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Panach-Navarrete J, Valls-González L, Martínez-Jabaloyas JM. Prospective comparison of two methods for correct ureteral stent placement in pediatric laparoscopic pyeloplasty. J Pediatr Urol 2024; 20:730.e1-730.e5. [PMID: 38760259 DOI: 10.1016/j.jpurol.2024.05.001] [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: 02/11/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Ureteral stent placement during laparoscopic pyeloplasty is a common procedure in pediatric patients. Although an apparently safe maneuver, ascending placement of the stent can lead to complex removal or repositioning reinterventions. OBJECTIVE In this study we compare two methods for intraoperative verification of correct positioning. STUDY DESIGN Prospective observational study collecting data on laparoscopic pyeloplasties in pediatric patients in our center over three years. We carried out descriptive and univariate comparative analyses. Data were compared between ultrasound and reflux visualized by the catheter after intraoperative salineinjection into the bladder through the urethral catheter. We recorded time to catheter visualization in both ultrasonography and in reflux from the start of bladder instillation, as well as bladder volume at the time of placement verification with each method. RESULTS Data were collected from 20 patients (15 male and 5 female) with a median age of 48 months. Pyeloplasty was successful in 100% of the sample (as observed by ultrasound and MAG-3), while one patient had postoperative leak requiring nephrostomy placement. Correct distal positioning of the ureteral stent could be verified by intraoperative ultrasound and reflux in all cases. Using reflux, the bladder volume needed to verify correct positioning exceeded the age-related maximum in half the cohort, while on ultrasound, the stent was visualized in the bladder without reaching the maximum bladder capacity for age in any case (p = 0.02 comparing percentages). Likewise, mean time to verification was lower with ultrasound than with reflux (61.8 s versus 115 s), but without these differences reaching statistical significance (p = 0.14). DISCUSSION The present study is the first to compare two methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasties in pediatric patients. Our results show that both intraoperative ultrasound and visualization of reflux are useful methods, although ultrasound requires a lower volume of saline instilled through the bladder catheter for verification. This work can be very useful for the daily clinical practice of urologists and pediatric surgeons. CONCLUSIONS Both intraoperative ultrasound and visualization of reflux are useful methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasty of pediatric patients. With ultrasound, a smaller volume is required to check for reflux. Although ultrasound is faster for verification, there are no differences in procedural times.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia, INCLIVA, Instituto de Investigación Sanitaria, Facultat de Medicina i Odontologia, Universitat de València, Av Blasco Ibáñez, 17, CP 46010 Valencia, Spain.
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia, INCLIVA, Instituto de Investigación Sanitaria, Facultat de Medicina i Odontologia, Universitat de València, Av Blasco Ibáñez, 17, CP 46010 Valencia, Spain.
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia, INCLIVA, Instituto de Investigación Sanitaria, Facultat de Medicina i Odontologia, Universitat de València, Av Blasco Ibáñez, 17, CP 46010 Valencia, Spain.
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Fischer KM, Samet E, Messina A, Berry A, Zderic SA, Van Batavia JP. Who needs an ultrasound? Using patient symptom questionnaire & UTI history to determine when to obtain an RBUS in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol 2023; 19:542.e1-542.e7. [PMID: 37537092 PMCID: PMC10543542 DOI: 10.1016/j.jpurol.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Non-neurogenic lower urinary tract dysfunction (LUTD) is one of the most common reasons for presentation to a pediatric urologist, affecting up to 20% of children. Predicting who will benefit from RBUS as part of their work-up is challenging as the majority will have normal imaging. OBJECTIVE Our objective was to assess the utility of using the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and urinary tract infection (UTI) history to predict which LUTD patients were most likely to have an abnormal RBUS as well as determine a DVISS cutoff to aid in making this prediction. We hypothesized that higher DVISS scores and a positive urinary tract infection (UTI) history would be associated with increased likelihood of RBUS abnormality. STUDY DESIGN We retrospectively reviewed outpatients seen for LUTD from 5/2014-1/2016 who received an RBUS. Association between prior UTI, DVISS score, gender, and race and RBUS abnormality were evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curves were created to evaluate the predictive model and a Youden index calculated to determine the optimal cutoff for DVISS score to predict abnormal RBUS. RESULTS 15 of 333 patients (4.5%) had a clinically significant RBUS abnormality. Significantly more patients with abnormal RBUS had a positive UTI history and median DVISS was higher. UTI history and DVISS score were associated with RBUS abnormality whereas neither gender nor race were. A DVISS score cutoff of 12 was determined to be ideal for predicting abnormal imaging. Using DVISS≥12 and positive UTI history, patients with both risk factors were significantly more likely to have an abnormal RBUS than those with zero or one risk factor (Figure). DISCUSSION To the best of our knowledge this is the first study to try to identify risk factors associated with RBUS abnormality in pediatric LUTD patients and create an evidence-based approach to imaging these patients. We found both DVISS cutoff ≥12 and positive UTI history to be useful to risk stratify LUTD patients' likelihood of abnormal RBUS. Limitations include the study's retrospective nature as well as the fact the population was drawn from a tertiary care pediatric hospital with a large referral population and the fact that the decision to order an RBUS was based on individual clinician preference and decision making. CONCLUSIONS We found that DVISS score≥12 and UTI history are useful in guiding the decision to obtain RBUS in pediatric LUTD patients.
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Affiliation(s)
- Katherine M Fischer
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA.
| | - Ethan Samet
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Adriana Messina
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Amanda Berry
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Stephen A Zderic
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Jason P Van Batavia
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
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Editorial: Urinary tract obstruction in children. Curr Opin Pediatr 2021; 33:217-219. [PMID: 33605626 DOI: 10.1097/mop.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xu Z, Wu D, Tao C, Zhou J, Zheng Z, Tang D. Treatment efficacy of tolterodine versus belladonna mixture in children with idiopathic overactive bladder. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2019-000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesChildren with symptoms of urinary urgency, frequency and incontinence are common in the clinic. The aim of the present study was to compare the tolerability and efficacy of tolterodine, a bladder-selective muscarinic receptor antagonist, with belladonna mixture, a traditional anticholinergic drug, in the treatment of idiopathic overactive bladder in children.MethodsChildren aged 5–10 years with a history of diurnal urgency, frequency and incontinence were randomly divided into two groups. Participants in group 1 were given tolterodine 1 mg twice a day for 14 days. If the results were found to be mildly ineffective, after the first 14 days of therapy, prolonged course with 2 mg twice a day was given. In group 2, the children were treated with belladonna mixture 5 mL twice a day for 14 days. Anticholinergic side effects were recorded during the therapy and efficacy was evaluated with voiding diary recorded by the parents at the beginning and end of therapy.ResultsA total of 668 cases were included in this study and 334 for each 25 group (496 boys and 172 girls). Evident anticholinergic side effects which could cease the therapy, such as dry mouth, constipation, mood changes, irritability, and so on, exhibited only on 2% of participants in the tolterodine group but 69% in the belladonna mixture group (p≤0.05). The symptoms of detrusor overactivity disappeared or significantly improved in 80% of children in the tolterodine group and 37% in the belladonna mixture (p≤0.05) group.ConclusionsTolterodine had better tolerability and efficacy than belladonna mixture in treating overactive bladder in children.
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Ladi-Seyedian SS, Sharifi-Rad L, Nabavizadeh B, Kajbafzadeh AM. Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior? Curr Urol Rep 2019; 20:38. [PMID: 31147796 DOI: 10.1007/s11934-019-0901-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Pelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction. RECENT FINDINGS Today, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training component, is not an effective treatment. Biofeedback is an adjunct to the pelvic floor training. In the current review, we develop the role of pelvic floor physical therapy in management of children with non-neuropathic voiding dysfunction and compare it with biofeedback therapy alone.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.,Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
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Fuentes M, Magalhães J, Barroso U. Diagnosis and Management of Bladder Dysfunction in Neurologically Normal Children. Front Pediatr 2019; 7:298. [PMID: 31404146 PMCID: PMC6673647 DOI: 10.3389/fped.2019.00298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/04/2019] [Indexed: 12/28/2022] Open
Abstract
Normal bladder and urethral sphincter development as well as neural/volitional control over bladder-sphincter function are essential steps for regular lower urinary tract function. These maturational sequences are clinically evident by the age of 5 years. However, in 17-22% of children, symptoms persist beyond that age, characterizing lower urinary tract dysfunction (LUTD). The clinical spectrum is wide and includes overactive bladder, voiding postponement, underactive bladder, infrequent voiding, extraordinary daytime only urinary frequency, vaginal reflux, bladder neck dysfunction, and giggle incontinence. LUTD may lead to vesicoureteral reflux and recurrent urinary tract infections, increasing the likelihood of renal scarring. LUTD is often associated with constipation and emotional/behavioral disorders such as anxiety, depression, aggressiveness, and social isolation, making diagnosis, and treatment imperative. Diagnosis of LUTD is essentially based on clinical history, investigation of bladder storage, voiding symptoms (urinary frequency, daytime incontinence, enuresis, urgency) and constipation. Dysfunctional Voiding Score System (DVSS) is a helpful tool. Physical examination focuses on the abdomen to investigate a distended bladder or palpable fecal mass, the lumbosacral spine, and reflex testing. Bladder diaries are important for recording urinary frequency and water balance, while uroflowmetry is used to assess voided volume, maximum flow, and curve patterns. Bladder ultrasonography to measure post-void residual urine volume and urodynamics are used as supplemental tests. Current first line treatment is urotherapy, a combination of behavioral measures to avoid postponing micturition, and a restricted diet for at least 2 months. Anticholinergics, β3 agonists and neuromodulation are alternative therapies to manage refractory overactive bladder. Cure rates, at around 40%, are considered satisfactory, with daytime symptoms improving in 32% of cases. Furthermore, children who are also constipated need treatment, preferentially with polyethylene glycol at doses of 1-1.5 g/kg in the 1st 3 days and 0.25-0.5 g/kg thereafter until the 2-month period of behavioral therapy is complete. If urotherapy fails in cases of dysfunctional voiding, the next step is biofeedback to teach the child how to relax the external urethral sphincter during micturition. Success rate is around 80%. Children with underactive bladder usually need a combination of clean intermittent catheterization, alpha-blockers, biofeedback and neuromodulation; however, cure rates are uncertain.
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Affiliation(s)
- Mirgon Fuentes
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Juliana Magalhães
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
| | - Ubirajara Barroso
- Center of Urinary Disorders in Children (CEDIMI), Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil.,Aliança Hospital, Salvador, Brazil
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Non-invasive Testing and Its Role in Diagnosis and Management of Children With Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction. Curr Urol Rep 2018; 19:34. [PMID: 29623450 DOI: 10.1007/s11934-018-0784-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW The symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children. RECENT FINDINGS Non-invasive tests such urine studies, uroflowmetry ± simultaneous electromyography, assessment of post-void residual, renal/bladder ultrasound, and pelvic ultrasound when used appropriately can provide valuable information to facilitate decision making during the evaluation of children with LUTD. While these tests should be employed prior to more invasive testing such as urodynamic studies, they can often act as a surrogate for the more invasive tests. Non-invasive tests can help us in our goal of improving diagnostic ability to better classify the child's LUTD into an actual condition which allows targeted treatment in the hope of better outcomes and more satisfied patients and families.
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Wang J, Zheng X, Zhang L, Zhang Y, Xiong J, Cheng Y, Shi H, Qiu X, Zhou L, Sun X. The variation in urinary calcium levels in adult patients with fracture and surgical intervention. J Orthop Surg Res 2017; 12:123. [PMID: 28810891 PMCID: PMC5558773 DOI: 10.1186/s13018-017-0624-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022] Open
Abstract
Background Generally, a higher calcium diet is fed to fracture patients after surgery. However, recent studies have indicated that higher dietary calcium intakes increase the risk of urinary stones for fracture patients. Therefore, this study aimed to observe the variation in urinary calcium levels among fracture patients who underwent surgery, based on fracture type, fracture location, age and gender. Methods A total of 768 subjects were enrolled in this study from 2012 to 2015 and were divided into 2 groups: group A (fracture patients who underwent surgery) and group B (normal patients without fracture). Urine samples were collected for a 24-h period (24-h urine), at multiple specific time points before and after surgery for group A, or after hospitalisation for group B. Subsequently, urine calcium was detected and the changes were evaluated according to fracture location, fracture type, age and gender, as well as the distribution of hypercalciuria. Results Compared with group B, the level of urine calcium in group A significantly increased at different time points during the study period (P < 0.05). There were significant differences in the changes in urine calcium levels according to fracture location, fracture type and age, but not gender. Further, there were more patients with hypercalciuria in group A at the different time points, compared with group B. Conclusion Variation in urinary calcium among fracture patients that underwent surgery was of a regular pattern and hypercalciuria was also found in these patients. Therefore, a high-calcium diet and calcium supplements should be used with caution in this patient population.
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Affiliation(s)
- Junfei Wang
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xin Zheng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China
| | - Liming Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yifan Zhang
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jin Xiong
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Yixin Cheng
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Hongfei Shi
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Xusheng Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China
| | - Leqin Zhou
- Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xizhao Sun
- Department of Orthopedics, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, Jiangsu Province, 210008, China. .,Department of Urology, Nanjing Drum Tower Hospital, the affiliated hospital of Nanjing University Medical School, Nanjing, 210008, China.
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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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