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Hecht SL, Quach A, Gao D, Brazell A, Beltran G, Holbrook S, Gore L, Iguchi N, Malykhina A, Wilcox D, Cost NG. A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy. Pediatr Blood Cancer 2021; 68:e29226. [PMID: 34245214 PMCID: PMC8384667 DOI: 10.1002/pbc.29226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD). PROCEDURE Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts. RESULTS Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339). CONCLUSIONS Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.
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Affiliation(s)
- Sarah L. Hecht
- Department of Pediatric Urology, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR
| | - Alan Quach
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Dexiang Gao
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO
| | - Andrew Brazell
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Gemma Beltran
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Sheryl Holbrook
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Lia Gore
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplant, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Nao Iguchi
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anna Malykhina
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Duncan Wilcox
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Nicholas G. Cost
- Department of Pediatric Urology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO,Corresponding author: Nicholas G. Cost, MD, , 13123 E 16 Ave Box 463, Aurora, CO 80045, Tel: 720-777-5084, Fax: 720-777-7370
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Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature. J Pediatr Urol 2018; 14:494-501. [PMID: 30297226 PMCID: PMC6295280 DOI: 10.1016/j.jpurol.2018.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bowel and bladder dysfunction (BBD) is a clinical syndrome defined by the coexistence of constipation and lower urinary tract symptoms. Although BBD is a common condition in pediatric urology and can cause significant stress to patients/parents, clinical diagnosis of BBD has not been standardized. Bowel and bladder dysfunction instruments have gained popularity over the past decade to aid in diagnosis. In this review, the currently published BBD symptom questionnaires were summarized and an analysis on their psychometric validation process was provided. SUBJECTS/PATIENTS PubMed was searched for articles on BBD symptom questionnaires/instruments/surveys since 2000. Two investigators (R.Y.J. & M.S.K.) conducted the search in duplicate. The search was limited to English language. The included search terms were 'dysfunctional elimination syndrome', 'bowel and bladder dysfunction', 'dysfunctional voiding', 'voiding dysfunction symptom score', and 'dysfunctional voiding symptom scale'. Reference lists of included studies were screened for missed studies. Unpublished abstracts presented at the following scientific meetings were also manually searched for: the American Urological Association, the Society for Pediatric Urology, and the American Academy of Pediatrics Section on Urology. Exclusion criteria included articles in languages other than English, articles not related to BBD questionnaires, and articles not pertaining to pediatric patients. RESULTS After initial search, a total of 54 articles were obtained. Of the seven questionnaires reviewed, only one did not measure sensitivity or specificity. Almost all questionnaires showed excellent discriminative property with an Area under the curve (AUC) >0.85. Criterion validity was not reported in any of the questionnaires. Known-group validation was used as a common method to evaluate construct validity. Internal consistency was reported in 2 studies, and only 1 study measured questionnaire responsiveness during initial validation. CONCLUSIONS Although BBD is a common pediatric urology condition; a large amount of heterogeneity exists in the questionnaires' psychometric testing and validation process. To further improve the diagnosis and management of BBD in pediatric patients, there is a need for consensus on the gold standard questionnaire measure.
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Taylor AS, Cabo JJ, Lauderdale C, Maskan N, Thomas JC, Tanaka ST, Pope JC, Adams MC, Brock JW, Shannon CN, Clayton DB. Pelvic floor biofeedback therapy in children: Assessment of symptom scores in responders and non-responders. Neurourol Urodyn 2018; 38:254-260. [PMID: 30350888 DOI: 10.1002/nau.23842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. METHODS We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. RESULTS 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. CONCLUSION The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.
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Affiliation(s)
- Abby S Taylor
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jackson J Cabo
- Vanderbilt University Medical School, Nashville, Tennessee
| | - Chelsea Lauderdale
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Narges Maskan
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Gondim Oliveira R, Barroso, Jr U. Overactive Bladder in Children. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10314428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Overactive bladder (OAB) is clinically defined as the presence of urinary urgency and may be associated with diurnal urinary incontinence, frequency, and enuresis, and/or constipation. In children aged 5–10 years, the prevalence is 5–12%. Association with emotional disorders is widely described in the literature. Constipation is associated with voiding symptoms because of crosstalk between the gastrointestinal tract and the urinary tract. OAB is believed to be multifactorial. Correct functioning between the pontine micturition centre, the periaqueductal grey matter, anterior cingulate gyrus, and prefrontal cortex is important for correct voiding development and the process of maturation. Patients with OAB have greater anterior cingulate gyrus activity and deactivation of the pontine micturition centre urinary inhibition process, leading to a greater frequency of bladder repletion sensation. Urotherapy is the first treatment to be initiated and aims to change behavioural patterns inthese patients. Other treatment options are anticholinergics, with oxybutynin being the most widely studied, but also described is the use of tolterodine, darifenacin, and mirabegron. Alternative treatments, such as nerve stimulation in the parasacral or the posterior tibial area, have shown improvement of symptoms in comparative studies with conventional drug treatment, and, in refractory cases, botulinum toxin A is an option. In this article, we review the pathophysiology, associated conditions, and aspects related to diagnosis and treatment of OAB.
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Affiliation(s)
| | - Ubirajara Barroso, Jr
- Unit of Uro Nephrology and Discipline of Urology, Bahiana School of Medicine and Federal University of Bahia, Salvador, Brazil
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Altan M, Çitamak B, Bozaci AC, Mammadov E, Doğan HS, Tekgül S. Is There Any Difference Between Questionnaires on Pediatric Lower Urinary Tract Dysfunction? Urology 2017; 103:204-208. [DOI: 10.1016/j.urology.2016.12.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/26/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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Dayanc MM, Kibar Y, Irkilata HC, Sancaktutar AA, Ebiloglu T, Gur A, Ergin G, Alp BF, Gok F. Effect of Voided Volume on Voiding Patterns and Reliability of Uroflowmetry-Electromyography Results in Children with Lower Urinary Tract Dysfunction. Low Urin Tract Symptoms 2017; 9:46-51. [PMID: 28120443 DOI: 10.1111/luts.12108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/29/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD). METHODS Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV <50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV >125% of EBC. RESULTS A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased. CONCLUSIONS In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated.
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Affiliation(s)
- M Murat Dayanc
- Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey
| | - H Cem Irkilata
- Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey
| | | | | | - Ahmet Gur
- Kayseri Military Hospital, Kayseri, Turkey
| | | | - Bilal F Alp
- Department of Urology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Faysal Gok
- Section of Pediatric Nephrology, Department of Pediatrics, Gulhane Military Medical Academy, Ankara, Turkey
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Maximum Urine Flow Rate of Less than 15ml/Sec Increasing Risk of Urine Retention and Prostate Surgery among Patients with Alpha-1 Blockers: A 10-Year Follow Up Study. PLoS One 2016; 11:e0160689. [PMID: 27513673 PMCID: PMC4981394 DOI: 10.1371/journal.pone.0160689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/23/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the subsequent risk of acute urine retention and prostate surgery in patients receiving alpha-1 blockers treatment and having a maximum urinary flow rate of less than 15ml/sec. METHODS We identified patients who were diagnosed with benign prostate hyperplasia (BPH) and had a maximum uroflow rate of less than 15ml/sec between 1 January, 2002 to 31 December, 2011 from Taiwan's National Health Insurance Research Database into study group (n = 303). The control cohort included four BPH/LUTS patients without 5ARI used for each study group, randomly selected from the same dataset (n = 1,212). Each patient was monitored to identify those who subsequently developed prostate surgery and acute urine retention. RESULTS Prostate surgery and acute urine retention are detected in 5.9% of control group and 8.3% of study group during 10-year follow up. Compared with the control group, there was increase in the risk of prostate surgery and acute urine retention in the study group (HR = 1.83, 95% CI: 1.16 to 2.91) after adjusting for age, comorbidities, geographic region and socioeconomic status. CONCLUSIONS Maximum urine flow rate of less than 15ml/sec is a risk factor of urinary retention and subsequent prostate surgery in BPH patients receiving alpha-1 blocker therapy. This result can provide a reference for clinicians.
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Beksac AT, Koni A, Bozacı AC, Dogan HS, Tekgul S. Postvoidal residual urine is the most significant non-invasive diagnostic test to predict the treatment outcome in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol 2016; 12:215.e1-8. [PMID: 27233211 DOI: 10.1016/j.jpurol.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Uroflowmetry (UF) alone is often inadequate or unreliable to diagnose lower urinary tract dysfunction (LUTD). Therefore, other non-invasive tests, such as ultrasound (US), post-voiding residual volume (PVR) assessment and symptom scales, are used as well for objective definition of the problem. OBJECTIVE The aim of this study was to investigate the possible predictive function of the non-invasive diagnostic tests for the response to treatment. STUDY DESIGN The prospective registry data of 240 patients with LUTD, from November 2006 to September 2013, were retrospectively analyzed. All patients were aged 5-14 years old. Patients with a previous diagnosis of vesicoureteral reflux (VUR), neurogenic bladder, monosymptomatic nocturnal enuresis (NE) were excluded from the study. Uroflowmetry, US, PVR and the Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) were performed on every patient at their first visit and follow-ups. A DVISS <9 was considered as the DVISS response; parental opinion was based on International Continence Society criteria of clinical response. Time passed until clinical response was the last outcome parameter. RESULTS Mean age was 8.2 years. Median follow-up was 60.5 months. A total of 62% of patients had complete response, 28.1% had partial response, and 9.7% had no response. Demographic variables were not associated with clinical outcome. Co-existing enuresis nocturna, multiple pharmacotherapy, and increased DVISS were associated with longer time until clinical response. Post-voiding residual volume assessment was the only test to have a prognostic value. DISCUSSION Resolution rates of LUTD ranged from 40 to 90%. High resolution rate could be attributed to the long follow-up period, and the chance of spontaneous resolution. Treatment modalities and co-existing NE were associated with longer time until clinical response. Only PVR was associated with prognosis. This was the first study in literature to report such findings. It was seen that the normalization of pathologic patterns was a good sign for treatment success. The DVISS results showed significantly higher rates of incontinence compared to initial symptoms defined by the patients and/or their parents. This showed the importance of using scoring systems to better define the severity of symptoms. It was hard to establish a standardized cut-off value for bladder wall thickness on US. However, US was a good test for diagnosing additional pathologies. CONCLUSION Increased PVR was the single tool that was associated with prognosis and, therefore, should always be performed after UF. In addition, DVISS can help parents be counseled about their treatment expectations.
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Affiliation(s)
- A T Beksac
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
| | - A Koni
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - A C Bozacı
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - H S Dogan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - S Tekgul
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P. International Children's Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn 2015; 34:640-7. [DOI: 10.1002/nau.22783] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/17/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Stuart B. Bauer
- Harvard Medical School; Boston Children's Hospital; Boston MA
| | - Rien J.M. Nijman
- Department of Urology and Pediatric Urology; University Medical Centre Groningen; Groningen the Netherlands
| | - Beth A. Drzewiecki
- Albert Einstein College of Medicine; Montefiore Medical Center; Children's Hospital at Montefiore; Bronx NY
| | - Ulla Sillen
- Department of Pediatrics; University of Gothenberg; Gothenberg Sweden
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Furtado PS, Lordêlo P, Minas D, Menezes J, Veiga ML, Barroso U. The influence of positioning in urination: an electromyographic and uroflowmetric evaluation. J Pediatr Urol 2014; 10:1070-5. [PMID: 24951260 DOI: 10.1016/j.jpurol.2014.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/23/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE We conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS Ninety-four children between the ages of 3 and 14 years with symptoms of LUTD were evaluated. All underwent uroflowmetry and electromyography tests (abdominal and perineal) in two different positions: oriented position (trunk bent slightly forward and feet flat) and atypical position (standing on toes for boys and buttocks not in contact with the lavatory seat and legs flexed in girls). We excluded nine patients due to suspicions of outside interference or elements complicating the analysis of charts. RESULTS Among patients evaluated 55 (64.7%) were girls and 30 (35.3%) were boys with an average age of 8.5 years. Children urinating in atypical position showed higher levels of perineal electrical activity than when they were in normal position (p=0.018). However, there was no difference in the pattern of the curve if normal or abnormal when comparing the two groups (p=0.824). When evaluated separately, the boys demonstrated no difference between positions, in relation to perineal electrical activity (p=0.412) or abdominal electrical activity (p=0.202). CONCLUSIONS The electrical activity of the pelvic floor musculature is decreased in the oriented position when compared to atypical positions in female children. Our data suggest that special attention should be given to adopting an adequate posture during urination for girls with LUTD.
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Affiliation(s)
- Paulo Sampaio Furtado
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil; Federal University of Bahia, Salvador, Brazil
| | - Patrícia Lordêlo
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil; Physiotherapy Sector, Bahiana School of Medicine and Public Health (EBMSP), Salvador, Brazil
| | - Daniela Minas
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil; Physiotherapy Sector, Bahiana School of Medicine and Public Health (EBMSP), Salvador, Brazil
| | - Juliana Menezes
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil; Physiotherapy Sector, Bahiana School of Medicine and Public Health (EBMSP), Salvador, Brazil
| | - Maria Luíza Veiga
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil; Physiotherapy Sector, Bahiana School of Medicine and Public Health (EBMSP), Salvador, Brazil
| | - Ubirajara Barroso
- Division of Urology, Pediatric Urology Sector, Center for Voiding Disorders of Children (CEDIMI), Bahiana School of Medicine and Public Health (EBMSP), Federal University of Bahia, Salvador, Brazil.
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Gonçalves MLC, Fernandes SFF, de Almeida RM, Diaz FAF, de Oliveira PG, de Sousa JB. Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:280-5. [PMID: 24510035 DOI: 10.1590/s0102-67202013000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/19/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS Twenty-five adult women (mean age 45.5 ± 11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9 ± 10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.
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Berry A, Rudick K, Richter M, Zderic S. Objective versus subjective outcome measures of biofeedback: what really matters? J Pediatr Urol 2014; 10:620-6. [PMID: 25070936 DOI: 10.1016/j.jpurol.2014.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical epidemiologic studies suggest that once established, voiding dysfunction can become a lifelong condition if not treated correctly early on in life. Biofeedback is one component of a voiding retraining program to help children with voiding dysfunction. Our goal was to compare objective non-invasive urodynamic data obtained during office biofeedback sessions with patient reported voiding symptom scores. METHODS Charts of 55 children referred in 2010 for pelvic floor muscle biofeedback therapy for urinary incontinence were retrospectively reviewed. Patients with any anatomic diagnoses were excluded. Forty-seven (86%) females and eight males (14%) with a mean age of 8.2 years made up the cohort. Uroflow curves, voided volumes, and post-void residuals were recorded at each visit and served as objective data. Volumes were normalized as a percentage of expected bladder capacity according to age. The patient reported symptom score and patient reported outcome (improved, no change or worse) served as subjective measures of intervention. RESULTS The primary referral diagnoses were day and night wetting in 37 (67%) and daytime incontinence in 18 (33%) children. A history of urinary tract infection (UTI) was noted in 32 (64%) patients, and 25% were maintained on antibiotic prophylaxis during the study period. Twenty-nine percent were maintained on anticholinergic medication. Patients attended an average of 2.5 biofeedback sessions. Voided volumes and post void residual volumes were unchanged, 50% of the abnormal uroflow curves normalized over the course of treatment (p < 0.05). Patient reported symptom score decreased from 12.8 ± 5.6 to 8.0 ± 6.5 (p < 0.002) over an average follow-up time of 276 days reflecting fewer daytime voiding symptoms. There was no significant change in the patient symptom score component for the night-time wetting. Patient-reported outcomes at the final session of biofeedback were rated an improved in 26 (47%), no change in 15 (27%), worse in three (5%) patients, and not rated in 11 patients (21%). CONCLUSIONS Pelvic floor muscle biofeedback is associated with patient-reported improvement in symptoms, reduction in voiding symptom score, and normalization of uroflow curves, but these improvements are not correlated with objective parameters of voided volumes and post-void residual urine obtained during office visits for biofeedback. It is important to identify the most relevant outcome measures for BFB, as insurance coverage for medical interventions that cannot offer outcomes analysis that demonstrates a benefit for the patient will eventually be eliminated.
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Affiliation(s)
- Amanda Berry
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Kristen Rudick
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meg Richter
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephen Zderic
- Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Chang SJ, Chiang IN, Hsieh CH, Lin CD, Yang SSD. Age- and gender-specific nomograms for single and dual post-void residual urine in healthy children. Neurourol Urodyn 2013; 32:1014-8. [PMID: 23595887 DOI: 10.1002/nau.22342] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022]
Abstract
PURPOSE To establish the first age- and gender-specific nomograms for single and two consecutive tests for post-void residual urine (PVR). MATERIAL AND METHODS Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry and PVR. The first PVR and the lower value of the two consecutive PVRs of each child with a voided volume ≥50 ml were included for construction of Single- and Dual-PVR nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. RESULTS AND LIMITATIONS Totally, 1,128 children (583 boys and 545 girls) with a mean age of 7.7 ± 2.2 years were eligible for analysis. The 95th percentile of Single-PVR for all children was 27.2 ml, or 19.2% of bladder capacity (BC), while that for Dual-PVR were 11.2 ml or 6.0% of BC, respectively. Multivariate studies showed that PVR was positively associated with BC, negatively associated with age, higher in boys than girls, and higher in abnormal uroflow patterns. For children aged ≤6 years, a single PVR >30 ml or >21% BC, or repetitive PVR >20 ml or >10% BC can be regarded as elevated. For children aged ≥7 years, a single PVR >20 ml or 15% BC, or repetitive PVR >10 ml or 6% BC can be redefined as elevated. CONCLUSIONS Age, gender, and BC should be taken into considerations at interpretation of PVR tests in children. Repeating PVR test is recommended when a single PVR is higher than the 95th percentile of age- and gender-specific PVR. Neurourol. Urodynam. 32: 1014-1018, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Shang-Jen Chang
- Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan; Medical College of Buddhist, Tzu Chi University, Hualien, Taiwan
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Yang TK, Huang KH, Chen SC, Chang HC, Yang HJ, Guo YJ. Correlation between clinical manifestations of nocturnal enuresis and attentional performance in children with attention deficit hyperactivity disorder (ADHD). J Formos Med Assoc 2013; 112:41-7. [DOI: 10.1016/j.jfma.2012.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 01/14/2012] [Accepted: 01/16/2012] [Indexed: 11/29/2022] Open
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Drzewiecki BA, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting. J Urol 2012; 188:1578-83. [DOI: 10.1016/j.juro.2012.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Beth A. Drzewiecki
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Schneider D, Yamamoto A, Barone JG. Evaluation of consistency between physician clinical impression and 3 validated survey instruments for measuring lower urinary tract symptoms in children. J Urol 2011; 186:261-5. [PMID: 21600599 DOI: 10.1016/j.juro.2011.03.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Since many children with lower urinary tract symptoms are treated based on history and physical, it is important to know which symptom survey correlates best with the physician clinical impression. We evaluated 3 tools that have been demonstrated to predict severity of lower urinary tract symptoms, the Dysfunctional Voiding Symptom Score, the Akbal survey and the Nelson survey. Total scores from each survey were compared to clinical impression. MATERIALS AND METHODS Participants consisted of 36 males and 35 females referred to our pediatric urology center for lower urinary tract symptoms. A total of 37 children 4 to 10 years old completed the Dysfunctional Voiding Symptom Score with the help of their parents, and 34 of these parents completed the Akbal survey. A total of 35 children 11 to 17 years old completed the Nelson survey. Scores from the 3 instruments were compared to the clinical impression of a pediatric urologist using rank correlation (Kendall's tau-b test). RESULTS Mean total symptom scores were increased relative to physician rating for all 3 surveys. Symptoms reported by younger children using the Dysfunctional Voiding Symptom Score correlated better with physician rating of symptom severity (tau-b 0.43) compared to symptoms reported by parents using the Akbal survey (tau-b 0.41). Older children reporting symptoms using the Nelson survey had the strongest correlation with physician clinical impression (tau-b 0.48). CONCLUSIONS All 3 surveys were statistically significantly correlated with the physician impression of severity for lower urinary tract symptoms, with the Nelson survey being the most accurate.
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Affiliation(s)
- Dona Schneider
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University (DS), New Jersey, USA
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Hooman N, Hallaji F, Mostafavi SH, Mohsenifar S, Otukesh H, Moradi-Lakeh M. Correlation between Lower Urinary Tract Scoring System, Behavior Check List, and Bladder Sonography in Children with Lower Urinary Tract Symptoms. Korean J Urol 2011; 52:210-5. [PMID: 21461287 PMCID: PMC3065135 DOI: 10.4111/kju.2011.52.3.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 02/10/2011] [Indexed: 11/24/2022] Open
Abstract
Purpose The Pediatric Lower Urinary Tract Scoring System (PLUTSS) is a standardized questionnaire used for screening and evaluation of the response of children with lower urinary tract symptoms (LUTS) to therapy. We presumed that adding the Child Behavior Check List (CBCL) and bladder volume wall index (BVWI) to the PLUTSS would increase its validity in the detection of children with LUTS. Materials and Methods One hundred twenty-two children aged 5 to 15 years with LUTS were enrolled in the study. Seventy-two healthy, age-matched children without urinary complaints were considered as controls. The PLUTSS and CBCL were filled out for all children. Sonography was performed to measure BVWI. Chi-square test and likelihood ratio were used to compare frequencies, receiver operating curve (ROC) analysis was used to evaluate the correlation, and Cohen's kappa was used to measure the agreement between variables. p-values <0.05 were considered significant. Results Behavior problems were significantly more common in children with LUTS than in healthy children (p<0.05). The frequency of thick, thin, and normal BVWIs did not differ significantly in the two groups (p>0.05). ROC analysis showed that there was no correlation between PLUTSS, CBCL, and BVWI in either the LUTS subgroup or in the controls (p>0.05). The PLUTSS had the highest sensitivity and specificity, and adding the two other tests decreased its validity for the diagnosis of children with LUTS. Conclusions The PLUTSS by itself was the best predictor of LUTS. The CBCL and BVWI were not helpful in making a diagnosis; however, the CBCL was useful in the detection of behavior problems in children with non-monosymptomatic enuresis.
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Affiliation(s)
- Nakysa Hooman
- Department of Pediatric Nephrology, Ali-Asghar Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Chang SJ, Yang SSD, Chiang IN. Large voided volume suggestive of abnormal uroflow pattern and elevated post-void residual urine. Neurourol Urodyn 2010; 30:58-61. [DOI: 10.1002/nau.20901] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 02/03/2010] [Indexed: 11/11/2022]
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Glad Mattsson G, Brännström M, Eldh M, Mattsson S. Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction. J Pediatr Urol 2010; 6:490-5. [PMID: 19945349 DOI: 10.1016/j.jpurol.2009.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Individually applied urotherapy is first-line treatment in children with bladder dysfunction. A new concept of treatment for small groups of children was applied and evaluated. PATIENTS AND METHODS Two hundred children, 116 of them girls, aged 3-14 years (median 7.2) with bladder dysfunction and incontinence received urotherapy in small groups (2-5), called voiding school (VS). Outcome was evaluated after 3 and 12 months by voiding/leakage diary and questionnaire, and at 3 months by uroflow and post-void residual urine as well. RESULTS The outcome of VS was independent of age and gender. At follow up at 3 and 12 months, respectively, 35% and 40% of the children were cured and another 30% and 34% improved (P≤0.0001). Compared with the year before start of VS, urinary tract infections decreased from 34% to 6% (P<0.0001). Median residual urine decreased from 15 ml before VS to 6 ml after 3 months (P<0.001). CONCLUSION The concept of VS is a good alternative to individual urotherapy, with the outcome of fewer urinary tract infections and improved continence. Urotherapy for groups of children compared to individual treatment is also expected to have financial benefits.
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Affiliation(s)
- Gunilla Glad Mattsson
- Institute of Clinical and Experimental Medicine, Division of Pediatrics, University of Linköping, Sweden.
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Variability, Related Factors and Normal Reference Value of Post-Void Residual Urine in Healthy Kindergarteners. J Urol 2009; 182:1933-8. [DOI: 10.1016/j.juro.2009.02.086] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Indexed: 11/22/2022]
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Steward JE, Clemons JD, Zaszczurynski PJ, Butler RS, Damaser MS, Jiang HH. Quantitative evaluation of electrodes for external urethral sphincter electromyography during bladder-to-urethral guarding reflex. World J Urol 2009; 28:365-71. [PMID: 19680661 DOI: 10.1007/s00345-009-0463-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 07/27/2009] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Accuracy in the recording of external urethral sphincter (EUS) electromyography (EMG) is an important goal in the quantitative evaluation of urethral function. The aim of this study was to quantitatively compare electrode recordings taken during tonic activity and leak point pressure (LPP) testing. METHODS Several electrodes, including the surface electrode (SE), concentric electrode (CE), and wire electrode (WE), were placed on the EUS singly and simultaneously in six female Sprague-Dawley rats under urethane anesthesia. The bladder was filled via a retropubic catheter while LPP testing and EUS EMG recording were done. Quantitative baseline correction of the EUS EMG signal was performed to reduce baseline variation. Amplitude and frequency of 1-s samples of the EUS EMG signal were measured before LPP (tonic activity) and during peak LPP activity. RESULTS The SE, CE, and WE signals demonstrated tonic activity before LPP and an increase in activity during LPP, suggesting that the electrodes accurately recorded EUS activity during tonic activity and during the bladder-to-EUS guarding reflex, regardless of the size or location of detection areas. SE recordings required significantly less baseline correction than both CE and WE recordings. The activity in CE-recorded EMG was significantly higher than that of the SE and WE both in single and simultaneous recordings. CONCLUSIONS These electrodes may be suitable for testing EUS EMG activity. The SE signal had significantly less baseline variation and the CE detected local activity more sensitively than the other electrodes, which may provide insight into choosing an appropriate electrode for EUS EMG recording.
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Affiliation(s)
- James E Steward
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
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Rizzini M, Donatti TL, Bergamaschi DP, Brunken GS. Equivalência conceitual, de itens e semântica da versão brasileira do instrumento Dysfunctional Voiding Scoring System (DVSS) para avaliação de disfunção do trato urinário inferior em crianças. CAD SAUDE PUBLICA 2009; 25:1743-55. [DOI: 10.1590/s0102-311x2009000800010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 04/06/2009] [Indexed: 11/22/2022] Open
Abstract
Investiga-se a equivalência conceitual, de itens e semântica entre o instrumento Dysfunctional Voiding Scoring System (DVSS), utilizado para avaliar a disfunção funcional do trato urinário inferior em crianças, concebido em inglês e uma versão em português. Na primeira etapa realizou-se a avaliação da equivalência conceitual e de itens, seguida de duas traduções do instrumento original para o português. Na segunda etapa foram realizadas 63 entrevistas, com crianças de 3 a 10 anos e responsáveis, e modificação de itens segundo dificuldades de interpretação. Na terceira etapa foi realizada a retradução do instrumento em português para o inglês e avaliação da equivalência semântica. Na quarta etapa, a versão pré-teste foi aplicada em vinte duplas de crianças de 3 a 10 anos e responsáveis. Apresenta-se o instrumento em português com equivalência conceitual, de itens e semântica. Sugere-se que a aplicação do DVSS seja realizada por meio de entrevista por profissional treinado e não baseada em autopreenchimento como proposto no instrumento original.
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Chang SJ, Yang SSD, Chiang IN. Re: Jae Min Chung et al: Prevalence and Associated Factors of Overactive Bladder in Korean Children 5-13 Years Old: A Nationwide Multicenter Study. (Urology 2009;73:63). Urology 2009; 74:234-5; author reply 235-6. [DOI: 10.1016/j.urology.2009.02.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 02/19/2009] [Accepted: 02/20/2009] [Indexed: 11/15/2022]
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The Effects of Bladder Over Distention on Voiding Function in Kindergarteners. J Urol 2008; 180:2177-82; discussion 2182. [DOI: 10.1016/j.juro.2008.07.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Indexed: 11/18/2022]
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Non-invasive evaluation of voiding function in asymptomatic primary school children. Pediatr Nephrol 2008; 23:1115-22. [PMID: 18335255 DOI: 10.1007/s00467-008-0776-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 01/04/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
This study aimed to evaluate the voiding characteristics of primary school children by using questionnaires and non-invasive diagnostic tools. The voiding characteristics of 212 healthy children in two primary schools were evaluated with ultrasound for bladder wall thickness (BWT) in association with the Pediatric Lower Urinary Tract Symptom Score (PLUTSS), familial questionnaire, uroflowmetry (UF) and urinalysis. Most of the children (70%) had achieved urinary and fecal continence between the ages of 18 months and 36 months. Twenty-five per cent of healthy children void fewer than four times or more than seven times per day. Ninety percent of children had a PLUTSS within normal ranges (< 9). Fifteen percent of patients had a uroflowmetric pattern other than bell-shaped. The peak and average flow rates were higher in girls. Enuresis nocturna was detected in 10% of children. None of the children had documented urinary tract infection. The average BWT from posterior wall at full bladder in healthy children was 1.1 mm. The anterior and posterior BWT measurements before and after micturition were found to be thicker in boys. Regarding the UF pattern, in post-voiding measurements in children with abnormal UF pattern, the bladder walls were thicker. Non-invasive tests in non-symptomatic children showed a range of variability, and these deviations should be kept in mind during the evaluation of voiding characteristics of a child. The symptom scoring system, with the high sensitivity and specificity rates it possesses, is one of the promising tools for this purpose.
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Akkad T, Pelzer A, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Pinggera GM, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with overactive bladder syndrome: comparative urodynamics might provide better detection of dysfunctional voiding. BJU Int 2007; 100:830-4; discussion 834. [PMID: 17578465 DOI: 10.1111/j.1464-410x.2007.07047.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with symptoms of overactive bladder (OAB), by using comparative urodynamics (CUD). PATIENTS AND METHODS The study included 175 women who met the criteria of OAB (mean age 52.7 years, range 18-87). CUD included two sessions of pressure-flow studies (0.9% saline vs 0.2 m KCl) with simultaneous measurement of PFA using perineal electromyography (EMG) with surface electrodes. Dysfunctional voiding (DV) was diagnosed if significant PFA was measured by EMG during voiding. RESULTS In 44 patients (25%) there was increased EMG activity only in the presence of KCL; in 58 (33%) there was DV with increased PFA during filling with saline. In all these patients PFA was significantly greater in the presence of KCl (P < 0.001). In patients with DV, filling with KCl prompted a statistically significant difference in maximum bladder capacity, maximum flow rate, mean flow rate and postvoid residual urine volume (P < 0.05). In summary, 102 patients (58%) had DV. CONCLUSION These findings suggest that DV is associated with epithelial dysfunction of the bladder mucosa, which clinically leads to OAB syndrome and can be revealed by CUD. The detection of DV might elude conventional urodynamics, but can be significantly enhanced by CUD (0.9% saline vs 0.2 m KCl).
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Austria
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Akkad T, Pelzer AE, Mitterberger M, Rehder P, Leonhartsberger N, Bartsch G, Strasser H. Influence of intravesical potassium on pelvic floor activity in women with recurrent urinary tract infections: comparative urodynamics might lead to enhanced detection of dysfunctional voiding. BJU Int 2007; 100:1071-4. [PMID: 17784889 DOI: 10.1111/j.1464-410x.2007.07120.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the influence of intravesical potassium on pelvic floor activity (PFA) during voiding in women with recurrent urinary tract infections (rUTIs) by using comparative urodynamics (CUD). PATIENTS AND METHODS CUD was conducted in 49 women (mean age 34.6 years, range 15-82) with rUTI. Every patient had two sessions of pressure-flow studies with simultaneous measurement of PFA by perineal surface electromyography (EMG); the first was with 0.9% saline and in the second the bladder was filled with 0.2 m KCl solution. All patients had voiding cysto-urethrography, and dysfunctional voiding (DV) was diagnosed when significant PFA was measured by EMG during voiding. RESULTS Overall, DV was diagnosed in 37 patients (76%) using CUD; 16 (32%) had DV with saline on the pelvic floor EMG. In all these patients there were significantly greater EMG signals in the presence of KCL. In 21 patients (43%) DV was only detected using KCL; this improvement in the detection rate of DV was statistically significant (P = 0.006). Filling with KCl also prompted a statistically significant difference (P < 0.05) in maximum bladder capacity, maximum and average flow rates and in postvoid residual urine volume. CONCLUSION The present data show that DV is present in most women with rUTI but cannot sufficiently be diagnosed by conventional urodynamics with standard 0.9% saline. The present study suggests that CUD might enhance the detection rates of DV.
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Abstract
OBJECT The author describes the paucity of information known about occult tethered cord syndrome and summarizes the argument for using a nonsurgical approach in these cases. METHODS A review of what we do and do not know about this syndrome is provided. Surgical procedures to divide the terminal filum in patients with symptoms of tethered spinal cord without the imaging correlates are said to result in clinical improvement, yet there is little physiological evidence to support the surgical release of the filum in the absence of other anatomical lesions. Validated diagnostic and outcome measures are also lacking, which makes the interpretation of reported results exceedingly difficult. Finally, reports used to support surgical intervention are limited by small size, the absence of control groups, and observer bias. CONCLUSIONS Without conclusive clinical evidence, the arguments supporting surgery for occult tethered cord syndrome must be viewed cautiously.
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Affiliation(s)
- James M Drake
- Division of Neurosurgery, Department of Neurosurgery, University of Toronto, Ontario, Canada.
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Abstract
Lower urinary tract dysfunction is a common component of virtually every pediatric urologist's practice. Although lower urinary tract dysfunction should be considered more of a social nuisance than a true medical condition, if left unchecked, real comorbidities may occur. A thorough history, physical examination, voiding diary, and noninvasive urodynamic studies, such as flow rate or flow rate with electromyography, generally are used to make an accurate diagnosis. Once the diagnosis is established, a wide range of therapies are available and their use may be based on the age of the child, duration of symptoms, etiology of the lower urinary tract dysfunction and associated urologic disease, and physician or family preferences. Symptom scoring systems have been devised to confirm diagnosis of lower urinary tract dysfunction, classify its severity, and serve as a monitoring instrument to determine response to treatment.
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Affiliation(s)
- M Chad Wallis
- Division of Urology, The Hospital for Sick Children and the University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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