1
|
Kan KM, Agrawal G, Brosula R, Venkatapuram P, Chen AL, Zhang CA. Prevalence of pediatric lower urinary tract symptoms in a national claims database of privately insured patients, 2003-2014. Int Urol Nephrol 2024; 56:1785-1793. [PMID: 38289544 DOI: 10.1007/s11255-023-03913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately insured pediatric population who are 6-20 years old by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. METHODS We retrospectively reviewed Optum's de-identified Clinformatics® Data Mart Database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. RESULTS We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003 to 2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. The median age group of patients was 6-10 years. More patients were female (59.80%), white (65.97%), between 6 and 10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. CONCLUSIONS Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly insured populations.
Collapse
Affiliation(s)
- Kathleen M Kan
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA.
| | - Gunjan Agrawal
- Flushing Hospital Medical Center, 4500 Parsons Blvd, Flushing, NY, 11533, USA
| | - Raphael Brosula
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Pranaya Venkatapuram
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Abby L Chen
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| | - Chiyuan A Zhang
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Urology 5656, Palo Alto, CA, 94304, USA
| |
Collapse
|
2
|
Kan KM, Agrawal G, Brosula R, Venkatapuram P, Chen AL, Zhang CA. Prevalence of pediatric lower urinary tract symptoms in a US population seeking medical care, 2003- 2014. RESEARCH SQUARE 2023:rs.3.rs-2883579. [PMID: 37333169 PMCID: PMC10275036 DOI: 10.21203/rs.3.rs-2883579/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately-insured pediatric population who are 18 years of age or older by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. Methods We retrospectively reviewed Optum's de-identifed Clinformatics® Data Mart Database database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. Results We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003-2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. Mean age was 12.15 years. More patients were female (59.80%), white (65.97%), between 6-10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. Conclusions Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly-insured populations.
Collapse
|
3
|
Patil S, Daniel G, Tailor Y, Mamsaang M, Natarajan J, Moody E, James N, Vyas R, Shrikhande A. Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections. BJUI COMPASS 2022; 3:450-457. [PMID: 36267200 PMCID: PMC9579878 DOI: 10.1002/bco2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a debilitating condition characterised by bladder/pelvic pain and pressure as well as persistent or recurrent urinary symptoms in the absence of an identifiable cause. It is hypothesised that in addition to organ specific visceral hypersensitivity, contributions of the hypertonic pelvic floor, peripheral sensitisation, and central sensitisation exacerbate this condition. The aim of this paper is to investigate outcomes of treating underlying neuromuscular dysfunction and neuro-plastic mechanisms in BPS/IC patients. Methods A retrospective chart review of 84 patients referred to an outpatient pelvic rehabilitation centre with a diagnosis of BPS/IC given to them by a urologist. All 84 patients failed to progress after completing 6 weeks of pelvic floor physical therapy and underwent an institutional review board approved protocol (IRB# 17-0761) consisting of external ultrasound-guided trigger point injections to the pelvic floor musculature, peripheral nerve blocks of the pudendal and posterior femoral cutaneous nerves and continued pelvic floor physical therapy once weekly for 6 weeks. Pelvic pain intensity and functionality were measured pretreatment and 3 months posttreatment using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS). Results Pretreatment, mean VAS was 6.23 ± 2.68 (95% CI 5.65 to 6.80). Posttreatment mean VAS was 3.90 ± 2.63 (95% CI 3.07-4.74). Mean FPPS before treatment was 11.98 ± 6.28 (95% CI 10.63 to 13.32). Posttreatment mean FPPS was 7.68 ± 5.73 (95% CI 6.45-8.90). Analysis of subcategories within FPPS indicated highest statistically significant improvement in the categories of bladder, intercourse and working. Conclusions Analysis suggests the treatment was effective at ameliorating bladder pain and function including urinary urgency, frequency, and burning in BPS/IC patients.
Collapse
Affiliation(s)
- Soha Patil
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Gabrielle Daniel
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Yogita Tailor
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Marjorie Mamsaang
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Janaki Natarajan
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Erika Moody
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Neha James
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Rakhi Vyas
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| | - Allyson Shrikhande
- Pelvic Rehabilitation Medicine Clinical Research FoundationWest Palm BeachFLUSA
- The Feinstein Institute for Medical ResearchNorthwell HealthManhassetNYUSA
| |
Collapse
|
4
|
Management of Pediatric Urinary Tract Infections: A Delphi Study. Antibiotics (Basel) 2022; 11:antibiotics11081122. [PMID: 36009990 PMCID: PMC9404756 DOI: 10.3390/antibiotics11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.
Collapse
|
5
|
Lee CL, Chen SF, Jiang YH, Kuo HC. Effect of videourodynamic subtypes on treatment outcomes of female dysfunctional voiding. Int Urogynecol J 2022; 33:1283-1291. [PMID: 35301544 DOI: 10.1007/s00192-022-05154-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Dysfunctional voiding (DV) is not uncommon in women and is typically challenging to treat. This study retrospectively investigated the long-term treatment outcomes of DV women with different videourodynamics (VUDS) characteristics. METHODS Data of women with VUDS-proven DV (n = 302) were retrospectively analyzed. All patients at first received biofeedback pelvic floor muscle training and medications; urethral sphincter botulinum toxin A injection was administered after treatment failure. Long-term follow-up outcomes were graded by global response assessment (GRA) and objective responses of decrease of detrusor pressure (Pdet), increase in maximum flow rate (Qmax) and voiding efficiency (VE). The treatment outcomes were investigated among different VUDS subgroups. RESULTS Of 302 women, 165 (54.6%) had mid-urethral DV, 117 (38.7%) had distal urethral DV, and 20 (6.6%) had both bladder neck dysfunction (BND) and mid-urethral DV. A total of 170 (56.3%) patients were available for follow-up VUDS after treatment. Pdet was decreased in all three subgroups, but increase in Qmax and VE was only noted in the BND plus DV subgroup. Overall, 120 (70.6%) patients showed improvement (GRA ≥ 1), including 14 with BND plus DV (93.3%), 50 with mid-urethral DV (60.8%) and 56 with distal urethral DV (77.8%) (p = 0.044). All three subgroups showed significant reduction in bladder outlet obstruction index after treatment, with BND plus DV subgroup showing the greatest reduction. CONCLUSIONS Women with DV have different VUDS characteristics resulting from different pathophysiological mechanisms and treatment results. The VUDS characteristics may help predict treatment outcomes of female DV.
Collapse
Affiliation(s)
- Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
| |
Collapse
|
6
|
Hsieh KL, Chin HY, Lo TS, Long CY, Ho CH, Huang SKH, Chuang YC, Wu MP. Interstitial cystitis/bladder pain syndrome patient is associated with subsequent increased risks of outpatient visits and hospitalizations: A population-based study. PLoS One 2021; 16:e0256800. [PMID: 34492065 PMCID: PMC8423233 DOI: 10.1371/journal.pone.0256800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/17/2021] [Indexed: 12/30/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is not only a chronic urinary bladder pain syndrome but is also associated with multifactorial etiology. Our study aimed to test the hypothesis that IC/BPS is associated with subsequent increased risks of outpatient visits and hospitalizations. Using nationwide database, the diagnoses were based on the International Classification Codes (ICD-9-CM) (595.1) of at least three outpatient services during 2002-2008, (n = 27,990) and cystoscopic finding Hunner type and/or glomerulation with pre-audit criteria. All recruited cases monitored for subsequent outpatient visits and hospitalizations for 2 years, including all-cause and specialty-specific departments, were classified according to medical specialty and age group (<40, 40-60, ≥60 years of age). IC/BPS patients have more overall outpatient department (OPD) visits and an overall adjusted incidence rate ratio (IRR) of 1.64. As for specialty, IRRs were higher in psychiatry (2.75), Chinese medicine (2.01), and emergency medicine (2.00), besides urology and gynecology. The IRRs decreased as age advanced (2.01, 1.71, and 1.44, respectively), except for gynecology (2.42, 2.52, and 2.81). A similar phenomenon happens in hospitalization with IRR of 1.69. Due to claim data characteristics, whether ulcer type IC/BPS findings can be deductive to non-ulcer type remains inclusive. Current results indicate the impacts of healthcare burden in broad spectrum about IC/PBS patients. IC/BPS has been suggested to be associated with lower threshold of healthcare visits and some coexisting disease and is comprised of systemic dysregulation, and is beyond the scope of local bladder-urethra disease. Adequate recognition of associated or comorbid factors and possible recommendation or referral for IC/BPS patients can help provide better healthcare quality.
Collapse
Affiliation(s)
- Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Yen Chin
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
7
|
Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol 2021; 265:143-149. [PMID: 34492609 DOI: 10.1016/j.ejogrb.2021.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction.
Collapse
Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| |
Collapse
|
8
|
Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women. Toxins (Basel) 2021; 13:toxins13050362. [PMID: 34069448 PMCID: PMC8159094 DOI: 10.3390/toxins13050362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Although female dysfunctional voiding (DV) is common in urological practice, it is difficult to treat. This study evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female DV. Based on the videourodynamic study (VUDS), the DV was classified into three subgroups according to the obstructive site. A successful treatment outcome was defined as an improvement of voiding efficiency by 10% and reported global response assessment by ≥1. The study compared therapeutic efficacy, baseline urodynamic parameters, and changes in urodynamic parameters between the treatment success and failure groups and among three DV subgroups. Predictive factors for successful treatment were also investigated. A total of 81 women with DV were categorized into three groups: 55 (67.9%) had mid-urethral DV, 19 (23.5%) had distal urethral DV, and 7 (8.6%) had combined BN dysfunction and mid-urethral DV after BN transurethral incision. The treatment outcome was successful for 55 (67.9%) patients and failed for 26 (32.1%). Successfully treated patients had a significant decrease of detrusor pressure, post-void residual volume, and bladder outlet obstruction index, as well as an increase in voiding efficiency at follow-up versus the treatment failure group. The logistic regression of urodynamic parameters and clinical variables revealed that a greater volume of first sensation of filling predicts a successful BoNT-A treatment outcome (p = 0.047). The urethral BoNT-A injection is effective in treating non-neurogenic women with DV, with a success rate of 67.9%. The videourodynamic characteristics of DV may differ among patients but does not affect the treatment outcome.
Collapse
|
9
|
Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
Collapse
Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
| |
Collapse
|
10
|
Abstract
The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.What is New:• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
Collapse
|
11
|
Tanner L, Keppner K, Lesmeister D, Lyons K, Rock K, Sparrow J. Cancer Rehabilitation in the Pediatric and Adolescent/Young Adult Population. Semin Oncol Nurs 2020; 36:150984. [DOI: 10.1016/j.soncn.2019.150984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
12
|
Nieuwhof-Leppink AJ, van Geen FJ, van de Putte EM, Schoenmakers MAGC, de Jong TPVM, Schappin R. Pelvic floor rehabilitation in children with functional LUTD: does it improve outcome? J Pediatr Urol 2019; 15:530.e1-530.e8. [PMID: 31582335 DOI: 10.1016/j.jpurol.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION If children do not experience satisfactory relief of lower urinary tract dysfunction (LUTD) complaints after standard urotherapy is provided, other treatment options need to be explored. To date, little is known about the clinical value of pelvic floor rehabilitation in the treatment of functional voiding disorders. OBJECTIVE Therefore, we compared pelvic floor rehabilitation by biofeedback with anal balloon expulsion (BABE) to intensive urotherapy in the treatment of children with inadequate pelvic floor control and functional LUTD. STUDY DESIGN A retrospective chart study was conducted on children with functional incontinence and inadequate pelvic floor control. All children referred for both intensive inpatient urotherapy and pelvic floor rehabilitation between 2010 and 2018 were considered for inclusion. A total of 52 patients were eligible with 25 children in the group who received BABE before inpatient urotherapy, and 27 children in the group who received BABE subsequently to urotherapy. Main outcome measurement was treatment success according to International Children's Continence Society criteria measured after treatment rounds and follow-up. RESULTS Baseline characteristics demonstrate no major differences between the BABE and control group. There was a significant difference in improvement between BABE and inpatient urotherapy after the first and second round of treatment (round 1: BABE vs urotherapy; 12% vs 70%, respectively, round 2: urotherapy vs BABE; 92% vs 34%, respectively, both P < .001). In both cases, the urotherapy group obtained greater results (Fig. 1). When the additional effect of BABE on urotherapy treatment is assessed, no significant difference is found (P = .355) in the children who received BABE; 30 (58%) showed improvement on pelvic floor control. DISCUSSION Our findings imply that training pelvic floor control in combination with inpatient urotherapy does not influence treatment effectiveness on incontinence. Intensive urotherapy contains biofeedback by real-time uroflowmetry; children receive direct feedback on their voiding behaviour. Attention offered to the child and achieving cognitive maturity with corresponding behaviour is of paramount importance. It is known that combining several kinds of biofeedback does not enhance the outcome. However, our results do not provide a conclusive answer to the effectiveness of pelvic floor physical therapy in the treatment of children with LUTD because we specifically investigated BABE. CONCLUSION In this study, we could not prove that pelvic floor rehabilitation by BABE has an additional effect on inpatient urotherapy on incontinence outcomes. Considering the invasive nature of BABE, the use of BABE to obtain continence should therefore be discouraged.
Collapse
Affiliation(s)
- Anka J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
| | | | - Elise M van de Putte
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marja A G C Schoenmakers
- Department of Pediatrics, Physiotherapy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom P V M de Jong
- Pediatric Urology, University Children's Hospitals UMC Utrecht and Amsterdam AMC, Amsterdam, the Netherlands
| | - Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
13
|
Aerts L, Grangier L, Dallenbach P, Wenger JM, Streuli I, Bianchi-Demicheli F, Pluchino N. Understanding sexual pain in endometriosis. ACTA ACUST UNITED AC 2019; 71:224-234. [DOI: 10.23736/s0026-4784.19.04379-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
14
|
Kumar M, Batra G, Maletha M, Malhotra A. Hirschsprung's disease in a child with posterior urethral valve: An unwanted association. Indian J Urol 2018; 34:223-225. [PMID: 30034135 PMCID: PMC6034409 DOI: 10.4103/iju.iju_9_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a dysfunction in either may influence the function of the other. Although, the coexistence of bladder and bowel dysfunction has been previously reported in the literature, there are hardly any reports on coexistence of posterior urethral valve (PUV) with Hirschsprung's disease. Here, we report a case of a 20-month-old male child who was initially treated for PUV and was later found to have coexisting Hirschsprung's disease.
Collapse
Affiliation(s)
- Mritunjay Kumar
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Gaurav Batra
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Madhukar Maletha
- Department of Surgery, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Ankur Malhotra
- Department of Radiodiagnosis, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| |
Collapse
|
15
|
Patricolo M. Noninvasive Urodynamics and Flowmetry in Children, Adolescents, and Young Adults. URODYNAMICS, NEUROUROLOGY AND PELVIC FLOOR DYSFUNCTIONS 2018:63-71. [DOI: 10.1007/978-3-319-42193-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
16
|
Choi YJ, Seo BS, Lee JH, Jeong SJ. Treatment of fecal retention is important in the management of overactive bladder in children. Neurourol Urodyn 2017; 36:490-494. [DOI: 10.1002/nau.22963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- You Jin Choi
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Bo Seon Seo
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Jun Ho Lee
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| | - Su Jin Jeong
- Department of Pediatrics; Bundang CHA Medical Center; CHA University School of Medicine; Seongnam-si Gyeonggi-do Korea
| |
Collapse
|
17
|
van Engelenburg–van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA. Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings. Eur J Pediatr 2017; 176:207-216. [PMID: 27995361 PMCID: PMC5243895 DOI: 10.1007/s00431-016-2824-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 01/30/2023]
Abstract
UNLABELLED The aims of this study are to evaluate in a pragmatic cross-sectional study, the clinical characteristics of childhood bladder and/or bowel dysfunctions (CBBD) and locomotor problems in the primary through tertiary health care setting. It was hypothesized that problems would increase, going from primary to tertiary healthcare. Data were retrieved from patient-records of children (1-16 years) presenting with CBBD and visiting pelvic physiotherapists. Prevalence's of dysfunctions were compared between healthcare settings and gender using ANOVA and chi-square test. Agreement between physicians' diagnoses and parent-reported symptoms was evaluated (Cohen's Kappa). One thousand seventy hundred forty-eight children (mean age 7.7 years [SD 2.9], 48.9% boys) were included. Daytime urinary incontinence (P = 0.039) and enuresis (P < 0.001) were more diagnosed in primary healthcare, whereas constipation (P < 0.001) and abdominal pain (P = 0.009) increased from primary to tertiary healthcare. All parent-reported symptoms occurred more frequently than indicated by the physicians. Poor agreement between physicians' diagnoses and parent-reported symptoms was found (k = 0.16). Locomotor problems prevailed in all healthcare settings, motor skills (P = 0.041) and core stability (P = 0.015) significantly more in tertiary healthcare. CONCLUSIONS Constipation and abdominal pain (physicians' diagnoses) and the parent-reported symptoms hard stools and bloating increased from primary to tertiary healthcare. Discrepancies exist between the prevalence's of physicians' diagnoses and parent-reported symptoms. Locomotor problems predominate in all healthcare settings. What is Known: • Childhood bladder and/or bowel dysfunctions (CCBD) are common. • Particularly tertiary healthcare characteristics of CBBD are available What is New: • Characteristics of CBBD referred to pelvic physiotherapy are comparable in primary, secondary, and tertiary healthcare settings. • Concomitant CBBD appeared to be more prevalent than earlier reported. • Discrepancies exist between referring physicians' diagnoses and parent-reported symptoms.
Collapse
Affiliation(s)
- Marieke L. van Engelenburg–van Lonkhuyzen
- grid.412966.eDepartment of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Esther M.J. Bols
- grid.412966.eDepartment of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Marc A. Benninga
- Department of Paediatric Gastroenterology, Emma Children’s Hospital/Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Wim A. Verwijs
- Zuwe Hofpoort Ziekenhuis, Polanerbaan 2, 3447 GN Woerden, the Netherlands
| | - Rob A. de Bie
- grid.412966.eDepartment of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| |
Collapse
|
18
|
Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: an epidemiological study. World J Urol 2016; 35:459-465. [PMID: 27306687 DOI: 10.1007/s00345-016-1879-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the prevalence of mono-symptomatic nocturnal enuresis (MNE) and its risk factors among school-age children in our community. METHODS A cross-sectional study included school-age children from two governorates in south of Egypt. A questionnaire was presented to randomly selected students. It consisted of 3 domains: Domain 1 included questions about MNE, domain 2 was about risk factors for MNE, and domain 3 was about management of MNE. RESULTS The study included 4652 students (9 ± 2 years) from 12 primary schools (51 % males and 49 % females). Of 4652 students, 834 (18 %) had NE, with no significant difference between rural and urban areas (17.5 vs. 18.4 %, p = 0.4). Younger age categories showed higher prevalence of MNE than in older children. MNE caused moderate-to-severe bother for 44.5 and 87.8 % of students and parents, respectively. Urinary tract infection, pinworm infestation, constipation, and caffeine over-consumption significantly associated with MNE. Family history of MNE was positive in 84.7 %. Daytime incontinence coexisted in 16 % of cases. Children with ≥4 siblings and birth order ≥3 had more prevalent MNE. Deep sleepers and exposure to problems/violence correlated positively with occurrence of MNE. Father's level of education and work status, mother education, number of children per room, and socioeconomic status significantly associated with occurrence of MNE. There was no significant correlation between gender and prevalence of MNE. No treatment was used in 53.2 % of cases. CONCLUSION In the Egyptian community, pinworm infestation, UTI, constipation, and overconsumption of caffeine-containing beverages are potential reversible risk factors for MNE in school-age children.
Collapse
|
19
|
Ergin G, Kibar Y, Ebiloğlu T, Irkılata HC, Kopru B, Kaya E, Uyanık M, Tapan S, Dayanc MM. The role of urinary nerve growth factor for the diagnosis and assessment of the biofeedback success in children with dysfunctional voiding. J Pediatr Urol 2016; 12:118.e1-6. [PMID: 26701107 DOI: 10.1016/j.jpurol.2015.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. OBJECTIVES The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. STUDY DESIGN Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. RESULTS The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p < 0.001). The mean uNGF/Cr levels in the DV group at baseline and at the end of biofeedback therapy at 6 and 12 months were 0.90 ± 0.78, 0.26 ± 0.32, and 0.40 ± 0.50, respectively (p < 0.001) (Figure). DISCUSSION To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3-0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. CONCLUSIONS uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children.
Collapse
Affiliation(s)
- Giray Ergin
- Ağrı Military Hospital, Department of Urology, Ağri, Turkey.
| | - Yusuf Kibar
- Gulhane Military Medical Academy, Department of Urology, Gulhane, Turkey
| | - Turgay Ebiloğlu
- Etimesgut Military Hospital, Department of Urology, Etimesgut, Turkey
| | - H Cem Irkılata
- Gulhane Military Medical Academy, Department of Urology, Gulhane, Turkey
| | - Burak Kopru
- Gulhane Military Medical Academy, Department of Urology, Gulhane, Turkey
| | - Engin Kaya
- Gulhane Military Medical Academy, Department of Urology, Gulhane, Turkey
| | - Metin Uyanık
- Gulhane Military Medical Academy, Department of Biochemistry, Gulhane, Turkey
| | - Serkan Tapan
- Gulhane Military Medical Academy, Department of Biochemistry, Gulhane, Turkey
| | - M Murat Dayanc
- Gulhane Military Medical Academy, Department of Urology, Gulhane, Turkey
| |
Collapse
|
20
|
Dyspareunia and chronic pelvic pain in patients with interstitial cystitis/bladder pain syndrome. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
21
|
't Hoen LA, van den Hoek J, Wolffenbuttel KP, van der Toorn F, Scheepe JR. Breaking the vicious circle: Onabotulinum toxin A in children with therapy-refractory dysfunctional voiding. J Pediatr Urol 2015; 11:119.e1-6. [PMID: 25794865 DOI: 10.1016/j.jpurol.2014.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION An increased activity of the external urethral sphincter or pelvic floor muscles during voluntary voiding leads to dysfunctional voiding. Frequently reported symptoms are urinary incontinence, urinary tract infections and high post-void residuals. Dysfunctional voiding is a common problem in school-aged children and despite various treatment options, 10-40% of the children remain therapy-refractory. OBJECTIVE The aim of this study is to evaluate the effectiveness of Onabotulinum toxin-A (BTX-A) injections in the external urethral sphincter in children with therapy-refractory dysfunctional voiding. PATIENTS AND METHODS Patients with therapy-refractory dysfunctional voiding who have received BTX-A injections in the external urethral sphincter from 2010 to 2013 were analysed. Children with known neuropsychiatric disorders were excluded. All children had abnormal flow patterns and increased pelvic floor tone during uroflowmetry/EMG studies. They had received at least five sessions of urotherapy and two sessions of pelvic floor physical therapy prior to treatment. A total of 100 IU of BTX-A was injected in the external urethral sphincter at the 3, 9 and 12 o'clock positions. Our main outcome measures were urinary incontinence, recurrent urinary tract infections and post-void residual. RESULTS A total of twenty patients, of whom 16 girls, with a median age of 9 years (range 5-14) were treated with BTX-A. The median follow-up was 13 months (range 5-34). Post-void residual decreased by 75% after BTX-A, from a median of 47.5 ml (16.3-88.5 ml) to 0 ml (0.0-28.0 ml) (p = 0.001) Six patients had a post-void residual < 20 ml prior to treatment. After BTX-A sixteen patients had a post-void residual <20 ml (Figure). No significant changes in uroflowmetry results was seen. Sixteen children are no longer daily incontinent, of whom 9 became completely dry (p = 0.0001). Eleven patients suffered from recurrent urinary tract infections prior to treatment. After BTX-A five children remained infection free, while the other six experienced only one urinary tract infection during follow-up (p = 0.003). Fourteen patients received additional urotherapy after BTX-A. Repeat injections were necessary in four patients after initial satisfactory results, with repeated good clinical responses. Two children showed no improvement after first BTX-A injection. No serious adverse events were reported. DISCUSSION The results in this homogenous group of patients confirm the conclusions of previous studies in opting BTX-A in the external urethral sphincter to be a viable treatment option for the therapy-refractory group of patients with dysfunctional voiding. What is new, is that in most of our patients post-injection urotherapy was used to amplify the BTX-A effect. During our long-term follow-up the satisfactory results were sustained, similar to the results of the long-term follow-up presented by Vricella et al. [1]. The retrospective character and relative small sample size are limitations of this study. CONCLUSIONS This study shows safe and persistent satisfactory results during our average 13-month follow-up in 90% of our patients with therapy-refractory dysfunctional voiding. A prospective study using validated and standardized measurements will be performed to affirm our results and evaluate the exact role of post-injection urotherapy.
Collapse
Affiliation(s)
- L A 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - J van den Hoek
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - K P Wolffenbuttel
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - F van der Toorn
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - J R Scheepe
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
22
|
McKenna PH. Current Role of Biofeedback for Pediatric Lower Urinary Tract Symptoms. J Urol 2015; 193:14-5. [DOI: 10.1016/j.juro.2014.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Patrick H. McKenna
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
23
|
Awais M, Rehman A, Baloch NUA, Khan F, Khan N. Evaluation and management of recurrent urinary tract infections in children: state of the art. Expert Rev Anti Infect Ther 2014; 13:209-31. [PMID: 25488064 DOI: 10.1586/14787210.2015.991717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Urinary tract infections (UTIs) represent an important cause of febrile illness in young children and can lead to renal scarring and kidney failure. However, diagnosis and treatment of recurrent UTI in children is an area of some controversy. Guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence and European Society of Paediatric Radiology differ from each other in terms of the diagnostic algorithm to be followed. Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are also areas of considerable debate. In this review, we collate and appraise recently published literature in order to formulate evidence-based guidance for the diagnosis and treatment of recurrent UTI in children.
Collapse
Affiliation(s)
- Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi 74800, Sindh, Pakistan
| | | | | | | | | |
Collapse
|
24
|
Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJM, Radmayr C, Tekgül S. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2014; 67:546-58. [PMID: 25477258 DOI: 10.1016/j.eururo.2014.11.007] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/05/2014] [Indexed: 12/22/2022]
Abstract
CONTEXT In 30% of children with urinary tract anomalies, urinary tract infection (UTI) can be the first sign. Failure to identify patients at risk can result in damage to the upper urinary tract. OBJECTIVE To provide recommendations for the diagnosis, treatment, and imaging of children presenting with UTI. EVIDENCE ACQUISITION The recommendations were developed after a review of the literature and a search of PubMed and Embase. A consensus decision was adopted when evidence was low. EVIDENCE SYNTHESIS UTIs are classified according to site, episode, symptoms, and complicating factors. For acute treatment, site and severity are the most important. Urine sampling by suprapubic aspiration or catheterisation has a low contamination rate and confirms UTI. Using a plastic bag to collect urine, a UTI can only be excluded if the dipstick is negative for both leukocyte esterase and nitrite or microscopic analysis is negative for both pyuria and bacteriuria. A clean voided midstream urine sample after cleaning the external genitalia has good diagnostic accuracy in toilet-trained children. In children with febrile UTI, antibiotic treatment should be initiated as soon as possible to eradicate infection, prevent bacteraemia, improve outcome, and reduce the likelihood of renal involvement. Ultrasound of the urinary tract is advised to exclude obstructive uropathy. Depending on sex, age, and clinical presentation, vesicoureteral reflux should be excluded. Antibacterial prophylaxis is beneficial. In toilet-trained children, bladder and bowel dysfunction needs to be excluded. CONCLUSIONS The level of evidence is high for the diagnosis of UTI and treatment in children but not for imaging to identify patients at risk for upper urinary tract damage. PATIENT SUMMARY In these guidelines, we looked at the diagnosis, treatment, and imaging of children with urinary tract infection. There are strong recommendations on diagnosis and treatment; we also advise exclusion of obstructive uropathy within 24h and later vesicoureteral reflux, if indicated.
Collapse
Affiliation(s)
- Raimund Stein
- Division of Paediatric Urology, Department of Urology, Mainz University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
| | - Hasan S Dogan
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Radim Kočvara
- Department of Urology, General Teaching Hospital in Praha, and Charles University 1st Faculty of Medicine, Praha, Czech Republic
| | - Rien J M Nijman
- Department of Urology, Division of Pediatric Urology, University of Groningen, Groningen, The Netherlands
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Serdar Tekgül
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
| | | | | |
Collapse
|
25
|
Wyndaele M, De Winter BY, Pelckmans PA, De Wachter S, Van Outryve M, Wyndaele JJ. Exploring associations between lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems in women: a study in women with urological and GI problems vs a control population. BJU Int 2014; 115:958-67. [DOI: 10.1111/bju.12904] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Michel Wyndaele
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Benedicte Y. De Winter
- Laboratory of Experimental Medicine and Paediatrics; Division of Gastroenterology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Paul A. Pelckmans
- Laboratory of Experimental Medicine and Paediatrics; Division of Gastroenterology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
- Department of Gastroenterology; Faculty of Medicine; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Stefan De Wachter
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Mark Van Outryve
- Department of Gastroenterology; Faculty of Medicine; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Jean Jacques Wyndaele
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| |
Collapse
|
26
|
Minardi D, Pellegrinelli F, Conti A, Fontana D, Mattia M, Milanese G, Muzzonigro G. α1-Blockers for the treatment of recurrent urinary tract infections in women with dysfunctional voiding: A prospective randomized study. Int J Urol 2014; 22:115-21. [DOI: 10.1111/iju.12601] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniele Minardi
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Francesco Pellegrinelli
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Alessandro Conti
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Donatella Fontana
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Michela Mattia
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Giulio Milanese
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| | - Giovanni Muzzonigro
- Department of Clinic and Specialistic Sciences; Institute of Urology; Polytechnic University of the Marche Region; Azienda Ospedaliero-Universitaria Ospedali Riuniti; Ancona Italy
| |
Collapse
|
27
|
Cervigni M, Natale F. Gynecological disorders in bladder pain syndrome/interstitial cystitis patients. Int J Urol 2014; 21 Suppl 1:85-8. [DOI: 10.1111/iju.12379] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/19/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Mauro Cervigni
- Obstetrics and Gynecology Department; Catholic University; Rome Italy
- Urogynecologic Department; S.Carlo-IDI; Rome Italy
| | | |
Collapse
|
28
|
Steffan JJ, Dykes SS, Coleman DT, Adams LK, Rogers D, Carroll JL, Williams BJ, Cardelli JA. Supporting a role for the GTPase Rab7 in prostate cancer progression. PLoS One 2014; 9:e87882. [PMID: 24505328 PMCID: PMC3914878 DOI: 10.1371/journal.pone.0087882] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Invasion and subsequent metastasis is the major cause of death from most cancers including prostate cancer. Herein we report on the potential tumor suppressive properties of Rab7, a GTPase that regulates trafficking of lysosomes. The movement of lysosomes to the cell surface in response to environmental cues increases the secretion of proteinases and cell invasion. We determined that Troglitazone and other members of the Thiazolidinedione family inhibit cell-surface directed lysosome trafficking and cathepsin B secretion through a Rab7-dependent mechanism. Moreover, Rab7 shRNA expressing cells were found to be more invasive in vitro and in vivo. Increased invasiveness was accompanied by elevated expression of the c-Met receptor and prolonged downstream signaling, thereby supporting a role for Rab7 as a mediator of signaling down-regulation. Taken together, these results suggested that Rab7 acts as a negative regulator of prostate tumor growth and invasion, providing further evidence for its potential as a tumor suppressor.
Collapse
Affiliation(s)
- Joshua J. Steffan
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Natural Science, Dickinson State University, Dickinson, North Dakota, United States of America
| | - Samantha S. Dykes
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - David T. Coleman
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Lisa K. Adams
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Donna Rogers
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Jennifer L. Carroll
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - B. Jill Williams
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Department of Urology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - James A. Cardelli
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
- * E-mail:
| |
Collapse
|
29
|
Franco I, von Gontard A, De Gennaro M. Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children's Continence Society. J Pediatr Urol 2013; 9:234-43. [PMID: 23260268 DOI: 10.1016/j.jpurol.2012.10.026] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 10/31/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE This document represents the consensus guidelines recommended by the ICCS on how to evaluate and treat children with nonmonosymptomatic nocturnal enuresis (NMNE). The document is intended to be clinically useful in primary, secondary and tertiary care. MATERIALS AND METHODS Discussions were held by the board of the ICCS and a committee was appointed to draft this document. The document was then made available to the members of the society on the web site. The comments were vetted and amendments were made as necessary to the document. RESULTS The main scope of the document is the treatment of NMNE with drugs other than desmopressin-based therapy. Guidelines on the assessment, and nonpharmacologic and pharmacologic management of children with NMNE are presented. CONCLUSIONS The text should be regarded as an expert statement, not a formal systematic review of evidence-based medicine. It so happens that the evidence behind much of what we do in the care of enuretic children is quite weak. We do, however, intend to present what evidence there is, and to give preference to this rather than to experience-based medicine, whenever possible.
Collapse
Affiliation(s)
- Israel Franco
- Section of Pediatric Urology, Maria Fareri Children's Hospital and New York Medical College, Valhalla, NY 10595, USA.
| | | | | | | |
Collapse
|
30
|
Carter D, Beer-Gabel M. Lower urinary tract symptoms in chronically constipated women. Int Urogynecol J 2012; 23:1785-9. [DOI: 10.1007/s00192-012-1812-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
|
31
|
Krzemińska K, Maternik M, Drożyńska-Duklas M, Szcześniak P, Czarniak P, Gołębiewski A, Zurowska A. High efficacy of biofeedback therapy for treatment of dysfunctional voiding in children. Cent European J Urol 2012; 65:212-5. [PMID: 24578964 PMCID: PMC3921803 DOI: 10.5173/ceju.2012.04.art6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/16/2012] [Accepted: 08/21/2012] [Indexed: 11/22/2022] Open
Abstract
Introduction Dysfunctional voiding is a frequent condition in children associated with symptoms of incontinence. The aim of this study was to present the efficacy of biofeedback treatment on the resolution of clinical symptoms in a large cohort of children with urodynamically confirmed dysfunctional voiding. Material and methods 81 children (75 girls and 6 boys) aged 6-18 years (mean: 10.32 ±3.17 yrs.) with a dysfunctional voiding pattern are presented. 74/81 (92.6%) of children were unresponsive to standard urotherapy and prior pharmacotherapy. Symptoms of bladder dysfunction were evaluated by questionnaire, bladder diary and an urodynamic study according to definitions and standards set by ICCS. The biofeedback training was planned for 2 months. Each session consisted of about 30 repeats of 5 s contraction and 30 s relaxation of pelvic floor muscles and external urethral sphincter. Biofeedback was performed together with standard urotherapy. Results 67 (82.72%) of the 81 children declared wetting during the day and 41 (50, 62%) – wetting during the night. 32/81 (39.5%) children had increased voiding frequency and 43 (53.08%) had decreased bladder capacity. Following 2 months of biofeedback therapy daytime incontinence resolved in 34/67 (50.7%) children and nighttime incontinence in 22/41 (53.65%). A further 40,3% declared partial improvement in daytime and 26.7% in nighttime wetting. Conclusions Biofeedback treatment is an effective therapeutic option for children with dysfunctional voiding. Pelvic floor therapy with biofeedback should be offered to children with dysfunctional voiding resistant to standard urotherapy.
Collapse
Affiliation(s)
- Katarzyna Krzemińska
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Michał Maternik
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | | | - Przemysław Szcześniak
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Piotr Czarniak
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| | - Andrzej Gołębiewski
- Department Pediatric & Adolescent Surgery and Urology Medical University Gdańsk, Poland
| | - Aleksandra Zurowska
- Department Pediatric & Adolescent Nephrology & Hypertension Medical University Gdańsk, Poland
| |
Collapse
|
32
|
Averbeck MA, Madersbacher H. Constipation and LUTS - how do they affect each other? Int Braz J Urol 2011; 37:16-28. [PMID: 21385476 DOI: 10.1590/s1677-55382011000100003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2010] [Indexed: 01/04/2023] Open
Abstract
CONTEXT Urinary bladder and rectum share a common embryological origin. Their autonomic and somatic innervations have close similarities. Moreover, the close proximity of these two organ systems could suggest that dysfunction in one may influence, also mechanically, the function of the other. Therefore, it is not surprising that defecation problems and lower urinary tract symptoms (LUTS) occur together, as reported in the literature. OBJECTIVE To study the relationship between constipation and LUTS focusing on what is evidence-based. EVIDENCE ACQUISITION We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE) database in February 2010 to retrieve English language studies (from 1997 to 2009) and the 2005, 2006 and 2007 abstract volumes of the European Association of Urology (EAU), American Urological Association (AUA) and International Continence Society (ICS). EVIDENCE SYNTHESIS We present the findings according to the studied population in four groups: (a) children, (b) middle-aged women, (c) elderly and (d) neuropathic patients. Most published studies that correlated rectal and bladder dysfunction were carried out in children or in young women. On the other hand, there are few studies regarding the association between constipation and LUTS in the elderly and in neuropathic patients. CONCLUSIONS Several studies in children documented that constipation is linked to urinary tract problems, including infections, enuresis, vesicoureteral reflux and upper renal tract dilatation. The underlying pathophysiology of these findings has not yet been clearly defined. Studies in middle-aged women also support a high prevalence of constipation among patients suffering from urinary tract dysfunction. Furthermore, an association between constipation and urinary incontinence, as well as between constipation and pelvic organ prolapse, has been suggested. The only prospective study in constipated elderly with concomitant LUTS demonstrates that the medical relief of constipation also significantly improves LUTS. Finally, the available data on neuropathic patients suggest that stool impaction in the rectum may mechanically impede bladder emptying. However, most of the studies only include a small number of patients, are not prospective and are uncontrolled. Therefore, there is a need for large-scale, controlled studies to further improve evidence and to provide a valid recommendation for all groups, especially for the elderly and neuropathic patients.
Collapse
Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Mae de Deus Center Hospital, Porto Alegre, Brazil.
| | | |
Collapse
|
33
|
Vijverberg MA, Stortelder E, de Kort LM, Kok ET, de Jong TP. Long-term Follow-up of Incontinence and Urge Complaints After Intensive Urotherapy in Childhood (75 Patients Followed Up for 16.2-21.8 Years). Urology 2011; 78:1391-6. [DOI: 10.1016/j.urology.2011.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 10/16/2022]
|
34
|
Beetz R, Westenfelder M. Antimicrobial therapy of urinary tract infections in children. Int J Antimicrob Agents 2011; 38 Suppl:42-50. [PMID: 22036250 DOI: 10.1016/j.ijantimicag.2011.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The main objectives in childhood urinary tract infections are rapid recovery from complaints, prevention of urosepsis and infection-related complications as well as the prevention of renal parenchymal damage. Calculated antibiotic therapy should take the local resistance rates of uropathogens into consideration. The current situation of bacterial resistances differs from region to region. In Escherichia coli, resistance rates against cephalosporins, aminoglycosides, nitrofurantoin und chinolones have been relatively low. In contrast, resistance rates against ampicillin have increased over the last 20 years. A similar trend has been observed for TMP/SMX. The choice of appropriate antibiotics, the duration of therapy and the form of application depend on age, severity of clinical symptoms and the presence of complicating factors. In early infancy, a combination of aminoglycoside/ampicillin or ceftazidime/ampicillin is commonly recommended as first-line treatment in pyelonephritis. Pyelonephritis in young infants should always be treated in a paediatric clinic. In later infancy and childhood, an oral third-generation cephalosporin can be used.
Collapse
Affiliation(s)
- Rolf Beetz
- Paediatric Nephrology, Center for Paediatric and Adolescent Medicine, University Medical Clinic, Langenbeckstr. 1, 55131 Mainz, Germany.
| | | |
Collapse
|
35
|
Sinha S. Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol 2011; 27:437-47. [PMID: 22279306 PMCID: PMC3263208 DOI: 10.4103/0970-1591.91429] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Dysfunctional voiding (DV) is a voiding disorder characterized by dyssynergic striated sphincteric activity in the absence of a proven neurological etiology. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. There is a striking lack of clarity regarding what this entity represents, the diagnostic methodology and treatment. The limitations of existing guideline documents are analyzed. Specifically, use of the term "habitual", the assumption that bladder changes are secondary to the outlet, the emphasis on "staccato" voiding and the implication of striated urethral sphincter are discussed. Literature shows that DV may also present with continuous slow flow or normal flow. Dyssynergia may be at the level of the striated urethral sphincter, the pelvic floor or both, better termed "striated urethral sphincter-pelvic floor complex" (SUS-PFC).A diagnostic algorithm is provided so that patients are evaluated on merit rather than on the basis of different philosophies of individual centers. High-risk markers such as hydronephrosis, vesicoureteral reflux, renal failure or marked voiding difficulty should prompt a formal urodynamics evaluation and imaging for neurological etiology. Patients with predominantly storage symptoms with incidental staccato voiding can be managed initially, on the basis of non-invasive evaluation. Conservative urotherapy including biofeedback is appropriate initial management for patients without high risk factors. Treatment and evaluation should be escalated based on response. Patients with severe DV will need treatment similar to neurogenic bladder including clean intermittent catheterization and measures to control storage pressures.
Collapse
Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| |
Collapse
|
36
|
Prospective Evaluation of Clinical Voiding Reeducation or Voiding School for Lower Urinary Tract Conditions in Children. J Urol 2011; 186:648-54. [DOI: 10.1016/j.juro.2011.03.148] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Indexed: 11/22/2022]
|
37
|
Vesna ZD, Milica L, Stanković I, Marina V, Andjelka S. The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding. J Pediatr Urol 2011; 7:336-41. [PMID: 21527231 DOI: 10.1016/j.jpurol.2011.02.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the study was to compare the treatment outcome of two urotherapy programs in children with dysfunctional voiding (DV) through analyzing the clinical manifestations and uroflowmetry parameters. MATERIALS AND METHODS Eighty-six children with DV were randomly divided into two groups (A and B). Children in both groups were educated about the importance of regular voiding and hydratation, and about the appropriate posture during voiding. Simple voiding instructions were provided. In group A diaphragmatic breathing and pelvic floor muscles (PFM) retraining were additionally assigned to children. Constipation and recurrent urinary tract infections (UTIs) were treated in both groups. Selected children from both groups received pharmacotherapy (anticholinergics or desmopressin). Uroflowmetry with pelvic floor electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. RESULTS After one year of therapy, urinary incontinence and nocturnal enuresis were cured in a significantly larger number of children in group A than in group B (P < 0.001; P < 0.05). Although more children with UTIs were cured in group A, the difference was not statistically significant compared to group B. There was a significant recovery constipation-wise in both groups. Post-treatment uroflowmetry parameters and curve pattern were markedly improved only in group A. CONCLUSIONS Carefully planned and regularly controlled abdominal and PFM retraining is beneficial in children with DV for curing urinary incontinence, nocturnal enuresis, UTIs and normalizing urinary function. Further trials are needed to define the most effective treatment program for achieving the best treatment outcome.
Collapse
Affiliation(s)
- Zivkovic D Vesna
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Stara zeleznicka kolonija 5/6, 18 000 Nis, Clinical Centre Nis, Serbia.
| | | | | | | | | |
Collapse
|
38
|
Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, Kim HG, Moon DG, Park KH, Park YH, Pai KS, Suh HJ, Lee JW, Cho WY, Ha TS, Han SW. An Epidemiologic Study of Voiding and Bowel Habits in Korean Children: A Nationwide Multicenter Study. Urology 2010; 76:215-9. [PMID: 20163840 DOI: 10.1016/j.urology.2009.12.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/08/2009] [Accepted: 12/15/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Although a great deal of media attention has been given to the negative effects of playing video games, relatively less attention has been paid to the positive effects of engaging in this activity. Video games in health care provide ample examples of innovative ways to use existing commercial games for health improvement or surgical training. Tailor-made games help patients be more adherent to treatment regimens and train doctors how to manage patients in different clinical situations. In this review, examples in the scientific literature of commercially available and tailor-made games used for education and training with patients and medical students and doctors are summarized. There is a history of using video games with patients from the early days of gaming in the 1980s, and this has evolved into a focus on making tailor-made games for different disease groups, which have been evaluated in scientific trials more recently. Commercial video games have been of interest regarding their impact on surgical skill. More recently, some basic computer games have been developed and evaluated that train doctors in clinical skills. The studies presented in this article represent a body of work outlining positive effects of playing video games in the area of health care.
Collapse
|
40
|
The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology 2010; 75:1299-304. [PMID: 20303577 DOI: 10.1016/j.urology.2009.11.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 10/23/2009] [Accepted: 11/03/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a training program with uroflowmetry biofeedback and pelvic floor relaxation biofeedback on urodynamic and voiding parameters in women with dysfunctional voiding. METHODS Eighty-six women with recurrent urinary tract infections (UTIs) and dysfunctional voiding were randomly assigned to receive a treatment schedule as follows: uroflowmetry biofeedback (group 1), biofeedback training of the pelvic floor muscles (group 2), uroflowmetry biofeedback combined to biofeedback training of the pelvic floor muscles (group 3), no treatment (group 4). Patients were regularly evaluated by American Urological Association Symptom Index and urodynamics during the study period. All the patients were followed up for 1 year with monthly urine cultures. A further evaluation was done at month 24 by American Urological Association Symptom Index and free uroflowmetry with measurement of residual urine. RESULTS The prevalence of storage and emptying symptoms decreased significantly at 3, 6, and 12 months in the groups 1, 2, and 3, and remained stable during the study period. Mean flow rate, flow time, voiding volume increased significantly, whereas postvoid residual urine decreased. The prevalence of UTI decreased significantly in groups 1, 2, and 3. At month 24, storage and emptying symptoms and voiding patterns were similar to the baseline values in all the patients. The incidence of UTIs was similar to baseline values in groups 1, 2, and 3. CONCLUSIONS Training the voluntary control of the pelvic floor seems essential in obtaining control over the bladder function. These results reinforce the importance of pelvic floor therapy in the resolution of UTIs.
Collapse
|
41
|
|
42
|
Chase J, Austin P, Hoebeke P, McKenna P. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children's Continence Society. J Urol 2010; 183:1296-302. [PMID: 20171678 DOI: 10.1016/j.juro.2009.12.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE We present a consensus view of members of the International Children's Continence Society on the management of dysfunctional voiding in children. MATERIALS AND METHODS Discussions were held by the board of the International Children's Continence Society and a multi-disciplinary core group of authors was appointed. The draft document review process was open to all International Children's Continence Society members via the web site. Feedback was considered by the core authors and, by agreement, amendments were made as necessary. RESULTS Guidelines on the assessment, and nonpharmacological and pharmacological management of dysfunctional voiding are presented. CONCLUSIONS The final document is not a systematic literature review. It includes relevant research when available as well as expert opinion on the current understanding of dysfunctional voiding in children.
Collapse
Affiliation(s)
- Janet Chase
- Monash Medical Centre Paediatric Continence Clinic, Melbourne, Australia
| | | | | | | | | |
Collapse
|
43
|
Drzewiecki BA, Kelly PR, Marinaccio B, Borer JG, Estrada CR, Lee RS, Bauer SB. Biofeedback Training for Lower Urinary Tract Symptoms: Factors Affecting Efficacy. J Urol 2009; 182:2050-5. [DOI: 10.1016/j.juro.2009.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Indexed: 11/28/2022]
Affiliation(s)
| | - Pamela R. Kelly
- Children's Hospital Boston, Harvard University, Boston, Massachusetts
| | | | - Joseph G. Borer
- Children's Hospital Boston, Harvard University, Boston, Massachusetts
| | - Carlos R. Estrada
- Children's Hospital Boston, Harvard University, Boston, Massachusetts
| | - Richard S. Lee
- Children's Hospital Boston, Harvard University, Boston, Massachusetts
| | - Stuart B. Bauer
- Children's Hospital Boston, Harvard University, Boston, Massachusetts
| |
Collapse
|
44
|
Butrick CW. Pelvic Floor Hypertonic Disorders: Identification and Management. Obstet Gynecol Clin North Am 2009; 36:707-22. [DOI: 10.1016/j.ogc.2009.08.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
45
|
Nemett DR, Fivush BA, Mathews R, Camirand N, Eldridge MA, Finney K, Gerson AC. A randomized controlled trial of the effectiveness of osteopathy-based manual physical therapy in treating pediatric dysfunctional voiding. J Pediatr Urol 2008; 4:100-6. [PMID: 18631903 DOI: 10.1016/j.jpurol.2007.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2007] [Accepted: 11/02/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pediatric dysfunctional voiding (DV) presents physical and emotional challenges as well as risk of progression to renal disease. Manual physical therapy and osteopathic treatment have been successfully used to treat DV in adult women; a pediatric trial of manual physical therapy based on an osteopathic approach (MPT-OA) has not been reported. The aim of this study was to determine whether MPT-OA added to standard treatment (ST) improves DV more effectively than ST alone. METHODS Twenty-one children (aged 4-11 years) with DV were randomly assigned to receive MPT-OA plus standard treatment (treatment group) or standard treatment alone (control group). Pre-treatment and post-treatment evaluations of DV symptoms, MPT-OA evaluations and inter-rater reliability of DV symptom resolution were completed. RESULTS The treatment group exhibited greater improvement in DV symptoms than did the control group (Z=-2.63, p=0.008, Mann-Whitney U-test). Improved or resolution of vesicoureteral reflux and elimination of post-void urine residuals were more prominent in the treatment group. CONCLUSIONS Results suggest that MPT-OA treatment can improve short-term outcomes in children with DV, beyond improvements observed with standard treatments, and is well liked by children and parents. Based on these results, a multi-center randomized clinical trial of MPT-OA in children with vesicoureteral reflux and/or post-void urinary retention is warranted.
Collapse
Affiliation(s)
- Diane R Nemett
- Kennedy Krieger Institute, Physical Therapy Department, 707 North Broadway, Baltimore, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Mota DM, Barros AJD. Treinamento esfincteriano precoce: prevalência, características materna da criança e fatores associados numa coorte de nascimentos. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2008. [DOI: 10.1590/s1519-38292008000100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: avaliar a prevalência de crianças sem fraldas, a idade de início do treinamento esfincteriano e a expectativa materna em relação à aquisição deste controle numa coorte de nascimentos. MÉTODOS: todas as crianças nascidas em 2004 em Pelotas, Rio Grande do Sul, Brasil, foram incluídas em um estudo longitudinal. Aos 12 meses, as crianças tiveram seu desenvolvimento avaliado e as mães questionadas sobre o início do treinamento esfincteriano e expectativa em relação à idade da retirada das fraldas. Diferenças entre grupos foram avaliadas através de testes qui-quadrado para heterogeneidade e tendência linear. RESULTADOS: aos 12 meses de idade, 14,7% das mães tinham iniciado o treinamento esfincteriano. Apenas 2,2% receberam orientação pediátrica sobre retirada de fraldas. Os grupos de mães com maior prevalência de início de treinamento aos 12 meses foram as do primeiro quintil econômico, cinco a oito anos de escolaridade, adolescentes e maiores de 40 anos. Dois terços acham que o momento para deixar as fraldas é antes dos 18 meses; 1,3% das crianças estão sem fraldas de dia. CONCLUSÕES: o treinamento esfincteriano começou precocemente em uma parcela significativa destas crianças, sendo desprezível a proporção de mães orientadas pelos pediatras. Informações sobre o momento ideal e métodos adequados de controle esfincteriano devem ser oferecidas às mães, no contexto da puericultura e atenção básica à saúde.
Collapse
|
47
|
Han SW. Urotherapy for Pediatric Voiding Dysfunction. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.11.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Won Han
- Division of Pediatric Urology, Yonsei University College of Medicine, Korea.
| |
Collapse
|
48
|
Abstract
Constipation and encopresis (fecal soiling) are common childhood disorders that may lead to significant functional impairment. The etiology and course of constipation and encopresis are increasingly conceptualized from a broad biopsychosocial perspective, and therefore a holistic approach to assessment and treatment is indicated. Many children experience symptoms of chronic constipation and/or encopresis that are only partially responsive to conventional medical therapy. Complementary/alternative therapies can often help in the treatment of constipation/encopresis and are well accepted by patients and families.
Collapse
Affiliation(s)
- Timothy P Culbert
- Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA.
| | | |
Collapse
|
49
|
Kibar Y, Ors O, Demir E, Kalman S, Sakallioglu O, Dayanc M. Results of Biofeedback Treatment on Reflux Resolution Rates in Children with Dysfunctional Voiding and Vesicoureteral Reflux. Urology 2007; 70:563-6; discussion 566-7. [PMID: 17905115 DOI: 10.1016/j.urology.2007.03.085] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Revised: 01/04/2007] [Accepted: 03/01/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children. METHODS A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements. RESULTS The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%). CONCLUSIONS Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.
Collapse
Affiliation(s)
- Yusuf Kibar
- Department of Urology, Gulhane Military Medical Academy School of Medicine, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Perspective on the paper by Loening‐Baucke (see page 486)
Collapse
Affiliation(s)
- Graham Clayden
- King's College London and the Evelina Children's Hospital of Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | |
Collapse
|