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Khondker A, Ahmad I, Rajesh Z, Balkaran S, Al-Daqqaq Z, Kim JK, Brownrigg N, Varghese A, Chua M, Rickard M, Lorenzo AJ, Dos Santos J. The Role of Secondary Conservative Management Strategies in Bladder and Bowel Dysfunction: A Systematic Review and Meta-analysis. J Pediatr 2024; 273:114152. [PMID: 38906507 DOI: 10.1016/j.jpeds.2024.114152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/11/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE We sought to determine the effect of secondary management strategies in addition to urotherapy on bowel bladder dysfunction outcomes. STUDY DESIGN The review protocol was prospectively registered (CRD42023422168). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (database initiation until June 2023) were searched. Comparative studies of secondary management strategies vs conventional urotherapy alone were included. Two authors independently screened titles, abstracts, and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS In this systematic review and meta-analysis of 18 studies and 1228 children, secondary management strategies (home-based education, biofeedback, and physical therapy) were associated with reduced symptom burden, fewer recurrent urinary tract infections, and improved uroflowmetry findings than children treated solely with urotherapy for conservative management. CONCLUSIONS Although there is significant reporting heterogeneity, secondary conservative management strategies such as home education, biofeedback or cognitive behavioral therapy, and physiotherapy-based education are associated with less urinary incontinence, fewer infections, and fewer abnormal uroflowmetry findings.
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Affiliation(s)
- Adree Khondker
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ihtisham Ahmad
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zwetlana Rajesh
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sabrina Balkaran
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zizo Al-Daqqaq
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Abby Varghese
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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Schloss J, Ryan K, Steel A. A randomised, double-blind, placebo-controlled clinical trial found that a novel herbal formula Urox® (Bedtime Buddy®) assisted children for the treatment of nocturnal enuresis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 93:153783. [PMID: 34628241 DOI: 10.1016/j.phymed.2021.153783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nocturnal enuresis or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. HYPOTHESIS/PURPOSE To determine if a herbal capsule formulation taken once daily can reduce incidence and frequency of nocturnal enuresis in children. STUDY DESIGN This randomised double-blind placebo-controlled trial evaluated the efficacy of an herbal medicine product to reduce the symptoms of nocturnal enuresis. Participants, aged between 6 and 14 years of age, were recruited from the community in Australia. They were randomised via computerised random-number generation at study enrolment to receive one or two oral capsules in the morning of either Urox® (Bedtime Buddy®) or placebo. The Paediatric Quality of life (Pin-Q) was used as a quality-of-life measure and waking wet, fluid intake and urinary urgency per week were monitored. RESULTS Forty-one children completed the trial with an attrition rate of 16%. There were more males (64.6%) compared to females (35.4%) and the mean age was 8.6 years. Forty-one point seven percentages (41.7%) of participants had improvements in bed wetting by two months which was a highly clinically relevant effect (Cohen's D = 0.98). The primary outcome found that there was a statistically significant reduction in NE (p = 0.034; CI 0.086-2.095) and between groups using longitudinal analysis (p = 0.04, Coefficient -1.12, CI 95% -2.20 - -0.04). In the secondary outcomes, urinary urgency reduced statistically significantly for the intervention (p = 0.002; a reduction of 18.3% difference for Bedtime Buddy compared to an increase of 3.7% for the placebo). CONCLUSION Urox® (Bedtime Buddy®) may assist children in reducing nocturnal enuresis compared to placebo. In addition, it may assist in reducing daily incontinence and urinary urgency.
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Affiliation(s)
- Janet Schloss
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney Australia.
| | - Kimberley Ryan
- The Royal Brisbane Women's Hospital, Herston, Brisbane, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney Australia
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Pokarowski M, Rickard M, Kanani R, Mistry N, Saunders M, Rockman R, Sam J, Varghese A, Malach J, Margolis I, Roushdi A, Levin L, Singh M, Lopes RI, Farhat WA, Koyle MA, Dos Santos J. Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction. Pediatr Qual Saf 2021; 6:e383. [PMID: 33718744 PMCID: PMC7952106 DOI: 10.1097/pq9.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care. METHODS We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients. RESULTS Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction. CONCLUSIONS Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
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Affiliation(s)
- Martha Pokarowski
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mandy Rickard
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, North York, Ontario, Canada
| | - Niraj Mistry
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Megan Saunders
- Department of Pediatrics, North York General Hospital, North York, Ontario, Canada
| | - Rebecca Rockman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Sam
- Department of Pediatrics, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Abby Varghese
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Malach
- Department of Pediatrics, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Ivor Margolis
- Department of Pediatrics, William Osler Health Centre-Brampton Civic Hospital, Brampton, Ontario, Canada
| | - Amani Roushdi
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Leo Levin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Manbir Singh
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Walid A. Farhat
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A. Koyle
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana Dos Santos
- From the Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Afshar K, Dos Santos J, Blais AS, Kiddoo D, Dharamsi N, Wang M, Noparast M. Canadian Urological Association guideline for the treatment of bladder dysfunction in children. Can Urol Assoc J 2020; 15:13-18. [PMID: 33007188 DOI: 10.5489/cuaj.6975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Darcie Kiddoo
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Nafisa Dharamsi
- Department of Surgery, Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Mannan Wang
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Maryam Noparast
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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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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Miyakita H, Hayashi Y, Mitsui T, Okawada M, Kinoshita Y, Kimata T, Koikawa Y, Sakai K, Satoh H, Tokunaga M, Naitoh Y, Niimura F, Matsuoka H, Mizuno K, Kaneko K, Kubota M. Guidelines for the medical management of pediatric vesicoureteral reflux. Int J Urol 2020; 27:480-490. [PMID: 32239562 PMCID: PMC7318347 DOI: 10.1111/iju.14223] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Urinary tract infection is a bacterial infection that commonly occurs in children. Vesicoureteral reflux is a major underlying precursor condition of urinary tract infection, and an important disorder in the field of pediatric urology. Vesicoureteral reflux is sometimes diagnosed postnatally in infants with fetal hydronephrosis diagnosed antenatally. Opinions vary regarding the diagnosis and treatment of vesicoureteral reflux, and diagnostic procedures remain debatable. In terms of medical interventions, options include either follow‐up observation in the hope of possible spontaneous resolution of vesicoureteral reflux with growth/development or provision of continuous antibiotic prophylaxis based on patient characteristics (age, presence/absence of febrile urinary tract infection, lower urinary tract dysfunction and constipation). Furthermore, there are various surgical procedures with different indications and rationales. These guidelines, formulated and issued by the Japanese Society of Pediatric Urology to assist medical management of pediatric vesicoureteral reflux, cover the following: epidemiology, clinical practice algorithm for vesicoureteral reflux, syndromes (dysuria with vesicoureteral reflux, and bladder and rectal dysfunction with vesicoureteral reflux), diagnosis, treatment (medical and surgical), secondary vesicoureteral reflux, long‐term prognosis and reflux nephropathy. They also provide the definition of bladder and bowel dysfunction, previously unavailable despite their close association with vesicoureteral reflux, and show the usefulness of diagnostic tests, continuous antibiotic prophylaxis and surgical intervention using site markings.
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Affiliation(s)
- Hideshi Miyakita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yutaro Hayashi
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiko Mitsui
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Manabu Okawada
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Yoshiaki Kinoshita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takahisa Kimata
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuhiro Koikawa
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Fukuoka City Medical Center of Sick Children, Fukuoka, Japan
| | - Kiyohide Sakai
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Miyagi Children's Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Satoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology and Kidney Transplantation, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masatoshi Tokunaga
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yasuyuki Naitoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumio Niimura
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Tokai University School of Medicine, Hiratsuka, Kanagawa, Japan
| | - Hirofumi Matsuoka
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kentaro Mizuno
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazunari Kaneko
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masayuki Kubota
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Schloss J, Ryan K, Reid R, Steel A. A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children. BMC Pediatr 2019; 19:421. [PMID: 31706286 PMCID: PMC6842251 DOI: 10.1186/s12887-019-1797-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nocturnal enuresis (NE), or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE. METHODS This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion. DISCUSSION This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registration Number: 12618000288224. PROTOCOL 23 February 2018, version 1.1.
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Affiliation(s)
- Janet Schloss
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kimberley Ryan
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Rebecca Reid
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Amie Steel
- Office of Research, Endeavour College of Natural Health, Brisbane, Australia
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Assis GM, Silva CPCD, Martins G. Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Assis GM, Silva CPCD, Martins G. Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review. J Pediatr (Rio J) 2019; 95:628-641. [PMID: 31009619 DOI: 10.1016/j.jped.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. METHOD Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. RESULTS Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. CONCLUSION This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.
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Affiliation(s)
- Gisela Maria Assis
- Affiliate Member in the Associação Brasileira de Estomaterapia (SOBEST), São Paulo, SP, Brazil; Universidade de Brasília (UnB), Departamento de Enfermagem, Brasília, DF, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas (HC), Equipe de Estomaterapia, Curitiba, PR, Brazil.
| | - Camilla Pinheiro Cristaldi da Silva
- Affiliate Member in the Associação Brasileira de Estomaterapia (SOBEST), São Paulo, SP, Brazil; Pontifícia Universidade Católica do Paraná (PUC/PR), Pós-graduação em Estomaterapia, Curitiba, PR, Brazil
| | - Gisele Martins
- Universidade de Brasília (UnB), Departamento de Enfermagem, Brasília, DF, Brazil; Affiliate Member in the Society for Pediatric Urology (SPU), United States
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Buckley BS, Sanders CD, Spineli L, Deng Q, Kwong JSW. Conservative interventions for treating functional daytime urinary incontinence in children. Cochrane Database Syst Rev 2019; 9:CD012367. [PMID: 31532563 PMCID: PMC6749940 DOI: 10.1002/14651858.cd012367.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In children, functional daytime urinary incontinence is the term used to describe any leakage of urine while awake that is not the result of a known underlying neurological or congenital anatomic cause (such as conditions or injuries that affect the nerves that control the bladder or problems with the way the urinary system is formed). It can result in practical difficulties for both the child and their family and can have detrimental effects on a child's well-being, education and social engagement. OBJECTIVES To assess the effects of conservative interventions for treating functional daytime urinary incontinence in children. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains studies identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 11 September 2018). We also searched Chinese language bibliographic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang. No language restrictions were imposed. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised, multi-arm studies, cross-over studies and cluster-randomised studies that included children aged between 5 and 18 years with functional daytime urinary incontinence. DATA COLLECTION AND ANALYSIS Two review authors independently screened records and determined the eligibility of studies for inclusion according to predefined criteria. Where data from the study were not provided, we contacted the study authors to request further information. Two review authors assessed risk of bias and processed included study data as described in the Cochrane Handbook for Systematic Reviews of Interventions. Where meta-analysis was possible, we applied random-effects meta-analysis using the Mantel-Haenszel method for dichotomous outcomes. MAIN RESULTS The review included 27 RCTs involving 1803 children. Of these, six were multi-arm and one was also a cross-over study. Most studies were small, with numbers randomised ranging from 16 to 202. A total of 19 studies were at high risk of bias for at least one domain. Few studies reported data suitable for pooling due to heterogeneity in interventions, outcomes and measurements.Individual conservative interventions (lifestyle, behavioural or physical) versus no treatmentTranscutaneous electrical nerve stimulation (TENS) versus sham (placebo) TENS. More children receiving active TENS may achieve continence (risk ratio (RR) 4.89, 95% confidence interval (CI) 1.68 to 14.21; 3 studies; n = 93; low-certainty evidence).One individual conservative intervention versus another individual or combined conservative interventionPelvic floor muscle training (PFMT) with urotherapy versus urotherapy alone. We are uncertain whether more children receiving PFMT with urotherapy achieve continence (RR 2.36, 95% CI 0.65 to 8.53, 95% CI 25 to 100; 3 studies; n = 91; very low-certainty evidence).Voiding education with uroflowmetry feedback and urotherapy versus urotherapy alone. Slightly more children receiving voiding education with uroflow feedback and urotherapy may achieve continence (RR 1.13, 95% CI 0.87 to 1.45; 3 studies; n = 151; low-certainty evidence).Urotherapy with timer watch versus urotherapy alone. We are uncertain whether urotherapy plus timer watch increases the number of children achieving continence compared to urotherapy alone (RR 1.42, 95% CI 1.12 to 1.80; 1 study; n = 58; very low-certainty evidence).Combined conservative interventions versus other combined conservative interventionsTENS and standard urotherapy versus PFMT with electromyographic biofeedback and standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.11, 95% CI 0.73 to 1.68; 1 study; n = 78; very low-certainty evidence).PFMT with electromyography biofeedback and standard urotherapy versus PFMT without feedback but with standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.05, 95% CI 0.72 to 1.52; 1 study; n = 41; very low-certainty evidence).Individual conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)PFMT versus anticholinergics. We are uncertain whether more children receiving PFMT than anticholinergics achieve continence (RR 1.92, 95% CI 1.17 to 3.15; equivalent to an increase from 33 to 64 per 100 children; 2 studies; n = 86; very low-certainty evidence).TENS versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 0.81, 95% CI 0.05 to 12.50; 2 studies; n = 72; very low-certainty evidence).Combined conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)Voiding education with uroflowmetry feedback versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportion of children achieving continence (RR 1.02, 95% CI 0.58 to 1.78; 1 study; n = 64; very low-certainty evidence). AUTHORS' CONCLUSIONS The review found little reliable evidence that can help affected children, their carers and the clinicians working with them to make evidence-based treatment decisions. In this scenario, the clinical experience of individual clinicians and the support of carers may be the most valuable resources. More well-designed research, with well-defined interventions and consistent outcome measurement, is needed.
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Affiliation(s)
- Brian S Buckley
- University of the PhilippinesDepartment of SurgeryManilaPhilippines
| | - Caroline D Sanders
- University of Northern British ColumbiaSchool of Nursing3333 University WayPrince GeorgeBritish ColumbiaCanadaV7M 2A9
| | - Loukia Spineli
- Hannover Medical SchoolDepartment of Obstetrics, Gynecology and Reproductive Medicine, Midwifery Research UnitCarl‐Neuberg‐Straße 1HannoverGermany30625
| | - Qiaoling Deng
- Zhongnan Hospital of Wuhan UniversityClinical Laboratory169 Donghu RoadWuhanHubei ProvinceChina430071
| | - Joey SW Kwong
- United Nations Population FundAsia and the Pacific Regional Office4th Floor, United Nations Service BuildingRajdamnern Nok AvenueBangkokThailand10200
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Collis D, Kennedy-Behr A, Kearney L. The impact of bowel and bladder problems on children's quality of life and their parents: A scoping review. Child Care Health Dev 2019; 45:1-14. [PMID: 30328126 DOI: 10.1111/cch.12620] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Functional bladder and bowel problems are common in children and have a serious psychological as well as physical impact. The objective of this scoping review was to synthesise evidence on the impact of such conditions both on children's quality of life (QOL) and their parents. METHODS The scoping review followed Arksey and O'Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases. Inclusion criteria focused on children with bladder and bowel dysfunction, their QOL, and impact on parents. Studies were analysed for aims, study populations, measures, and results. RESULTS A total of 783 records were retrieved with 30 meeting the criteria. Most studies found that QOL was reduced in children with nocturnal enuresis, day bladder dysfunction, bowel dysfunction, and combined bladder and bowel dysfunction. Parents' QOL and social-emotional functioning were also negatively affected. CONCLUSIONS Functional bladder and bowel problems should be identified and treated as early as possible to minimise negative impacts on QOL of children and their carers. Future research should focus on how to best provide early and effective intervention in the most accessible manner.
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Affiliation(s)
- Dianne Collis
- Women's and Families Service Group, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Ann Kennedy-Behr
- School of Health and Sport Science, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Lauren Kearney
- Women's and Families Service Group, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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13
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Braga LH, Rickard M, Farrokhyar F, Jegatheeswaran K, Brownrigg N, Li C, Bansal R, DeMaria J, Lorenzo AJ. Bladder Training Video versus Standard Urotherapy for Bladder and Bowel Dysfunction: A Noninferiority Randomized, Controlled Trial. J Urol 2016; 197:877-884. [PMID: 27569433 DOI: 10.1016/j.juro.2016.08.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We evaluated whether an animated bladder training video was as effective as standard individual urotherapy in improving bladder/bowel symptoms. MATERIALS AND METHODS Patients 5 to 10 years old who scored greater than 11 on the bladder/bowel Vancouver questionnaire were included in a noninferiority randomized, controlled trial. Children with vesicoureteral reflux, neuropathic bladder, learning disabilities, recent urotherapy or primary nocturnal enuresis were excluded from analysis. Patients were randomly assigned to receive standard urotherapy or watch a bladder training video in clinic using centralized blocked randomization schemes. Bladder/bowel symptoms were evaluated at baseline and 3-month followup by intent to treat analysis. A sample size of 150 patients ensured a 3.5 difference in mean symptomology scores between the groups, which was accepted as the noninferiority margin. RESULTS Of 539 screened patients 173 (37%) were eligible for study and 150 enrolled. A total of 143 patients (95%) completed the trial, 5 (4%) were lost to followup and 2 (1%) withdrew. Baseline characteristics were similar between the groups. Baseline mean ± SD symptomology scores were 19.9 ± 5.5 for the bladder training video and 19.7 ± 6.0 for standard urotherapy. At 3 months the mean symptomology scores for the bladder training video and standard urotherapy were reduced to 14.4 ± 6.5 and 13.8 ± 6.0, respectively (p = 0.54). The mean difference was 0.6 (95% CI -1.4-2.6). The upper 95% CI limit of 2.6 did not exceed the preset 3.5 noninferiority margin. CONCLUSIONS The bladder training video was not inferior to standard urotherapy in reducing bladder/bowel symptoms in children 5 to 10 years old. The video allows families to have free access to independently review bladder training concepts as often as necessary.
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Affiliation(s)
- Luis H Braga
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada.
| | - Mandy Rickard
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Forough Farrokhyar
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Kizanee Jegatheeswaran
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Natasha Brownrigg
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Christine Li
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Rahul Bansal
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Jorge DeMaria
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
| | - Armando J Lorenzo
- McMaster Pediatric Surgery Research Collaborative (KJ, CL, JD), Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University (LHB, FF), Hamilton, Ontario, Canada; Clinical Urology Research Enterprise Program, McMaster Children's Hospital (LHB, MR, FF, KJ, NB, JD, AJL), Hamilton, Ontario, Canada; Division of Urology, Hospital for Sick Children (AJL), Toronto, Ontario, Canada
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Johnston DL, Qureshi AH, Irvine RW, Giel DW, Hains DS. Contemporary Management of Vesicoureteral Reflux. ACTA ACUST UNITED AC 2016; 2:82-93. [PMID: 27570729 DOI: 10.1007/s40746-016-0045-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD) when present, are the foundation of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe the benefits outweigh the risks and costs for many patients. Careful observation can be considered in patients with a single medical home, parental understanding of what UTI signs and symptoms are, low grade VUR, no history of complicated UTIs and close follow-up. Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.
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Affiliation(s)
- Derrick L Johnston
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Aslam H Qureshi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
| | - Rhys W Irvine
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - Dana W Giel
- Division of Pediatric Urology, Department of Surgery, University of Tennessee Health Science Center
| | - David S Hains
- Division of Pediatric Nephrology, Department of Pediatrics, University of Tennessee Health Science Center
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