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Li F, Feng L, Yang Y, Ma X, Kang T, Huang W. The effect of biofeedback on nonneurological dysfunctional voiding in children: A meta-analysis and systematic review. J Pediatr Urol 2024; 20:565-580. [PMID: 38997937 DOI: 10.1016/j.jpurol.2024.06.042] [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: 05/23/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE This study was conducted to investigate the effect of biofeedback (BF) on the rehabilitation of children with nonneurological dysfunctional voiding (NDV). METHODS RCTs were retrieved from various databases (published from inception to February 29, 2024). The effects of the BF and non-BF treatments were compared. A random-effects model was used to evaluate the combined data. RESULTS Meta-analysis revealed that BF increased the maximum urinary flow rate (SMD = 3.78, 95% CI 1.33∼6.22), improved urination time (SMD = 5.88, 95% CI 3.75∼8.01), and reduced the postvoid residual (SMD = -19.18, 95% CI -27.03∼-11.33) and urinary tract infection incidence (RR = 0.43, 95% CI 0.21∼0.87). Electromyogram activity (RR = 0.46, 95% CI 0.25∼0.84) and abnormal urination patterns (RR = 0.51, 95% CI 0.35∼0.74) improved, with effects persisting for more than 1 year. However, the effect of BF on the mean urinary flow rate in children with NDV was significant only after 1 year of follow-up (SMD = 1.90, 95% CI 0.87∼2.92). CONCLUSION Existing evidence indicates that BF can enhance urinary parameters and patterns in children with NDV. However, its effectiveness in addressing constipation, daytime urinary incontinence, and nocturnal urinary incontinence is not substantial. High-quality randomized controlled trials can offer additional insights.
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Affiliation(s)
- Fangqin Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Liwei Feng
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Yang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xueping Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Kang
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Wenjiao Huang
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.
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Hoelscher SAA, de Angst IB, Buijnsters ZA, Bramer WM, Akkermans FW, Kuindersma ME, Scheepe JR, Hoen LA'. The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding - A systematic review. J Pediatr Urol 2024; 20:211-218. [PMID: 38135586 DOI: 10.1016/j.jpurol.2023.10.034] [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: 05/29/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV. OBJECTIVE The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. METHODS A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. RESULTS From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33-69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. CONCLUSIONS BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.
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Affiliation(s)
- S A A Hoelscher
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - I B de Angst
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Z A Buijnsters
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - F W Akkermans
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M E Kuindersma
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J R Scheepe
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L A 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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von Gontard A, Kuwertz-Bröking E. [Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:375-400. [PMID: 37272401 DOI: 10.1024/1422-4917/a000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract: Objective: Enuresis and daytime urinary incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. This interdisciplinary guideline summarizes the current state of knowledge regarding somatic and psychiatric assessment and treatment. We formulate consensus-based, practical recommendations. Methods: The members of this guideline commission consisted of 18 professional associations. The guideline results from current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: According to the International Children's Continence Society (ICCS), there are four different subtypes of nocturnal enuresis and nine subtypes of daytime urinary incontinence. Organic factors first have to be excluded. Clinical and noninvasive assessment is sufficient in most cases. Standard urotherapy is the mainstay of treatment. If indicated, one can add specific urotherapy and pharmacotherapy. Medication can be useful, especially in enuresis and urge incontinence. Psychological and somatic comorbid disorders must also be addressed. Conclusions: The recommendations of this guideline were passed with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required especially regarding functional (nonorganic) daytime urinary incontinence.
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Affiliation(s)
- Alexander von Gontard
- Psychiatrische Dienste Graubünden, Ambulante Dienste für Kinder- und Jugendpsychiatrie, Chur, Schweiz
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, Niederlande
| | - Eberhard Kuwertz-Bröking
- Ehemals: Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Nephrologie, Münster, Deutschland
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4
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Rouse CM. Pediatric Psychology in a Urology Division: Unifying Complex Medical and Mental Health Treatment. Curr Urol Rep 2023; 24:17-24. [PMID: 36434371 DOI: 10.1007/s11934-022-01127-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although pediatric psychology is heavily involved in many medical divisions, its involvement in a urology division is still relatively new and its role continuously evolving and growing. RECENT FINDINGS This article reviews the limited research on the use of psychology in a urology division, including psychosocial struggles across urology diagnoses, dysfunctional voiding, and anxiety surrounding medical procedures and surgery. Urinary diagnoses and presenting problems seen by pediatric psychologists and medical providers at an urban children's hospital are also included. Based on the complex conditions and varied presenting concerns in a urology division, potential assessments and future research are suggested to help gather data for this population moving forward and expand the literature on urology psychology.
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Affiliation(s)
- Christina M Rouse
- Division of Urology, Civic Center Boulevard, Children's Hospital of Philadelphia, Philadelphia, PA, 19141, USA.
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Dönmez Mİ, Selvi I, Dereli E, Özgür K, Oktar T, Ziylan O. Maintenance biofeedback therapy for dysfunctional voiding: Does every child need it? Int J Urol 2023; 30:83-90. [PMID: 36305569 DOI: 10.1111/iju.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of the present study is to analyze the long-term clinical outcomes in children who were treated with biofeedback therapy (BF) for dysfunctional voiding (DV) and to determine the need for maintenance of BF due to clinical relapse. METHODS Files of children with DV who underwent BF between 2013 and 2020 were retrospectively reviewed. Patients with neurological or anatomical problems were excluded. A total of 64 patients (52 girls, 12 boys) with a mean age of 8.89 ± 2.48 years who completed the initial BF sessions were included in the study. The demographic and clinical data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters were recorded before and after the initial BF sessions. Clinical success was regarded as the cessation of electromyography activity as well as concurrent resolution of lower urinary tract symptoms and improvement in uroflowmetry parameters. After the initial BF sessions, children who had initial success showed DV relapse at any time during follow-up received the maintenance BF sessions. Therefore, the patients with successful initial BF were divided into two groups: the group that needed maintenance BF, and the group which required no maintenance BF. RESULTS Clinical success was achieved in 48 (75.0%) of 64 children following a median of 6 sessions (range 2-8). At the follow-up, 10 (20.8%) out of 48 patients showed symptom relapse at a median of 8 months (range 2-24 months). After a median of 3.5 maintenance BF sessions (range 1-6), clinical success was observed in all patients. Both groups showed a significant DVSS decrease after initial BF, however, those who needed maintenance had significantly higher DVSS (6.80 ± 2.53 vs. 3.61 ± 1.12, p < 0.001). At admission, DVSS <17.5 (odds ratio [OR]: 4.31, p = 0.025) and post-voiding residual volume as a percentage of estimated bladder capacity for age <28.9 (OR: 5.00, p = 0.009) were found as the predictive factors for initial BF success. The need for maintenance BF was 2.56-fold higher with a DVSS above 5.5 after initial BF sessions. CONCLUSIONS Our results show that despite a clinical success rate of 75% after the initial BF, relapse can be seen within 2 years in approximately 20% of the patients. Nevertheless, maintenance of BF may provide clinical success in all patients. Relatively higher DVSS after initial BF can be used as a predictor of the need for maintenance BF.
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Affiliation(s)
- Muhammet İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismail Selvi
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Dereli
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kerime Özgür
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tayfun Oktar
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Qi W, Zhou Y, Zhong M, Lv G, Li R, Wang W, Li Y, Shi B, Guo H, Zhang Q. The effect of biofeedback treatment for children with non-neurogenic voiding dysfunction: A systematic review and meta-analysis. Neurourol Urodyn 2022; 41:868-883. [PMID: 35191548 DOI: 10.1002/nau.24886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/28/2021] [Accepted: 01/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Children's non-neurogenic voiding dysfunction (NVD) is a syndrome characterized by lower urinary tract symptoms (LUTs) because of the inability to relax the external sphincter. Patients with NVD always suffer from urinary tract infections (UTI), incontinence, constipation. The aim of this study is to assess the efficacy of biofeedback treatment for children's NVD. METHODS PubMed, Embase, Cochrane library database were searched for all relevant studies. Two independent reviewers decided whether to include the study, conducted quality evaluation, and extracted article data. A random-effects model was used to calculate overall effect sizes. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) served as the summary statistics for meta-analysis. And sensitivity analysis was subsequently performed. RESULTS Fifteen studies and 1274 patients were included in the systemic review, seven RCTs and 539 patients were included in meta-analysis. Meta-analysis showed efficacy of biofeedback treatment in following aspects, (1) relieving UTI (RR: 1.71, 95% CI: 1.11 to 2.64), (2) reducing PVR (MD: 9.51, 95% CI: 2.03 to 16.98), (3) increasing maximum urine flow rate (MD: 4.28, 95% CI: 2.14 to 6.42) and average urine flow rate (MD: 1.49, 95% CI: 0.53 to 2.46), (4) relieving constipation (RR: 1.59, 95% CI: 1.12 to 2.26),(5) improving abnormal voiding pattern (RR: 1.75, 95% CI: 1.30 to 2.36) and abnormal EMG during voiding (RR: 1.55, 95% CI: 1.25 to 1.91). The improvement of UTI symptoms, maximum urine flow rate and average urine flow rate took a longer time (12 months). In terms of daytime incontinence (RR: 1.20, 95% CI [0.96, 1.50], p = 0.11), nighttime incontinence (RR: 1.20, 95% CI [0.62, 2.32], p = 0.58), no significant difference was found between biofeedback treatment and standard urotherapy. The qualitative analysis showed that biofeedback treatment was beneficial for NVD. CONCLUSION Compared with standard urotherapy, biofeedback treatment is effective for some symptoms, such as UTI and constipation, and can improve some uroflowmetric parameters, such as PVR. Biofeedback treatment seems to have a better long-term effect.
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Affiliation(s)
- Wenqiang Qi
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yongheng Zhou
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Minglei Zhong
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guangda Lv
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Rongyang Li
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenfu Wang
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Li
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Benkang Shi
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hu Guo
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiujie Zhang
- Department of Urology Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
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Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
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Nieuwhof-Leppink AJ, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P, Yang S, von Gontard A. Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). J Pediatr Urol 2021; 17:172-181. [PMID: 33478902 DOI: 10.1016/j.jpurol.2020.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Urotherapy is an umbrella term for all non-surgical, non-pharmacological interventions for lower urinary tract disorders (LUTD) in children and adolescents. Urotherapy is a specialized practice, which has become mainstay therapy not only for daytime urinary incontinence, but also for nocturnal enuresis, functional constipation and fecal incontinence. The aim of urotherapy is to achieve the normalization of the micturition and bowel pattern and to prevent further functional disturbances by repeated training. It is well known that in the treatment of adult and childhood incontinence a team approach is best, where there are shared areas of expertise and also discipline-specific expertise available. AIM We present a consensus view from a cross-professional team of experts affiliated with the International Children's Continence Society on definitions, indications and practice of urotherapy. This is a selective, non-systematic review with practical recommendations for the implementation and research on urotherapy. METHODS The document uses the globally accepted ICCS terminology. Evidence-based literature serves as the basis, but in areas lacking in primary evidence, expert consensus is used. Before submission, a full draft was made available to all ICCS members for additional comments. RESULTS Urotherapy uses non-pharmacological, non-surgical methods and focuses on behavioral interventions, largely based on cognitive-behavioral psychotherapy (CBT). Standard urotherapy comprises components such as provision of information, instructions, life-style advice, counselling and registration of symptoms. Specific urotherapy is tailored towards specific disorders and includes alarm treatment, biofeedback training, pelvic floor training, neurostimulation and other interventions. Fig. 1. Urotherapy is a treatment that addresses all aspects of incontinence, leading to the best clinical outcome. This includes somatic, psychosocial, and behavioral problems and quality of life. Therefore urotherapy is recommended by the ICCS as the first-line treatment for most types of LUTD. The document is intended to be clinically useful in primary, secondary and tertiary care.
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Affiliation(s)
- A J Nieuwhof-Leppink
- Department Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
| | - J Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital Homburg, Germany
| | - J Chase
- Victorian Children's Continence Clinic, Paediatric Gastroenterology Victoria, Royal Children's Hospital, Melbourne, Australia
| | - J Larsson
- Section for Paediatric Nephrology, Kristianstad Hospital CSK, Sweden
| | - C Renson
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - S Yang
- Department of Urolgy, Taipei Tzu Chi Hospital and Buddhist Tzu Chi Universtiy, New Taipei, Taiwan
| | - A von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital Homburg, Germany
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Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
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Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
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Darling KE, Benore ER, Webster EE. Biofeedback in pediatric populations: a systematic review and meta-analysis of treatment outcomes. Transl Behav Med 2020; 10:1436-1449. [PMID: 31420986 DOI: 10.1093/tbm/ibz124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Biofeedback is commonly used for both pediatric and adult patients with a myriad of diagnoses in clinical settings. The majority of previous research has focused on the use of biofeedback in adults, with only a small body of literature examining the usefulness of biofeedback in treating children. The current systematic review and meta-analysis seeks to quantitatively examine the usefulness of biofeedback in addressing pediatric conditions. A systematic review of biofeedback interventions in children was conducted using four databases (Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL). Outcomes included changes in symptoms of associated conditions or changes in physiological functioning. Out of 3,128 identified articles, 23 studies (with 24 effect sizes) were eligible for inclusion in the meta-analysis. Using a random effects model, the overall effect of pediatric biofeedback was statistically significant with a large effect size. Despite the large effect size, general study quality was low, limiting interpretation of findings. Despite widespread clinical use of biofeedback in pediatric populations, research is still limited concerning the efficacy of biofeedback in children. While findings suggest potential positive effects of biofeedback to address pediatric conditions, high-quality studies are necessary to fully support the use of biofeedback in children.
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Affiliation(s)
| | - Ethan R Benore
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Erin E Webster
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Management of Bladder Bowel Dysfunction in Children by Pelvic Floor Interferential Electrical Stimulation and Muscle Exercises: A Randomized Clinical Trial. Urology 2020; 144:182-187. [DOI: 10.1016/j.urology.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022]
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12
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Abstract
The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.What is New:• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
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Fahrenkamp A, Sim L, Roers L, Canny M, Harrison T, Harbeck-Weber C. An Innovative and Accessible Biofeedback Intervention for Improving Self-Regulatory Skills in Pediatric Chronic Pain: A Pilot Study. J Altern Complement Med 2020; 26:212-218. [DOI: 10.1089/acm.2019.0297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy Fahrenkamp
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
| | - Lisbeth Roers
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Mark Canny
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Tracy Harrison
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
| | - Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
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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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Tarcan T, Gontard A, Apostolidis A, Mosiello G, Abrams P. Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018? Neurourol Urodyn 2019; 38 Suppl 5:S82-S89. [DOI: 10.1002/nau.24088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Tufan Tarcan
- Department of Urology, School of MedicineMarmara UniversityIstanbul Turkey
- Department of Urology, School of MedicineKoç UniversityIstanbul Turkey
| | - Alexander Gontard
- Department of Child and Adolescent PsychiatrySaarland University HospitalHomburg Germany
| | - Apostolos Apostolidis
- Second Department of Urology, Papageorgiou General HospitalAristotle University of ThessalonikiThessaloniki Greece
| | - Giovanni Mosiello
- Department of Surgery, Neuro‐Urology UnitBambino Gesu Pediatric HospitalRome Italy
| | - Paul Abrams
- Bristol Urological InstituteSouthmead HospitalBristol UK
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Ladi-Seyedian SS, Sharifi-Rad L, Nabavizadeh B, Kajbafzadeh AM. Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior? Curr Urol Rep 2019; 20:38. [PMID: 31147796 DOI: 10.1007/s11934-019-0901-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Pelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction. RECENT FINDINGS Today, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training component, is not an effective treatment. Biofeedback is an adjunct to the pelvic floor training. In the current review, we develop the role of pelvic floor physical therapy in management of children with non-neuropathic voiding dysfunction and compare it with biofeedback therapy alone.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.,Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
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von Gontard A, Kuwertz-Bröking E. The Diagnosis and Treatment of Enuresis and Functional Daytime Urinary Incontinence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:279-285. [PMID: 31159915 PMCID: PMC6549126 DOI: 10.3238/arztebl.2019.0279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 06/22/2018] [Accepted: 02/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Elimination disorders in childhood are common and treatable. Approximately 10% of 7-year-olds wet the bed at night, and 6% are affected by incontinence during the daytime. Two main types of disturbance are distinguished: nocturnal enuresis and functional (i.e., non-organic) daytime urinary incontinence. Each type contains a wide variety of subtypes. Effective treatment requires precise identification of the subtype of elimination disorder. METHODS This review is based on a selection of current publications, including principally the German S2k-AWMF guideline and the recommendations of the International Children's Continence Society (ICCS). RESULTS Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. 20-50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. Elements of specific urotherapy are provided only if indicated. For enuresis, the treatment of first choice is alarm therapy, with which 50-70% of the affected children become dry. Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. In intractable cases, training techniques have been found useful. CONCLUSION Childhood elimination disorders can be treated effectively after targeted diagnostic evaluation and the establishment of specific indications for treatment. In view of the emotional distress these disorders cause, the associated physical and mental disturbances, and their potential persistence into adolescence, they should be evaluated and treated in affected children from the age of five years onward.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Saarland University Medical Center, Homburg, Germany
| | - Eberhard Kuwertz-Bröking
- Formerly: Department of Pediatrics, Pediatric Nephrology, University Hospital Münster, Münster, Germany
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Ladi-Seyedian SS, Sharifi-Rad L, Kajbafzadeh AM. Pelvic floor electrical stimulation and muscles training: a combined rehabilitative approach for management of non-neuropathic urinary incontinence in children. J Pediatr Surg 2019; 54:825-830. [PMID: 29960741 DOI: 10.1016/j.jpedsurg.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess the efficacy of combined transcutaneous interferential (IF) electrical stimulation and pelvic floor muscle training through biofeedback on non-neuropathic urinary incontinence in children. METHODS This prospective study comprised of 46 anatomically and neurologically normal children (9 boys, 37 girls; mean age of 8.4 ± 2.2 years old) with non-neuropathic urinary incontinence. All children were evaluated by kidney and bladder ultrasounds, uroflowmetry with electromyography (EMG), a complete voiding diary and a dysfunctional voiding scoring questionnaire at the baseline. Children were randomly allocated into two treatment groups including group A (n = 23) who underwent biofeedback therapy in addition to IF electrical stimulation and group B (n = 23) who received only biofeedback therapy. Re-evaluation was performed 6 months and one year after completion of the treatment sessions. RESULTS Improvement of non-neuropathic urinary incontinence was significantly higher in group A in comparison to group B at two follow ups (P < 0.05). Daytime incontinence was improved in 19/23(82%) and 13/23(56.5%) of children in groups A and B respectively after the treatment (P < 0.01). There was no significant difference in uroflowmetry measures between two groups after the treatment. CONCLUSIONS Combination of biofeedback therapy and transcutaneous IF electrical stimulation is a potential effective modality in treating non-neuropathic urinary incontinence in children. LEVEL OF EVIDENCE Type of study: Treatment study. Level I: Randomized controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up >80%.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI); Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
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Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, Rittig S, De Gennaro M, Jackson E, Fonseca E, Nieuwhof-Leppink A, Austin P. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol 2018; 33:2207-2219. [PMID: 28975420 DOI: 10.1007/s00467-017-3799-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. METHODS A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. RESULTS BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. CONCLUSIONS This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.
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Affiliation(s)
- Stephen Yang
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Michael E Chua
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan
- Department of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Anne Wright
- Department of Paediatric Nephrourology, Evelina Children's Hospital, London, UK
| | - Per Brandström
- Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Department of Pediatrics, Aarhus University, Aarhus, Denmark
| | - Mario De Gennaro
- Department of Urology, Bambino Gesù Children's Hospital of Rome, Rome, Italy
| | - Elizabeth Jackson
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eliane Fonseca
- Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Paul Austin
- Department of Urology, St Louis Children's Hospital, St. Louis, MO, USA
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Taylor AS, Cabo JJ, Lauderdale C, Maskan N, Thomas JC, Tanaka ST, Pope JC, Adams MC, Brock JW, Shannon CN, Clayton DB. Pelvic floor biofeedback therapy in children: Assessment of symptom scores in responders and non-responders. Neurourol Urodyn 2018; 38:254-260. [PMID: 30350888 DOI: 10.1002/nau.23842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. METHODS We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. RESULTS 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. CONCLUSION The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.
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Affiliation(s)
- Abby S Taylor
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jackson J Cabo
- Vanderbilt University Medical School, Nashville, Tennessee
| | - Chelsea Lauderdale
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Narges Maskan
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Alyami F, Ewida T, Alhazmi H, Trbay M, Arafa M, Tahir M, Neel KF. Biofeedback as single first-line treatment for non-neuropathic dysfunctional voiding children with diurnal enuresis. Can Urol Assoc J 2018; 13:E7-E9. [PMID: 30059283 DOI: 10.5489/cuaj.5209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Non-neurogenic dysfunctional voiding (NDV) accounts for a significant portion of pediatric urology outpatient clinic visits. Biofeedback (BF) is a promising, non-invasive modality for treating children with DV and daytime wetting. Our objective was to investigate BF's efficacy as a single first-line treatment for children with NDV and diurnal enuresis. METHODS A retrospective cohort study was conducted with a total of 61 consecutive patient records from January 2009 to March 2016. All children with NDV who had BF as first-line treatment were included. Full urological histories, physical examinations, dysfunctional voiding symptom score (DVSS), urine analysis, ultrasound (US), and uroflowmetry (UFM), and electromyogram (EMG) were performed and recorded for all patients before and after finishing the last BF cycle. The patient's satisfaction scale was also obtained. RESULTS The mean age was 10±2.6 years. Most patients (80.3%) were females. The presenting symptoms were diurnal enuresis, urinary tract infections, and voiding discomfort in 52 (85.2%), 16 (26.2%), and 38 (62.3%) patients, respectively. Six months after the last BF cycle, there was a statistically significant objective improvement in US and UFM+EMG findings with the disappearance of EMG signals in 40 of 61 (65.5%) patients. There was also a significant subjective symptomatic improvement, as the mean DVSS had decreased from 14 to 7.9 (p=0.003). Forty-seven patients (77%) were satisfied, while only eight (13.1%) were not. CONCLUSIONS BF is considered a potentially effective, single first-line treatment modality for children with DV and diurnal enuresis. Long-term outcome assessments are needed to assess the children's compliance and symptom recurrence.
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Affiliation(s)
- Fahad Alyami
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Tamer Ewida
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hamdan Alhazmi
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Trbay
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Arafa
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Moina Tahir
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Fouda Neel
- Division of Urology, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jarczyk KS, Pieper P, Brodie L, Ezzell K, D'Alessandro T. An Integrated Nurse Practitioner-Run Subspecialty Referral Program for Incontinent Children. J Pediatr Health Care 2018; 32:184-194. [PMID: 29289407 DOI: 10.1016/j.pedhc.2017.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/15/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. METHODS Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. RESULTS Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. DISCUSSION This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations.
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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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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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Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol 2015; 5:13-9. [PMID: 26140267 PMCID: PMC4482817 DOI: 10.5662/wjm.v5.i2.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/03/2015] [Accepted: 04/16/2015] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to find a safer, effective and acceptable alternative. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vaccinium Macrocarpon (cranberry), commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus (LA-5) and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli (E. coli) 83972 has resulted in subjective benefit and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interventions.
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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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Sacral neuromodulation for the dysfunctional elimination syndrome: a 10-year single-center experience with 105 consecutive children. Urology 2014; 84:911-7. [PMID: 25096339 DOI: 10.1016/j.urology.2014.03.059] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/15/2014] [Accepted: 03/31/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate our initial experience using sacral neuromodulation via implanted pulse generator as a treatment for children with dysfunctional elimination syndrome and symptoms refractory to maximum medical therapy. MATERIALS AND METHODS There were 105 consecutive patients who underwent a 2-stage procedure with a trial period (n = 89) or a single procedure (n = 16) for device implantation. They were followed up prospectively for a median of 2.72 years (average, 3.18 years; range, 0.01-9.63 years) for symptom improvement and resolution. RESULTS Nearly all children (99 of 105 [94%]) experienced improvement of at least 1 symptom; 12 of 105 patients (11%) had at least 1 symptom worsen. Urinary incontinence, constipation, frequency and/or urgency, and nocturnal enuresis improved in 89 of 101 (88%), 73 of 92 (79%), 54 of 81 (67%), and 59 of 89 (66%) children, respectively, and resolved in 41 of 101 (41%), 37 of 92 (40%), 23 of 81 (28%), and 25 of 89 (28%) children, respectively. Outcomes among patients who did and did not undergo the trial were not significantly different (P = .19-1.00), and only 2 of 88 patients did not undergo permanent implantation. Reoperations (n = 85) occurred in 59 of 105 children (56%), mainly for device malfunction (n = 42), whereas explantation was performed in 36 of 104 children (35%) at an average of 2.68 years since implantation (median, 2.36 years; range, 0.03-9.04 years), mainly for complete symptom resolution (n = 12). Explantation for any reason was less common after single-stage procedures (1 of 16 [6%] vs 35 of 88 [40%] patients; P = .01). CONCLUSION Sacral neuromodulation should be considered for children with dysfunctional elimination syndrome whose symptoms are refractory to maximum medical therapy understanding that the risk of reoperation is >50%. Elimination of the trial period reduces the number of general anesthetics without sacrificing outcomes.
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Fazeli MS, Lin Y, Nikoo N, Jaggumantri S, Collet JP, Afshar K. Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials. J Urol 2014; 193:274-9. [PMID: 25072179 DOI: 10.1016/j.juro.2014.07.097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Biofeedback has been used to treat children with symptoms of bladder dysfunction not responding to standard therapy alone. However, evidence of the effectiveness of biofeedback is scarce and is based on small studies. We conducted a systematic review of the literature to assess the effects of biofeedback as adjunctive therapy for symptoms of nonneuropathic voiding disorders in children up to age 18 years. MATERIALS AND METHODS We searched MEDLINE(®), Embase(®) and CENTRAL on the OvidSP(®) platform as well as conference proceedings for randomized trials presented at scientific conventions, symposia and workshops through August 13, 2013. Hand searches and review of reference lists of retrieved articles were also performed. RESULTS Five eligible studies were included in the systematic review, of which 4 (382 participants) were pooled in the meta-analysis based on available outcomes data. The overall proportion of cases with resolved incontinence at month 6 was similar in the biofeedback and control groups (OR 1.37 [95% CI 0.64 to 2.93], RD 0.07 [-0.09, 0.23]). There was also no significant difference in mean maximum urinary flow rate (mean difference 0.50 ml, range -0.56 to 1.55) or likelihood of urinary tract infection (OR 1.30 [95% CI 0.65 to 2.58]). CONCLUSIONS Current evidence does not support the effectiveness of biofeedback in the management of children with nonneuropathic voiding disorders. More high quality, randomized controlled trials are needed to better evaluate the effect of biofeedback.
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Affiliation(s)
- Mir Sohail Fazeli
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yiqun Lin
- School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nooshin Nikoo
- School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sravan Jaggumantri
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kourosh Afshar
- Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada.
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Springer A, Subramaniam R. Relevance of current guidelines in the management of VUR. Eur J Pediatr 2014; 173:835-43. [PMID: 24384795 DOI: 10.1007/s00431-013-2253-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED In recent years, there have been fundamental changes in the understanding of vesicoureteral reflux (VUR). This is reflected by current international guidelines that cover diagnosis, screening, and treatment of VUR. However, literature is still lacking and many questions are unsolved. In this article, we shortly review the important aspects of the current guidelines. Due to the lack of high-powered randomized controlled trials, guidelines often are based on an expert's opinion rather than evidence. In this review article, we address the controversies in the management of VUR; siblings and children with antenatally diagnosed hydronephrosis and the management of a patient with VUR. CONCLUSION With an individualized approach and patient risk stratification, the goal today must be to address the clinical problem, avoid unnecessary tests, and provide good quality of life for the patient and parents.
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Affiliation(s)
- Alexander Springer
- Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
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Pollock MR, Metz AE, Barabash T. Association Between Dysfunctional Elimination Syndrome and Sensory Processing Disorder. Am J Occup Ther 2014; 68:472-7. [DOI: 10.5014/ajot.2014.011411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
OBJECTIVE. We explored whether sensory processing disorder (SPD) is related to dysfunctional elimination syndrome (DES).
METHOD. We used the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire and the Short Sensory Profile with participants who sought treatment of DES (n = 19) and healthy control participants (n = 55).
RESULTS. Significantly more children with DES (53%) had SPD than was reported for the general population (p < .001; Ahn, Miller, Milberger, & McIntosh, 2004). Control participants did not have a greater rate of SPD (p = .333). We found a significant association between the occurrence of DES and SPD, χ2(1) = 20.869, p < .001, and a significant correlation between test scores (Spearman’s ρ = −.493, Rs2 = .243, p < .001).
CONCLUSION. Many children with DES may also have SPD, suggesting that a child’s sensory processing pattern would be an important aspect that could influence the plan of care.
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Affiliation(s)
- Mary R. Pollock
- Mary R. Pollock, OTD, CLT, OTR/L, is Pediatric Therapist, Wood County Hospital, Toledo, OH
| | - Alexia E. Metz
- Alexia E. Metz, PhD, OTR/L, is Associate Professor, Department of Rehabilitation Sciences, The University of Toledo, 2801 West Bancroft, MS 119, Toledo, OH 43606;
| | - Theresa Barabash
- Theresa Barabash, MSN, APRN–BC, was Nurse Practitioner, Pediatric Urology, Mercy St. Vincent Medical Center, Toledo, OH, at the time of the study
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Kieran K, Cooper CS. Role of Bladder Dysfunction in Vesicoureteral Reflux. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee LC, Koyle MA. The Role of Bladder and Bowel Dysfunction (BBD) in Pediatric Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Bear-down maneuver is a useful adjunct in the evaluation of children with chronic constipation. J Pediatr Gastroenterol Nutr 2013; 57:775-9. [PMID: 23945314 DOI: 10.1097/mpg.0b013e3182a698df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic constipation is a common problem in pediatrics and often the result of obstructed defecation. The aim of this study was to determine the use of the bear-down maneuver (BDM) in the evaluation of children with chronic constipation and to establish optimal conditions for its performance. METHODS This retrospective study compares BDM with balloon expulsion testing (BET) during anorectal manometry in 38 children with chronic constipation. BDM was performed with 0-, 20-, 40-, and 60-mL balloon inflation. BET, performed with a 60-mL balloon, was considered normal if the balloon was expelled within 1 minute. RESULTS Rectal pressure during BDM was 48% higher in patients able to expel the balloon during BET compared with those who could not (P < 0.05). Anal canal pressure was 46% lower in patients able to expel the balloon (P < 0.05). A rectoanal pressure differential greater than zero during BDM was 90% predictive that the subject would be able to expel the balloon. The optimal balloon inflation volume was 60 mL. CONCLUSIONS BDM using an inflated balloon provides valuable mechanistic information in the evaluation of children with dyssynergic defecation. We found that patients often had either an insufficient rectal pressure during bear-down or an abnormally high anal canal pressure. This information may be useful in planning further treatment for these children.
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Abstract
Vesicoureteral reflux (VUR) is a significant risk factor for clinical pyelonephritis and renal scarring. In 2010, the American Urological Association (AUA) reported that bladder and bowel dysfunction (BBD), which is common in patients with VUR, increases the risk of breakthrough UTI in children receiving antibiotic prophylaxis, reduces the success rate for endoscopic injection therapy, and increases the risk of postoperative UTI, irrespective of the surgical success rate for VUR. Accordingly, physicians are strongly recommended to investigate BBD in their patients with VUR. Symptoms and signs of BBD include urinary frequency and urgency, prolonged voiding intervals, daytime wetting, perineal and penile pain, holding manoeuvres (posturing to prevent wetting), constipation, and encopresis. Primary assessment tools include the Pediatric Symptom Checklist, urinalysis, urine culture, bladder diary, measurement of the postvoid residual urine volume, Dysfunctional Voiding Symptom Score, uroflow with electromyography, and Bristol Stool Form Score. The Rome III criteria can also be used for diagnostic assessment of bowel function. Treatment of BBD should be individualized, directed at symptomatic and objective improvement, and can include behavioural modification, biofeedback, selective use of anticholinergics and α-blockers, and bowel management.
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Affiliation(s)
- Jack S Elder
- Vattikuti Urology Institute, Henry Ford Hospital, Department of Pediatric Urology, Children's Hospital of Michigan, 2799 West Grand Boulevard, K-9, Detroit, MI 48202, USA
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The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial. BMC Pediatr 2013; 13:112. [PMID: 23914827 PMCID: PMC3750818 DOI: 10.1186/1471-2431-13-112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background Functional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking. Methods/design A two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria. Discussion This section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care. Trial registration Current Controlled Trials NL30551.068.09
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Amira PA, Dušan P, Gordana ML, Sandra T, Ivaniševic I. Bladder control training in girls with lower urinary tract dysfunction. Int Braz J Urol 2013; 39:118-26; discussion 127. [PMID: 23489504 DOI: 10.1590/s1677-5538.ibju.2013.01.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years. MATERIALS AND METHODS 72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns. RESULTS BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DVI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients. CONCLUSION Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, while presence of nocturnal enuresis may be a negative predictor of the training effect.
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Abstract
PURPOSE OF REVIEW Recent guidelines on the management of urinary tract infections (UTIs) in children have seen a shift from aggressive imaging studies and the use of prophylactic antibiotics to a more restrictive and targeted approach. This review focuses on new additions to the literature on management of UTI from January 2011 to September 2012. RECENT FINDINGS The causal relationship between UTI-vesicoureteral reflux (VUR) and renal scarring has been challenged by several studies. Concerns about unnecessary exposure to ionizing radiation, invasiveness of some of the procedures, and risk of infection have also been raised. With improved prenatal ultrasound, a 'top-down' approach to investigating febrile UTI in children using renal bladder ultrasound alone as an initial study has become popular. Several studies have reported that prophylactic antibiotics and imaging studies after first UTI can be reduced substantially without affecting the risk of recurrent UTI or renal scarring. SUMMARY The use of targeted imaging approach in evaluating febrile UTI in children may lead to improved resource use and reduction of potential harmful procedures and interventions, without affecting outcomes of UTI in children. Providers using current guidelines should endeavor to collect practice-based evidence to validate and inform future guidelines.
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Affiliation(s)
- Elijah Paintsil
- Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, Connecticut 06520-8064, USA.
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Dwyer ME, Reinberg YE. The Dysfunctional Elimination Syndrome in Children—Is Sacral Neuromodulation Worth the Trouble? J Urol 2012; 188:1076-7. [PMID: 22901582 DOI: 10.1016/j.juro.2012.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reply by Authors. J Urol 2011. [DOI: 10.1016/j.juro.2011.07.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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