The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity

Overactive bladder, differential diagnosis, and clinical utility of fesoterodine

Overactive bladder is a symptom syndrome with urgency, frequency and, in many cases, nocturia. Urge incontinence is not present in all. There is no direct correlation with detrusor overactivity, an objective finding during urodynamic testing where involuntary contractions can be noticed. In the pathophysiology, much more attention has been given to the afferent/sensory arm of the micturition reflex in the last decade. Anatomical and infectious causes have to be diagnosed or ruled out. Diagnosis of overactive bladder is made mostly by history-taking, but other tests can be necessary in specific patients. Treatment consists of behavioral measures, a good explanation of the condition, training, and pelvic floor physiotherapy. Drugs are often used. Until recently, antimuscarinic drugs have been the mainstay of pharmacological therapy. Fesoterodine is a newer antimuscarinic agent which is more pharmacodynamically stable then tolterodine. Fesoterodine has been extensively researched using different dosages and compared with placebo and tolterodine, in different age groups, and under different conditions. Fesoterodine is superior to placebo and to tolterodine in the short term and long term. Its safety is very acceptable.

Chiropractic treatment for primary nocturnal enuresis: a case series of 33 consecutive patients

OBJECTIVE

The purpose of this study was to evaluate the effect of a specific type of chiropractic treatment on the wet night frequency of patients between the ages of 3 and 18 years who were treated for primary nocturnal enuresis (PNE) in the chiropractic setting.

CLINICAL FEATURES

Thirty-three consecutive patient records, dating over a 3-year period, of children 3 to 18 years old who had been treated for PNE using a form of chiropractic treatment method (NeuroImpulse Protocol) were included.

INTERVENTION AND OUTCOME

All patient records were analyzed for a baseline wet night frequency and at 3, 6, 9, and 12 months after the commencement of treatment. Data were collected regarding the number of treatment visits over the 12-month period and the presence of constipation and/or positive family history at presentation. Data were analyzed using descriptive statistics, Friedman's test, and Dunn's Multiple Comparison test. Of the 33 patient records analyzed, 22 showed resolution of PNE during the 12 months after commencement of chiropractic care. The mean number of treatments in the responders group was 2.05 +/- 1.33. Ten responders presented with constipation and a further 8 with a positive family history of PNE. Resolution of constipation was noted to be essential to the successful response to treatment. A combination of constipation and positive family history at presentation represented a poor prognostic factor.

CONCLUSIONS

There was a 66.6% resolution rate within 1 year in 33 consecutive children and teenagers who experienced PNE. This study provides an indication for possible effectiveness of chiropractic treatment in patients with PNE.

[Biofeedback for urinary bladder dysfunctions in childhood. Indications, practice and the results of therapy]

In children, abnormal behavior during micturition, i.e. detrusor/sphincter dyscoordination, causes persistent voiding problems, urinary incontinence and/or recurrent urinary tract infections in up to 15% of cases. Contractions of the external urethral sphincter during micturition lead to functional subvesical obstruction. Nowadays, biofeedback training is the most suitable therapy. Biofeedback training for children is based on the assumption that relaxation and contraction of the urinary external sphincter is a habitual phenomenon and can be restored. With specially developed, computer-assisted biofeedback programs, sphincter contraction and relaxation can be transformed into acoustic or visual signals. Acoustic or optical feedback indicates relaxation and contraction control to the patient. The residual urine volume should subsequently be assessed. The results should be reviewed after each micturition. Poor compliance sometimes makes biofeedback training impossible. Further biofeedback training at home is a reasonable suggestion. Good results-a response rate of up to 90%-demonstrates that biofeedback training is successful in the treatment of detrusor-sphincter dyscoordination. After effective therapy, associated urinary tract infections and vesicoureterorenal reflux may disappear.