvers (p < 0.001) were independent predictors. It was noted also noted that constipated children, according to the Rome III criteria, possess a worse DVSS (p < 0.001). Regarding the presence of nocturnal enuresis, 12.6% of children and adolescents had constipation in association with this symptom. However, this relationship was not statistically significant (p = 0.483). CONCLUSION Constipated children were 6.8 times more likely to have LUTD than those not constipated. Among the urinary symptoms, infrequent voiding and holding maneuvers are independent factors of urinary expressions in constipated children. Children with more severe constipation have more prominent urinary symptoms. The presence of enuresis was not associated with constipation.
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Affiliation(s)
- Clara Sampaio
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Ariane Sampaio Sousa
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Luis Gustavo A Fraga
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Maria Luiza Veiga
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - José Murillo Bastos Netto
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Ubirajara Barroso
- Centro de Distúrbios Miccionais na Infância (CEDIMI), Escola Bahiana de Medicina e Saúde Pública, Universidade Federal da Bahia, Salvador, Brazil; Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
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Gurocak S, Konac E, Ure I, Senol C, Onen IH, Sozen S, Menevse A. The Impact of Gene Polymorphisms on the Success of Anticholinergic Treatment in Children with Overactive Bladder. DISEASE MARKERS 2015; 2015:732686. [PMID: 26166934 PMCID: PMC4488149 DOI: 10.1155/2015/732686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/30/2023]
Abstract
AIM To determine the impact of gene polymorphisms on detrusor contraction-relaxation harmony in children with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS Toilet trained children older than 5 years of age with LUTS and normal neurological examination underwent videourodynamic study. The control group was composed of age matched children with no voiding complaints. The study group who filled out the voiding dysfunction symptom score before and after the treatment received standard oxybutynin treatment and was reevaluated 1 year after treatment. Genomic DNA was isolated from all patients and subjected to PCR for amplification. Genotyping of ARGHEF10, ROCK2, ADRB3, and CYP3A4 was carried out with Polymerase Chain Reaction- Restriction Fragment Length Polymorphism (PCR-RFLP) method. RESULTS 34 (45%) and 42 (55%) patients were enrolled in the study and control group, respectively. ARGEF10 GG, ADRB3 TC, and CYP3A4 AG genotype patients displayed insignificant difference between pre- and posttreatment voiding dysfunction symptom score and bladder volumes. CONCLUSIONS The polymorphism of genes in the cholinergic pathway did not significantly differ clinical parameters. On the other hand, polymorphic patients in the adrenergic pathway seemed to suffer from clinical disappointment. For this reason, we think that the neglected adrenergic pathway could be a new therapeutic target for the treatment of anticholinergic resistant LUTS in children.
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Affiliation(s)
- Serhat Gurocak
- Department of Urology, Gazi University School of Medicine, 06500 Ankara, Turkey
- Department of Medical Biology and Genetics, Gazi University School of Medicine, 06500 Ankara, Turkey
| | - Ece Konac
- Department of Medical Biology and Genetics, Gazi University School of Medicine, 06500 Ankara, Turkey
| | - Iyimser Ure
- Department of Urology, Osmangazi University School of Medicine, 26040 Eskisehir, Turkey
| | - Cem Senol
- Department of Urology, Gazi University School of Medicine, 06500 Ankara, Turkey
| | - Ilke Hacer Onen
- Department of Medical Biology and Genetics, Gazi University School of Medicine, 06500 Ankara, Turkey
| | - Sinan Sozen
- Department of Urology, Gazi University School of Medicine, 06500 Ankara, Turkey
| | - Adnan Menevse
- Department of Medical Biology and Genetics, Gazi University School of Medicine, 06500 Ankara, Turkey
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Genetics of human congenital urinary bladder disease. Pediatr Nephrol 2014; 29:353-60. [PMID: 23584850 DOI: 10.1007/s00467-013-2472-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 01/23/2023]
Abstract
Lower urinary tract and/or kidney malformations are collectively the most common cause of end-stage renal disease in children, and they are also likely to account for a major subset of young adults requiring renal replacement therapy. Advances have been made regarding the discovery of the genetic causes of human kidney malformations. Indeed, testing for mutations of key nephrogenesis genes is now feasible for patients seen in nephrology clinics. Unfortunately, less is known about defined genetic bases of human lower urinary tract anomalies. The focus of this review is the genetic bases of congenital structural and functional disorders of the urinary bladder. Three are highlighted. First, prune belly syndrome, where mutations of CHRM3, encoding an acetylcholine receptor, HNF1B, encoding a transcription factor, and ACTA2, encoding a cytoskeletal protein, have been reported. Second, the urofacial syndrome, where mutations of LRIG2 and HPSE2, encoding proteins localised in nerves invading the fetal bladder, have been defined. Finally, we review emerging evidence that bladder exstrophy may have genetic bases, including variants in the TP63 promoter. These genetic discoveries provide a new perspective on a group of otherwise poorly understood diseases.
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Thyoka M, Henderson A, Starzyk B, Lall A. Two siblings with unbalanced t(10;21) translocations and non-neuropathic neuropathic bladder. BMJ Case Rep 2014; 2014:bcr-2013-201757. [PMID: 24510694 DOI: 10.1136/bcr-2013-201757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an unusual case of two siblings, aged 5 years and 5 months, with an unbalanced t(10;21) translocation and concomitant non-neuropathic neuropathic bladder abnormalities, whose father was a known balanced carrier of the translocation, t(10;21). Postnatally both siblings had normal spine and neurological examination. However, ultrasound scans and micturition cystourethrograms revealed grossly distended non-neuropathic neuropathic bladder. In both siblings, the bladder abnormalities responded to clean intermittent catheterisation. On follow-up, dimercaptosuccinic acid scans for both siblings showed equal split function with no scarring.
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14
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Sanders C, Bray L. Young people's evaluation of a nurse-led bladder training service: working towards developing a patient reported experience and outcome measure. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2013. [DOI: 10.1111/j.1749-771x.2012.01164.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Stuart H, Roberts N, Burgu B, Daly S, Urquhart J, Bhaskar S, Dickerson J, Mermerkaya M, Silay M, Lewis M, Olondriz M, Gener B, Beetz C, Varga R, Gülpınar Ö, Süer E, Soygür T, Özçakar Z, Yalçınkaya F, Kavaz A, Bulum B, Gücük A, Yue W, Erdogan F, Berry A, Hanley N, McKenzie E, Hilton E, Woolf A, Newman W. LRIG2 mutations cause urofacial syndrome. Am J Hum Genet 2013; 92:259-64. [PMID: 23313374 PMCID: PMC3567269 DOI: 10.1016/j.ajhg.2012.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/23/2012] [Accepted: 12/05/2012] [Indexed: 01/23/2023] Open
Abstract
Urofacial syndrome (UFS) (or Ochoa syndrome) is an autosomal-recessive disease characterized by congenital urinary bladder dysfunction, associated with a significant risk of kidney failure, and an abnormal facial expression upon smiling, laughing, and crying. We report that a subset of UFS-affected individuals have biallelic mutations in LRIG2, encoding leucine-rich repeats and immunoglobulin-like domains 2, a protein implicated in neural cell signaling and tumorigenesis. Importantly, we have demonstrated that rare variants in LRIG2 might be relevant to nonsyndromic bladder disease. We have previously shown that UFS is also caused by mutations in HPSE2, encoding heparanase-2. LRIG2 and heparanase-2 were immunodetected in nerve fascicles growing between muscle bundles within the human fetal bladder, directly implicating both molecules in neural development in the lower urinary tract.
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Affiliation(s)
- Helen M. Stuart
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Neil A. Roberts
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Berk Burgu
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Sarah B. Daly
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Jill E. Urquhart
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Sanjeev Bhaskar
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Jonathan E. Dickerson
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Murat Mermerkaya
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Mesrur Selcuk Silay
- Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Malcolm A. Lewis
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - M. Beatriz Orive Olondriz
- Unidad de Nefrología Infantil, Servicio de Pediatría, Hospital Universitario Araba, Vitoria-Gasteiz 01009, Spain
| | - Blanca Gener
- Servicio de Genética, Hospital Universitario Cruces, Baracaldo, Vizcaya 48903, Spain
| | - Christian Beetz
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena 07747, Germany
| | - Rita E. Varga
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena 07747, Germany
| | - Ömer Gülpınar
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Evren Süer
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Tarkan Soygür
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Zeynep B. Özçakar
- Department of Urology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Fatoş Yalçınkaya
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Aslı Kavaz
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Burcu Bulum
- Department of Pediatric Nephrology, School of Medicine, Ankara University, Ankara 06100, Turkey
| | - Adnan Gücük
- Department of Urology, Faculty of Medicine, Abant Izzet Baysal University, Bolu 14280, Turkey
| | - Wyatt W. Yue
- Structural Genomics Consortium, Old Road Campus Research Building, University of Oxford, Oxford OX3 7DQ, UK
| | - Firat Erdogan
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul 34718, Turkey
| | - Andrew Berry
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Neil A. Hanley
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Edward A. McKenzie
- Protein Expression Facility, Manchester Institute of Biotechnology, Faculty of Life Sciences, University of Manchester, Manchester M1 7DN, UK
| | - Emma N. Hilton
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - Adrian S. Woolf
- Centre for Paediatrics and Child Health, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and the Royal Manchester Children’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
| | - William G. Newman
- Centre for Genetic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester and St. Mary’s Hospital, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Doxazosin Versus Tizanidine for Treatment of Dysfunctional Voiding in Children: A Prospective Randomized Open-labeled Trial. Urology 2012; 79:428-33. [DOI: 10.1016/j.urology.2011.10.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/14/2011] [Accepted: 10/21/2011] [Indexed: 11/20/2022]
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17
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Perkins J, Johnson CM. Vaginal weights for pelvic floor training: a multiple participant case report. Physiother Theory Pract 2012; 28:499-508. [PMID: 22288659 DOI: 10.3109/09593985.2011.653708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Activity-related incontinence is a problem for women, many with limited access to specialty clinics and practitioners. Incontinence inhibits participation in health-promoting levels of physical activity. Vaginal weights are a treatment option available without a prescription for home use that may help some of these women. This multiple baseline across-participant case study investigated the use of weights in a 'hands-off' pelvic floor exercise program for pre-menopausal women. Three of four participants improved, but did not cure, their incontinence with use of the weights. A fourth participant was unable to successfully use the weights. Referral to a women's health physical therapist was suggested for her. Poor adherence was noted at follow-up in two of three participants, with the one who maintained practice demonstrating continued improvement and increased physical activity. Weights provide a low-cost exercise adjunct to women interested in a flexible and independent incontinence management program. For continued improvement, behavioral factors promoting adherence should also be addressed. Weights are one of the options for women wanting a low-cost solution for activity-related urinary leakage. Problems using the weights or failure to benefit from their use may be indicators of a need for more advanced evaluation by women's health specialists.
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Affiliation(s)
- Jan Perkins
- Graduate Program in Physical Therapy, HPB 1220, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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18
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Tyritzis SI, Skolarikos A. Reply. Urology 2011. [DOI: 10.1016/j.urology.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lower Urinary Tract Dysfunction: A Childhood Problem in Adults? CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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