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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] [MESH Headings] [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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Hoppman T, Ouchi T, Dong Y, Barber TD, Weatherly DL, Steinhardt GF. Sonographically Determined Fecal Width: An Objective Indicator of Management of Bladder and Bowel Dysfunction in Children. Urology 2024; 184:224-227. [PMID: 38176617 DOI: 10.1016/j.urology.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To test whether sonographically determined fecal width (SDFW) correlates with symptom improvement in a population of children with bladder and bowel dysfunction (BBD) managed with standard urotherapy (SU), even for those patients lacking initial bowel complaints. METHODS We retrospectively analyzed 200 pediatric BBD patients managed with SU for at least 3 months. Self-reported symptom improvement (complete, partial, no response) following International Children's Continence Society guidelines was tabulated. Patients with complex urologic diagnoses other than vesicoureteral reflux (VUR) were excluded. Pharmacotherapy choice, physical therapy (PT), urinary tract infection (UTI) occurrence, and VUR status were tabulated. SDFW was recorded. Non-parametric analysis of variants (ANOVA) and parametric/non-parametric t testing were used for analysis. RESULTS Patients had a mean age of 9.5 years (4-12). Forty-eight patients had no gastrointestinal complaints at presentation. Urotherapy yielded complete, partial, and no responses in 14% (n = 27), 33% (n = 67), and 53% (n = 106) of patients, respectively. The average SDFW for those patients with complete response (2.6 cm) was smaller than the SDFW of those with a partial response (3.1 cm) or no response (3.3 cm) (P = .0001). Non-compliance led to greater SDFW compared to compliant patients (3.7 cm and 3.1 cm, respectively, P = .0001). Fecal width was unaffected by VUR, UTI, PT, or pharmacotherapy. CONCLUSION SDFW correlates well with symptom improvement in pediatric patients managed for BBD, confirming our hypothesis. SDFW is reasonable as single objective parameter to identify successful management in patients with BBD, extending to those without bowel complaints at presentation.
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Affiliation(s)
| | | | - Yiqing Dong
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Theodore D Barber
- Helen DeVos Children's Hospital/ Urologic Consultants Grand Rapids, MI
| | - David L Weatherly
- Helen DeVos Children's Hospital/ Urologic Consultants Grand Rapids, MI
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Akinci A, Baklaci CU, Oğuz ES, Kubilay E, Sanci A, Aydoğ E, Hajiyev P, Soygür T, Burgu B. Can lockdown and homeschooling change the outcome of urotherapy for lower urinary tract dysfunction in children? J Pediatr Urol 2021; 17:651.e1-651.e7. [PMID: 34183271 DOI: 10.1016/j.jpurol.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lower urinary tract dysfunction (LUTD) are still important for both children and pediatric urologists. Urotherapy is recommended in LUTD treatment management. In our country, all citizens under the age of 20 were banned from going out of their homes due to Covid-19 and the homeschooling system has been adopted The aim of this study is to investigate the effect of lockdown and homeschooling on the effectiveness of urotherapy used for LUTD treatment. METHODS 83 patients were included in the study group. Besides 306 patients were determined as the control group (pre-Covid). The patients in the study group and the control group were compared in terms of improvement in Dysfunctional voiding and incontinence scoring system (DVISS), quality of life scores, bladder diary, Bristol stool scale, and treatment responses at 3rd and 6th months. RESULTS The study group and control group were compared in terms of DVISS, voiding frequency and incontinence in the voiding diary, quality of life score, and Bristol stool scale at admission visit and the group characteristics were similar. During the 6th month visit, the mean DVISS of the study group was found to be significantly lower (7.12 ± 3.48; 8.58 ± 4.06 respectively (p 0.002)). Daily voiding frequency was similar in the study group and the control group during the 2nd and 3rd visit. The study group's mean number of daily incontinence was significantly lower at visit 3 (0.57 ± 0.9; 0.94 ± 0.27, respectively (p 0.02).After six months of treatment, 13.3% of the study group patients had a complete response, 44.6% had a partial response, whereas 42.2% non-responders. In the control group, the response rates were as 5.9%, 39.2% and 54.9% respectively (p 0.02). CONCLUSIONS LUTD is still very common in pediatric urology. Standard urotherapy is widely used in treatment management. According to our results, the success of standard urotherapy increases with lockdown and homeschooling. We have shown that the success of standard urotherapy can be improved by regulating environmental conditions. In terms of LUTD management, environmental conditions can be regulated to provide a better quality of life and a better cure in a more economical way.
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Affiliation(s)
- Aykut Akinci
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey.
| | - Can Utku Baklaci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Efe Semetey Oğuz
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Eralp Kubilay
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Adem Sanci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Ezel Aydoğ
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Hajiyev
- Department of Pediatric Urology, Guven Klinik Hospital, Baku, Azerbaijan
| | - Tarkan Soygür
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey
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Yilmaz EŞ, Büyük ET. Effect of education given to children with enuresis on quality of life. J Pediatr Urol 2021; 17:648.e1-648.e7. [PMID: 34518125 DOI: 10.1016/j.jpurol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The quality of life of children diagnosed with enuresis is affected negatively compared with that of healthy children. OBJECTIVES This study aimed to evaluate the effect of the education program given within the framework of nursing activities on the quality of life of children diagnosed with enuresis. STUDY DESIGN The study was conducted on 60 children aged 7-12 years who applied to the urology clinic of a hospital in Turkey and were diagnosed with enuresis. Data were collected using the Pediatric Incontinence Questionnaire (PINQ). Children who met the study criteria were divided into two groups, control and experimental, using the random draw method. Participants in the experimental group were educated by the researcher with using the Enuresis Education Booklet. RESULTS Of the 60 children, 43.3% were aged 7-8 years and 63.3% were male. At baseline, the children in the control group revealed a total mean PINQ score of 45.00 ± 11.52, and the total mean PINQ score was 45.80 ± 12.05 at 1 month. At baseline, the children in the experimental group revealed a total mean PINQ score of 47.00 ± 11.88, and the total mean PINQ score of was 32.404 ± 8.62 at 1 month. A measurement carried out in the education and control groups 1 month later showed a statistically significant difference in the total mean PINQ scores (P < 0.001). CONCLUSION Explaining the disease thoroughly to a child created a positive effect on the child's quality of life.
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Affiliation(s)
| | - Esra Tural Büyük
- Department of Child Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey.
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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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Keefe DT, Rickard M, Anderson P, Bagli D, Blais AS, Bolduc S, Braga LH, Brownrigg N, Chua M, Dave S, dos Santos J, Guerra L, Hayashi AH, Keays MA, Kim S, Koyle MA, Lee LC, Lorenzo AJ, MacLellan D, MacDonald L, MacNeily AE, Metcalfe PD, Moore K, Romao RL, Wang PZ. Prioritization and management recommendations of pediatric urology conditions during the COVID-19 pandemic. Can Urol Assoc J 2020; 14:E237-E250. [PMID: 32525802 PMCID: PMC7654666 DOI: 10.5489/cuaj.6693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Daniel T. Keefe
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Peter Anderson
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Darius Bagli
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne-Sophie Blais
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Stéphane Bolduc
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Luis H. Braga
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Natasha Brownrigg
- Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Joana dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Luis Guerra
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Allen H. Hayashi
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Mélise A. Keays
- Department of Surgery, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Soojin Kim
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Martin A. Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Linda C. Lee
- Division of Pediatric Surgery, Department of Surgery, Victoria General Hospital, Victoria, BC, Canada
| | - Armando J. Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn MacLellan
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Landan MacDonald
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Andrew E. MacNeily
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter D. Metcalfe
- Department of Surgery, Division of Pediatric Surgery, University of Alberta, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Katherine Moore
- Division d’Urologie, Département de Chirurgie, CHU de Québec, Quebec City, QC, Canada
| | - Rodrigo L.P. Romao
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Surgery, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Z.T. Wang
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
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Cantrell A, Croot E, Johnson M, Wong R, Chambers D, Baxter SK, Booth A. Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy.
Objectives
To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research.
Data sources
MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018.
Review methods
The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis.
Results
The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters.
Limitations
The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes.
Conclusions
Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Croot
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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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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11
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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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Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature. J Pediatr Urol 2018; 14:494-501. [PMID: 30297226 PMCID: PMC6295280 DOI: 10.1016/j.jpurol.2018.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bowel and bladder dysfunction (BBD) is a clinical syndrome defined by the coexistence of constipation and lower urinary tract symptoms. Although BBD is a common condition in pediatric urology and can cause significant stress to patients/parents, clinical diagnosis of BBD has not been standardized. Bowel and bladder dysfunction instruments have gained popularity over the past decade to aid in diagnosis. In this review, the currently published BBD symptom questionnaires were summarized and an analysis on their psychometric validation process was provided. SUBJECTS/PATIENTS PubMed was searched for articles on BBD symptom questionnaires/instruments/surveys since 2000. Two investigators (R.Y.J. & M.S.K.) conducted the search in duplicate. The search was limited to English language. The included search terms were 'dysfunctional elimination syndrome', 'bowel and bladder dysfunction', 'dysfunctional voiding', 'voiding dysfunction symptom score', and 'dysfunctional voiding symptom scale'. Reference lists of included studies were screened for missed studies. Unpublished abstracts presented at the following scientific meetings were also manually searched for: the American Urological Association, the Society for Pediatric Urology, and the American Academy of Pediatrics Section on Urology. Exclusion criteria included articles in languages other than English, articles not related to BBD questionnaires, and articles not pertaining to pediatric patients. RESULTS After initial search, a total of 54 articles were obtained. Of the seven questionnaires reviewed, only one did not measure sensitivity or specificity. Almost all questionnaires showed excellent discriminative property with an Area under the curve (AUC) >0.85. Criterion validity was not reported in any of the questionnaires. Known-group validation was used as a common method to evaluate construct validity. Internal consistency was reported in 2 studies, and only 1 study measured questionnaire responsiveness during initial validation. CONCLUSIONS Although BBD is a common pediatric urology condition; a large amount of heterogeneity exists in the questionnaires' psychometric testing and validation process. To further improve the diagnosis and management of BBD in pediatric patients, there is a need for consensus on the gold standard questionnaire measure.
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Brownrigg N, Braga LH, Rickard M, Farrokhyar F, Easterbrook B, Dekirmendjian A, Jegatheeswaran K, DeMaria J, Lorenzo AJ. The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: A randomized controlled trial. J Pediatr Urol 2017; 13:374.e1-374.e8. [PMID: 28733159 DOI: 10.1016/j.jpurol.2017.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Bladder and bowel dysfunction (BBD) can negatively impact the quality of life (QoL) of children. Urotherapy is an accepted treatment option for BBD; however, literature that examines the impact of management options on QoL in this population is scarce. OBJECTIVE To determine whether a bladder training video (BTV) is non-inferior to standard urotherapy (SU) in improving QoL in children with BBD. METHODS Children aged 5-10 years and who scored ≥11 on the Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES) were recruited from a pediatric tertiary care center. Children were excluded with known vesicoureteral reflux; spinal dysraphism; learning disabilities; recent urotherapy; and primary nocturnal enuresis. Quality of life was evaluated using the Pediatric Incontinence Quality-of-Life questionnaire (PinQ). Questionnaires were administered at the baseline and 3-month follow-up clinic visits. Following centralized electronic blocked randomization schemes to guarantee allocation concealment, patients were assigned to receive SU or BTV during their regular clinic visits. An intention-to-treat protocol was followed. Between-group baseline and follow-up QoL scores were compared using paired and unpaired t-tests, and linear regression analysis. RESULTS Of the 539 BBD patients who were screened, 173 (32%) were eligible, and 150 (87%) were randomized. Of these, 143 (96%) completed the study, five (3%) were lost to follow-up, and two (1%) withdrew. In total, 140/143 (97%) completed the QoL questionnaire at baseline and follow-up. Mean follow-up time was 3.5 ± 1.1 months for BTV patients and 3.7 ± 1.6 months for SU. At baseline, BTV and SU patients had a mean QoL score of 26.6 ± 13 and 23.8 ± 12, respectively (P = 0.17). Between-group mean change in PinQ scores from baseline was not statistically significant (BTV: 6.25 ± 12.5 vs SU: 3.75 ± 12.2; P = 0.23; Summary Fig.). Significant predictors of positive change in QoL were: higher symptomatology score, with a correlation coefficient of 0.5 (95% CI: 0.2-0.9; P = 0.003), and worse baseline QoL score, with a correlation coefficient of 0.5 (95% CI: 0.4-0.7; P < 0.001). Overall, most patients had improved symptomatology and QoL scores. CONCLUSION Significant and similar QoL changes from baseline to follow-up were observed in both the BTV and SU groups, suggesting that BTV was non-inferior to SU in improving QoL in children with BBD. Quality of life assessment should be considered when evaluating interventions for BBD, as it appears to be an important clinical outcome with which to determine urotherapy success.
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Affiliation(s)
- N Brownrigg
- McMaster Children's Hospital, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada
| | - L H Braga
- McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - M Rickard
- McMaster Children's Hospital, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada
| | - F Farrokhyar
- McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - B Easterbrook
- McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada
| | - A Dekirmendjian
- McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada
| | - K Jegatheeswaran
- McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada
| | - J DeMaria
- McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada
| | - A J Lorenzo
- Clinical Urology Research Enterprise (CURE) Program, Hamilton, Ontario, Canada; The Hospital for Sick Children, Division of Urology, Toronto, Ontario, Canada
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