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Radojicic Z, Milivojevic S, Lazovic JM, Radojicic O, Laketic D, Zelenovic A, Dasic I, Milic N. Reduction of transverse rectal diameter and its effect on bladder dynamics in children with spinal dysraphism. BMC Urol 2022; 22:155. [PMID: 36131256 PMCID: PMC9490932 DOI: 10.1186/s12894-022-01105-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To examine the reduction of transverse rectal diameter and its effect on bladder dynamics in children with spinal dysraphism. METHODS We prospectively evaluated 61 consecutive children with spinal dysraphism, 25 (41%) boys and 36 (59%) girls, aged 4 to 16 years; mean age 9.3 ± 3.8 years, who received bowel management. All children underwent echosonographic measurement of transverse rectal diameter before and after starting bowel management. Also, all the patients had undergone urodynamic studies before and after starting bowel management, with no changes in their urological treatment. RESULTS Bowel management caused an decrease in transverse rectal diameter by 56 ± 7.2% (p < 0.001). In addition, a decrease was observed for maximal detrusor pressure by 27.8 ± 7.8% (p < 0.001), leak point pressure by 37.2 ± 4.4% (p < 0.001), and PVR by 36.7 ± 8.0 (p < 0.001). Maximum bladder capacity was significantly increased after bowel management in both non-adjusted (36.4 ± 14.8%; p < 0.001) and adjusted analysis for age (39.4 ± 14.3%, p < 0.001). Detrusor compliance was also increased by 89.2 ± 24.8% (p < 0.001). Female gender and % change of maximal detrusor pressure were significant predictors of transversal rectal diameter change in univariate as well as in multivariate analysis (OR = 10.548, 95% CI 2.309-48.180; p = 0.002 and OR = 1.121, 95% CI 1.009-1.245; p = 0.034). CONCLUSIONS Decrease in transverse rectal diameter may be useful for bladder function and urodynamic findings in children with spinal dysraphism. Therefore, decrease in transverse rectal diameter should be a supplement to standard urotherapy.
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Affiliation(s)
| | | | - Jelena Milin Lazovic
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - Ognjen Radojicic
- Clinic for Gynecology and Obstetrics, Narodni Front, Belgrade, Serbia
| | - Darko Laketic
- Faculty of Medicine, Institute of Anatomy "Niko Miljanic", Belgrade, Serbia
| | | | - Ivana Dasic
- University Children's Hospital, Belgrade, Serbia
| | - Natasa Milic
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
- Department of Internal Medicine, Mayo Clinic, Rochester, USA
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Milivojevic S, Zelenovic A, Milin-Lazovic J, Radojicic O, Laketic D, Dasic I, Milic N, Radojicic Z. The correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. Front Pediatr 2022; 10:957123. [PMID: 36245719 PMCID: PMC9557052 DOI: 10.3389/fped.2022.957123] [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: 05/30/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. METHODS Between 2014 and 2022, we prospectively evaluated 81 consecutive spina bifida children with neurogenic bowel and bladder dysfunction (35 boys and 46 girls, mean age 9.5 ± 3.4 years). All patients underwent echosonographic measurement of transverse rectal diameter and urodynamic studies. RESULTS We found a strong negative correlation between transverse rectal diameter and maximum bladder capacity (r = -0.682, p < 0.001) and compliance (r = -0.690, p < 0.001). There was also a strong positive correlation between transverse rectal diameter and maximal detrusor pressure (r = 0.650, p < 0.001), leak point pressure (r = 0.793, p < 0.001), and PVR (r = 0.762, p < 0.001). In ROC analysis, transverse rectal diameter demonstrated good performance for distinguishing children with upper urinary tract deterioration, with an AUC of 0.857 (95% CI 0.761-0.953). A transverse rectal diameter ≥40 mm was 83.3% sensitive and 100% specific for the diagnosis of unfavorable urodynamic patterns. CONCLUSION There is a correlation between the transverse rectal diameter and urodynamic findings in children with neurogenic bowel and bladder dysfunction. Ultrasonographically assessed transverse rectal diameter of ≥40 mm may be used as a risk factor for upper urinary tract deterioration (unfavorable urodynamic findings). We suggest the transverse rectal diameter echosonographic measurement use as an integral part of the diagnostic approach in children with neurogenic bowel and bladder dysfunction, as it can help decision-making while waiting for urodynamic testing.
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Affiliation(s)
- Sasa Milivojevic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
| | | | - Jelena Milin-Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ognjen Radojicic
- Clinic for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia
| | - Darko Laketic
- Institute of Anatomy "Niko Miljanic", Faculty of Medicine, Belgrade, Serbia
| | - Ivana Dasic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Zoran Radojicic
- Department of Urology, University Children's Hospital, Belgrade, Serbia
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Severe kidney dysfunction in a child who presented with constipation: Answers. Pediatr Nephrol 2021; 36:4079-4082. [PMID: 34331130 DOI: 10.1007/s00467-021-05189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
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Milivojevic S, Milic N, Lazovic JM, Radojicic Z. The influence of bowel management on urodynamic findings in spina bifida children with detrusor overactivity and detrusor sphincter dyssynergia. J Pediatr Urol 2020; 16:556.e1-556.e7. [PMID: 32376289 DOI: 10.1016/j.jpurol.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the effects of bowel management on urodynamic findings in spina bifida children with detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD). MATERIAL AND METHODS Between 2014 and 2019 we prospectively evaluated 39 consecutive spina bifida children with DO and DSD (18 (46.2%) boys and 21 (53.8%) girls, aged 4-16 years; mean age 9.5 ± 3.7 years) who received bowel management and we treated their bowel dysfunction with an aim of alleviating the symptoms of constipation, preventing constant overdistension of the rectosigmoid, providing regular emptying of the colon and faecal continence. Bowel management included daily enema, laxative application and a special diet who was performed during 12 months. All children had undergone urodynamic studies before and after starting bowel management, with no changes in their urological treatment. RESULTS Bowel management caused an increase in maximum bladder capacity from 183.0 (112.0-234.0) to 237.0 (165.0-298.0) (p < 0.001). When maximal bladder capacity adjusted for age there was also significant increment (adjusted before 0.54 (0.47-0.64), adjusted after 0.75 (0.70-0.82), p < 0.001). In addition, we observed a decrease in maximal detrusor pressure from 64.3 (49.0-77.0) to 46.4 (32.0-59.0) cm H2O (p < 0.001) and an increase in bladder compliance from 3.0 (2.0-3.3) to 5.6 (3.9-6.6) ml/cm H2O (p < 0.001). There was also significant reductions in leak point pressure from 62.0 (48.0-69.0) to 39.0 (30.0-43.0) cm H2O (p = 0.001), and significant reductions in post-void residual volume (PVR) from 165.0 (128.0-187.0) to 98.0 (68.0-136.0) ml in our 13 patients who could achieve spontaneous voiding (p = 0.001). CONCLUSION Administering bowel management may be useful for bladder function and urodynamic findings in spina bifida children with DO and DSD. Therefore, bowel management should form an integral part of the treatment in spina bifida children with DO and DSD.
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Affiliation(s)
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Internal Medicine, Mayo Clinic, Rochester, USA
| | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Kowalik CG, Daily A, Goodridge SD, Hartigan SM, Kaufman MR, Fowke JH, Dmochowski RR, Reynolds WS. Factors associated with urinary incontinence in a community sample of young nulligravid women. Neurourol Urodyn 2020; 39:1430-1436. [PMID: 32324941 DOI: 10.1002/nau.24368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/30/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
AIMS The aim of this study is to identify factors associated with urinary incontinence (UI) in a community sample of young nulligravid women. METHODS This was a secondary analysis from a cross-sectional survey-based study of cisgender women aged 18 to 25 years recruited through a national registry of research volunteers. Participants completed validated questionnaires assessing toileting behaviors, lower urinary tract symptoms (LUTS), and bowel symptoms. Women were excluded from analysis if currently pregnant, any prior pregnancy, cystectomy, or any neurologic disease including spinal cord injury, stroke, or multiple sclerosis. Analyses determined the prevalence of symptoms and evaluated candidate risk factors for UI. RESULTS Final analyses included 964 women (mean age, 22.6 ± 2.0). Monthly UI was identified in 295 (30.6%) subjects, with mixed UI being the most common (56.9%; n = 168). Seventy-two women (7.4%) reported fecal incontinence (FI) and 24 (3.5%) women reported both UI and FI. After multivariable regression modeling, UI was associated with an intermittent urine stream and the delayed voiding toileting behavior subscale. CONCLUSIONS UI in this cohort of young nulliparous women was highly prevalent and warrants further study as to the cause. Therapeutic guidelines to prevent UI and LUTS may need to be adjusted by targeting populations earlier than traditionally considered.
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Affiliation(s)
- Casey G Kowalik
- Department of Urology, University of Kansas Health System, Kansas City, Kansas
| | - Adam Daily
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophia D Goodridge
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Siobhan M Hartigan
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jay H Fowke
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William S Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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Daily AM, Kowalik CG, Delpe SD, Kaufman MR, Dmochowski RR, Reynolds WS. Women With Overactive Bladder Exhibit More Unhealthy Toileting Behaviors: A Cross-sectional Study. Urology 2019; 134:97-102. [PMID: 31499079 DOI: 10.1016/j.urology.2019.08.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors. METHODS A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire - Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression. RESULTS Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18). CONCLUSION OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.
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Affiliation(s)
| | | | - Sophia D Delpe
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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Kowalik CG, Daily A, Delpe S, Kaufman MR, Fowke J, Dmochowski RR, Reynolds WS. Toileting Behaviors of Women-What is Healthy? J Urol 2019; 201:129-134. [PMID: 30053511 PMCID: PMC6309941 DOI: 10.1016/j.juro.2018.07.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The objective of this study was to assess toileting behaviors in community dwelling women. MATERIALS AND METHODS Women 18 years old or older were recruited through a national registry of research volunteers. They were asked to complete validated questionnaires assessing urinary symptoms and toileting behaviors, specifically place preference for voiding, convenience voiding, delayed voiding, straining during voiding and position preference for voiding. The PPBC (patient perception of bladder condition) was administered to assess the participant impression of bladder health. Analyses were done to determine the prevalence of each toileting behavior reported to occur sometimes or more often as well as differences in toileting behaviors in women with vs without self-perceived bladder problems based on the PPBC response. RESULTS The 6,695 women who completed the questionnaires were 18 to 89 years old (mean ± SD age 41.4 ± 15). Of the women 79.9% identified as white and 71.0% were college educated. Of the women 6,613 (98.8%) reported a place preference for voiding. The 3,552 women (53.1%) who reported a bladder problem were more likely to report convenience voiding, delayed voiding and strained voiding behaviors. While 6,657 women (99.4%) reported sitting to void at home only 5,108 (76.2%) reported sitting when using public toilets. CONCLUSIONS Certain toileting behaviors, of which some may be considered unhealthy, were common in this sample of women and most were associated with a perception of bladder problems. Voiding positions other than sitting were frequently used when away from home. These data have important implications for defining bladder health and implementing behavior based interventions for women with lower urinary tract symptoms.
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Affiliation(s)
- Casey G. Kowalik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam Daily
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophia Delpe
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa R. Kaufman
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jay Fowke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Radojicic Z, Milivojevic S, Milic N, Lazovic JM, Lukac M, Sretenovic A. The influence of bowel management on the frequency of urinary infections in spina bifida patients. J Pediatr Urol 2018; 14:318.e1-318.e7. [PMID: 29980392 DOI: 10.1016/j.jpurol.2018.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the effects of bowel management on the frequency of urinary infections in spina bifida patients. STUDY DESIGN The research was carried out from 2014 to 2017, with the recruitment process from June 2014 to March 2016. The first group consisted of 35 patients who were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC). The second group consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application, and a special diet, with a view to treating constipation that was estimated on the basis of Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary infections were estimated on the basis of the number of urinary infections before and after the administered therapy. The observation period of every patient was 1 year. RESULTS There were no significant statistical differences regarding age, gender, and baseline clinical features between the two groups. In the group treated with bowel management combined with anticholinergic medication therapy and CIC, the average number of urinary infections was 0.3 ± 0.5 SD, whereas in the group treated exclusively with anticholinergic medication therapy and CIC the average number of urinary infections was 1.1 ± 1.0 SD. There was a statistical difference regarding urinary infections, that is the average number of urinary infections between these two groups of patients (p < 0.001). CONCLUSION Administering bowel management considerably decreases the frequency of urinary infections, and should form an integral part of treatment of spina bifida patients.
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Affiliation(s)
| | | | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Lukac
- University Children's Hospital Belgrade, Belgrade, Serbia
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Radojicic Z, Milivojevic S, Milic N, Lazovic JM, Lukac M, Sretenovic A. Impact of bowel management in alleviating symptoms of urinary incontinence in patients with spina bifida associated with overactive bladder and detrusor sphincter dyssynergia. BJU Int 2018; 123:118-123. [PMID: 29802783 DOI: 10.1111/bju.14414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the effects of bowel management on urinary incontinence in patients with spina bifida associated with overactive bladder (OAB) and detrusor sphincter dyssynergia (DSD). MATERIALS AND METHODS The research was carried out during the period 2014-2017. A total of 35 patients (group 1) were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC) and 35 patients (group 2) were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application and a special diet, with the aim of treating constipation, evaluated according to the Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary incontinence were assessed according to the mean dry interval between two CICs for all patients. All patients were followed up for 1 year, during which data were prospectively collected. RESULTS There was no statistically significant difference with regard to age, gender and baseline clinical features between the two groups. In group 1, the mean ± sd dry interval between two CICs was 150.0 ± 36.4 min, and group 2 it was 101.3 ± 51.6 min. There was a significant difference in urinary incontinence, i.e. in the mean dry interval, between the two groups (P < 0.001). CONCLUSION Administering bowel management considerably increased the mean dry interval, thus greatly alleviating the symptoms of urinary incontinence. For this reason, bowel management should form an integral part of the treatment of patients with spina bifida and OAB and DSD.
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Affiliation(s)
| | | | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Lukac
- University Children's Hospital Belgrade, Belgrade, Serbia
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Non-invasive Testing and Its Role in Diagnosis and Management of Children With Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction. Curr Urol Rep 2018; 19:34. [PMID: 29623450 DOI: 10.1007/s11934-018-0784-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW The symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children. RECENT FINDINGS Non-invasive tests such urine studies, uroflowmetry ± simultaneous electromyography, assessment of post-void residual, renal/bladder ultrasound, and pelvic ultrasound when used appropriately can provide valuable information to facilitate decision making during the evaluation of children with LUTD. While these tests should be employed prior to more invasive testing such as urodynamic studies, they can often act as a surrogate for the more invasive tests. Non-invasive tests can help us in our goal of improving diagnostic ability to better classify the child's LUTD into an actual condition which allows targeted treatment in the hope of better outcomes and more satisfied patients and families.
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Costantini E, Illiano E, Giannitsas K, Prestipino M, Pastore AL, Carbone A, Palleschi G, Balsamo R, Natale F, Villari D, Bini V, Maruccia S, Filocamo MT, Zucchi A. Urological dysfunction in young women: an inheritance of childhood? BJU Int 2017; 121:453-457. [PMID: 29160004 DOI: 10.1111/bju.14081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the correlation of a history of lower urinary tract symptomatology during childhood with lower urinary tract dysfunction in young adult women. SUBJECTS AND METHODS This was a multicentre, prospective, case-control study conducted between April 2013 and November 2015. A total of 300 women, aged 18-40 years, participated. The case group comprised women attending urogynaecology clinics for various lower urinary tract complaints and the control group was recruited from a healthy population. Exclusion criteria were designed to avoid common causes of lower urinary tract dysfunction and symptoms and included diabetes mellitus, neurological disease and pelvic inflammatory disease. All women completed a self-administered 77-item questionnaire, exploring childhood urological and bowel history, as well as current urological, bowel and sexual symptoms. Statistical analysis was performed using chi-squared and Fisher's exact tests to compare categorical variables. Multivariate logistic regression models were fit for the prediction of the adult outcomes, incorporating as explanatory variables all those that showed a significant P value in bivariate analysis. P values < 0.05 were considered statistically significant. RESULTS Women with childhood urinary voiding and storage symptoms had a higher prevalence of these symptoms in adult life compared with women without such history. Women with urinary tract infections (UTIs) during childhood had a higher incidence of adult UTIs compared with women without this problem in childhood. CONCLUSIONS Lower urinary tract dysfunction in childhood seems to 'persist' in young adult life but the implications of this finding in clinical practice need to be defined in future studies.
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Affiliation(s)
- Elisabetta Costantini
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
| | - Ester Illiano
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
| | - Konstantinos Giannitsas
- Department of Urology, University of Patras School of Medicine, Patras University Hospital, Patras, Greece
| | - Marco Prestipino
- Department of Paediatric Surgery, C.U. Paediatric Surgery, University of Perugia, Perugia, Italy
| | - Antonio Luigi Pastore
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Antonio Carbone
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Giovanni Palleschi
- Department of Medico Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University, ICOT, Rome, Italy
| | - Raffaele Balsamo
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Franca Natale
- Department of Obstetrics and Gynecology, S. Carlo-IDI Hospital, Rome, Italy
| | - Donata Villari
- Department of Urology, University of Florence, Florence, Italy
| | - Vittorio Bini
- Internal Medicine, University of Perugia, Perugia, Italy
| | | | | | - Alessandro Zucchi
- Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia, Italy
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Doiron RC, Kogan BA, Tolls V, Irvine-Bird K, Nickel JC. Childhood bladder and bowel dysfunction predicts irritable bowel syndrome phenotype in adult interstitial cystitis/bladder pain syndrome patients. Can Urol Assoc J 2017; 11:255-259. [PMID: 28798827 DOI: 10.5489/cuaj.4251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Many clinicians have suggested that a history of bladder and bowel dysfunction (BBD) in childhood predisposes to the development of interstitial cystitis/bladder pain syndrome (IC/BPS) or irritable bowel syndrome (IBS) in adulthood. We hypothesized that BBD symptoms in childhood would predict the IBS-associated phenotype in adult IC/BPS patients. METHODS Consecutive female patients (n=190) with a diagnosis of IC/BPS were administered a modified form of a clinical BBD questionnaire (BBDQ) to capture childhood BBD-like symptoms, as well as Interstitial Cystitis Symptoms Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/Frequency (PUF) questionnaires and UPOINT categorization. Patients were stratified to IBS-positive or IBS-negative according to clinical assessment of IBS-like symptoms. RESULTS The 127 patients (67%) identified with IBS-like symptoms recalled significantly higher BBDQ scores than the 63 patients (33%) who were IBS-negative (2.8 vs. 2.3; p=0.05). The IBS-positive patients also reported a higher number of UPOINT domains than their non-IBS counterparts (3.8 vs. 2.9; p=0.0001), while their PUF total scores were significantly higher (13.6 vs. 12.3; p=0.04). IBS-positive patients more often recalled that in childhood they did not have a daily bowel movement (BM) (p=0.04) and had "to push for a BM" (p=0.009). In childhood, they "urinated only once or twice per day" (p=0.03) and recalled "painful urination" more than those without IBS (p=0.03). There were no significant differences between the groups in answers to the other five questions of the BBDQ. CONCLUSIONS Our symptom recollection survey was able to predict the IBS phenotype of IC/BPS based on a childhood BBDQ. Further prospective studies are needed to further evaluate these novel findings.
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Affiliation(s)
| | - Barry A Kogan
- Division of Urology, Albany Medical College, Albany, NY, United States
| | - Victoria Tolls
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
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Toileting behavior and urinary tract symptoms among younger women. Int Urogynecol J 2017; 28:1677-1684. [PMID: 28382484 PMCID: PMC5655598 DOI: 10.1007/s00192-017-3319-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
Introduction and hypothesis Irregular or infrequent voiding due to avoiding school toilets can contribute to a number of urinary problems among school children. There is, however, a lack of studies on younger women. The aim of this study was to investigate toileting behavior and the correlation to lower urinary tract symptoms (LUTS) among young women (age 18–25 years). A further aim was to validate the Swedish version of the Toileting Behavior scale (TB scale). Methods Quantitative descriptive design was used with two questionnaires: the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and the TB scale, together with six background questions. The questionnaires were distributed in November 2014 to 550 women aged 18–25 years randomly selected from the population register in southern Sweden. Results A total of 173 (33%) women responded. Mean age was 21.6 years (range 18–25). The Swedish version of TB scale showed good construct validity and reliability, similar to the original. Most toileting behavior was significantly correlated with LUTS, which were common, as 34.2% reported urgency and 35.9% urine leakage at least sometimes or more often. Conclusions LUTS were quite common in this group of young women. Toileting behaviors were also significantly related to urinary tract symptoms. Thus, TB scale was useful in this population, and the translated Swedish version showed good construct validity and reliability.
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Gonçalves MLC, Fernandes SFF, de Almeida RM, Diaz FAF, de Oliveira PG, de Sousa JB. Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:280-5. [PMID: 24510035 DOI: 10.1590/s0102-67202013000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/19/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS Twenty-five adult women (mean age 45.5 ± 11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9 ± 10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.
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Brownrigg N, Pemberton J, Jegatheeswaran K, DeMaria J, Braga LH. A pilot randomized controlled trial evaluating the effectiveness of group vs individual urotherapy in decreasing symptoms associated with bladder-bowel dysfunction. J Urol 2014; 193:1347-52. [PMID: 25444961 DOI: 10.1016/j.juro.2014.10.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE We determined the feasibility of a definitive trial comparing the effectiveness of group vs individual urotherapy for children with bladder-bowel dysfunction. MATERIALS AND METHODS Children 6 to 10 years old with bladder-bowel dysfunction were recruited during the course of 1 year. Feasibility data on screening, eligibility, recruitment and protocol compliance rates were collected. Patients with high grade hydronephrosis, vesicoureteral reflux or learning disabilities and those who had previously undergone urotherapy were excluded. Patients were randomized to 1-hour group urotherapy or 15-minute individual urotherapy. Symptoms and quality of life were measured using the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire and the Pediatric Incontinence Questionnaire at baseline and at 3 to 6 months of followup. Within/between group comparisons were conducted using t-tests. RESULTS Of 455 screened children 79 were eligible and 60 were recruited to participate. A total of 24 patients randomized to group urotherapy and 25 randomized to individual urotherapy completed the pilot trial (6 undergoing group and 5 undergoing individual urotherapy withdrew from the study). Symptomology scores between group and individual urotherapy were not different at followup (mean ± SD 14.7 ± 7.9 vs 13.4 ± 6.3, p = 0.54, 95% CI -5.4-2.8). Quality of life scores between patients undergoing group and individual urotherapy at baseline differed (mean ± SD 21.1 ± 10.8 vs 31.0 ± 14.3, p < 0.01, 95% CI 2.7-7.3) but became similar at followup (21.0 ± 14.2 vs 20.1 ± 15.3, p = 0.84, 95% CI -9.4-7.6). Within group analyses demonstrated improvement in symptomology from baseline to followup in patients undergoing group (mean ± SD 3.6 ± 7.6, p = 0.03, 95% CI 0.4-6.8) and individual urotherapy (6.0 ± 5.4, p < 0.01, 95% CI 3.8-8.3). Within group quality of life analyses revealed improvement in Pediatric Incontinence Questionnaire scores from baseline to followup in patients undergoing individual urotherapy (p < 0.01, 95% CI 5.0-16.9) only. CONCLUSIONS Urotherapy, regardless of modality, effectively improved bladder-bowel dysfunction symptoms. A definitive randomized controlled trial is feasible, considering that a high recruitment rate (76%) for this population has been established.
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Affiliation(s)
- Natasha Brownrigg
- Department of Pediatric Urology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Julia Pemberton
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kizanee Jegatheeswaran
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jorge DeMaria
- Department of Pediatric Urology, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luis H Braga
- Department of Pediatric Urology, McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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A 20-year study of persistence of lower urinary tract symptoms and urinary incontinence in young women treated in childhood. J Pediatr Urol 2014; 10:441-5. [PMID: 24560802 DOI: 10.1016/j.jpurol.2014.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether urinary incontinence (UI) and lower urinary tract symptoms (LUTS) persist over years, patients treated for UI and LUTS in childhood were re-evaluated in adulthood. MATERIALS AND METHODS Forty-seven women (cases) treated in childhood for daytime UI/LUTS (group A) and nocturnal enuresis (group B) self-completed (average age: 24.89 ± 3.5 years) the International Consultation on Incontinence Questionnaire for Female with LUTS (ICIQ-FLUTS). ICIQ-FLUTS was self-administered to 111 healthy women (average age: 23 ± 5.1 years) from a nursing school as a control group. Data obtained from ICIQ-FLUTS and quality of life (QoL) score (0-10) were compared (Fisher's exact test) between patients and controls, and between group A (n = 28) and group B (n = 19). RESULTS Prevalence of LUTS was higher in patients than in controls. The difference between patients and controls was statistically significant (p = 0.0001) for UI (34% vs. 7%) and feeling of incomplete bladder emptying (49% vs. 28%). QoL score was >5 in 59% of patients and 1% of controls (p = 0.0001). No significant differences were found between groups A and B. CONCLUSIONS UI and LUTS are confirmed in young women who suffered for the same condition in childhood. Longitudinal studies are needed to assess if these symptoms persist or are newly onset.
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Imamura M, Sugino Y, Long X, Slivano OJ, Nishikawa N, Yoshimura N, Miano JM. Myocardin and microRNA-1 modulate bladder activity through connexin 43 expression during post-natal development. J Cell Physiol 2013; 228:1819-26. [PMID: 23359472 DOI: 10.1002/jcp.24333] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 01/18/2013] [Indexed: 12/27/2022]
Abstract
Overactive bladder (OAB) is a pervasive clinical problem involving alterations in both neurogenic and myogenic activity. While there has been some progress in understanding neurogenic inputs to OAB, the mechanisms controlling myogenic bladder activity are unclear. We report the involvement of myocardin (MYOCD) and microRNA-1 (miR-1) in the regulation of connexin 43 (GJA1), a major gap junction in bladder smooth muscle, and the collective role of these molecules during post-natal bladder development. Wild-type (WT) mouse bladders showed normal development from early post-natal to adult including increases in bladder capacity and maintenance of normal sensitivity to cholinergic agents concurrent with down-regulation of MYOCD and several smooth muscle cell (SMC) contractile genes. Myocardin heterozygous-knockout mice exhibited reduced expression of Myocd mRNA and several SMC contractile genes concurrent with bladder SMC hypersensitivity that was mediated by gap junctions. In both cultured rat bladder SMC and in vivo bladders, MYOCD down-regulated GJA1 expression through miR-1 up-regulation. Interestingly, adult myocardin heterozygous-knockout mice showed normal increases in bladder and body weight but lower bladder capacity compared to WT mice. These results suggest that MYOCD down-regulates GJA1 expression via miR-1 up-regulation, thereby contributing to maintenance of normal sensitivity and development of bladder capacity.
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Affiliation(s)
- Masaaki Imamura
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial. BMC Pediatr 2013; 13:112. [PMID: 23914827 PMCID: PMC3750818 DOI: 10.1186/1471-2431-13-112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background Functional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking. Methods/design A two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria. Discussion This section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care. Trial registration Current Controlled Trials NL30551.068.09
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Baek M, Park K, Lee HE, Kang JH, Suh HJ, Kim JH, Lee SD, Pai KS, Han SW, Park YH, Kim KD. A nationwide epidemiological study of nocturnal enuresis in Korean adolescents and adults: population based cross sectional study. J Korean Med Sci 2013; 28:1065-70. [PMID: 23853491 PMCID: PMC3708079 DOI: 10.3346/jkms.2013.28.7.1065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/09/2013] [Indexed: 11/20/2022] Open
Abstract
We performed a nationwide epidemiological study to evaluate the prevalence and characteristics of nocturnal enuresis (NE) in Korean adolescents and adults. A questionnaire was sent via e-mail to 51,073 people aged 16-40 yr by stratified sampling according to age, sex, and region among a 200,000 internet survey panel pool. The questionnaire included following information; presence or absence of NE, frequency of NE, possible risk factors for NE, self-esteem scale score and depression score results, and measures for the treatment of NE. Among the 2,117 responders, 54 (2.6%) had NE (≥1 enuretic episode within 6 months). Of 54 bedwetters, 9.3% wet ≥1 night per week and 20.5% wet ≥1 per month. The prevalence rates remained relatively stable with no apparent trend of reduction with age. The presence of sleep disturbance, family history, urgency, or urge incontinence increased the probability of NE episode significantly. The self-esteem score was lower (P=0.053) and the depression scale score was higher (P=0.003) in bedwetters compared with non-bedwetters. Overall 2.6% of Korean aged 16-40 yr have NE. The higher rate of urgency and urge incontinence in adolescent and adult enuretics suggests that bladder function has an important role in adolescent and adult NE.
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Affiliation(s)
- Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwanjin Park
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hahn-Ey Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju Hyung Kang
- Department of Pediatrics, Eul-Ji University School of Medicine, Daejeon, Korea
| | - Hong Jin Suh
- Department of Urology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Ki Soo Pai
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Sang Won Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hoon Park
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Kyung Do Kim
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
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D'Ancona CAL, Lopes MHBDM, Faleiros-Martins AC, Lúcio AC, Campos RM, Costa JV. Childhood enuresis is a risk factor for bladder dysfunction in adult life? Neurourol Urodyn 2012; 31:634-6. [DOI: 10.1002/nau.21195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 06/29/2011] [Indexed: 11/08/2022]
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Salvatore S, Serati M, Origoni M, Candiani M. Is overactive bladder in children and adults the same condition?: ICI-RS 2011. Neurourol Urodyn 2012; 31:349-51. [PMID: 22422704 DOI: 10.1002/nau.22223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 11/10/2022]
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23
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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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Cameron A, Fenner DE, DeLancey JOL, Morgan DM. Self-report of difficult defecation is associated with overactive bladder symptoms. Neurourol Urodyn 2011; 29:1290-4. [PMID: 20127839 DOI: 10.1002/nau.20839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The association of dysfunctional bowel elimination with lower urinary tract symptoms is well known in children, but not in adults. It was our objective to assess lower urinary tract symptoms (LUTS) in women who report difficult defecation (DD). METHODS This is a secondary analysis of 2,812 women, aged 35-64, who participated in a telephone interview. All subjects were asked "When you move your bowels, does the stool come out easily?" DD was considered present in those answering "no." All subjects were queried regarding LUTS, urinary infections in the past year, self-perceived health status, medical history, and demographics. Symptoms of stress incontinence (five items), urge incontinence (five items), and the impact of these symptoms on their quality of life were solicited from subjects reporting more than 12 episodes of incontinence in 1 year. RESULTS DD was reported by 10.4% (290/2,790) of women. Women with DD had higher LUTS than those who did not: nocturia (mean 1.8 ± 0.1 vs. 1.3 ± 0.0), urgency (47.6% vs. 29.2%), increased daytime frequency (mean 8.2 ± 0.3 vs. 7.2 ± 0.1), dysuria (22.9% vs. 13.7%), and a sensation of incomplete bladder emptying (55.6% vs. 28.2%). DD women were more often menopausal, reported a fair or poor self-reported health status, and had a higher number of comorbidities, less formal education, and lower annual household income. CONCLUSIONS Women with symptoms of DD have an increased rate of LUTS, consistent with the diagnosis of overactive bladder without incontinence. The pathophysiology underlying this association is worthy of future research.
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Affiliation(s)
- Anne Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA.
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Labrie J, de Jong T, Nieuwhof-Leppink A, van der Deure J, Vijverberg M, van der Vaart C. The Relationship Between Children With Voiding Problems and Their Parents. J Urol 2010; 183:1887-91. [DOI: 10.1016/j.juro.2010.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Indexed: 10/19/2022]
Affiliation(s)
- J. Labrie
- Department of Perinatology and Gynecology, (University Children's Hospital), University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - A. Nieuwhof-Leppink
- Department of Pediatric Urology (University Children's Hospital), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. van der Deure
- Department of Pediatrics, Deventer Ziekenhuis, Deventer, The Netherlands
| | - M.A.W. Vijverberg
- Department of Pediatric Urology (University Children's Hospital), University Medical Center Utrecht, Utrecht, The Netherlands
| | - C.H. van der Vaart
- Department of Perinatology and Gynecology, (University Children's Hospital), University Medical Center Utrecht, Utrecht, The Netherlands
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Bower W, Swithinbank L, de Jong T, de Kort L, Marschall-Kehrel D. Assessment of non-neurogenic incontinence and lower urinary tract symptoms in adolescents and young adults. Neurourol Urodyn 2010; 29:702-7. [DOI: 10.1002/nau.20829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Sacral Neuromodulation in Children With Dysfunctional Elimination Syndrome: Description of Incisionless First Stage and Second Stage Without Fluoroscopy. Urology 2009; 73:641-4; discussion 644. [DOI: 10.1016/j.urology.2008.10.067] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 10/18/2008] [Accepted: 10/27/2008] [Indexed: 11/21/2022]
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Kistner M. Dysfunctional elimination behaviors and associated complications in school-age children. J Sch Nurs 2009; 25:108-16. [PMID: 19233931 DOI: 10.1177/1059840509331442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lack of privacy, risk of bullying, limited access, lack of essential products for good hygiene, and dirty bathrooms can all contribute to encouraging a child to withhold urine and stool while in school. Withholding behaviors over time can create a condition known as dysfunctional elimination syndrome (DES). DES is any pattern of voiding or stooling that varies from the developmental norm. These abnormal patterns of elimination can eventually lead to complications of urinary tract infection, vesicoureteral reflux, and incontinence of urine and/or stool. School officials (teachers, school nurses, and school administrators) can help in the prevention of learned behaviors that lead to DES in school-age children. School officials need to realize children are individuals and should not be expected to empty their bowels and bladders according to a set, rigid schedule. In addition, school officials should not expect children to use dirty, unsafe bathrooms that they themselves would not tolerate. School nurses can be a powerful force in protecting children's health by participating in research and developing evidence-based guidelines to improve bathroom access and conditions.
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Affiliation(s)
- Mary Kistner
- General Surgery Department at Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, Texas, USA
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Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, Kim HG, Moon DG, Park KH, Park YH, Pai KS, Suh HJ, Lee JW, Cho WY, Ha TS, Han SW. Prevalence and associated factors of overactive bladder in Korean children 5-13 years old: a nationwide multicenter study. Urology 2008; 73:63-7; discussion 68-9. [PMID: 18829077 DOI: 10.1016/j.urology.2008.06.063] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 05/24/2008] [Accepted: 06/02/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the prevalence of overactive bladder (OAB) in Korean children, 5-13 years of age, and to assess the associated factors for OAB. METHODS A randomly selected cross-section study was conducted in 26 kindergartens and 27 elementary schools nationwide in Korea. A total of 19 240 children were included; a parent was asked to complete the questionnaires, which included items about OAB and voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, usually with increased daytime frequency and nocturia (International Children's Continence Society, 2006). Its prevalence and associated factors were also investigated. RESULTS The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%. The prevalence of OAB decreased with age from 22.99% to 12.16% (P = .0001). The overall incidence of wet and dry OAB was 26.97% and 73.03%, respectively. Compared with normal children, those with OAB had a greater prevalence of nocturnal enuresis, constipation, fecal incontinence, urinary tract infection, delayed bladder control, and poor toilet facilities (P < .05). The incidence of increased daytime frequency and urge incontinence was 3.69% and 2.31% (P = .009) and 26.97% and 14.78% (P = .0001) in OAB and non-OAB children, respectively. The corresponding prevalence decreased with age from 5.04% to 3.06% and from 45.74% to 18.50% in OAB children (P = .0001). CONCLUSIONS The overall prevalence of OAB in Korean children, 5-13 years of age, was 16.59% and decreased with age. Nocturnal enuresis, constipation, fecal incontinence, history of urinary tract infection, delayed bladder control, and poor toilet facilities might be factors associated with the development of OAB.
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Affiliation(s)
- Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
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Nijman RJM. Diagnosis and management of urinary incontinence and functional fecal incontinence (encopresis) in children. Gastroenterol Clin North Am 2008; 37:731-48, x. [PMID: 18794006 DOI: 10.1016/j.gtc.2008.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.
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Affiliation(s)
- Rien J M Nijman
- Department of Urology, University Medical Centre Groningen, Hanzeplein 1,9713 GZ Groningen, The Netherlands.
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Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A Single Center Experience With 20 Children. J Urol 2008; 180:306-11; discussion 311. [DOI: 10.1016/j.juro.2008.03.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Pam Hollatz
- Pediatric Urology, Pediatric Surgical Associates, Minneapolis, Minnesota
| | - Brant A. Inman
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Yuri E. Reinberg
- Pediatric Urology, Pediatric Surgical Associates, Minneapolis, Minnesota
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Chrzan R, Klijn AJ, Vijverberg MA, Sikkel F, de Jong TP. Colonic Washout Enemas for Persistent Constipation in Children with Recurrent Urinary Tract Infections Based on Dysfunctional Voiding. Urology 2008; 71:607-10. [DOI: 10.1016/j.urology.2007.11.136] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/21/2007] [Accepted: 11/30/2007] [Indexed: 11/30/2022]
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Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, Kim HG, Moon DG, Park KH, Park YH, Pai KS, Suh HJ, Lee JW, Cho WY, Ha TS, Han SW, Cho BM. The Prevalence and Risk Factors of Overactive Bladder in Korean Children: A Comparative Analysis according to Definition. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.12.1131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jae Min Chung
- Department of Urology, Kosin University College of Medicine, Busan, Korea
| | - Sang Don Lee
- Department of Urology, College of Medicine, Pusan National University, Busan, Korea
| | - Dong Il Kang
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University College of Medicine, Korea
| | - Kun Suk Kim
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Yung Kim
- Department of Pediatrics and Adolescent Medicine, College of Medicine, Pusan National University, Busan, Korea
| | - Han Gwun Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Du Geon Moon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Kwan Hyun Park
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Hoon Park
- Department of Pediatrics and Adolescent Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Ki Soo Pai
- Department of Pediatrics and Adolescent Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hong Jin Suh
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jung Won Lee
- Department of Pediatrics and Adolescent Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Won Yeol Cho
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Tae Sun Ha
- Department of Pediatrics and Adolescent Medicine, Chungbuk National University, Cheongju, Korea
| | - Sang Won Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Mann Cho
- Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, Korea
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Lee JW. Urinary incontinence - Anatomy and physiology of bladder and bowel -. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.11.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
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Gargollo PC, Diamond DA. Therapy Insight: what nephrologists need to know about primary vesicoureteral reflux. ACTA ACUST UNITED AC 2007; 3:551-63. [PMID: 17895932 DOI: 10.1038/ncpneph0610] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/20/2007] [Indexed: 12/11/2022]
Abstract
Vesicoureteral reflux (VUR) is the abnormal, retrograde flow of urine from the bladder to the upper urinary tract. This disease affects about 1% of otherwise normal children, 30-50% of those who present with urinary tract infections, and approximately 10% with prenatally diagnosed hydronephrosis. Over the past 50 years, tremendous progress has been made in the diagnosis, treatment and management of VUR. The realization that VUR is probably a component of generalized dysfunction of the lower urinary tract (i.e. dysfunctional elimination syndrome) has further enhanced understanding of the disease. This Review covers basic pathogenesis, diagnosis, management, clinical presentation, and current controversies surrounding VUR.
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Affiliation(s)
- Patricio C Gargollo
- Harvard Medical School, and Children's Hospital Boston, Boston, MA 02115, USA
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Abstract
Perspective on the paper by Loening‐Baucke (see page 486)
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Affiliation(s)
- Graham Clayden
- King's College London and the Evelina Children's Hospital of Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Bower WF, Sit FKY, Yeung CK. Nocturnal Enuresis in Adolescents and Adults is Associated With Childhood Elimination Symptoms. J Urol 2006; 176:1771-5. [PMID: 16945646 DOI: 10.1016/j.juro.2006.04.087] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE Since nocturnal enuresis in adults and adolescents is rarely monosymptomatic, we identified the prevalence of childhood bladder and bowel dysfunction, and compared findings to those in a normative cohort. MATERIALS AND METHODS Childhood and current bladder and bowel dysfunction were investigated in 56 consecutive adolescents and adults attending a public nocturnal enuresis service and in 293 normative adults using a self-administered questionnaire. Analysis involved descriptive statistics, the chi-square and Kruskal-Wallis tests, and regression analysis with p <0.05 considered significant. RESULTS Adolescents and adults attending a public nocturnal enuresis service had significantly higher childhood scores than normative adults, and significantly more childhood urgency, frequency, urge incontinence, infrequent voiding and small volume, high urge voids. Infrequent bowel action and fecal soiling in childhood were also significantly more common in those with nocturnal enuresis than in controls. Adult symptoms of urge incontinence, general bowel symptoms and nocturnal enuresis were significantly more common in adults and adolescents with nocturnal enuresis. Significant associations were found between childhood symptoms and adult overactive bladder, and childhood emptying dysfunction and adult voiding dysfunction. Higher childhood scores in adults and adolescents with nocturnal enuresis correlated significantly with current adult symptoms of urge, urge leakage, stress incontinence, hesitancy, incomplete emptying and UTI within the last year. CONCLUSIONS Significant childhood bladder and bowel symptoms along with more adult urge and bowel dysfunction were found in adults and adolescents with nocturnal enuresis. The association with adult urgency and urinary tract infection supports the likelihood of underlying bladder and or voiding dysfunction in unremitting nocturnal enuresis.
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Affiliation(s)
- W F Bower
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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Hoebeke P. Twenty Years of Urotherapy in Children: What Have We Learned? Eur Urol 2006; 49:426-8. [PMID: 16439053 DOI: 10.1016/j.eururo.2005.12.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 12/20/2005] [Indexed: 11/28/2022]
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