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Pujol J, Blanco-Hinojo L, Persavento C, Martínez-Vilavella G, Falcón C, Gascón M, Rivas I, Vilanova M, Deus J, Gispert JD, Gómez-Roig MD, Llurba E, Dadvand P, Sunyer J. Functional structure of local connections and differentiation of cerebral cortex areas in the neonate. Neuroimage 2024; 298:120780. [PMID: 39122060 DOI: 10.1016/j.neuroimage.2024.120780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/16/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024] Open
Abstract
Neuroimaging research on functional connectivity can provide valuable information on the developmental differentiation of the infant cerebral cortex into its functional areas. We examined healthy neonates to comprehensively map brain functional connectivity using a combination of local measures that uniquely capture the rich spatial structure of cerebral cortex functional connections. Optimal functional MRI scans were obtained in 61 neonates. Local functional connectivity maps were based on Iso-Distance Average Correlation (IDAC) measures. Single distance maps and maps combining three distinct IDAC measures were used to assess different levels of cortical area functional differentiation. A set of brain areas showed higher connectivity than the rest of the brain parenchyma in each local distance map. These areas were consistent with those supporting basic aspects of the neonatal repertoire of adaptive behaviors and included the sensorimotor, auditory and visual cortices, the frontal operculum/anterior insula (relevant for sucking, swallowing and the sense of taste), paracentral lobule (processing anal and urethral sphincter activity), default mode network (relevant for self-awareness), and limbic-emotional structures such as the anterior cingulate cortex, amygdala and hippocampus. However, the results also indicate that brain areas presumed to be actively developing may not necessarily be mature. In fact, combined distance, second-level maps confirmed that the functional differentiation of the cerebral cortex into functional areas in neonates is far from complete. Our results provide a more comprehensive understanding of the developing brain systems, while also highlighting the substantial developmental journey that the neonatal brain must undergo to reach adulthood.
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain.
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; ISGlobal, Barcelona, Spain
| | - Cecilia Persavento
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerard Martínez-Vilavella
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain
| | - Carles Falcón
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; CIBER Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mireia Gascón
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Ioar Rivas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marc Vilanova
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain; CIBER Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Dolors Gómez-Roig
- BCNatal, Fetal Medicine Research Center, Hospital Sant Joan de Déu and Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/1&3, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Llurba
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/1&3, Instituto de Salud Carlos III, Madrid, Spain; Department of Obstetrics and Gynaecology. Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Sillen U, Hansson S, Jernmark S, Sjöström S, Brandström P. Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial. J Pediatr Urol 2024; 20:118-126. [PMID: 37684195 DOI: 10.1016/j.jpurol.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/31/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known. OBJECTIVE This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI). STUDY DESIGN Of the 161 eligible children at SRT study-end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut-off ≥7) and uroflowmetry, at five (T2) and ten years (T3) after study-end. T1 was the SRT study-end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores. RESULTS BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p = 0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p = 0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p = 0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups. DISCUSSION The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort. CONCLUSION In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.
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Affiliation(s)
- U Sillen
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Hansson
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Jernmark
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Sjöström
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - P Brandström
- From the Pediatric Uronephrology Center, Department of Pediatrics and Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Davis M, Mohan S, Russell T, Feng C, Badillo A, Levitt M, Ho CP, Pohl HG, Varda BK. A prospective cohort study of assisted bladder emptying following primary cloacal repair: The Children's National experience. J Pediatr Urol 2023; 19:371.e1-371.e11. [PMID: 37037763 DOI: 10.1016/j.jpurol.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/20/2023] [Accepted: 03/11/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION/BACKGROUND Although the combination of bladder dysfunction and upper tract anomalies puts patient with cloaca at risk for renal disease, the rarity of this condition makes it difficult to study empirically. As a high-volume center, we uniquely capture bladder function outcomes following our growing number of cloacal repairs. OBJECTIVE 1) Describe the rates of incomplete bladder emptying following primary cloacal repair (at 2-3 months after repair and last follow up), and 2) identify clinical factors associated with assisted bladder emptying. STUDY DESIGN We performed a prospective cohort study of patients undergoing primary cloaca repair by our Children's National Colorectal Center team between 2020 and 2021. The primary outcome was assisted bladder emptying at 2-3 months postoperatively and last visit. Covariables included preoperative characteristics (cloacagram measurements), ARM complexity (moderate = common channel [CC] <3-cm, severe = CC ≥ 3-cm), vesicoureteral reflux (VUR) status, sacral ratio (good ≥0.7, intermediate 0.7-0.4, poor ≤0.4), spinal cord status, means of preoperative bladder emptying, and operative details (age at repair, repair type, & concomitant laparotomy). RESULTS Eighteen participants were eligible. A majority had moderate cloaca (78%), VUR (67%), spinal cord abnormalities (89%), and good sacral ratios (56%). Preoperatively, 10 patients were diapered for urine and 8 had assisted bladder emptying. Surgical repairs were performed at a median age of 8 months (range 4-46). Nine (50%) patients underwent urogenital separation (UGS), eight (44%) total urogenital mobilization, and 1 (6%) perineal sparing posterior sagittal anorectoplasty with introitoplasty. Exploratory laparotomy was performed in 7 (39%) patients. At 2-3 months, 7 patients were voiding and 11 required assisted bladder emptying. Median length of long-term follow up was 12 months (range 5-25), and 8 patients were voiding and 10 required assisted bladder emptying. Postoperative need for assisted bladder emptying was significantly associated with assisted bladder emptying preoperatively, a shorter urethra and increasing common channel length, UGS and exploratory laparotomy. Spinal cord imaging findings were not associated. DISCUSSION Bladder emptying following cloaca repair is likely a result of congenital function and surgical effects. Indeed, increasingly cloaca complexity requiring UGS and laparotomy was associated with both pre- and post-operative assisted bladder emptying. The lack of association with spinal cord imaging may reflect a divergence between anatomy and function. CONCLUSION Approximately half of patients required assisted bladder emptying in this study. Associated factors included urethral and common channel length, the need for assisted bladder emptying preoperatively, the type of surgical approach and additional laparotomy. Being diapered with seemingly normal voiding prior to surgery did not guarantee normal bladder function postoperatively.
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Affiliation(s)
- Meghan Davis
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Shruthi Mohan
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Teresa Russell
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Christina Feng
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Andrea Badillo
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Marc Levitt
- Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Christina P Ho
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA
| | - Hans G Pohl
- Children's National Hospital, Division of Urology, Washington D.C, USA
| | - Briony K Varda
- Children's National Hospital, Division of Urology, Washington D.C, USA; Children's National Hospital, Division of Colorectal and Pelvic Reconstruction, Washington D.C, USA.
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Oktay C, Işık G. Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting: A Single-Center Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1327-1332. [PMID: 36478362 DOI: 10.1002/jum.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) is a frequent cause of admission to pediatric nephrology outpatient clinics. The aim of this study was to determine whether anatomical changes in lower urinary tract structures (retrovesical angulation [RVA] and bladder neck position [BNP]) are associated with UI in pediatric patients with daytime-wetting in comparison to healthy children. METHODS In this prospective study, patients with daytime UI diagnosed using the Dysfunctional Voiding Symptom Score of the International Children's Continence Society and 3-day-voiding/bowel diary were compared with an age- and sex-matched control group without incontinence. In addition to routine clinical evaluation, RVA and BNP were measured at rest using transabdominal ultrasound (TA-US). Intra-rater agreement was estimated. RESULTS A total of 88 children were included in the study, with 44 children (22 boys, 22 girls) each in patient and control groups. RVA was significantly greater and BNP was significantly lower in the patient group versus control group (RVA: 134.30 ± 10.05 vs 127.94 ± 13.15, P = .013; BNP: 11.88 ± 4.53 vs 17.20 ± 5.55, P < .001, respectively). Irrespective of the presence of incontinence, girls had a significantly greater RVA than boys (P < .001). However, there was no difference between sexes in BNP values (P = .630). Intra-rater agreement was very strong for RVA (P < .001, r = .897), and strong for BNP (P < .001, r = .774). CONCLUSIONS TA-US imaging is a non-invasive and practical procedure routinely performed in pediatric patients presenting with UI complaints. Our study demonstrated anatomical changes in lower urinary tract structures in pediatric patients with UI. These changes should be considered in the diagnosis, follow-up, and treatment of patients with UI.
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Affiliation(s)
- Cemil Oktay
- Department of Radiology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Güneş Işık
- Department of Pediatric Nephrology, Adıyaman University Medical Faculty, Adıyaman, Turkey
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Lim LY, Chang SJ, Yang SSD. Age- and gender-specific normal post void residual urine volume in healthy adolescents. J Pediatr Urol 2023:S1477-5131(23)00113-4. [PMID: 37029009 DOI: 10.1016/j.jpurol.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. OBJECTIVE To establish age- and gender-specific normal PVR urine volume in adolescents. MATERIAL AND METHODS Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. RESULTS A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV < 100 ml) in both assessments (n = 12), BV < 100 ml in one assessment (n = 1), or failure to provide relevant history (n = 1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n = 152), BV < 100 ml (n = 27), PVR >100 ml (n = 5) and missing information (n = 6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6 ± 1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P < 0.001). Moreover, they were higher in females than in males (P < 0.001). Multivariate analysis revealed that PVR was positively influenced by age (P = 0.001) and BV (P < 0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20 ml (7% BV) for males of both the age groups, and PVR >25 ml (9% BV) and PVR >35 ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30 ml (8% BV) and >30 ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35 ml (11% BV) and >45 ml (13% BV) for females aged 12-14 and 15-18 years, respectively. CONCLUSION PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.
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Affiliation(s)
- Li Yi Lim
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; Division of Urology, Department of Surgery, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Shang-Jen Chang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; Department of Urology, National Taiwan University, No 7, Zhongshan S Road, Zhongsheng District, Taipei City, 100, Taiwan, R.O.C.
| | - Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; School of Medicine, Tzu Chi University, 289, Jianguo Road, Xindian District, New Taipei City, Hualien, 23142, Taiwan, R.O.C.
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Axelgaard S, Kristensen R, Kamperis K, Hagstrøm S, Jessen AS, Borch L. Functional constipation as a risk factor for pyelonephritis and recurrent urinary tract infection in children. Acta Paediatr 2023; 112:543-549. [PMID: 36435986 PMCID: PMC10108045 DOI: 10.1111/apa.16608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
AIM Acute pyelonephritis is one of the most common bacterial infections in childhood. This potentially serious condition can lead to renal scarring, loss of kidney function and hypertension. The aim of this study was to identify risk factors associated with pyelonephritis in children without kidney or urinary tract abnormalities. METHODS Medical records of children aged 4-18 diagnosed with 1st time pyelonephritis from 2016 to 2021 were retrospectively analysed. Children with abnormal kidney ultrasound were excluded. In addition to demographic data, information on bladder and bowel function was extracted together with habits of fluid intake. RESULTS A total of 105 patients were diagnosed with 1st time pyelonephritis. Of these, 47% were diagnosed with constipation according to the Rome IV criteria within a mean follow-up period of 167 days after their pyelonephritis, which is markedly higher than the estimated prevalence of constipation in the background population. Constipation was positively associated with recurrent urinary tract infection (p = 0.01). CONCLUSION Constipation is associated with pyelonephritis and recurrent urinary tract infection in children (primarily girls) 4-18 years of age without evident kidney or urinary tract abnormalities. We recommend systematic evaluation of bowel and bladder function after 1st time pyelonephritis in all children >4 years.
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Affiliation(s)
- Sofie Axelgaard
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Herning, Denmark.,NIDO
- Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Rasmus Kristensen
- NIDO
- Centre for Research and Education, Gødstrup Hospital, Herning, Denmark.,Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Konstantinos Kamperis
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Hagstrøm
- Department of Pediatrics and Adolescent Medicine, Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Alexander Slot Jessen
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Herning, Denmark
| | - Luise Borch
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Herning, Denmark.,NIDO
- Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
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Nilsson T, Leijon A, Sillén U, Hellström AL, Skogman BH. Bowel and bladder function in infant toilet training (BABITT) - protocol for a randomized, two-armed intervention study. BMC Pediatr 2022; 22:294. [PMID: 35590259 PMCID: PMC9118841 DOI: 10.1186/s12887-022-03355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up. METHODS This randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0-2 months or at 9-11 months of age. The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0-2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored. DISCUSSION This protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy of assisted infant toilet training on functional gastrointestinal disorders up to the age of 9 months. Furthermore, the study will evaluate whether assisted infant toilet training during the first year of life can prevent functional gastrointestinal and urinary tract disorders in children up to 4 years of age. If effective, assisted infant toilet training could be recommended in child healthcare settings and new evidence-based guidelines on infant toilet training could be implemented. TRIAL REGISTRATION The study protocol was retrospectively registered at ClinicalTrials. gov ( NCT04082689 ), initial release June 12th, 2019).
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Affiliation(s)
- Terese Nilsson
- Department of Family medicine and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.,Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - Anna Leijon
- Department of Family medicine and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.,Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden
| | - Ulla Sillén
- Department of Pediatric Surgery, Pediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Anna-Lena Hellström
- Institute of Health and Care Sciences, University of Gothenburg, Göteborg, Sweden
| | - Barbro Hedin Skogman
- Department of Medicine and Health Sciences, Örebro University, Örebro, Sweden. .,Department of Pediatrics and Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden.
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Gatzinsky C, Redfors S, Borg H, Linnér C, Sillén U, Sjöström S. High-Resolution Anorectal Manometry-A Prospective Cohort Study in Healthy Infants. J Pediatr Gastroenterol Nutr 2022; 74:e57-e64. [PMID: 34732647 DOI: 10.1097/mpg.0000000000003350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders (FGD) are common during early childhood. In severe defecation disorders, anorectal manometry (AM) is done to exclude aganglionosis. High-resolution anorectal manometry (HRAM) can probably improve diagnostics but normative data in infants are scarce. This study aims to provide HRAM data in healthy infants overall and in subgroups of infants with FGD, defined as functional constipation (FC), infant colic (IC), and infant dyschezia (ID) (ROME 3 criteria). METHODS This prospective observational cohort study enrolled healthy term infants, having HRAM at 2 and 6 months, using a water-perfused pediatric anorectal silicone catheter. Data were provided for presence of anorectal waves and recto anal inhibitory reflex (RAIR), volume needed to elicit RAIR and anal resting pressure (ARP). Questionnaires at 2 and 6 months identified subjects with FC, IC, and ID. RESULTS A total of 187 HRAM investigations were done in 107 infants, without any complications. Normal RAIR was found in all, at least on one occasion. Mean ARP increased between 2- and 6-month investigations in infants without FGD. No other differences in HRAM data could be seen between infants with or without an FGD. At 2 months FC, IC, and ID were seen (2%, 4%, and 17%), whereas at 6 months only FC and ID were seen (7% and 1%). CONCLUSION We can provide data on HRAM in infants at 2 and 6 months of age. When performing repeated HRAM in healthy infants, RAIR was found in all subjects. HRAM is safe, easy tolerable, and can be recommended in infants with or without FGD.
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Affiliation(s)
| | - Staffan Redfors
- Department of Pediatric Clinical Physiology, Queen Silvia Children's Hospital, Göteborg, Sweden
| | | | - Christina Linnér
- Department of Pediatric Clinical Physiology, Queen Silvia Children's Hospital, Göteborg, Sweden
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Salö M, Nejstgaard MC, Hambraeus M, Graneli C, Börjesson A, Hagelsteen K, Stenström P. Sex and age differences in lower urinary tract dysfunction in healthy children. Acta Paediatr 2021; 110:2618-2626. [PMID: 34050977 DOI: 10.1111/apa.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
AIM Information about healthy children's urinary tract symptoms is scarce but would be helpful in children with congenital urinary tract conditions. The aim of this study was to develop and evaluate a Lower Urinary Tract Dysfunction (LUTD) questionnaire. METHODS A 15-item questionnaire based on definitions by the International Children's Continence Society (ICCS) about urinary tract function, was given to children 4-15 years old with no gastrointestinal or urinary tract conditions. The study was approved ethically. RESULTS The response rate was 82% (311/377), 50% (n = 155) were girls. Children were of the age groups 3.5-7 years (n = 136), 8-12 years (n = 127), and 13-15 years (n = 48). More girls than boys reported urinary tract infections (20% vs 3%, p < 0.001), while prevalences of incontinence and enuresis were equivalent in both sexes. In the youngest age group, enuresis was the most frequently reported symptom (11%), then daytime incontinence (10%). The older children more frequently reported previous urinary tract infections (12% and 17% in respective groups) and daytime incontinence (9% and 6%, respectively). CONCLUSION A LUTD questionnaire is developed and evaluated within this study. Daytime urinary incontinence is the overall most common lower urinary tract symptom and girls report infections more frequently than boys.
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Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
| | | | - Mette Hambraeus
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Christina Graneli
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Anna Börjesson
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Kristine Hagelsteen
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
| | - Pernilla Stenström
- Department of Clinical Sciences, Pediatrics Lund University Lund Sweden
- Department of Pediatric Surgery Skåne University Hospital Lund Sweden
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10
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Raturi S, Li FX, Wong CM. Recognition and management of bladder bowel dysfunction in children with autism spectrum disorder. BMJ Case Rep 2021; 14:e242646. [PMID: 34078623 PMCID: PMC8173284 DOI: 10.1136/bcr-2021-242646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/03/2022] Open
Abstract
Children with autism spectrum disorder (ASD) with rigidities, anxiety or sensory preferences may establish a pattern of holding urine and stool, which places them at high risk of developing bladder bowel dysfunction (BBD). BBD, despite being common, is often unrecognised in children with ASD. With this case report of a 7-year-old girl with ASD presenting with acute retention of urine, we attempt to understand the underlying factors which may contribute to the association between BBD and ASD. Literature review indicates a complex interplay of factors such as brain connectivity changes, maturational delay of bladder function, cognitive rigidities and psychosocial stressors in children with ASD may possibly trigger events which predispose some of them to develop BBD. Simple strategies such as parental education, maintaining a bladder bowel diary and treatment of constipation may result in resolution of symptoms.
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Affiliation(s)
- Shilpee Raturi
- Child Development, KK Women's and Children's Hospital, Singapore
| | - Fay Xiangzhen Li
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Chui Mae Wong
- Child Development, KK Women's and Children's Hospital, Singapore
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11
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Van Aggelpoel T, De Wachter S, Neels H, Van Hal G, Roelant E, Vermandel A. Implementing a new method of group toilet training in daycare centres: a cluster randomised controlled trial. Eur J Pediatr 2021; 180:1393-1401. [PMID: 33230718 DOI: 10.1007/s00431-020-03879-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Despite the existing methods, a trend towards a later initiation and completion of toilet training has been seen in Western society. This study is the first to investigate prospectively the efficacy of intensive group toilet training in daycare centres. The primary outcome of interest is the duration until the child is toilet trained. A cluster randomised controlled trial was established in daycare centres; clusters of participants were randomly allocated to an intervention or control group. Intervention group was subjected to an intensive toilet training session. Innovative aspects of this toilet training method were a 2-h training on two consecutive days, carried out in small groups in daycare centres. Parents of children in the control group were encouraged to start TT in their own manner. Children were monitored until they were considered to be fully toilet trained during the day. Median toilet training duration in the intervention group was 2 weeks compared to 5 weeks in controls (p value log rank test = 0.007). The hazard of being clean during the follow-up of 6 weeks was twice as high in the intervention compared to controls (p = 0.018).Conclusion: The intervention had a significant influence on the duration of toilet training in healthy children, with a median duration of 2 weeks. Our findings are clinically relevant for daycare educators, having a considerable responsibility in the development of children.Trial Registration Number: ClinicalTrials.gov NCT04221776. What is Known: • Despite different existing methods, a later initiation of toilet training has been seen in Western society and coherent to this an increasing age of acquiring full bladder control. • Child daycare centres have a growing role in the toilet training process. What is New: • This is the first prospective report describing the results of a new method of toilet training healthy children in small groups in daycare centres. • The intervention had a significant influence on the duration of toilet training, with a median duration of 2 weeks.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium. .,Department of Urology, Antwerp University Hospital, Edegem, Belgium.
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Hedwig Neels
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Guido Van Hal
- Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital - University of Antwerp, Edegem, Belgium.,StatUa, Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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12
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Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
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13
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Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol 2020; 16:342-349. [PMID: 32253149 DOI: 10.1016/j.jpurol.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Affiliation(s)
- Alexandra Vermandel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Guido Van Hall
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium.
| | | | - Tinne Van Aggelpoel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Hedwig Neels
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Gunter De Win
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Stefan De Wachter
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
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14
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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15
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Morgan KE, Leroy SV, Corbett ST, Shepard JA. Complementary and Integrative Management of Pediatric Lower Urinary Tract Dysfunction Implemented within an Interprofessional Clinic. CHILDREN (BASEL, SWITZERLAND) 2019; 6:children6080088. [PMID: 31366055 PMCID: PMC6721344 DOI: 10.3390/children6080088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind–body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind–body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children. This paper outlines recommendations for integrative management of these patients and discusses a recently developed interprofessional clinic that aims to better meet these patients’ complex needs and to provide patients with an integrated holistic plan of care. Additional work is needed to scientifically assess these treatment models and educate providers across the various disciplines that evaluate and treat these patients.
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Affiliation(s)
- Kathryn E Morgan
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA.
| | - Susan V Leroy
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Sean T Corbett
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, P.O. Box 800223, Charlottesville, VA 22908, USA
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16
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Bladder-Bowel Dysfunction in Children: Consequences, Risk Factors and Recommendations for Primary Care Interventions. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Van Aggelpoel T, De Wachter S, Van Hal G, Van der Cruyssen K, Neels H, Vermandel A. Parents' views on toilet training: a cross-sectional study in Flanders. Nurs Child Young People 2018; 30:30-35. [PMID: 29714428 DOI: 10.7748/ncyp.2018.e944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
Abstract
AIMS The goals of this research were to investigate parents' perceptions of toilet training and their beliefs and views on how to toilet train children. METHODS Questionnaires were provided to parents of healthy children, aged 18-72 months, who were or had just finished toilet training. There were 928 questionnaires returned (38% response rate). After correcting for age compliance with the range stated in the study, 832 parents remained. RESULTS The data confirm a postponement of the age at which children start to potty train and the age at which they are toilet training. Fifty per cent (n=401) of the parents start because the child will soon be attending nursery school and only 27% (n=226) start toilet training because their child shows certain readiness signs. The latter group will significantly end toilet training sooner. Constipation is common and varies considerably in its severity, the complaint should not be ignored. No significant relationship between toilet training and the general family situation - parental status, working status or educational level - was found, suggesting that these factors do not have a significant impact. CONCLUSION Proper education of parents in toilet training and readiness signs could reduce the uncertainties that exist. In that way, toilet training could be carried out more efficiently and at the right time for the child.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, University of Antwerp and Department of Urology, Antwerp University Hospital, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp and Department of Urology, Antwerp University Hospital, Belgium
| | - Guido Van Hal
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | | | - Hedwig Neels
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp and Department of Urology, Antwerp University Hospital, Belgium
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18
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Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol 2018; 33:381-394. [PMID: 28567611 PMCID: PMC5799351 DOI: 10.1007/s00467-017-3679-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 10/31/2022]
Abstract
In Dysfunctional voiding, failure of the external sphincter-pelvic floor complex to relax during micturition results in bladder outflow obstruction with a spectrum of presentation from more benign lower urinary tract dysfunction including recurrent urinary tract infections, to significant upper tract pathology and end-stage renal failure. There is no underlying neurological or anatomical cause and the condition is postulated to be a largely learnt behavior. Diagnosis relies on non-invasive urodynamics and in particular uroflowmetry, plus or minus EMG, which is also used in biofeedback, the mainstay of treatment. The etiology, presentation, diagnosis, and treatment with particular emphasis on non-invasive urodynamics are covered.
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Cavallari P, Bolzoni F, Esposti R, Bruttini C. Cough-Anal Reflex May Be the Expression of a Pre-Programmed Postural Action. Front Hum Neurosci 2017; 11:475. [PMID: 29021750 PMCID: PMC5624195 DOI: 10.3389/fnhum.2017.00475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 01/23/2023] Open
Abstract
When coughing, an involuntary contraction of the external anal sphincter occurs, in order to prevent unwanted leakages or sagging of the pelvis muscular wall. Literature originally described such cough-anal response as a reflex elicited by cough, therefore identifying a precise cause-effect relationship. However, recent studies report that the anal contraction actually precedes the rise in abdominal pressure during cough expiratory effort, so that the sphincter activity should be pre-programmed. In recent years, an important family of pre-programmed muscle activities has been well documented to precede voluntary movements: these anticipatory actions play a fundamental role in whole body and segmental postural control, hence they are referred to as anticipatory postural adjustments (APAs). On these basis, we searched in literature for similarities between APAs and the cough-anal response, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to prevent the unwanted mechanical consequences induced by the primary movement. We thus propose that the cough-anal response also belongs to the family of pre-programmed actions, as it may be interpreted as an APA acting on the abdominal-thoracic compartment; in other words, the cough-anal response may actually be an Anticipatory Sphincter Adjustment, the visceral counterpart of APAs.
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Affiliation(s)
- Paolo Cavallari
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Francesco Bolzoni
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Roberto Esposti
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Carlo Bruttini
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
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Grzeda MT, Heron J, Tilling K, Wright A, Joinson C. Examining the effectiveness of parental strategies to overcome bedwetting: an observational cohort study. BMJ Open 2017; 7:e016749. [PMID: 28710225 PMCID: PMC5541498 DOI: 10.1136/bmjopen-2017-016749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine whether a range of common strategies used by parents to overcome bedwetting in 7½-year-old children (including lifting, restricting drinks before bedtime, regular daytime toilet trips, rewards, showing displeasure and using protection pants) are effective in reducing the risk of bedwetting at 9½ years. DESIGN Prospective cohort study. SETTING General community. PARTICIPANTS The starting sample included 1258 children (66.7% boys and 33.2% girls) who were still bedwetting at 7½ years. OUTCOME MEASURE Risk of bedwetting at 9½ years. RESULTS Using propensity score-based methods, we found that two of the parental strategies used at 7½ years were associated with an increased risk of bedwetting at 9½ years, after adjusting the model for child and family variables and other parental strategies: lifting (risk difference=0.106 (95% CI 0.009 to 0.202), ie, there is a 10.6% (0.9% to 20.2%) increase in risk of bedwetting at 9½ years among children whose parents used lifting compared with children whose parents did not use this strategy) and restricting drinks before bedtime (0.123 (0.021 to 0.226)). The effect of using the other parental strategies was in either direction (an increase or decrease in the risk of bedwetting at 9½ years), for example, showing displeasure (-0.052 (-0.214 to 0.110)). When we re-analysed the data using multivariable regression analysis, the results were mostly consistent with the propensity score-based methods. CONCLUSION These findings provide evidence that common strategies used to overcome bedwetting in 7½-year-olds are not effective in reducing the risk of bedwetting at 9½ years. Parents should be encouraged to seek professional advice for their child's bedwetting rather than persisting with strategies that may be ineffective.
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Affiliation(s)
- Mariusz T Grzeda
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Anne Wright
- Evelina London Children’s Hospital, St Thomas’ Hospital, London, UK
| | - Carol Joinson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Lower Urinary Tract Terminology in Daytime Lower Urinary Tract Symptoms in Children: A View of the Pediatric Urologist. Eur Urol Focus 2017; 3:189-197. [DOI: 10.1016/j.euf.2017.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 11/20/2022]
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Sammour ZM, de Bessa J, Hisano M, Bruschini H, Kim CA, Srougi M, Gomes CM. Lower urinary tract symptoms in children and adolescents with Williams-Beuren syndrome. J Pediatr Urol 2017; 13:203.e1-203.e6. [PMID: 27876405 DOI: 10.1016/j.jpurol.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/04/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Williams-Beuren syndrome (WBS) is a genetic condition caused by a microscopic deletion in the chromosome band 7q11.23. Individuals with WBS may present with congenital cardiovascular defects, neurodevelopmental disturbances and structural abnormalities of the urinary tract. Lower urinary tract symptoms (LUTS) seem to be frequent in this population, but studies on this topic are scarce and based on small case series. OBJECTIVE To systematically evaluate the prevalence of lower urinary tract symptoms (LUTS) and the acquisition of bladder control in a large population with WBS. STUDY DESIGN A cross-sectional study evaluating 87 consecutive patients with WBS; there were 41 girls and 46 boys. Genetic studies confirmed WBS in all patients. Subjects were clinically evaluated with: a history of LUTS obtained from the parents and child, a structured questionnaire of LUTS, a 3-day urinary frequency-volume chart, a quality of life question regarding LUTS, and physical examination. A history regarding the acquisition of bladder control was directly evaluated from the parents. RESULTS Mean age of patients was 9.0 ± 4.2 years, ranging from 3 to 19 years. Based on the symptoms questionnaire and the frequency-volume chart, 70 patients (80.5%) were symptomatic. The most common symptom was urgency, affecting 61 (70.1%) patients, followed by increased urinary frequency in 60 (68.9%) patients, and urge-incontinence in 53 (60.9%), as shown in Summary Fig. More than half of the children reported nocturnal enuresis, including 61% of the girls and 52% of the boys. Twenty-three patients (25.6%) had a history of urinary tract infections. The mean age for acquisition of dryness during the day was 4.4 ± 1.9 years. Parents of 61 patients (70.1%) acknowledged that LUTS had a significant impact on the quality of life of their children. DISCUSSION A high prevalence of LUTS was confirmed with a significant negative impact on quality of life in a large population of children and adolescents with WBS. It was shown for the first time that the achievement of daytime bladder control is delayed in children with WBS. Although LUTS are not recognized as one of the leading features of the syndrome, it is believed that it should be considered as a significant characteristic of the clinical diagnosis of WBS. CONCLUSIONS LUTS are highly prevalent in children and adolescents with WBS and have a significant negative impact on patient's quality of life.
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Affiliation(s)
- Z M Sammour
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - J de Bessa
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M Hisano
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
| | - H Bruschini
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C A Kim
- Genetics Unit of the Pediatrics Department, Children's Institute, University of São Paulo, São Paulo, Brazil
| | - M Srougi
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C M Gomes
- Division of Urology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Effects of urinary incontinence on psychosocial outcomes in adolescence. Eur Child Adolesc Psychiatry 2017; 26:649-658. [PMID: 27943057 PMCID: PMC5446552 DOI: 10.1007/s00787-016-0928-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/03/2016] [Indexed: 01/02/2023]
Abstract
To examine whether daytime wetting and bedwetting urinary incontinence (UI) in childhood and adolescence are associated with psychosocial problems in adolescence. We used data from the Avon Longitudinal Study of Parents and Children to examine the association between trajectories of UI from 4 to 9 years and self-reported psychosocial problems in adolescence (13-14 years) including depressive symptoms, peer victimisation, poor self-image and school experiences (negative perception of school and teachers, problems with peer relationships). Sample sizes ranged from 5162 (perception of teachers) to 5887 (self-image). We also examined associations between self-reported UI at 14 years and psychosocial problems. Relative to normative development, adolescents who experienced delayed development of bladder control had poorer self-image [standardised mean difference = 0.18 (95% CI 0.04, 0.32)], more negative perceptions of school [0.18 (0.02, 0.34)] and more problems with peer relationships at school [0.25 (0.10, 0.40)]. Persistent wetting (bedwetting with daytime wetting) in childhood was associated with increased problems with peer relationships in adolescence [0.19 (0.03, 0.34)]. The strongest associations between adolescent UI and psychosocial problems were found for daytime wetting (reference = no UI at 14 years): depressive symptoms [OR = 3.04 (95% CI 1.91-4.84)], peer victimisation [2.14 (1.48-3.10)], poor self-image (t = -8.49, p < 0.001) and problems with peer relationships (t = -4.69, p < 0.001). Children with delayed development of bladder control and persistent wetting have increased psychosocial problems in adolescence. Adolescents with UI reported a range of psychosocial problems and clinicians should be aware that they might require support from psychological services.
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Bremer J, Böthig R, Domurath B, Kutzenberger J, Kaufmann A, Pretzer J, Klask JP, Geng V, Vance W, Kurze I. [Objective and subjective requirement of aids and appliances in patients with neurogenic lower urinary tract dysfunction : Multicenter study to determinate the daily necessity of urological aids and appliances]. Urologe A 2016; 55:1553-1563. [PMID: 27725995 DOI: 10.1007/s00120-016-0250-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The provision of urological appliances for patients with neurogenic lower urinary tract dysfunction (NLUTD) is essential. Hitherto existing standard guidelines for the estimation of monthly material requirements are based solely on estimates. OBJECTIVE The goal of this work was to define the objective and subsequently subjective requirements for urological appliances on a scientifically validated basis. MATERIALS AND METHODS Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD were collected through a standardized survey at six different centers in Germany during the period of October to December 2014 and statistically evaluated. RESULTS In all, 767 patient records were analyzed: 543 men and 221 woman (N/A = 3). The daily disposable catheter consumption of 577 patients who exclusively used intermittent catheterization was 5.13. Patients who used other means of bladder emptying (n = 31) in addition to catheterization consumed on average 3.17 catheters. The margin of deviation was larger for children. Of the 608 patients with intermittent catheterization, 94 (15.5 %) required additional paddings as absorbent aids (on average 2.29 paddings per day), 34 patients (5.6 %) additionally used pants (2.55 per day) and 46 patients (7.6 %) utilized condom catheters (3.81 per day) between catheterization. Among all surveyed patients, 126 (16.4 %) used paddings (5.03 per day) and 51 patients (6.6 %) pants (3.03 per day). Of all male respondents 82 (15.1 %) used condom catheters (2.80 urinary sheaths per day). CONCLUSION Applying twice the standard deviation of the mean as a measure of assessing the objective requirement of urological appliances and aids for adult patients with NLUTD allows the following daily thresholds to be defined: 1-9 disposable catheters, 0-7 urinary sheaths, 1-9 paddings and 0-7 pants. These thresholds can serve as a basis for estimating the subjective need. They allow for a scientifically validated benchmark for an economically feasible and patient-tailored supply with urological aids and appliances. Individually required appliances and aids have to be recognized. Verifiable quality standards need to be developed.
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Affiliation(s)
- J Bremer
- Neurologisches Rehabilitationszentrum und Querschnittgelähmtenzentrum, BDH-Klinik Greifswald GmbH, Karl-Liebknecht-Ring 26a, 17491, Greifswald, Deutschland
| | - R Böthig
- Abt. Neuro-Urologie, Querschnittgelähmtenzentrum, BG-Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland.
| | - B Domurath
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - J Kutzenberger
- Abteilung für Neuro-Urologie, Werner Wicker KG, Im Kreuzfeld 4, 34537, Bad Wildungen-Reinhardshausen, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH, Viersener Straße 450, 41063, Mönchengladbach, Deutschland
| | - J Pretzer
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland
| | - J P Klask
- Urologie, BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland
| | - V Geng
- Manfred-Sauer-Stiftung, Neurott 20, 74931, Lobbach, Deutschland
| | - W Vance
- Neurologische Rehabilitationsklinik, Neuro-Urologisches Zentrum, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Deutschland
| | - I Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland
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Tu A, Hengel AR, Cochrane DD. Radiographic predictors of deterioration in patients with lumbosacral lipomas. J Neurosurg Pediatr 2016; 18:171-6. [PMID: 27082975 DOI: 10.3171/2016.1.peds15614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although patients with lumbosacral lipomas may be asymptomatic at presentation, most develop neurological symptoms over time. Given the challenges in examining infants, the authors sought to determine whether MRI would be helpful in identifying patients who are more likely to deteriorate early in life and who would potentially benefit from early surgical intervention. METHODS A retrospective review of all patients with lumbosacral lipomas who were seen at the authors' institution between 1997 and 2013 and who were managed without prophylactic surgery was performed. The clinical history and imaging results for each patient were reviewed in detail and then correlated to the pattern of and age at clinical deterioration. RESULTS Twenty-four patients were identified. Nine worsened within the first 18 months of life (early deterioration), and 15 patients deteriorated or remained stable after 30 months (late deterioration/stable). No patients worsened between 18 and 30 months of age. Patients who deteriorated early were more likely to have large intradural lipomas that filled the canal, increased during the 1st year of life, and compressed neurological structures. Some had a syrinx extending above the neural-lipoma interface. Syrinxes in patients with early deterioration were large and expanded in infancy. Patients with early deterioration had motor deficits at the time of deterioration, whereas patients with late deterioration developed mixed urological and motor dysfunction. CONCLUSIONS Patients with large lipomas displacing the cord and an enlarging syrinx have a propensity for early clinical deterioration. Given this, their families may be counseled that 1) the risk of deterioration in infancy may be higher than in infants without these features, and 2) they require more diligent observation. Intervention before deterioration in these infants should also be considered. Patients without these features may be safely observed to a lesser extent.
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Affiliation(s)
- Albert Tu
- Division of Neurosurgery, Vancouver General Hospital; and
| | - Alexander R Hengel
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Douglas Cochrane
- Division of Pediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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von Gontard A, Niemczyk J, Wagner C, Equit M. Voiding postponement in children-a systematic review. Eur Child Adolesc Psychiatry 2016; 25:809-20. [PMID: 26781489 DOI: 10.1007/s00787-015-0814-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/21/2015] [Indexed: 01/19/2023]
Abstract
Voiding postponement (VP) has been defined as a habitual postponement of micturition using holding maneuvers. VP can represent both a symptom, as well as a condition. As divergent definitions are used internationally, the aim was to review the current state of knowledge on VP and provide recommendations for assessment, diagnosis and treatment. A Scopus and a Pubmed search was conducted, entering the terms 'voiding postponement' without any restrictions or specifications. Other publications relevant to the topic were added. VP can represent a symptom in healthy children. As a condition, VP in combination with nocturnal enuresis (NE) is a subtype of non-monosymptomatic NE. Most studies have focused on daytime urinary incontinence (DUI) with VP, or more aptly termed voiding postponement incontinence (VPI). It is a behaviorally defined syndrome, i.e., by the habitual deferral of micturition and DUI. VPI is associated with a low micturition frequency, urgency and behavioral problems. The most common comorbid disorder is oppositional defiant disorder (ODD). VP as a symptom and VPI as a condition should be differentiated. VPI is a common disorder with many associated problems and disorders. Urotherapy and timed voiding are the main treatment approaches. Due to the high rate of comorbid ODD, other forms of treatment, especially cognitive behavioral therapy, are often needed.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany.
| | - Justine Niemczyk
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Catharina Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Monika Equit
- Department of Clinical Psychology, Saarland University, Saarbrücken, Germany
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27
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Tatlow-Golden M, O'Farrelly C, Booth A, Doyle O. "Bursting" to Go and Other Experiences. J Sch Nurs 2016; 33:214-222. [PMID: 27177551 DOI: 10.1177/1059840516646422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Children's use of the toilet at school, although rarely explored, is an important facet of school experience with consequences for physical and psychological health. A mixed methods study investigated views of 25 children (4-5 years) regarding potential stressors in the first school year, including views of toileting, in Dublin, Ireland. Despite very positive responses to school, most responses to toileting (15 of 25) were mixed or negative. Although some liked to go, or noted the toilets were clean, most indicated delayed toilet use ("bursting" to go) and ambivalent or negative experiences such as fear of not identifying the right toilet, fear of being alone, lack of privacy, and potential bullying. Many children did not expect to receive help from the teacher. As delaying toilet use can have lasting health consequences, teacher-nurse collaboration could be used to develop whole-school policies to support children's early adjustment in this sensitive area of functioning.
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Affiliation(s)
- Mimi Tatlow-Golden
- 1 UCD School of Medicine and Medical Science, University College Dublin, Belfield, Ireland
| | - Christine O'Farrelly
- 2 Department of Medicine, Centre for Mental Health, Imperial College London, London, United Kingdom
| | - Ailbhe Booth
- 3 UCD School of Psychology & UCD Geary Institute for Public Policy, University College Dublin, Belfield, Ireland
| | - Orla Doyle
- 4 UCD School of Economics & UCD Geary Institute for Public Policy, University College Dublin, Belfield, Ireland
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28
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Kakizaki H, Kita M, Watanabe M, Wada N. Pathophysiological and Therapeutic Considerations for Non-Neurogenic Lower Urinary Tract Dysfunction in Children. Low Urin Tract Symptoms 2016; 8:75-85. [PMID: 27111618 DOI: 10.1111/luts.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/17/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children.
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Affiliation(s)
- Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masaki Watanabe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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29
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Lundblad B, Johansson R, Wigert H, Hellström AL. Satisfying Toilet Needs in Pre-School <br/>—Experiences of 5 - 6 Years Old. Health (London) 2016. [DOI: 10.4236/health.2016.815164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. ACTA ACUST UNITED AC 2015; 11:225-38. [PMID: 25776296 DOI: 10.2217/whe.14.66] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fecal incontinence (FI) is a physically and psychosocially debilitating disorder which negatively impacts quality of life (QOL). It bears a significant burden not only on patients but also on their families, caretakers as well as society as a whole. Even though it is considered a somewhat common condition, especially as women age, the prevalence is often underestimated due to patients' reluctance to report symptoms or seek care. The evaluation and treatment of FI can be also hindered by lack of understanding of the current management options among healthcare providers and how they impact on QOL. This article provides a comprehensive review on the impact of FI and its treatment on QOL in women.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology & Pelvic Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6th Avenue South, Suite 10382, Birmingham, AL 35233, USA
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Van der Cruyssen K, De Wachter S, Van Hal G, De Win G, Van Aggelpoel T, Vermandel A. The voiding pattern in healthy pre- and term infants and toddlers: a literature review. Eur J Pediatr 2015; 174:1129-42. [PMID: 26074371 DOI: 10.1007/s00431-015-2578-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/29/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Toilet training in Western culture starts between 18 and 24 months. At this age, a child is assumed to have procured the competences needed for bladder control. Since the knowledge of reference values of a normal micturition serves as a guide to diagnose urologic pathology, the aim of this systematic review is to obtain a more comprehensive picture of normal voiding pattern in healthy infants, who have not yet reached bladder control. The systematic literature search was performed in two databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Twenty-one studies were selected that demonstrate factors associated with voiding pattern. Diuresis, interrupted voiding, post-void residual urine and voiding frequency are parameters decreasing with age. Bladder capacity, the lowest volume triggering micturition, flow rate, voiding volume and the level of awake voiding expand with age. CONCLUSION When evaluating the voiding pattern in infants, the normal evaluation of micturition parameters in healthy normal developing infants must be taken into consideration. WHAT IS KNOWN • Different voiding parameters in healthy infants who are not yet toilet trained are reported. • Voiding was believed to be induced by a constant bladder volume, while nowadays, it is detected that infants possess a functional spino-pontospinal voiding pathway. WHAT IS NEW • Arousal was detected in less than 60 % of all preterm micturitions, while it was present in more than 90 % of the micturitions of healthy "term" infants. • Voided volume, bladder capacity, and flow rate tend to increase with age. In contrast, voiding frequency, post-void residual urine, and interrupted voiding diminishes with an increasing age.
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Affiliation(s)
- Kelly Van der Cruyssen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium,
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Chang SJ, Tsai LP, Hsu CK, Yang SS. Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children. Pediatr Nephrol 2015; 30:1131-7. [PMID: 25673516 DOI: 10.1007/s00467-014-3009-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/21/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to examine whether toilet-trained children with a history of febrile urinary tract infection (fUTI) and elevated postvoid residual (PVR) urine volume according to a recently published PVR nomogram were at greater risk of UTI recurrence. MATERIALS AND METHODS One month after recovery from febrile UTI, constipation was diagnosed according to the Rome III criteria, and lower urinary tract (LUT) function was evaluated with two sets of uroflowmetry and PVR by ultrasonography. For children aged ≦ 6 and ≧ 7 years, elevated PVR is defined as >20 and >10 ml, respectively. Cox proportion hazards regression was used to evaluate the risk factors for recurrence of UTI. RESULTS Between 2005 and 2011, 60 children aged 6.5 ± 2.5 years (boy:girl ratio 27:33) were enrolled for analysis. Univariate analysis showed that recurrent febrile UTI was more commonly observed in children with elevated PVR [repetitive elevated PVR: hazard ratio (HR) 5.75, 95% confidence interval (CI) 1.41-23.4; one elevated PVR: HR 4.53, 95% CI 1.01-20.2] and high-grade vesicoureteral reflux (VUR; HR 4.53, 95% CI 1.46-14.07). Multivariate analysis showed that younger age (HR 1.37, 95% CI 1.03-1.82, p < 0.01) and elevated PVR (HR 2.88, 95% CI 1.44-5.73, p = 0.01) were significant, independent risk factors for recurrent febrile UTI--but not gender, presence of high-grade VUR and constipation. CONCLUSION Elevated PVR defined by the new PVR nomogram predicted recurrent UTI in children with history of febrile UTI. Care should be taken to manage children with elevated PVR.
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Affiliation(s)
- Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 16F, 289 Chienkuo Road, Xindian, New Taipei, 231, Taiwan
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Fernández-Ibieta M, Zambudio-Carmona G, Guirao-Piñera MJ, Martínez-Castaño I, García-López A, Ruiz-Jiménez JI. A modified device to facilitate flow measurements during voiding cystometry studies in infants. J Pediatr Urol 2015; 11:157-60. [PMID: 25921874 DOI: 10.1016/j.jpurol.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/09/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Urodynamic studies (UDS) in infants are traditionally hampered by technique and flow collection; both are difficult and have not yet been standardized. METHODS A very simple device has been developed to collect urine during the voiding phase in UDS. It is based on a urine-collection adhesive bag, which is connected to a tube that conducts the urine to a flowmeter. RESULTS Eleven infants (4-23 months) were selected and a complete UDS was performed on all of them. A diagnosis was obtained for all of the infants. DISCUSSION This device is easily available in every pediatric clinic; it is also disposable and inexpensive. It enables UDS in infants to be complete and achievable.
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Affiliation(s)
- M Fernández-Ibieta
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
| | - G Zambudio-Carmona
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
| | - M J Guirao-Piñera
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
| | - I Martínez-Castaño
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
| | - A García-López
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
| | - J I Ruiz-Jiménez
- Urology Unit, Pediatric Surgery Department, Hospital CUV Arrixaca, Murcia, Spain.
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Felberg K, Sillén U, Bachelard M, Abrahamson K, Sjöström S. Radiological bladder characteristics in VCU for young children with high-grade VUR. J Pediatr Urol 2015; 11:30.e1-6. [PMID: 25697980 DOI: 10.1016/j.jpurol.2014.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES It has been suggested that infants with dilating vesicoureteral reflux (VUR) often have lower urinary tract (LUT) dysfunction. Signs such as high voiding pressure levels, low bladder capacity and dyscoordination at voiding have previously been thought to be indicative of dysfunction. However, these findings have also been recognised in healthy infants and are, thus, not specific to dysfunction in this age group. The urodynamic findings of interest for LUT dysfunction in children with high-grade VUR have been shown to be high bladder capacity with incomplete emptying, and often with overactivity during filling. Because the bladders in children with VUR are often only investigated with voiding cystourethrography (VCUG) and not urodynamics, the question has arisen as to whether some of the urodynamic findings indicating dysfunction can be recognised as radiological signs. The aim of the present study was to evaluate whether cystometric signs of LUT dysfunction in infants with high-grade VUR could be recognised in VCUG. MATERIALS AND METHODS One hundred and fifteen infants (80 boys) with Grades III-V VUR were included and investigated repeatedly with videocystometry (VCM) at a median age 6, 21 and 39 months. The sign looked for in the VCUG was bladder size (large, normal or small), according to the chosen levels in the bony pelvis. To validate the chosen levels for the different bladder sizes, bladder capacity data from a longitudinal study in healthy children were used. In addition, abnormalities in bladder wall/form and filling of the posterior urethra without voiding, as signs of bladder overactivity and detrusor-sphincter dyscoordination, were evaluated. RESULTS Bladder size was estimated on VCUG as large, normal or small, according to pelvic landmarks. Large bladder size was mainly seen at the second and third evaluations (64% and 46%), whereas small capacity was mainly seen during the first year (33%). Corresponding cystometric capacities (ml) showed a significant difference between the groups of small, normal and large bladder size. The cystometric capacities of large and small bladder size were also compared with bladder capacity in healthy controls, where large had significantly higher bladder capacity versus age (P = 0.0001) and small had significantly lower (P = 0.011) bladder capacity versus age than in the healthy controls. Bladder shape/wall pathology was mainly seen during the first year (42%), combined with small capacity, and correlated to overactive contractions during filling. Moreover, filling of the posterior urethra without voiding, indicating detrusor/sphincter dyscoordination at voiding, was quite common during the first year (33%), and then successively decreased. CONCLUSIONS The clinical implication from this study of small children with high-grade VUR was that a large bladder on VCUG was synonymous with a high-capacity bladder. According to earlier studies, this is a sign of LUT dysfunction in this age group and should therefore be an indicator for additional studies of bladder function. Overactive contractions could also be recognised in VCUG, but only at the infant evaluation, which should also be regarded as an indicator of LUT dysfunction. All other bladder VCUG signs mainly seen during early infancy were signs of immature bladder function and not a result of VUR dysfunction.
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Affiliation(s)
- K Felberg
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; The Children's Memorial Health Institute, Warsaw, Poland.
| | - U Sillén
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - M Bachelard
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - K Abrahamson
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - S Sjöström
- Pediatric Uronephrologic Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Duong TH, Jansson UB, Hellström AL. Vietnamese mothers' experiences with potty training procedure for children from birth to 2 years of age. J Pediatr Urol 2013. [PMID: 23182948 DOI: 10.1016/j.jpurol.2012.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study addresses mothers' experiences with potty training in a Vietnamese population. SUBJECTS AND METHODS Forty-seven mothers were interviewed and followed from the time that their children were newborns until they were 24-months old. The interviews were analyzed using qualitative content analysis. RESULTS According to tradition, diapers were used only rarely. The mothers used a whistling sound at certain times to remind their children to eliminate and frequently checked for signs of need. With this process, all children used the potty by the age of 9 months. At the age of 24 months the potty training was completed, and most of the children managed the whole process independent of help. CONCLUSION This study shows that it is possible to start potty training with good outcomes very early in life. The process described can be achieved through an ongoing communication between parent and child.
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Affiliation(s)
- Thi Hoa Duong
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Box 457, SE 405 30 Göteborg, Sweden; National Hospital of Pediatrics, 18/879 La Thanh, Dong Da, Hanoi, Viet Nam; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
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Urinary bladder control during the first 3 years of life in healthy children in Vietnam--a comparison study with Swedish children. J Pediatr Urol 2013; 9:700-6. [PMID: 23759503 DOI: 10.1016/j.jpurol.2013.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 04/29/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To study outcomes of early potty training in a population of healthy children with a tradition of early potty training and to compare these findings with a group of children to whom potty training was applied later. SUBJECTS AND METHODS Mothers and their 47 healthy children in Vietnam participated in this longitudinal study. The voiding pattern and emptying ability were followed by the 4-h voiding observation method from 3 months to 3 years of age. A comparison is made with a group of 57 Swedish children investigated in a similar manner. RESULTS In the group of Vietnamese children, 89% were on daily potty training at the age of 6 months. At the age of 24 months, potty training was complete for 98%. In the Swedish group, just a few (5%) had started daily potty training by the age of 24 months (p < 0.001). The Vietnamese group had fewer voidings and lower voided volumes than the Swedish group. In the Vietnamese children, bladder emptying could be regarded as having been completed, with no residual urine at 9 months, compared with the Swedish group, which first showed complete emptying at the age of 36 months. CONCLUSION Potty training performed daily affects the emptying ability positively. In the Vietnamese group, no residual urine was found at the age of 9 months. These results differ significantly from those of the group of Swedish children.
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Abstract
Vesicoureteral reflux (VUR) is a significant risk factor for clinical pyelonephritis and renal scarring. In 2010, the American Urological Association (AUA) reported that bladder and bowel dysfunction (BBD), which is common in patients with VUR, increases the risk of breakthrough UTI in children receiving antibiotic prophylaxis, reduces the success rate for endoscopic injection therapy, and increases the risk of postoperative UTI, irrespective of the surgical success rate for VUR. Accordingly, physicians are strongly recommended to investigate BBD in their patients with VUR. Symptoms and signs of BBD include urinary frequency and urgency, prolonged voiding intervals, daytime wetting, perineal and penile pain, holding manoeuvres (posturing to prevent wetting), constipation, and encopresis. Primary assessment tools include the Pediatric Symptom Checklist, urinalysis, urine culture, bladder diary, measurement of the postvoid residual urine volume, Dysfunctional Voiding Symptom Score, uroflow with electromyography, and Bristol Stool Form Score. The Rome III criteria can also be used for diagnostic assessment of bowel function. Treatment of BBD should be individualized, directed at symptomatic and objective improvement, and can include behavioural modification, biofeedback, selective use of anticholinergics and α-blockers, and bowel management.
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Affiliation(s)
- Jack S Elder
- Vattikuti Urology Institute, Henry Ford Hospital, Department of Pediatric Urology, Children's Hospital of Michigan, 2799 West Grand Boulevard, K-9, Detroit, MI 48202, USA
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Amarante MA, Shrensel JA, Tomei KL, Carmel PW, Gandhi CD. Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature. Neurosurg Focus 2013; 33:E4. [PMID: 23025445 DOI: 10.3171/2012.7.focus12232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An intact, fully functional spine is the result of a complex sequence of embryological events involving both nervous and musculoskeletal system precursors. Deviations from this highly ordered system can result in congenital abnormalities ranging from clinically insignificant cosmetic changes to CNS malformations that are incompatible with life. Closure of the neural tube, which is believed to be the embryological event gone awry in these cases, is complete by just 28 days' gestation, often before pregnancy is detected. Although progress has been made to help prevent neural tube defects in the children of those attempting to conceive, these congenital deformities unfortunately continue to affect a startling number of infants worldwide each year. Furthermore, the precise mechanisms governing closure of the neural tube and how they might be interrupted remain elusive. What is known is that there are a large number of individuals who must deal with congenital spine dysraphism and the clinical sequelae on a daily basis. Bladder and urinary dysfunction are frequently encountered, and urological care is a critical, often neglected, component in the lifelong multidisciplinary approach to treatment. Although many treatment strategies have been devised, a need remains for evidence-based interventions, analysis of quality of life, and preemptive education of both caregivers and patients as they grow older. Pediatric neurosurgeons in particular have the unique opportunity to address these issues, often in the first few days of life and throughout pre- and postoperative evaluation. With proper management instituted at birth, many patients could potentially delay or avoid the potential urological complications resulting from congenital neurogenic bladder.
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Affiliation(s)
- Matthew A Amarante
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA
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Ellsworth P, Marschall-Kehrel D, King S, Lukacz E. Bladder health across the life course. Int J Clin Pract 2013; 67:397-406. [PMID: 23574100 DOI: 10.1111/ijcp.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/07/2013] [Indexed: 12/22/2022] Open
Abstract
Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bladder habits and dysfunctions at one stage of life may affect bladder health in subsequent stages. However, bladder problems are neither a normal part of aging nor inevitable at any stage of life. Many of the factors that negatively impact bladder health at all ages may be modifiable, and healthy bladder habits may prevent or reverse bladder dysfunctions that can occur naturally or in response to life events. There are opportunities to further define and promote healthy bladder habits through focused research and heightened public awareness of the importance of bladder health, which may lead to improvements in overall health and quality of life. It is our hope that this paper will inform and encourage public health initiatives and research programs aimed at this goal.
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Affiliation(s)
- P Ellsworth
- University Urological Associates Inc., Brown University, Providence, RI 02905, 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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Negoro H, Kanematsu A, Matsuo M, Okamura H, Tabata Y, Ogawa O. Development of Diurnal Micturition Pattern in Mice After Weaning. J Urol 2013; 189:740-6. [DOI: 10.1016/j.juro.2012.07.140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Hiromitsu Negoro
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Sakyo, Kyoto, Japan
| | - Akihiro Kanematsu
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masahiro Matsuo
- Department of Systems Biology, Graduate School of Pharmaceutical Sciences, Kyoto University, Sakyo, Kyoto, Japan
| | - Hitoshi Okamura
- Department of Systems Biology, Graduate School of Pharmaceutical Sciences, Kyoto University, Sakyo, Kyoto, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Sakyo, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
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Nguyen TKA, Vernon SJ, Bengtson A, Hellström AL. Toilet habits in kindergarten children in a kindergarten in Hanoi. Health (London) 2013. [DOI: 10.4236/health.2013.511237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nevéus T, Sillén U. Lower urinary tract function in childhood; normal development and common functional disturbances. Acta Physiol (Oxf) 2013; 207:85-92. [PMID: 23088436 DOI: 10.1111/apha.12015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/02/2012] [Accepted: 09/10/2012] [Indexed: 01/15/2023]
Abstract
This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4-6 and the detrusor muscle is formed during weeks 9-12 of gestation. Higher CNS centres are involved in micturition at birth, and the infant usually wakes up, at least briefly, to void. Voiding during the first years of life is often incomplete, owing to detrusor-sphincter dyscoordination, but this disappears when bladder control is attained. Approximately 5-10% of 7-year-old children suffer from daytime incontinence and/or nocturnal enuresis, and a few per cent of them will not outgrow it. Daytime incontinence in childhood is usually attributable to detrusor overactivity, although it is unclear to what extent it is the detrusor or the micturition reflex per se that is overactive. Enuresis - nocturnal incontinence - is caused by either nocturnal polyuria and/or nocturnal detrusor overactivity, in both cases combined with high arousal thresholds. Bladder problems in childhood constitute a risk factor for the development or persistence of bladder problems in adulthood.
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Affiliation(s)
- T. Nevéus
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | - U. Sillén
- Paediatric Urology Unit; Queen Silvia's Children's Hospital; Göteborg; Sweden
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Kaerts N, Vermandel A, Lierman F, Van Gestel A, Wyndaele JJ. Observing signs of toilet readiness: results of two prospective studies. ACTA ACUST UNITED AC 2012; 46:424-30. [PMID: 22746539 DOI: 10.3109/00365599.2012.693537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were to check the possibility of observing readiness signs proposed in the literature (Study 1) and to investigate the interrater reliability of observing readiness signs between different researchers (Study 2). MATERIAL AND METHODS In Study 1, 24 healthy children, recruited in Flemish childcare centres, were observed. Each child was observed for 8 h. In this study a list of readiness signs was used as described in a recent literature review on readiness signs in young, healthy children. In Study 2, two observers independently evaluated an adapted list with readiness signs in another 24 healthy children recruited in a similar setting. SPSS was used to analyse the interrater reliability between these observations, calculating Cohen's kappa per readiness sign. RESULTS The results of Study 1 show that not all readiness signs are easy to assess. This resulted in a shortened checklist with 20 signs, which can be easily observed in young, healthy children during an 8 h period, and which was used in Study 2. The results of Study 2 show that, for most readiness signs, Cohen's kappa and the agreement between observers varied from good to perfect. CONCLUSIONS This article presents the results of two studies that are the first in a series investigating the use of readiness signs. Further research on readiness signs is being conducted to reach consensus on when to start toilet training based on readiness signs, and to obtain evidence-based guidelines.
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Affiliation(s)
- Nore Kaerts
- Department of Urology, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Chang SJ, Hsieh CH, Yang SSD. Constipation is associated with incomplete bladder emptying in healthy children. Neurourol Urodyn 2011; 31:105-8. [DOI: 10.1002/nau.21225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/05/2011] [Indexed: 01/19/2023]
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Abstract
A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, 'healthy' bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the recommendations for improving and maintaining bladder health presented herein.
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Affiliation(s)
- E S Lukacz
- University of California, San Diego, San Diego, CA 92037, USA.
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Lower Urinary Tract Dysfunction: A Childhood Problem in Adults? CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yang SSD, Zhao LL, Chang SJ. Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurourol Urodyn 2011; 30:1253-7. [PMID: 21394761 DOI: 10.1002/nau.20982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/11/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners. PATIENTS AND METHODS In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations. RESULTS Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU. CONCLUSION Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction.
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Affiliation(s)
- Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan
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Duong TH, Jansson UB, Holmdahl G, Sillén U, Hellstrom AL. Development of bladder control in the first year of life in children who are potty trained early. J Pediatr Urol 2010; 6:501-5. [PMID: 19939737 DOI: 10.1016/j.jpurol.2009.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe longitudinally the development of micturition patterns in children who are potty trained early. SUBJECTS AND METHODS Healthy children in Vietnam from newborn up to 1 year were investigated every 3 months. This included mapping of the micturition pattern through the 4-h micturition observation method. RESULTS Forty-seven children participated in all five investigations. At the ages of newborn, 3, 6, 9 and 12 months, 70%, 82%, 91%, 99% and 100% of the mothers, respectively, were potty training their children. Mean lowest bladder volume (voided volume + residual urine) triggering a micturition was 18 ml at the age of 2 weeks compared to 33 ml at 12 months. Post-void residual urine decreased according to age, and already at 9 months was less than 7 ml (mean 0.7 ml). CONCLUSIONS The dyscoordination between the sphincter and detrusor muscle seems to have already disappeared at the age of 9 months in infants who are potty trained very early. These findings suggest that potty training can be beneficial in small children with urinary tract infections or renal scars.
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Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: concept analysis. J Adv Nurs 2010; 66:1874-84. [DOI: 10.1111/j.1365-2648.2010.05341.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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