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Ono T, Watanabe T, Oyake C, Onuki Y, Watanabe Y, Fuyama M, Ikeda H. Sleep features of nocturnal enuresis: relationship between rapid eye movement sleep latency prolongation and nocturnal enuresis. Sleep Biol Rhythms 2023; 21:461-466. [PMID: 38476188 PMCID: PMC10899902 DOI: 10.1007/s41105-023-00473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/18/2023] [Indexed: 03/14/2024]
Abstract
Nocturnal enuresis, or bed wetting, is the involuntary urination during sleep. One of its causes is difficulty awakening during sleep, suggesting a relationship between Nocturnal enuresis (NE) and sleep. However, no studies have yet clarified the relationship between NE and sleep, and the effects of sleep structure in NE children are not yet known. Assuming that changes in sleep structure are related to NE, there would be a difference in sleep structure between days with and without NE. We measured the sleep electroencephalograms of 27 at home patients aged 6-16 years, evaluated the differences between days with and without NE, and examined the NE-associated sleep characteristics associated. The evaluation items were total sleep time, sleep efficiency, the ratio of rapid eye movement (REM) to non-REM sleep, REM sleep latency, and non-REM sleep latency. Factors influencing NE were examined by logistic regression analysis, with NE presence/absence as the dependent variable and each evaluation item as the independent variable. Given that 2-6 measurements were made for each patient, Generalized Estimating Equations was used in the analysis. NE positively correlated with prolonged REM sleep latency, but no significant differences were found in other sleep structures. A positive correlation exists between NE and prolonged REM sleep latency. Changes in sleep structure in the early stages of sleep may lead to increased nocturnal urine volume and increased NE frequency.
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Affiliation(s)
- Takahiro Ono
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Tsuneki Watanabe
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Chisato Oyake
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Yuta Onuki
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Yoshitaka Watanabe
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Masaki Fuyama
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
| | - Hirokazu Ikeda
- Children’s Medical Center, Showa University Northern Yokohama Hospital, Kawasaki, Kanagawa Japan
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2
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Shim J, Oh MM. Updates of Overactive Bladder in Pediatrics. Int Neurourol J 2023; 27:3-14. [PMID: 37015720 PMCID: PMC10073000 DOI: 10.5213/inj.2244228.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 04/06/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as urinary urgency with or without urinary incontinence. It is associated with daytime frequency or constipation and has a prevalence of approximately 5%-12% among 5- to 10-year-olds. The appropriate functional exchange between the pontine micturition center, periaqueductal gray matter, and prefrontal cortex is important for proper micturition control. Several studies on pediatric cases observed a link between OAB and neuropsychiatric problems, such as anxiety, depression, and attention deficit, and treatment of these comorbidities improved patient symptoms. In this review, we present the pathophysiology of OAB, its associated conditions, and aspects related to updates in OAB treatment, and we propose a step-by-step treatment approach following this sequence: behavioral therapy, medical treatment, and invasive treatment. Although anticholinergic drugs are the mainstay of OAB medical treatment, beta-3 agonists and alpha-blockers are now recommended as a result of significant advancements in pharmacologic treatment in the last 10 years. Electrical stimulation techniques and botulinum toxin are also effective and can be used, especially in conventional treatment-refractory cases.
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Affiliation(s)
- Jisung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, College of Medicine, Korea University, Seoul, Korea
| | - Mi Mi Oh
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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3
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Westwell-Roper C, Best JR, Naqqash Z, Afshar K, MacNeily AE, Stewart SE. Bowel and Bladder Dysfunction Is Associated with Psychiatric Comorbidities and Functional Impairment in Pediatric Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2022; 32:358-365. [PMID: 35404114 DOI: 10.1089/cap.2021.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: Neuropsychiatric disorders are common in children with bowel and bladder dysfunction (BBD), a syndrome associated with urinary frequency, urgency, holding, incontinence, and constipation. We evaluated BBD symptom severity in children and youth attending a tertiary care obsessive-compulsive disorder (OCD) clinic. Methods: Consecutive patients attending initial OCD assessments between 2016 and 2020 were invited to participate in a registry study. Diagnosis of OCD and comorbidities was established by structured clinical interview. OCD severity and impact were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and the Child Obsessive Compulsive Impact Scale (COIS-R; self-report), respectively. BBD symptoms were quantified with the Vancouver Symptom Score (VSS), a validated self-report measure. Results: One hundred twelve participants completed the VSS (mean age 13.5 ± 3.3, range 7-20). Based on a cutoff score of 11 corresponding to pediatric urologist-diagnosed BBD, 30.4% of participants screened positive, including more females than males (39.3% vs. 21.4%; p = 0.04). Daytime urinary incontinence was present in a greater proportion of participants with OCD forbidden thoughts (34.8% vs. 8.2%, p = 0.002), major depressive disorder (MDD; 38.5% vs. 6.8%, p = 0.001), and somatization disorder (60% vs. 9%, p = 0.001) compared with those without. A regression model including CY-BOCS, COIS-R, psychiatric comorbidities, medications, age, and gender explained 52.2% of the variance in VSS; COIS-R, tic disorder, and MDD were significant predictors. Conclusion: BBD symptoms are common and associated with high OCD-related impairment and psychiatric comorbidities. Standardized assessment may facilitate identification of BBD symptoms in this population and is critical to mitigating long-term physical and mental health impacts. Further studies are required to assess the relationship between BBD and OCD treatment outcomes.
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Affiliation(s)
- Clara Westwell-Roper
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - John R Best
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zainab Naqqash
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Division of Pediatric Urology, BC Children's Hospital, Vancouver, Canada
| | - Andrew E MacNeily
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Division of Pediatric Urology, BC Children's Hospital, Vancouver, Canada
| | - S Evelyn Stewart
- Provincial OCD Program, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Psychiatry and Faculty of Medicine, University of British Columbia, Vancouver, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, Canada
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da Silva CPC, Miranda JNR, Arruda DF, Martins G, Assis GM. SINTOMAS URINÁRIOS E INTESTINAIS EM CRIANÇAS DA REDE PÚBLICA DE ENSINO FUNDAMENTAL. ESTIMA 2022. [DOI: 10.30886/estima.v19.1140_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:levantar a ocorrência de sintomas urinários e intestinais em crianças da rede pública de ensino fundamental da capital paranaense. Método: estudo quantitativo, exploratório-descritivo e de corte transversal. Amostra de pais/responsáveis que preencheram os seguintes instrumentos: Dysfunctional Voiding Scoring System; critérios de Roma IV; escala de Bristol. Análise realizada pelo IBM SPSS Statistics v.20.0. Os dados foram coletados no período de agosto a outubro de 2019. Os critérios de inclusão eram a criança estar matriculada e frequentando regularmente o ensino fundamental e a entrega do questionário preenchido ou parcialmente preenchido. Resultados: Foram entregues 458 questionários. Dos totalmente preenchidos, 51,9% era de meninas, e a de idade foi de 7,7 anos; 83% das crianças apresentaram algum sintoma urinário e/ou intestinal de baixa gravidade. Sem diferença significativa de sintomas entre sexos, e com acréscimo significativo de gravidade em crianças com 7 anos ou menos. Sintomas mais prevalentes: frequência miccional reduzida, frequência evacuatória reduzida, esforço evacuatório, urgência miccional e manobras de contenção; 39,6% das crianças apresentavam Constipação Intestinal Funcional. Disfunção vesical e intestinal em 35 crianças, a maior prevalência no sexo feminino. Conclusão: alta ocorrência de sintomas urinários e intestinais nas crianças. O sintoma mais prevalente foi constipação.
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da Silva CPC, Miranda JNR, Arruda DF, Martins G, Assis GM. URINARY AND INTESTINAL SYMPTOMS IN PUBLIC ELEMENTARY SCHOOL CHILDREN. ESTIMA 2022. [DOI: 10.30886/estima.v19.1140_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: survey the occurrence of urinary and intestinal symptoms in children from public elementary schools in the capital of Paraná. Method: quantitative, exploratory-descriptive and cross-sectional study. Sample of parents/ guardians who completed the following instruments: Dysfunctional Voiding Scoring System; Rome IV criteria; Bristol scale. Analysis performed by IBM SPSS Statistics v.20.0. Data were collected from August to October 2019. Inclusion criteria were the child being enrolled and regularly attending elementary school and the delivery of the completed or partially completed questionnaire. Results: 458 questionnaires were delivered. Of those fully completed, 51.9% were girls, and the age was 7.7 years; 83% of the children had some urinary and/or intestinal symptoms of low severity. There was no significant difference in symptoms between genders, and with a significant increase in severity in children aged 7 years and under. Most prevalent symptoms: reduced voiding frequency, reduced defecation frequency, defecation effort, voiding urgency and containment maneuvers; 39.6% of the children had Functional Intestinal Constipation. Bladder and bowel dysfunction in 35 children, the highest prevalence in females. Conclusion: high occurrence of urinary and intestinal symptoms in children. The most prevalent symptom was constipation.
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Sebesta EM, Connors EL, Rourke E, Reynolds WS, McKernan LC. Psychosocial Factors in Neurogenic Lower Urinary Tract Dysfunction: Implications for Multidisciplinary Care. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-021-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang R, Van den Heuvel M, Rickard M, El-Bardisi Y, Mistry N, Koyle M, Farhat W, Santos JD. Neurodevelopmental and psychiatric disorders in pediatric bladder and bowel dysfunction. J Pediatr Urol 2021; 17:450.e1-450.e6. [PMID: 33947637 DOI: 10.1016/j.jpurol.2021.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bladder and bowel dysfunction (BBD) is a common pediatric problem that describes a constellation of lower urinary tract symptoms associated with constipation and/or encopresis. Its association with neurodevelopmental and psychiatric (NDP) problems is not well understood. OBJECTIVES Our primary aim was to identify pre-existing NDP disorders in children with BBD. Secondarily, we aimed to screen for new behavioral problems and evaluate the association between bladder or bowel symptoms and behaviors symptoms. METHODS A cross sectional study was conducted in urology clinics. New patients referred for BBD between 4 and 17 years old were recruited and completed: a demographics survey, Dysfunctional Voiding Score System questionnaire, assessment of bowel movements with the Bristol Stool Scale, and Strength and Difficulties questionnaire (SDQ). Those with known spinal dysraphism were excluded. SDQ scores were evaluated for abnormal screens in different subscales and total difficulties scores. Pearson correlation analyses were conducted for association. RESULTS We included 61 participants (age 9.5 ± 4.1 years), including 33 females and 28 males. One or more pre-existing NDP disorder(s) was reported in 14 (23%) children; most commonly being learning disability (43%) and attention deficit hyperactivity disorder (29%). This cohort had more severe BBD symptoms as reflected in DVSS scores. SDQ scores demonstrated that 12 patients without pre-existing NDP diagnoses scored in the clinical range, with hyperactivity as the most common difficulty (6/12; 50%). CONCLUSIONS A significant proportion of children with BBD have a comorbid NDP disorder and present with more severe symptomatology. The SDQ can be used as a behavioral screening tool this population for the identification of children who may benefit from formal developmental pediatrics assessment.
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Affiliation(s)
- Rebecca Wang
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada; Faculty of Art & Science, University of Toronto, Ontario, Canada
| | - Meta Van den Heuvel
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Yara El-Bardisi
- Faculty of Art & Science, University of Toronto, Ontario, Canada
| | - Niraj Mistry
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Martin Koyle
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada
| | - Walid Farhat
- Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada.
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Raturi S, Li FX, Wong CM. Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder. BMJ Case Rep 2021; 14:14/6/e242646. [PMID: 34078623 DOI: 10.1136/bcr-2021-242646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Children with autism spectrum disorder (ASD) with rigidities, anxiety or sensory preferences may establish a pattern of holding urine and stool, which places them at high risk of developing bladder bowel dysfunction (BBD). BBD, despite being common, is often unrecognised in children with ASD. With this case report of a 7-year-old girl with ASD presenting with acute retention of urine, we attempt to understand the underlying factors which may contribute to the association between BBD and ASD. Literature review indicates a complex interplay of factors such as brain connectivity changes, maturational delay of bladder function, cognitive rigidities and psychosocial stressors in children with ASD may possibly trigger events which predispose some of them to develop BBD. Simple strategies such as parental education, maintaining a bladder bowel diary and treatment of constipation may result in resolution of symptoms.
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Affiliation(s)
- Shilpee Raturi
- Child Development, KK Women's and Children's Hospital, Singapore
| | - Fay Xiangzhen Li
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Chui Mae Wong
- Child Development, KK Women's and Children's Hospital, Singapore
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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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Mehari K, Iyengar S, Schneider M, Berg K, Bennett A. Adverse Childhood Experiences Among Children with Neurodevelopmental Delays: Relations to Diagnoses, Behavioral Health, and Clinical Severity. J Clin Psychol Med Settings 2021; 28:808-814. [PMID: 33761107 DOI: 10.1007/s10880-021-09769-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Limited research has examined adverse childhood experiences (ACEs) among children at risk for neurodevelopmental delays. The purpose of this study was to (1) identify the prevalence of ACEs among children at risk for neurodevelopmental delays; (2) explore differences in rates of ACEs across neurodevelopmental diagnoses; and (3) examine relations between ACEs and indicators of behavioral health functioning (e.g., enuresis, feeding problems, sleeping problems, and functional impairment). Participants were 193 children ages 2 to 11 who received a developmental and behavioral pediatrics evaluation at a subspecialty clinic. Caregivers completed a survey about their child's ACEs, and researchers conducted an electronic health record review. Overall, 47% experienced at least one ACE. ACEs were not related to neurodevelopmental diagnosis or to externalizing symptoms. ACEs were related to difficulty sleeping, lower hyperactivity, and greater functional impairment at home. The relations between early adversity and poor behavioral health functioning may develop over time, creating an excellent window of opportunity for prevention work.
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Affiliation(s)
- Krista Mehari
- Department of Psychology, University of South Alabama, 307 N University Blvd, UCOM 1000, Mobile, AL, 36606, USA.
| | - Sandhyaa Iyengar
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mallory Schneider
- Department of Psychology, University of South Alabama, Mobile, AL, USA.,Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristin Berg
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | - Amanda Bennett
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Affiliation(s)
- Andrew MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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12
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Lorenzo AJ, Rickard M, Santos JD. The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children. Pediatr Nephrol 2020; 35:1395-1408. [PMID: 30671629 DOI: 10.1007/s00467-019-4193-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 02/03/2023]
Abstract
Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal bladder habits, bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without "traditional" lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes-consisting primarily of LUTS-which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of bladder function, particularly for toilet-trained children, as well as the importance of implementing bladder training strategies, aggressive management of constipation, and pharmacological management as necessary.
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Affiliation(s)
- Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. .,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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Ribeiro RS, Abreu GED, Dourado ER, Veiga ML, Lobo VA, Barroso U. BLADDER AND BOWEL DYSFUNCTION IN MOTHERS AND CHILDREN: A POPULATION-BASED CROSS-SECTIONAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:126-130. [PMID: 32401953 DOI: 10.1590/s0004-2803.202000000-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE To evaluate bladder and bowel dysfunction between mothers and children. METHODS A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS A total of 441 mother-child pairs was obtained. Children's mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers' mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn't any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.
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Affiliation(s)
- Rebeca Sadigursky Ribeiro
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Glícia Estevam de Abreu
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Eneida Regis Dourado
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Maria Luiza Veiga
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Victoria Andrade Lobo
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
| | - Ubirajara Barroso
- Escola Bahiana de Medicina e Saúde Pública (BAHIANA), Centro de Distúrbios Miccionais na Infância (CEDIMI), Salvador, BA, Brasil
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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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Wang R, Kanani R, Mistry N, Rickard M, Dos Santos J. Practical tips for paediatricians: Assessment and management of bladder and bowel dysfunction in the office. Paediatr Child Health 2019; 25:136-138. [PMID: 32296273 DOI: 10.1093/pch/pxz084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/19/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rebecca Wang
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Ronik Kanani
- Department of Paediatrics, North York General Hospital, University of Toronto, Toronto, Ontario
| | - Niraj Mistry
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Mandy Rickard
- Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Joana Dos Santos
- Division of Paediatric Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Xu Z, Wu D, Tao C, Zhou J, Zheng Z, Tang D. Treatment efficacy of tolterodine versus belladonna mixture in children with idiopathic overactive bladder. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2019-000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesChildren with symptoms of urinary urgency, frequency and incontinence are common in the clinic. The aim of the present study was to compare the tolerability and efficacy of tolterodine, a bladder-selective muscarinic receptor antagonist, with belladonna mixture, a traditional anticholinergic drug, in the treatment of idiopathic overactive bladder in children.MethodsChildren aged 5–10 years with a history of diurnal urgency, frequency and incontinence were randomly divided into two groups. Participants in group 1 were given tolterodine 1 mg twice a day for 14 days. If the results were found to be mildly ineffective, after the first 14 days of therapy, prolonged course with 2 mg twice a day was given. In group 2, the children were treated with belladonna mixture 5 mL twice a day for 14 days. Anticholinergic side effects were recorded during the therapy and efficacy was evaluated with voiding diary recorded by the parents at the beginning and end of therapy.ResultsA total of 668 cases were included in this study and 334 for each 25 group (496 boys and 172 girls). Evident anticholinergic side effects which could cease the therapy, such as dry mouth, constipation, mood changes, irritability, and so on, exhibited only on 2% of participants in the tolterodine group but 69% in the belladonna mixture group (p≤0.05). The symptoms of detrusor overactivity disappeared or significantly improved in 80% of children in the tolterodine group and 37% in the belladonna mixture (p≤0.05) group.ConclusionsTolterodine had better tolerability and efficacy than belladonna mixture in treating overactive bladder in children.
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von Gontard A, Vrijens D, Selai C, Mosiello G, Panicker J, van Koeveringe G, Apostolidis A, Anding R. Are psychological comorbidities important in the aetiology of lower urinary tract dysfunction-ICI-RS 2018? Neurourol Urodyn 2019; 38 Suppl 5:S8-S17. [PMID: 31059602 DOI: 10.1002/nau.24016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/10/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Abstract
AIMS To review studies on the comorbid psychological symptoms and disorders in patients with lower urinary tract disorders (LUTD) over the life-span, to analyse how they contribute toward the aetiology of LUTD and to discuss optimal service implementation. MATERIALS AND METHODS A review of relevant literature was conducted and presented during the ICI-RS meeting in 2018. Open questions and future directions were discussed. RESULTS On the basis of current research, there is overwhelming evidence in all age groups that psychological comorbidities are more common in patients with LUTD. Vice versa, patients with psychiatric disorders have higher rates of LUTD. The types of LUTDs and psychiatric disorders are heterogeneous. Complex aetiological models best explain specific associations of comorbidity. Irrespective of aetiology, it is advisable to address both urological and psychological issues in patients of all age groups with LUTD. CONCLUSIONS Psychological symptoms and disorders play a decisive role in the development of LUTD in all age groups and need to be considered in the assessment and treatment of LUTD.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Giovanni Mosiello
- Department of Surgery, Urology and Neuro-Urology, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Jalesh Panicker
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
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Jackson KG, Malphrus EL, Blum E, Kalloo NB, Finkel JC. Pupillometric assessment of dysautonomia in pediatric bowel and bladder dysfunction: a pilot study. J Pediatr Urol 2019; 15:226.e1-226.e5. [PMID: 31014982 DOI: 10.1016/j.jpurol.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 01/23/2023]
Abstract
Bowel and bladder dysfunction (BBD) refers to a heterogeneous group of voiding disorders, accounting for an estimated 40% of pediatric urology visits. Symptoms of BBD include enuresis, urgency, and urinary retention, often accompanied by constipation. The aim of this pilot study was to explore whether a pupillary response can be characterized for BBD, by examining the pupillary light reflex (PLR) before and after voiding among patients with BBD. A total of 28 patients aged from 7 to 21 years were recruited from the Wetting, Infections, and Stooling Help clinic at Children's National Medical Center. An infrared pupilometer was used to assess the PLR. Both baseline static and dynamic pupillometry assessments were obtained before and after voiding. Measurements were also taken after 5 min in the supine position, followed by 5 min standing to induce an orthostatic stressor. Visual inspection of the graphed data revealed a characteristic shape in 11 of 28 patients with voiding symptoms. In these 11 patients, the redilation arm of the PLR shows a 'notch,' or a brief reconstriction of the pupil before resting pupil size is reestablished (figure). This feature of the PLR has not been seen in previous and parallel studies using pupillometry to evaluate other populations. The results of this study suggest that a subset of patients with BBD may have a significant perturbation of autonomic regulation, identifiable through analysis of the PLR. To our knowledge, this 'notch' during redilation has not been previously described or seen in other patient populations and may represent a distinctive and readily identifiable physiologic marker of disease. These results are broadly aligned with results of other studies that have examined ANS activity in patients with BBD, although further study is needed to confirm the results of this pilot study and to assess relative contributions of sympathetic and parasympathetic function in producing pupillary abnormalities. This study has several limitations, including the small sample size, the absence of data on severity and duration of symptoms, and the absence of a control group of patients without any voiding symptoms. A simple tool for diagnosing BBD and for monitoring response to treatment could significantly improve the quality of treatment for one of the most common pediatric urologic complaints. Given the heterogeneity of symptoms under the BBD umbrella, pupillometric data could guide selection of treatment options, as well as assess adequacy of response to pharmacologic therapy.
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Affiliation(s)
- K G Jackson
- Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA.
| | - E L Malphrus
- Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA.
| | - E Blum
- Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA.
| | - N B Kalloo
- Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA.
| | - J C Finkel
- Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA.
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Wang R, Kanani R, El Bardisi Y, Mistry N, Dos Santos J. Development of a Standardized Approach for the Assessment of Bowel and Bladder Dysfunction. Pediatr Qual Saf 2019; 4:e144. [PMID: 31321361 PMCID: PMC6494228 DOI: 10.1097/pq9.0000000000000144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bowel and bladder dysfunction (BBD) is a common pediatric condition that describes a constellation of lower urinary tract symptoms (LUTS) associated with constipation. Many children with BBD have comorbid neuropsychiatric and psychosocial concerns that are not routinely assessed. The aim of quality improvement (QI) was to establish a comprehensive assessment for BBD by developing and evaluating (1) a standardized clinician assessment form and (2) parent-reported questionnaire. METHODS From July 2017 to April 2018, a prospective QI study was conducted in the BBD network. A standardized assessment form was developed based on literature review and expert opinions, with targeted sections for LUTS, constipation, and psychosocial history. Before clinic, families of children referred for BBD were given a questionnaire to clarify voiding, stooling, and dietary patterns. Physicians utilized the assessment form for new referrals. Afterward, both physicians and parents evaluated the assessment process anonymously. RESULTS A total of 15 physicians and 45 parents responded, with 67% of patients being between 4 and 10 years old and 51% male. Physicians responded that the assessment form reminded them to ask about specific LUTS (93%), constipation (87%), and psychosocial history (87%). Parents responded positively by agreeing that they felt included in care decisions (96%) and had questions answered appropriately (100%). Only 47% found the previsit package easy to complete. CONCLUSIONS In pediatric BBD consultations, a standardized assessment form can guide clinicians to efficiently gather a comprehensive history and screen for psychosocial risk factors. It can empower more pediatricians to evaluate BBD in the future.
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Affiliation(s)
- Rebecca Wang
- From the Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yara El Bardisi
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Niraj Mistry
- From the Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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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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21
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Gondim Oliveira R, Barroso, Jr U. Overactive Bladder in Children. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10314428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as the presence of urinary urgency and may be associated with diurnal urinary incontinence, frequency, and enuresis, and/or constipation. In children aged 5–10 years, the prevalence is 5–12%. Association with emotional disorders is widely described in the literature. Constipation is associated with voiding symptoms because of crosstalk between the gastrointestinal tract and the urinary tract. OAB is believed to be multifactorial. Correct functioning between the pontine micturition centre, the periaqueductal grey matter, anterior cingulate gyrus, and prefrontal cortex is important for correct voiding development and the process of maturation. Patients with OAB have greater anterior cingulate gyrus activity and deactivation of the pontine micturition centre urinary inhibition process, leading to a greater frequency of bladder repletion sensation. Urotherapy is the first treatment to be initiated and aims to change behavioural patterns inthese patients. Other treatment options are anticholinergics, with oxybutynin being the most widely studied, but also described is the use of tolterodine, darifenacin, and mirabegron. Alternative treatments, such as nerve stimulation in the parasacral or the posterior tibial area, have shown improvement of symptoms in comparative studies with conventional drug treatment, and, in refractory cases, botulinum toxin A is an option. In this article, we review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.
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Affiliation(s)
| | - Ubirajara Barroso, Jr
- Unit of Uro Nephrology and Discipline of Urology, Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
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Experiencias Adversas en la Infancia: Revisión de su impacto en niños de 0 a 5 años. ENFERMERÍA UNIVERSITARIA 2017. [DOI: 10.1016/j.reu.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Santos JD, Lopes RI, Koyle MA. Bladder and bowel dysfunction in children: An update on the diagnosis and treatment of a common, but underdiagnosed pediatric problem. Can Urol Assoc J 2017; 11:S64-S72. [PMID: 28265323 DOI: 10.5489/cuaj.4411] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bladder and bowel dysfunction (BBD) describes a spectrum of lower urinary symptoms (LUTS) accompanied by fecal elimination issues that manifest primarily by constipation and/or encopresis. This increasingly common entity is a potential cause of significant physical and psychosocial burden for children and families. BBD is commonly associated with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTIs), which at its extreme may lead to renal scarring and kidney failure. Additionally, BBD is frequently seen in children diagnosed with behavioural and neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with concomitant BBD and neuropsychiatric disorders have less favourable treatment outcomes. Early diagnosis and treatment of BBD are critical to avoid secondary comorbidities that can adversely impact children's kidney and bladder function, and psychosocial well-being. The majority of patients will improve with urotherapy, adequate fluid intake, and constipation treatment. Pharmacological treatment must only be considered if no improvement occurs after intensive adherence to at least six months of urotherapy ± biofeedback and constipation treatment. Anticholinergics remain the mainstay of medical treatment. Selective alpha-blockers appear to be effective for improving bladder emptying in children with non-neurogenic detrusor overactivity (DO), incontinence, recurrent UTIs, and increased post-void residual (PVR) urine volumes. Alpha-1 blockers can also be used in combination with anticholinergics when overactive bladder (OAB) coexists with functional bladder outlet obstruction. Minimally invasive treatment with onabotulinumtoxinA bladder injections, and recently neurostimulation, are promising alternatives for the management of BBD refractory to behavioural and pharmacological treatment. In this review, we discuss clinical presentation, diagnostic approach, and indications for behavioural, pharmacological, and surgical treatment of BBD in children based on a thorough literature review. Expert opinion will be used when scientific evidence is unavailable.
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Affiliation(s)
- Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Roberto I Lopes
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
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24
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Salehi B, Yousefichaijan P, Rafeei M, Mostajeran M. The Relationship Between Child Anxiety Related Disorders and Primary Nocturnal Enuresis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e4462. [PMID: 27822271 PMCID: PMC5097340 DOI: 10.17795/ijpbs-4462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/05/2015] [Accepted: 04/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nocturnal enuresis, often called bedwetting or sleep wetting, is a common problem in children after the age of five and may lead to symptoms such as infection, incontinence and frequent urination. This problem refers to a state in which children after the age of five have no control of their urine for six continuous months and it cannot be attributed to any organic factors or drug use. OBJECTIVES In this study we aimed to study generalized anxiety disorder as one of the possible causes of primary nocturnal enuresis. MATERIALS AND METHODS In this case-control study 180 children with primary nocturnal enuresis and same number of healthy children with a mean age of 7 - 17 years old with the same demographic characteristics were selected. The study took place at Amir Kabir hospital of Arak, Iran during year 2014. After collecting the information, diagnosis was verified based on the diagnostic and statistical manual of mental disorders (DSM) IV-TR criteria. Results were analyzed using the SPSS software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, version 20.0. Armonk, NY: IBM Corp.). RESULTS Frequency of generalized anxiety disorder, panic disorder, school phobia, social anxiety, separation anxiety, history of anxiety in mother, history of primary nocturnal enuresis in parent's family and body mass index had a significant difference between the two groups (P = 0.005). CONCLUSIONS With the results obtained from this study we could say that there was a clear significant difference between the two control and patient groups for all subgroups of anxiety disorders such as generalized anxiety disorder and their relationship with primary nocturnal enuresis. Given the higher prevalence of generalized anxiety disorder, panic disorder, school phobia, social anxiety, separation anxiety and comparison with healthy children, it is recommended for all children with primary nocturnal enuresis to be investigated and treated for generalized anxiety disorder.
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Affiliation(s)
- Bahman Salehi
- Department of Psychiatry, Arak University of Medical Sciences, Arak, IR Iran
| | | | - Mohammad Rafeei
- Department of Biostatistics, Arak University of Medical Sciences, Arak, IR Iran
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Martins G, Minuk J, Varghese A, Dave S, Williams K, Farhat WA. Non-biological determinants of paediatric bladder bowel dysfunction: A pilot study. J Pediatr Urol 2016; 12:109.e1-6. [PMID: 26586295 DOI: 10.1016/j.jpurol.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Children with bladder and bowel dysfunction (BBD) constitute a significant proportion of referrals at paediatric urology clinics worldwide, presenting with a wide range of symptom severity that may significantly affect quality of life. Non-biological factors may play a key role in triggering BBD severity, but these underpinning causes of BBD during childhood are still unknown. The aim of this study was to identify the effects of personal, family related and environmental variables on the severity of BBD symptoms in school-aged children. STUDY DESIGN A pilot, prospective, observational study was conducted on 53 children diagnosed with BBD, and their legal guardian(s), on their first referred visit to a paediatric BBD clinic led by nurse practitioners. Upon receiving consent, patients and their legal guardian(s) completed three study questionnaires, with the guidance of research coordinators. The first questionnaire was the Dysfunctional Voiding Scoring System (DVSS); the second, a three-part questionnaire used to collect demographic information and data on the patient, their family and environmental characteristics; and the third gathered a detailed history of the child's lifestyle regimen, focusing on their bowel and bladder function. RESULTS Most of the children were female (66%), with an average age of 8.35 years. Most children attended public schools (74%) and none reported failing a grade. The mean parental age was 41.4 years (SD = 4.9 years), 62% of the families had two children and 53% were Caucasian. The mean DVSS score for this sample was 9.9 (SD = 4.2, range 2-21). Daycare attendance, school problems and unplanned pregnancy showed statistically significant influences on the severity of BBD and were associated with higher DVSS scores according to the Table below. CONCLUSIONS Children with BBD attending urology outpatient clinics as new referrals had more severe symptoms when they were born from an unplanned pregnancy, attended daycare and/or had school problems. These findings suggest that interventions aimed at decreasing BBD severity, or preventing its onset in school-aged children, should focus on the environment surrounding them, specifically on the interaction between personal, familial and environmental factors. These factors seem to have an important effect on paediatric continence, as children grow and develop under numerous societal influences and social interactions.
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Affiliation(s)
- G Martins
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; Department of Nursing, Faculty of Health Sciences, University of Brasilia, SQN 214, Bloco K, Suite 613, Brasilia, Federal District, 70873-110, Brazil.
| | - J Minuk
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - A Varghese
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - S Dave
- London Health Sciences Centre (LHSC), Pediatric Urology, Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 4G5, Canada.
| | - K Williams
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
| | - W A Farhat
- Division of Urology, The Hospital for Sick Children (Sick Kids Hospital(®)), 555 University Ave, Toronto, Ontario, M5G 1X8, Canada.
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Slattery MJ, Logan BL, Mudge B, Secore K, von Reyn LJ, Maue RA. An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles. J Prof Nurs 2016; 32:412-420. [PMID: 27964811 DOI: 10.1016/j.profnurs.2016.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Indexed: 11/18/2022]
Abstract
It is important for nurses today and for those joining the workforce in the future to have familiarity and training with respect to interprofessional research, evidence-based practice, and quality improvement. In an effort to address this need, we describe a 10-week summer research program that immerses undergraduate nursing students in a broad spectrum of clinical and translational research projects as part of their exposure to advanced nursing roles. In doing so, the program increases the ability of the students to participate in research, effectively interact with academic medical center researchers, and incorporate elements of evidence-based practice into future nursing interventions. Their mentors are nurses practicing in roles as nurse researcher, advanced practice nurses involved in evidence-based practice or quality improvement, and clinical trials research nurses. Each student is matched with 3 of these mentors and involved in 3 different projects. Through this exposure, the students benefit from observing multiple nursing roles, taking an active role in research-related activities participating in interdisciplinary learning experiences. Overall, the program provides benefits to the students, who demonstrate measured improvement with respect to the program objectives, and to their mentors and each of the participating organizations.
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Affiliation(s)
- Mary Jo Slattery
- Clinical Program Coordinator for Nursing Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bridget Linehan Logan
- Nurse Practitioner, Pediatric Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Instructor, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Bridget Mudge
- Clinical Specialist, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Karen Secore
- Instructor, Geisel School of Medicine at Dartmouth, Lebanon, NH; Nurse Practitioner, Dartmouth-Hitchcock Epilepsy Center, Lebanon, NH
| | - Linda J von Reyn
- Chief Nursing Officer, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Mann EA, Alam Z, Hufgard JR, Mogle M, Williams MT, Vorhees CV, Reddy P. Chronic social defeat, but not restraint stress, alters bladder function in mice. Physiol Behav 2015; 150:83-92. [PMID: 25689100 DOI: 10.1016/j.physbeh.2015.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Voiding disorders in humans, particularly in children are associated with increased incidence of behavioral issues as well as past history of childhood abuse. We hypothesized that creating stress in mice, utilizing either a chronic social defeat model (SD) or restraint stress in shallow water model (RSSW) would engender changes in bladder function, morphology, and behavior, thereby enabling us to study the resultant voiding dysfunction. METHODS For SD stress (14 days), C57BL/6 male mice were exposed daily to a larger aggressive CD-1 male for 10 min, followed by sensory exposure in a barrier cage for 24h. Control mice were similarly housed with no exposure. For RSSW (21 days), C57BL/6 mice were put in a perforated conical tube with feet immersed in water daily for 4h, then returned to single housing cages. Control mice were also in single housing. After the stress period, voiding patterns were obtained on filter paper, followed by behavioral tests. At necropsy, blood was taken for corticosterone analysis, and bladder and body weights measured. Bladder cryosections were stained with hematoxylin and eosin (H&E) for morphological assessment. Sequential sections were immunostained with antibodies to Ki-67 as a proliferation marker, CD31 (endothelial cell marker), and uroplakin-II. ImageJ software was used to measure bladder wall thickness on blinded H&E photomicrographs as well as quantitate CD31 staining. Both Ki-67-positive and -negative nuclei were counted with Imaris software to obtain a proliferation index. RESULTS Only SD mice had a single large void pattern. Bladder-to-body weight ratios increased in SD mice (p≤0.02) but not in RSSW mice. Plasma corticosterone levels were elevated in all stressed mice. SD mice exhibited lower levels of locomotor activity compared with controls; RSSW mice were hyperactive. In SD mice, bladder wall thickness was increased (p ≤ 0.003) but no change was seen in Ki-67 proliferation index, consistent with hypertrophy. No difference with control mice was seen in vascularity as visualized by CD31 staining. Uniform uroplakin-II staining lined the urothelium of both SD and control mice. CONCLUSIONS Mice exposed to repeated SD (14 days) respond with altered voiding indicative of urine retention, and exhibit bladder wall changes consistent with hypertrophy while the urothelial barrier is maintained. These changes were not observed with repeated RSSW. SD, in contrast to RSSW, provides a model of psychological stress to further study the interplay of behavior and bladder dysfunction, enabling an improved understanding of voiding dysfunction, and the ability to create innovative and more effective management pathways for children who present with voiding dysfunction.
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Affiliation(s)
- Elizabeth A Mann
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Zaheer Alam
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Jillian R Hufgard
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Melissa Mogle
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Michael T Williams
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Charles V Vorhees
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
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