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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024:S0302-2838(24)02253-X. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Shimizu S. Insights into the associative role of hypertension and angiotensin II receptor in lower urinary tract dysfunction. Hypertens Res 2024; 47:987-997. [PMID: 38351189 DOI: 10.1038/s41440-024-01597-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
In men, the lower urinary tract comprises the urinary bladder, urethra, and prostate, and its primary functions include urine storage and voiding. Hypertension is a condition that causes multi-organ damage and an age-dependent condition. Hypertension and the renin-angiotensin system activation are associated with the development of lower urinary tract dysfunction. Hypertensive animal models show bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. In the renin-angiotensin system, angiotensin II and the angiotensin II type 1 receptor, which are expressed in the lower urinary tract, have been implicated in the pathogenesis of lower urinary tract dysfunction. Moreover, among the several antihypertensives, renin-angiotensin system inhibitors have proven effective in human and animal models of lower urinary tract dysfunction. This review aimed to elucidate the hitherto known mechanisms underlying the development of lower urinary tract dysfunction in relation to hypertension and the angiotensin II/angiotensin II type 1 receptor axis and the effect of renin-angiotensin system inhibitors on lower urinary tract dysfunction. Possible mechanisms through which hypertension or activation of Ang II/AT1 receptor axis causes LUTD such as bladder dysfunction, urethral dysfunction, and prostatic hyperplasia. LUT: lower urinary tract, LUTD: lower urinary tract dysfunction, AT1: angiotensin II type 1, ACE: angiotensin-converting enzyme.
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Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, 783-8505, Japan.
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3
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Li X, Li X, Liao L. Mechanism of Action of Tibial Nerve Stimulation in the Treatment of Lower Urinary Tract Dysfunction. Neuromodulation 2024; 27:256-266. [PMID: 37178068 DOI: 10.1016/j.neurom.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/03/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Tibial nerve stimulation (TNS) has long been used to effectively treat lower urinary tract dysfunction (LUTD). Although numerous studies have concentrated on TNS, its mechanism of action remains elusive. This review aimed to concentrate on the mechanism of action of TNS against LUTD. MATERIALS AND METHODS A literature search was performed in PubMed on October 31, 2022. In this study, we introduced the application of TNS for LUTD, summarized different methods used in exploring the mechanism of TNS, and discussed the next direction to investigate the mechanism of TNS. RESULTS AND CONCLUSIONS In this review, 97 studies, including clinical studies, animal experiments, and reviews, were used. TNS is an effective treatment for LUTD. The study of its mechanisms primarily concentrated on the central nervous system, tibial nerve pathway, receptors, and TNS frequency. More advanced equipment will be used in human experiments to investigate the central mechanism, and diverse animal experiments will be performed to explore the peripheral mechanism and parameters of TNS in the future.
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Affiliation(s)
- Xunhua Li
- School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China; University of Health and Rehabilitation Sciences, Qingdao, China
| | - Xing Li
- School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China
| | - Limin Liao
- School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China; University of Health and Rehabilitation Sciences, Qingdao, China; China Rehabilitation Science Institute, Beijing, China.
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4
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Ranchin B, Bidault V, Zekre F, DeMul A, Sanlaville D, Bacchetta J. Kidney and urological involvement in Down syndrome: frequent, underestimated, but associated with impaired quality of life and risk of kidney failure. Pediatr Nephrol 2024; 39:347-355. [PMID: 37386331 DOI: 10.1007/s00467-023-05986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/01/2023]
Abstract
Patients with Down syndrome (DS) are at risk of multiorgan dysfunction; kidney and urological impairment are common. This is due to a likely increased risk of congenital kidney and urological malformations (odds ratio of 4.5 compared to the general population in one study), more frequent associated comorbidities at risk of kidney dysfunction (such as prematurity in 9-24% of children, intrauterine growth retardation or low birth weight in 20%, and congenital heart disease in 44%), and more frequent lower urinary tract dysfunction (reported in 27-77% of children with DS). If present, malformations and comorbidities at risk of kidney dysfunction warrant regular kidney monitoring in addition to their treatment. Serum creatinine in children with DS has been shown to be higher than in the general population and asymptomatic hyperuricemia is reported in 12-33% of children or young adults with DS. Moreover cryptorchidism and testicular cancer are also more common and should be detected by clinical examination. Thus, persons with DS at risk of presenting kidney and urological impairment should be identified by prenatal ultrasonography, comorbidities at risk of kidney sequelae considered, and during regular medical follow-up, clinically examined and questioned to diagnose testicular anomalies and lower urinary tract dysfunction. This is of importance as such kidney and urological impairments are associated with impaired quality of life and mental health, and risk of kidney failure.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Franck Zekre
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Aurelie DeMul
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
| | - Damien Sanlaville
- Service de Génétique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Faculté de Médecine Lyon Sud Charles Mérieux, Université de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
- INSERM, UMR 1033, Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
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5
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Ding Z, Zhang W, Wang H, Ke H, Su D, Wang Q, Bian K, Su F, Xu K. An automatic diagnostic system for the urodynamic study applying in lower urinary tract dysfunction. Int Urol Nephrol 2024; 56:441-449. [PMID: 37755608 DOI: 10.1007/s11255-023-03795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To establish an automatic diagnostic system based on machine learning for preliminarily analysis of urodynamic study applying in lower urinary tract dysfunction (LUTD). METHODS The eight most common conditions of LUTDs were included in the present study. A total of 527 eligible patients with complete data, from the year of 2015 to 2020, were enrolled in this study. In total, two global parameters (patients' age and sex) and 13 urodynamic parameters were considered to be the input for machine learning algorithms. Three machine learning approaches were applied and evaluated in this study, including Decision Tree (DT), Logistic Regression (LR), and Support Vector Machine (SVM). RESULTS By applying machine learning algorithms into the 8 common LUTDs, the DT models achieved the AUC of 0.63-0.98, the LR models achieved the AUC of 0.73-0.99, and the SVM models achieved the AUC of 0.64-1.00. For mutually exclusive diagnoses of underactive detrusor and acontractile detrusor, we developed a classification model that classifies the patients into either of these two diseases or double-negative class. For this classification method, the DT models achieved the AUC of 0.82-0.85 and the SVM models achieved the AUC of 0.86-0.90. Among all these models, the LR and the SVM models showed better performance. The best model of these diagnostic tasks achieved an average AUC of 0.90 (0.90 ± 0.08). CONCLUSIONS An automatic diagnostic system was developed using three machine learning models in urodynamic studies. This automated machine learning process could lead to promising assistance and enhancements of diagnosis and provide more useful reference for LUTD treatment.
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Affiliation(s)
- Zehua Ding
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Weiyu Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Huanrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hanwei Ke
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Dongyu Su
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Qi Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Kaigui Bian
- School of Computer Science, Peking University, Beijing, China
| | - Feng Su
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, China.
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Kitta T, Ogawa T, Kuno S, Kakizaki H, Yoshimura N. Review: Lower urinary tract dysfunction in animal models of Parkinson's disease (PD): Translational aspects for the treatment of PD patients with overactive bladder. Int Rev Neurobiol 2024; 174:211-230. [PMID: 38341230 DOI: 10.1016/bs.irn.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Although the loss of dopaminergic neurons in the substantia nigra and consequent motor symptoms are the hallmarks of Parkinson's disease (PD), several non-motor symptoms may appear prior to these typical motor symptoms. While a variety of non-motor symptoms have emerged as the primary predictor of PD patients' quality of life, even though motor symptoms are undoubtedly distressing. According to a study, the prevalence of lower urinary tract symptoms (LUTS) varies between 27% and 64%, suggesting that PD-related lower urinary tract dysfunction may be affected by the disease stage, the presence of concomitant conditions affecting the lower urinary tract, and other autonomic dysfunctions. Animal models can serve as a platform for research into the causes of PD-related dysfunction and the evaluation of cutting-edge therapeutic approaches although the majority of animal research have been directed toward motor symptoms of PD. At present, the cause of lower urinary tract dysfunction in PD has not been fully clarified although the increasing evidence showing the multiple mechanisms underlying PD-related LUTS has emerged. In this chapter we summarize the findings of basic research in the studies of the lower urinary tract dysfunction using with different animal PD models and we try to shed light on the translational aspects for the development of future treatment modalities in PD patients with LUTS.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Teruyuki Ogawa
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Sadako Kuno
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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7
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Lee PJ, Kuo HC. Low detrusor contractility has a less favorable outcome of anti-incontinence surgery for women with stress urinary incontinence. Int Urol Nephrol 2023; 55:2789-2798. [PMID: 37505426 DOI: 10.1007/s11255-023-03725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Few studies exist comparing the effect of different lower urinary tract dysfunctions (LUTDs) on anti-incontinence surgery. This study investigates the long-term therapeutic outcome of a suburethral sling procedure among women with stress urinary incontinence (SUI) and different LUTDs. METHODS This study retrospectively reviewed 401 women treated with a suburethral sling for SUI. Following baseline videourodynamic findings, the patients were divided into pure SUI or SUI with concomitant LUTD (mixed detrusor overactivity and SUI, low detrusor contractility and SUI, and presence of bladder outlet obstruction and SUI) groups. The primary endpoint was the SUI-free-specific survival rate. A successful outcome was defined as the absence of any SUI event. The secondary endpoints included postoperative complications, surgical revision rate, and changes in videourodynamic parameters. RESULTS At a mean follow-up of 5.1 (standard deviation: 5.4, range 0.1-24.1) years, the median cumulative duration of SUI-free survival was 15.4 years and 15.9 years in the pure SUI and SUI and concomitant LUTD subgroup, respectively, without significant difference between the groups. No between-group difference in postoperative complications was also noted. The cumulative incidences of the overall reoperation rate were 15.3%, 11.6%, 30.9%, and 7.3% in the pure SUI, detrusor overactivity, low detrusor contractility, and bladder outlet obstruction subgroups, respectively, with a significant difference between the groups (p = 0.006). CONCLUSIONS Women who underwent suburethral sling surgery for SUI treatment had comparable long-term success rates regardless of baseline LUTD. However, those with low detrusor contractility may experience less favorable results in terms of higher reoperation rates.
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Affiliation(s)
- Ping-Jui Lee
- Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan.
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Lee UJ, Xavier K, Benson K, Burgess K, Harris-Hicks JE, Simon R, Proctor JG, Bittner KC, Stolen KQ, Irwin CP, Offutt SJ, Miller AE, Michaud EM, Falkner PC, Coetzee JC. Rationale and design of an implant procedure and pivotal study to evaluate safety and effectiveness of Medtronic's tibial neuromodulation device. Contemp Clin Trials Commun 2023; 35:101198. [PMID: 37691849 PMCID: PMC10491630 DOI: 10.1016/j.conctc.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023] Open
Abstract
Percutaneous tibial neuromodulation is a medical guideline recommended therapy for treating symptoms of overactive bladder. Stimulation is delivered to the tibial nerve via a thin needle placed percutaneously for 30 min once a week for 12-weeks, and monthly thereafter. Studies have shown that this therapy can effectively relieve symptoms of overactive bladder; however, the frequent office visits present a barrier to patients and can impact therapy effectiveness. To mitigate the burden of frequent clinic visits, small implantable devices are being developed to deliver tibial neuromodulation. These devices are implanted during a single minimally invasive procedure and deliver stimulation intermittently, similar to percutaneous tibial neuromodulation. Here, we describe the implant procedure and design of a pivotal study evaluating the safety and effectiveness for an implantable tibial neuromodulation device. The Evaluation of Implantable Tibial Neuromodulation (TITAN 2) pivotal study is a prospective, multicenter, investigational device exemption study being conducted at up to 30 sites in the United States and enrolling subjects with symptoms of overactive bladder.
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Affiliation(s)
- Una J. Lee
- Virginia Mason Medical Center, Seattle, WA, USA
| | - Keith Xavier
- Urology Partners of North Texas, Arlington, TX, USA
| | - Kevin Benson
- Sanford Female Pelvic Medicine Reconstructive Surgery Clinic, Sioux Falls, SD, USA
| | | | | | - Robert Simon
- Urologic Research and Consulting, Englewood, NJ, USA
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Van Batavia JP, Pohl HG, Farhat WA, Chiang G, BaniHani A, Collett-Gardere T, Franco I. Is it time to reconsider how we document pediatric uroflow studies?: A study from the SPU Voiding Dysfunction task force. J Pediatr Urol 2023; 19:546-554. [PMID: 37302925 DOI: 10.1016/j.jpurol.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Uroflowmetry is a non-invasive study used in the diagnosis and monitoring of treatment response for lower urinary tract disorders. For optimal clinical utility, uroflow studies rely on careful clinical interpretation by a trained provider, but currently there is a lack of accepted standardized normal values for the measured uroflow parameters in children. The International Children's Continence Society proposed standardizing the terminology for uroflow curve shapes. However, the patterning of curves is largely at the physician's subjective discretion. OBJECTIVES The aims of this study were to understand inter-rater reliability in interpreting uroflow curves and to define characteristics of uroflow curves that could be used to provide definitive criteria for uroflowmetry parameters. METHODS All members of the SPU Voiding dysfunction Task Force were invited to contribute deidentified uroflows to a centralized HIPAA complaint receiving database. All studies were then distributed to all raters for review. Each observer's findings were recorded according to ICCS criteria (ICCS), additional readings were done using a previously reported system which defined curves as smooth or fractionated (SF) and whether the shape resembled a bell, tower, or plateau (BTP). Flow indexes (Qact/Qest) (FI) for Qmax and Qavg were generated using formulas previously reported for children 4-12 and for patients≥12 years. RESULTS A total of 119 uroflow studies were read by 7 raters and curves were contributed from 5 sites. Kappa scores for the 5 readers from different institutions were 0.34 and 0.28 for the ICCS and BTP methods, respectively (both considered fair agreement). Kappa for smooth and fractionated curves was 0.70 (for each; considered substantial agreement), which were the two highest agreement scores obtained throughout the study. Discriminant analysis (DA) revealed that the FI Qmax was the dominant vector, and that the ICCS uroflow parameters have a total of 42.8% prediction rate in the training sample. Using DA of a smooth/fractionated system, the total prediction rates were 72% and 65.5% for smooth and fractionated, respectively. DISCUSSION Given the poor inter-rater agreement for analyzing uroflow curve pattern based on ICCS criteria in this study and others, one may find it reasonable to consider alternative approaches to describing and characterizing uroflow curves. Our study is limited by lack of EMG and post-void residual data. CONCLUSIONS For a more objective uroflow interpretation and comparison of studies among different centers, we recommend using our proposed system (based on FI, and smooth vs. fractionated curve pattern), which is more reliable.
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Affiliation(s)
- Jason P Van Batavia
- Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Hans G Pohl
- Division of Urology, Children's National Hospital, Washington, DC, 20010, USA
| | - Walid A Farhat
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - George Chiang
- Department of Urology, Rady Children's Hospital-San Diego, University of California San Diego, CA 92123, USA
| | - Ahmad BaniHani
- Department of Urology, Nemours Children's Health, Wilmington, DE 19803, USA
| | | | - Israel Franco
- Department of Urology, Yale School of Medicine, New Haven, CT 06520, USA
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Ajiki J, Naitoh Y, Kanazawa M, Fujihara A, Ukimura O. Assessment of lower urinary tract function in pediatrics using ultrasonography. J Med Ultrason (2001) 2023:10.1007/s10396-023-01358-z. [PMID: 37656379 DOI: 10.1007/s10396-023-01358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
Ultrasound imaging is a less invasive imaging modality without radiation exposure and is available for repeated tests. It is the gold standard examination for diagnosing and managing disorders of the urinary tract, including lower urinary tract dysfunction (LUTD) in pediatric urology. Ultrasound imaging is effective for screening underlying diseases and determining treatment strategies. Ultrasound examination at the bedside should focus on post-voided residual urine (PVR), bladder wall thickening, renal morphology, and rectal diameter. Since PVR must be tested immediately after voiding, examining infants who cannot complain of the urge to void is difficult. PVR measurement combined with a 4-h voiding observation or alarm system activated by urine is recommended for these infants. Early diagnosis is important because LUTD is associated with the risk of morbid residual urine and high voiding pressure, which can result in renal deterioration, urinary leakage, and febrile urinary tract infection.
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Affiliation(s)
- Jun Ajiki
- Kyoto-Chubu Medical Center, Yagicho-Yagiueno 25, Nantan City, Kyoto, 629-0197, Japan.
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji 465, Kyoto City, Kyoto, 602-8566, Japan.
| | - Yasuyuki Naitoh
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji 465, Kyoto City, Kyoto, 602-8566, Japan
| | - Motohiro Kanazawa
- Kyoto-Chubu Medical Center, Yagicho-Yagiueno 25, Nantan City, Kyoto, 629-0197, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji 465, Kyoto City, Kyoto, 602-8566, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji 465, Kyoto City, Kyoto, 602-8566, Japan
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Oktar T, Selvi I, Kart M, Dönmez Mİ, Çetin B, Boyuk A, Ziylan O. Lower Urinary Tract Reconstruction for Ectopic Ureterocele: What Happens in the Long-term Follow-up? J Pediatr Surg 2023; 58:1566-1572. [PMID: 36241446 DOI: 10.1016/j.jpedsurg.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to analyze the long-term clinical and lower urinary tract function outcomes in children with duplex system ectopic ureterocele who underwent ureteroneocystostomy and ureterocelectomy. METHODS Fifty-one patients (28 females, 23 males) who underwent a series of surgical interventions including lower urinary tract reconstruction in childhood for duplex system ectopic ureterocele in our center between 1998 and 2019, were retrospectively reviewed. The demographic and clinical data, surgical history, and the indication for ureterocelectomy were noted. Lower urinary tract dysfunction (LUTD) status was assessed through dysfunctional voiding symptom scores (DVSS) and uroflowmetry in all patients at the last follow-up. The clinical outcomes, and LUTD were evaluated. RESULTS At the last visit at a mean follow-up of 117.18 ± 57.87 months after ureterocelectomy, ipsilateral persistent lower pole VUR was detected in 5.6% (3/54 renal units, 2 females and 1 male) of the cases, who were treated using the subureteric injection. Abnormal DVSS (median 11, range 9-15) was detected in 27.4% (14/51 pts) of the patients. Out of these, 57.1% (8/14 pts) had storage symptoms, 35.7% (5/14 pts) had voiding symptoms, and 7.1% (1/14 pts) had both storage and voiding symptoms while 71.4%(10/14 pts) had abnormal uroflowmetry findings (plateau shaped flow curve in 2, staccato shaped curve with sustained EMG activity in 3, tower shaped curve in 2, interrupted shaped curve in 3 patients). Five patients had elevated residual volume. Anticholinergics were administered to six patients who had overactive bladder symptoms. In addition, two girls required open bladder neck reconstruction due to stress incontinence caused by bladder neck insufficiency. CONCLUSIONS Our findings showed that clinical success was achieved using the lower urinary tract reconstruction with no need for re-operation in 90.2% of patients with duplex system ectopic ureterocele. However, LUTD was present in 27.4% of our patients in the long-term follow-up. Therefore, LUTD should be carefully assessed in the long-term follow-up of these patients.
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Affiliation(s)
- Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.
| | - Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Mücahit Kart
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Bilal Çetin
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Abubekir Boyuk
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
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Nacif A, de Abreu GE, Bessa Junior J, Veiga ML, Barroso U. Agreement between the visual analogue scale (VAS) and the dysfunctional voiding scoring system (DVSS) in the post-treatment evaluation of electrical nerve stimulation in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:740.e1-8. [PMID: 36123285 DOI: 10.1016/j.jpurol.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Electrical nerve stimulation is one of the most commonly used and well-tolerated treatments for overactive bladder (OAB); however, different studies have used different instruments to assess patients' response to treatment. OBJECTIVE To analyze agreement between use of the visual analogue scale (VAS) and the Dysfunctional Voiding Scoring System (DVSS) for assessing improvement in urinary symptoms following electrical nerve stimulation treatment in children and adolescents with OAB. STUDY DESIGN A cross-sectional analytical study including children and adolescents of 4-17 years of age diagnosed with OAB who underwent 20 sessions of transcutaneous (TENS) or percutaneous (PENS) electrical nerve stimulation. The DVSS and the VAS were used to assess daytime urinary symptoms before and following treatment. While the DVSS was always applied by a physician, the VAS was applied separately by a physiotherapist and then by a physician. Treatment was considered successful when the DVSS score was zero and the VAS score was ≥90%. Correlations between post-treatment VAS and DVSS scores were evaluated using the kappa coefficient. The VAS scores evaluated by the different professionals were compared for agreement using intraclass correlation and the Bland-Altman plot. RESULTS Data from 49 cases were available for analysis. Of these, 27 (55.1%) were girls. Mean age was 7.1 ± 2.6 years. There was agreement between the two instruments used, the DVSS and the VAS, in 36/49 patients (73.5%), with a moderate Kappa of 0.44. There was moderate agreement between the VAS scores applied by the two different professionals. DISCUSSION imitations of the present study include the small sample size and the fact that the inter-observer evaluation was conducted following a single sequence, i.e. all the patients were first evaluated by the physiotherapist and then by the physician, which may have biased answers and the post-treatment VAS scores. Furthermore, although the child participated actively in completing the questionnaires, in cases of divergent answers, the questions were redirected to the responsible adult, and the final answer may not fully represent the patient's true situation. CONCLUSION The present study found moderate agreement between the DVSS and the VAS, and moderate agreement between VAS scores when the instrument was applied by two different professionals. Although both tools appear to be important, and possibly complementary, a DVSS score of zero precludes the need to apply the VAS.
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Nakamura M, Nakayama K, Murakami A, Morise S, Kaneko S, Kusaka H, Yakushiji Y. Early presentation of lower urinary tract and bowel dysfunction in sporadic amyotrophic lateral sclerosis: A case report. eNeurologicalSci 2022; 28:100413. [PMID: 35769919 PMCID: PMC9234590 DOI: 10.1016/j.ensci.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 11/27/2022] Open
Abstract
An autopsy case of sporadic amyotrophic lateral sclerosis (ALS) with lower urinary tract (LUT) and bowel dysfunction is reported. The dysfunction occurred simultaneously with motor neuron symptoms in the early stages of the illness. A 75-year-old man developed exertional dyspnea and constipation following weight loss. Subsequently, he developed swallowing disturbance, fecal incontinence, and urinary retention. Neurological examination showed dysphagia, muscle weakness of the upper limbs, and prominent fasciculation affecting all four limbs and the tongue. All deep tendon reflexes were diminished, but the left plantar response was extensor. Orthostatic hypotension (OH) and the anal reflex were absent. Neuropathological findings did not show neuronal loss and gliosis in the thoracic and sacral intermediolateral nucleus (IML) and in Onuf's nucleus, whereas gliosis was observed in the periaqueductal gray (PAG) and striatum. Therefore, urinary retention may have resulted from involvement of the PAG. Phosphorylated TAR DNA binding protein 43 kDa (p-TDP-43)-positive inclusions were present in the peripheral nerves within the thoracic sympathetic ganglia, as well as the IML of the thoracic spinal cord. However, considering the lack of OH, the IML and peripheral sympathetic nerves unlikely played major roles. Furthermore, neuronal loss or p-TDP-43-immunoreactive deposits were absent in the Auerbach and Meissner plexuses of the rectum, suggesting that the responsible anatomical sites for fecal incontinence could not be found. Although it is difficult to elucidate the precise neuropathological lesions corresponding to LUT and bowel dysfunction, physicians need to recognize that neurogenic bladder and bowel dysfunction can occur in patients with ALS.
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Affiliation(s)
- Masataka Nakamura
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Kentaro Nakayama
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Aya Murakami
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Satoshi Morise
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Satoshi Kaneko
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Hirofumi Kusaka
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
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Ko JS, Corbett C, Fischer KM, Berry A, Weiss DA, Long CJ, Zderic SA, Van Batavia JP. Impact of Race, Gender, and Socioeconomic Status on Symptom Severity at Time of Urologic Referral. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01357-9. [PMID: 35960437 DOI: 10.1007/s40615-022-01357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The Dysfunctional Voiding and Incontinence Scoring System (DVISS) is a validated tool to evaluate lower urinary tract dysfunction (LUTD) severity in children. DVISS provides a quantitative score (0-35) including a quality-of-life measure, with higher values indicating more/worse symptoms. Clinically, variability exists in symptom severity when patients present to pediatric urology with LUTD. We hypothesized that symptom severity at consultation varied based on race, gender, and/or socioeconomic status. METHODS All urology encounters at a single institution with completed modified DVISS scores 6/2015-3/2018 were reviewed. Initial visits for patients 5-21 years old with non-neurogenic LUTD were included. Patients with neurologic disorders or genitourinary tract anomalies were excluded. Wilcoxon rank sum tests compared scores between White and Black patients and between male and female patients. Multiple regression models examined relationships among race, gender, estimated median household income, and insurance payor type. All statistics were performed using Stata 15. RESULTS In total, 4086 initial patient visits for non-neurogenic LUTD were identified. Median DVISS scores were higher in Black (10) versus White (8) patients (p < 0.001). Symptom severity was higher in females (9) versus males (8) (p < 0.001). When estimated median income and insurance payer types were introduced into a multiple regression model, race, gender, and insurance payer type were significantly associated with symptom severity at presentation. CONCLUSIONS Race, gender, and socioeconomic status significantly impact LUTS severity at the time of urologic consultation. Future studies are needed to clarify the etiologies of these disparities and to determine their clinical significance.
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Affiliation(s)
- Joan S Ko
- Division of Urology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Katherine M Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen A Zderic
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Jason P Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Uçan AB, Şencan A, Yaslı G, Polatdemir K, Payza AD, Dinçel N. Early endoscopic injection may prevent new scarring in idiopathic detrusor overactivity disorder with vesicoureteral reflux in children. Pediatr Surg Int 2022; 38:1075-1082. [PMID: 35507078 DOI: 10.1007/s00383-022-05129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present baseline characteristics and the long-term treatment results of three groups of patients with idiopathic detrusor overactivity (IDOD) and vesicoureteral reflux (VUR) according to different treatment regimens, which underwent endoscopic subureteric injection (STING) in the early phase of targeted treatment (TT) (ES group), underwent STING in the late phase of TT (LS group) and with TT only (TT group). PATIENTS AND METHODS A total of 49 IDOD cases with VUR which were divided into three groups according to treatment regimens were evaluated in terms of age, symptoms, bladder capacities, involuntary contraction pressures (ICP), presence and degree of renal scar, differential renal functions (DF), new scar formation and STING success. RESULTS There was no significant difference between the groups in terms of age, side, symptoms, presence of urinary tract infection (UTI), DF, ICP and bladder capacity at diagnosis. A high grade of reflux was found to be significantly lower in the TT group (p = 0.037). There was no significant difference in terms of ICP, DF, bladder capacity and reflux grade between ES and LS Group. But new scar formation was more in LS Group (p = 0.003). CONCLUSION The STING success is satisfactory in IDOD cases with VUR, waiting a long period of time for diminishing symptoms may cost new scar formation.
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Affiliation(s)
- Ayşe Başak Uçan
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Izmir, Turkey.
| | - Arzu Şencan
- Department of Pediatric Surgery, İzmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Gökben Yaslı
- İzmir Provincial Directorate of Health Non-Communicable Diseases Unit, Izmir, Turkey
| | - Kamer Polatdemir
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Izmir, Turkey
| | - Ayşe Demet Payza
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Izmir, Turkey
| | - Nida Dinçel
- Department of Pediatric Nephrology, İzmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
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Casal-Beloy I, García-Novoa MA, García González M, Acea Nebril B, Somoza Argibay I. Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children. J Pediatr Urol 2021; 17:644.e1-644.e10. [PMID: 34176749 DOI: 10.1016/j.jpurol.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/17/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays there is still no ideal treatment for paediatric overactive bladder. Initial management measures (urotherapy and constipation control), resolve 40% of cases. The second line of treatment in overactive bladder is anticholinergic drugs, above all oxybutynin. Although most patients improve with these therapies, the complete resolution rate is around 30-40%. Sacral transcutaneous electrical nerve stimulation has recently emerged as a new alternative in the management of patients with refractory paediatric overactive bladder. However, only a few studies have been done to compare the effectiveness of this therapy versus conventional drugs. OBJETIVE The objective of the present study is to compare, in children with overactive bladder, the efficacy of the sacral transcutaneous electrical nerve stimulation versus oxybutynin therapy. MATERIALS AND METHODS We performed a prospective and randomized study of patients with diagnosis of overactive bladder treated with sacral transcutaneous electrical nerve stimulation versus oxybutynin, during the period July 2018-July 2020. Patients refractory to standard urotherapy and constipation management randomly received one of the therapeutic alternatives. Treatment was maintained for 6 months. RESULTS 86 patients were included in the study: 40 patients received electrotherapy (group 1) and 46 patients received oxybutynin (group 2). Before starting the treatment assigned both groups were comparable related to the voiding symptomatology as well as the severity of the overactive bladder. Sacral transcutaneous electrical nerve stimulation was significantly more effective than oxybutynin, with a higher percentage of complete resolution of symptoms in the management of paediatric overactive bladder. VOIDING DIARY All the parameters obtained with the voiding calendar significantly improved in both groups at the end of the treatment. The increase in MaVV was significantly higher in group-1. DVISS (DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM) We observed a progressive decrease in the mean score obtained in the DVISS questionnaire over time in both groups. This decrease was significantly higher in group-1 compared to group-2 (p < 0.005). The mean value obtained in the DVISS questionnaire in group-1 was 6 (interquartile range: 3-9) at the end of the treatment (lower than the diagnostic cut-off point for daytime condition in the DVISS, 8.5). In group-2, the mean value obtained in the DVISS questionnaire was 10 (interquartile range: 8.75-13.25), higher than the cut-off point. COMPLICATIONS A greater number of adverse effects was obtained in group-2 (26.1% versus 15%, p < 0.05). Constipation (n: 6, 10.9%), and abdominal pain (n: 2,4.3%) were the most frequent adverse effects in this group. The adverse events reported in group-1 were contact dermatitis (n: 1.2%) and fecal losses [2] or urgency [5]. CONCLUSION Oxybutynin and sacral transcutaneous electrical nerve stimulation are both effective therapies in the management of paediatric overactive bladder. However, electrotherapy has been shown to be a more effective therapy with a complete clinical resolution rate in a larger number of patients. Furthermore, the rate of adverse effects secondary to electrotherapy is significantly lower than those treated with oxybutynin.
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Affiliation(s)
- Isabel Casal-Beloy
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - María Alejandra García-Novoa
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Miriam García González
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
| | - Benigno Acea Nebril
- Breast Unit, General Surgery Department, University Hospital of A Coruña. Praza Parrote, s/n, 15006, A Coruña, Spain.
| | - Iván Somoza Argibay
- Pediatric Urology Division, Pediatric Surgery Department, University Children´s Hospital of A Coruña. As Xubias, 84. CP: 15009, A Coruña, Spain.
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Akinci A, Baklaci CU, Oğuz ES, Kubilay E, Sanci A, Aydoğ E, Hajiyev P, Soygür T, Burgu B. Can lockdown and homeschooling change the outcome of urotherapy for lower urinary tract dysfunction in children? J Pediatr Urol 2021; 17:651.e1-651.e7. [PMID: 34183271 DOI: 10.1016/j.jpurol.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Lower urinary tract dysfunction (LUTD) are still important for both children and pediatric urologists. Urotherapy is recommended in LUTD treatment management. In our country, all citizens under the age of 20 were banned from going out of their homes due to Covid-19 and the homeschooling system has been adopted The aim of this study is to investigate the effect of lockdown and homeschooling on the effectiveness of urotherapy used for LUTD treatment. METHODS 83 patients were included in the study group. Besides 306 patients were determined as the control group (pre-Covid). The patients in the study group and the control group were compared in terms of improvement in Dysfunctional voiding and incontinence scoring system (DVISS), quality of life scores, bladder diary, Bristol stool scale, and treatment responses at 3rd and 6th months. RESULTS The study group and control group were compared in terms of DVISS, voiding frequency and incontinence in the voiding diary, quality of life score, and Bristol stool scale at admission visit and the group characteristics were similar. During the 6th month visit, the mean DVISS of the study group was found to be significantly lower (7.12 ± 3.48; 8.58 ± 4.06 respectively (p 0.002)). Daily voiding frequency was similar in the study group and the control group during the 2nd and 3rd visit. The study group's mean number of daily incontinence was significantly lower at visit 3 (0.57 ± 0.9; 0.94 ± 0.27, respectively (p 0.02).After six months of treatment, 13.3% of the study group patients had a complete response, 44.6% had a partial response, whereas 42.2% non-responders. In the control group, the response rates were as 5.9%, 39.2% and 54.9% respectively (p 0.02). CONCLUSIONS LUTD is still very common in pediatric urology. Standard urotherapy is widely used in treatment management. According to our results, the success of standard urotherapy increases with lockdown and homeschooling. We have shown that the success of standard urotherapy can be improved by regulating environmental conditions. In terms of LUTD management, environmental conditions can be regulated to provide a better quality of life and a better cure in a more economical way.
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Affiliation(s)
- Aykut Akinci
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey.
| | - Can Utku Baklaci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Efe Semetey Oğuz
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Eralp Kubilay
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Adem Sanci
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Ezel Aydoğ
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Hajiyev
- Department of Pediatric Urology, Guven Klinik Hospital, Baku, Azerbaijan
| | - Tarkan Soygür
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Cebeci Children's Hospital, Ankara, Turkey
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Zhuang H, Wang X, Xu H, Jing X, Yue J. Characteristics and risk factors of lower urinary tract dysfunction in patients with Parkinson's disease: A systematic evaluation and meta-analysis. Clin Neurol Neurosurg 2021; 209:106885. [PMID: 34455168 DOI: 10.1016/j.clineuro.2021.106885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
To systematically evaluate the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease(PD), and to provide theoretical basis for clinical medical staff to identify the risk factors of lower urinary tract dysfunction in patients with PD. From the establishment of the database to January 2021, PubMed, the Cochrane Library, EMBASE, Web of Science, other English database, were searched for literatures about the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease. According to the inclusion and exclusion criteria, after browsing the title, abstract and full text, the high-quality literature in line with the inclusion criteria was selected, and the Newcastle-Ottawa Scale(NOS)document quality evaluation tool was used to evaluate the literature quality and extract the data. The included research results were analyzed by RevMan 5.3 software. A total of 8 studies were included for Meta analysis. The results showed that 7 of the 20 related risk factors were statistically significant, and the statistically significant risk factors were duration of disease [Mean Difference (MD)= 0.59, 95% Confidence Interval (CI) (0.04, 1.14), P < 0.005], age [MD = 2.01, 95%CI (-0.36, 3.34), P < 0.005], Hoehn-Yahr (H-Y) score >2 [Odds Ratio (OR) = 1.56, 95%CI (1.09, 2.23), P < 0.001], sleep disorder [OR = 1.79, 95%CI (1.36,2.35), P < 0.001], constipation [OR = 1.88, 95%CI (1.42,2.48), P < 0.001], unified Parkinson's disease rating scale (UPDRS III) [MD= 4.43, 95%CI (2.20, 6.66), P < 0.001], Mini-mental state examination (MMSE) [MD = -1.16, 95%CI (1.23, -1.09), P < 0.001]. Age, duration of disease, H-Y score >2, sleep disorder, constipation, higher UPDRS Ⅲ score and lower MMSE score were the risk factors of lower urinary tract dysfunction in patients with Parkinson's disease.
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Affiliation(s)
- Hongxia Zhuang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
| | - Xueqi Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
| | - Hao Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
| | - Xiaolei Jing
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
| | - Jiajia Yue
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
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Cornwell LB, Ewing E, Algra J, Chiang GJ. Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy? J Pediatr Urol 2021; 17:527.e1-527.e7. [PMID: 34162517 DOI: 10.1016/j.jpurol.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. STUDY DESIGN All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. RESULTS 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13 h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. DISCUSSION Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. CONCLUSIONS Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
| | - Emily Ewing
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - Jeffrey Algra
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - George J Chiang
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
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20
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Turco AE, Oakes SR, Keil Stietz KP, Dunham CL, Joseph DB, Chathurvedula TS, Girardi NM, Schneider AJ, Gawdzik J, Sheftel CM, Wang P, Wang Z, Bjorling DE, Ricke WA, Tang W, Hernandez LL, Keast JR, Bonev AD, Grimes MD, Strand DW, Tykocki NR, Tanguay RL, Peterson RE, Vezina CM. A mechanism linking perinatal 2,3,7,8 tetrachlorodibenzo-p-dioxin exposure to lower urinary tract dysfunction in adulthood. Dis Model Mech 2021; 14:271057. [PMID: 34318329 PMCID: PMC8326766 DOI: 10.1242/dmm.049068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Benign prostatic hyperplasia/lower urinary tract dysfunction (LUTD) affects nearly all men. Symptoms typically present in the fifth or sixth decade and progressively worsen over the remainder of life. Here, we identify a surprising origin of this disease that traces back to the intrauterine environment of the developing male, challenging paradigms about when this disease process begins. We delivered a single dose of a widespread environmental contaminant present in the serum of most Americans [2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD), 1 µg/kg], and representative of a broader class of environmental contaminants, to pregnant mice and observed an increase in the abundance of a neurotrophic factor, artemin, in the developing mouse prostate. Artemin is required for noradrenergic axon recruitment across multiple tissues, and TCDD rapidly increases prostatic noradrenergic axon density in the male fetus. The hyperinnervation persists into adulthood, when it is coupled to autonomic hyperactivity of prostatic smooth muscle and abnormal urinary function, including increased urinary frequency. We offer new evidence that prostate neuroanatomical development is malleable and that intrauterine chemical exposures can permanently reprogram prostate neuromuscular function to cause male LUTD in adulthood. Summary: We describe a new mechanism of benign prostate disease, initiated by fetal chemical exposure, which durably increases prostatic noradrenergic axon density and causes smooth muscle hyperactivity and urinary voiding dysfunction.
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Affiliation(s)
- Anne E Turco
- Molecular and Environmental Toxicology Center, University of Wisconsin-Madison,Madison, WI 53705, USA
| | - Steven R Oakes
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Kimberly P Keil Stietz
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Cheryl L Dunham
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97331, USA
| | - Diya B Joseph
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
| | | | - Nicholas M Girardi
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Andrew J Schneider
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Joseph Gawdzik
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Celeste M Sheftel
- Cellular and Molecular Pharmacology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Peiqing Wang
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Zunyi Wang
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Dale E Bjorling
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - William A Ricke
- Department of Urology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Weiping Tang
- Department of Urology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Laura L Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Janet R Keast
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Adrian D Bonev
- Department of Pharmacology, University of Vermont, Burlington, VT 05405, USA
| | - Matthew D Grimes
- Department of Urology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Douglas W Strand
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Nathan R Tykocki
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI 58823, USA
| | - Robyn L Tanguay
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR 97331, USA
| | - Richard E Peterson
- Molecular and Environmental Toxicology Center, University of Wisconsin-Madison,Madison, WI 53705, USA.,School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Chad M Vezina
- Molecular and Environmental Toxicology Center, University of Wisconsin-Madison,Madison, WI 53705, USA.,Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53705, USA
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21
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Abstract
This article provides an introduction to patient selection for, and the processes involved in, sacral neuromodulation (SNM) device implantation as a treatment for urinary symptoms. SNM has been an option to treat lower urinary tract dysfunction for more than 20 years and is a treatment for both overactive bladder syndrome (OAB) and female non-obstructed chronic urinary retention (FCUR). It is recognised by the National Institute for Health and Care Excellence as a therapeutic option for OAB and FCUR. SNM has its place in the pathway for the treatment of both conditions and, in the correctly assessed patient, can be the last option before considering major surgical intervention.
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Affiliation(s)
- Nicholas Fletcher
- Urology Surgical Care Practitioner, Department of Urology, Salford Royal NHS Foundation Trust
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22
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Leitner L, Wanivenhaus F, Bachmann LM, Liechti MD, Aguirre JA, Farshad M, Kessler TM. Bladder management in patients undergoing spine surgery: An assessment of care delivery. N Am Spine Soc J 2021; 6:100059. [PMID: 35141624 PMCID: PMC8820009 DOI: 10.1016/j.xnsj.2021.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. METHODS Preoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. RESULTS Hundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p < 0.05). In the 46 preoperatively catheterized patients, re-catheterization was required in 6 (13%). In a fairly homogenous subgroup of 72 patients with a probability of PUC between 15 and 40%, no significant association between intraoperative urethral catheter-free management and the occurrence of PUC was found (odds ratio 2.09, 95% confidence interval 0.69 to 6.33; p = 0.193). CONCLUSIONS In case of postoperative PVR monitoring allowing de novo catheterization as appropriate, urethral catheter-free management seems to be a valuable option in spine surgery since it does not to increase PUC but minimizes unnecessary catheterizations with their related complications.
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Affiliation(s)
- Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Florian Wanivenhaus
- Spine Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - José A. Aguirre
- Department of Anesthesia, Intensive Care and Pain Therapy, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mazda Farshad
- Spine Division, Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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23
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Tateno F, Sakakibara R, Ogata T, Aiba Y, Takahashi O, Sugiyama M. The relationship between lower urinary tract function and 123ioflupane scintigraphy in drug-naïve Parkinson's disease. Auton Neurosci 2021; 233:102813. [PMID: 33894531 DOI: 10.1016/j.autneu.2021.102813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/28/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) is the most common degenerative cause of movement disorder, and autonomic dysfunction has been recognized in this disorder. PD patients' lower urinary tract (LUT) function is not established. We investigated LUT function in PD by single-photon emission computerized tomography (SPECT) imaging of the dopamine transporter with 123I-ioflupane and clinical-urodynamic observations. PATIENTS AND METHODS We retrospectively analyzed the cases of 30 patients diagnosed with PD based on published criteria who completed a systematized lower urinary tract symptoms (LUTS) questionnaire and a urodynamics examination irrespective of the presence of LUTS. None of the patients were taking anti-parkinsonian medication during the study. RESULTS The questionnaire revealed that all 30 patients had LUTS: night-time urinary frequency (in 70%), urinary incontinence (40%), and daytime urinary frequency (80%). A urodynamic study revealed a mean volume at the first sensation at 92.3 ml, bladder capacity at 200.9 ml, and detrusor overactivity in 50%. Sphincter electromyography revealed neurogenic change in 13.6% of those for whom the test was performed. The average SBR showed a significant correlation with bladder capacity (Spearman's correlation coefficient p = 0.0076) and Hoehn Yahr motor stage (Spearman's correlation coefficient p = 0.012). CONCLUSION Our findings demonstrate that the striatum is relevant to the higher control of storage in micturition function in PD.
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24
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Chen S, Wang S, Gao Y, Lu X, Yan J, Xuan L, Wang S. Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report. BMC Urol 2021; 21:37. [PMID: 33691669 PMCID: PMC7945661 DOI: 10.1186/s12894-021-00808-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00808-5.
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Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Xiaolian Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China.
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25
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Glykas I, Fragkoulis C, Mitsikostas DD, Papatsoris A, Mitsogiannis I, Papadopoulos G, Skolarikos A, Gkialas I, Ntoumas K, Dellis A. B3 agonists or anticholinergics in the treatment of the lower urinary tract dysfunction in patients with multiple sclerosis?-A randomized study. World J Urol 2021; 39:3049-56. [PMID: 33386947 DOI: 10.1007/s00345-020-03555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system. MS patients usually present with lower urinary tract dysfunction (LUTD). Objective of this study is to evaluate and compare the efficacy and safety of treating MS patients with LUTD with either a b3 agonist (mirabegron) or anticholinergics. The study's primary outcome is the LUTD symptom improvement. MATERIAL AND METHODS This is a multi-center, single-blinded, comparative study including 91 MS patients with LUTD. At baseline, patients underwent thorough clinical examination, urine cultivation and abdominal ultrasound and completed urination diaries and specific, validated questionnaires (NBSS, MusiQoL). At second visit, patients were administered either mirabegron or anticholinergics. Treatment was always carried out alongside with MS treatment. Reevaluation was performed 3 months after first visit. Patients underwent the same clinical and imaging tests that were carried out at first visit. RESULTS We compared several clinical and imaging parameters between the two groups at first visit and month 3 after treatment. Νo statistical difference was noted between the mirabegron group and the anticholinergic group in terms of LUTD improvement. In both groups, improvement from baseline regarding LUTD was recorded. Statistical analysis was performed using the paired and unpaired t test method. No patient discontinued either medication due to side effects. CONCLUSIONS MS patients receiving either mirabegron or anticholinergic therapy for LUTD showed improvement. Nevertheless, no statistical difference was noted between the two cohorts at 3 months in terms of drug efficacy in all the statistically significant parameters.
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26
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Marciano RC, Cardoso MGF, Vasconcelos MMA, Paula JJ, Oliveira EA, Lima EM. Depression, anxiety and quality of life impairment in parents of children with functional lower urinary tract dysfunction. J Pediatr Urol 2020; 16:838.e1-838.e7. [PMID: 33012646 DOI: 10.1016/j.jpurol.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is a common clinical condition in children, frequently associated with emotional issues both among the patients and their families. The objective of the present study was to measure depressive and anxious symptoms and quality of life (QoL) in parents of LUTD patients. METHODS This cross-sectional study applied Beck Depression and Anxiety Inventories and WHOQOL-Bref to 88 caregivers of children with LUTD followed at a tertiary care center. The prevalence of mental disorders in children and adolescents was assessed using the Child Behavior Check List (CBCL 6-18) answered by their caregivers. The association of clinical features and emotional aspects related to the caregivers' quality of life was evaluated through non-parametric correlation (Spearman) and multiple linear regression analysis. RESULTS Most of the caregivers were mothers (88%), with a mean age of 41.5 (SD 8.7 years), 67% of them married or in a stable union, and 38% had not completed elementary school. Considering 19 as the cutoff point for the Beck scale, 44% of the sample had a clinical score for depressive symptoms and 43% for anxious symptoms. According to the parents' report, 56% of children with LUTD had a clinical score for behavioral problems in CBCL. Parents' QoL was impaired, and the predictors of poor QoL were the age of the patients and presence of depressive/anxious symptoms in caregivers. Parents' depression/anxiety symptoms and poor QoL significantly correlated with behavioral problems in their children. The CBCL total problems score correlated both to depression (r = 0.38, p < 0.01) and to anxiety in parents (r = 0.49, p < 0.01) (Figure). CONCLUSIONS These findings indicate a possible emotional impact of LUTD in patients' caregivers. Our study suggests that an approach to the family of LUTD patients' may be an important therapeutic resource for an effective clinical control of this condition.
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Affiliation(s)
- Renata C Marciano
- Department of Psychiatry, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maíra Gloria F Cardoso
- Department of Psychology, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Monica M A Vasconcelos
- Division of Pediatric Nephrourology, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jonas J Paula
- Division of Pediatric Nephrourology, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eduardo A Oliveira
- Division of Pediatric Nephrourology, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Eleonora M Lima
- Division of Pediatric Nephrourology, School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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27
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Ke QS, Lee CL, Kuo HC. Recurrent urinary tract infection in women and overactive bladder - Is there a relationship? Tzu Chi Med J 2020; 33:13-21. [PMID: 33505873 PMCID: PMC7821830 DOI: 10.4103/tcmj.tcmj_38_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Overactive bladder (OAB) in women has similar symptomatology with other common urologic diseases such as recurrent urinary tract infection (UTI). Recent evidence showed that chronic low-grade bacterial bladder colonization might exacerbate OAB symptoms and could be the etiology of recurrent UTI. The high prevalence of lower urinary tract dysfunction is associated with OAB. Women with urgency urinary incontinence refractory to antimuscarinic therapy had more bacteria and a more diverse urinary microbiome. The bacterial reside in the superficial urothelial cells to form intracellular bacterial community and outbreak when the host innate immunity is low. Women with recurrent UTI are found to have highly prevalent voiding dysfunction and detrusor overactivity. These functional abnormalities will further damage the urothelial barrier integrity and create vulnerable to uropathogen invasion. The defective urinary microbiota is less common in women with recurrent UTI, suggesting that the normal flora in the urine might inhibit uropathogen growth and invasion. The defective urothelial barrier function, deficient basal proliferation, and deficient maturation might be owing to chronic suburothelial inflammation, resulting in activation of sensory nerves (causing OAB) and failure elimination of intracellular bacterial communities (causing recurrent UTI). Precision diagnosis and multidisciplinary treatment of the underlying pathophysiology of OAB and recurrent UTI is necessary.
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Affiliation(s)
- Qian-Sheng Ke
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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28
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Kopru B, Ergin G, Ebiloglu T, Kibar Y. Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective. J Pediatr Urol 2020; 16:38.e1-38.e7. [PMID: 31928898 DOI: 10.1016/j.jpurol.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunction (LUTD) is a situation that often disrupts the quality of life (QoL) of both the child and the family with daytime and nighttime incontinence. Although the first-line treatment option for children with LUTD is standard urotherapy, biofeedback therapy can be performed in children in which standard urotherapy failed. OBJECTIVE We studied the biofeedback success in children with LUTD according to parents' expressions. METHODS We retrospectively analyzed our hospital records of children who were diagnosed with LUTD between 2005 and 2017. In total, 281 patients, refractory to standard urotherapy were included into the study and directed to biofeedback treatment. Their parents completed the dysfunctional voiding symptom scores (DVSS) before and after biofeedback therapy. RESULTS At the end of the six-month follow-up period, all voiding disorders and voiding patterns were evaluated. According to DVSS, QoL tools before biofeedback treatment 48 (17%) parents appraised that LUTD caused no effect in their children's daily life, 104 (37.8%) expressed little effect, 89 (31%) moderate effect, and 40 (14.2%) serious effect. And, 120 (43%) parents expressed no effect, 95 (34%) little effect, 51 (18%) moderate effect, and 15 (5%) serious effect (P = 0.001) after biofeedback therapy. Biofeedback therapy affected positively the daily life of LUTD's family. The less serious the effect of LUTD on these children's family, the more success rate of biofeedback therapy. The effect of biofeedback therapy was less successful in moderated and serious affected families. CONCLUSIONS Biofeedback treatment is a non-invasive and effective treatment modality for improving the QoL for LUTD families who were less suffered from LUTD.
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Affiliation(s)
- Burak Kopru
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey.
| | - Giray Ergin
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
| | - Turgay Ebiloglu
- Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Koru Ankara Hospital, Ankara, Turkey
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Abello A, Badin J, Das AK. Worsening disability status in multiple sclerosis predicts urologic complications. Int Urol Nephrol 2020; 52:859-863. [PMID: 31983045 DOI: 10.1007/s11255-020-02381-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Multiple sclerosis (MS) causes voiding dysfunction and might predispose to urologic complications. However, long-term complications and risk factors for complications are unknown. We aim to assess long-term changes in voiding function and to determine risk factors for urologic complications during MS follow-up. METHODS We analyzed the records of MS patients and recorded baseline and follow-up voiding symptoms, urodynamic (UDS) findings, Expanded Disability Status Scale (EDSS), serum blood studies, imaging, and complications. T test and Chi-square test were used to determine statistical significance using a two-tailed p value < 0.05. We assessed complication-free survival using Kaplan-Meier curves and performed multiple variable Cox proportional hazard models to estimate hazard ratios predicting complications for various independent variables. RESULTS 126 women and 35 men with MS were followed for a median of 9.7 years (IQR 4.3-13). Mean age at MS diagnosis was 36.7 with a mean EDSS of 3.2. During follow-up, EDSS progressed to a mean of 5.5. In addition, at least one complication occurred in 60.2% and major complications were present in 16.7%. After multivariable analysis, EDSS progression ≥ 2.0 (p = 0.003), follow-up EDSS ≥ 6.0 (p = 0.01), use of intermittent catheterization (p < 0.001) and urinary reconstruction with continent catheterizable stoma (p = 0.009) were significantly related to an increased hazard for any complications. CONCLUSION Upper tract changes and other major complications were uncommon. Complications were related to MS progression, resultant increase in total disability, and the need for intervention to maintain functional continence. Lower tract infections occurred more frequently in patients with the need for catheterization.
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Affiliation(s)
- Alejandro Abello
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Badin
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb 440, Urology, Boston, MA, 02215, USA.
| | - Anurag K Das
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Rabb 440, Urology, Boston, MA, 02215, USA
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de Abreu GE, Dias Souto Schmitz AP, Dourado ER, Barroso U. Association between a constipation scoring system adapted for use in children and the dysfunctional voiding symptom score in children and adolescents with lower urinary tract symptoms. J Pediatr Urol 2019; 15:529.e1-529.e7. [PMID: 31494044 DOI: 10.1016/j.jpurol.2019.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A presumed association between more severe lower urinary tract symptoms (LUTS) and more severe functional constipation (FC) remains unconfirmed. Because the Rome IV criteria do not quantify FC, an adult constipation scoring system was modified and adapted for use in children. OBJECTIVES The objective of this study was to assess the correlation between FC severity as determined by the modified constipation scoring system and LUTS severity in children/adolescents and the correlation between this modified scoring system and the Rome IV criteria. STUDY DESIGN This was a cross-sectional study including 5- to 17-year-old patients with LUTS, with or without FC. Patients with neurological and/or anatomical abnormalities of the genitourinary and/or gastrointestinal tract were excluded. Girls with Dysfunctional Voiding Symptom Score (DVSS) ≥6 and boys with DVSS ≥9 were diagnosed with lower urinary tract dysfunction (LUTD). Patients with at least two positive Rome IV criteria were considered constipated. The severity of FC according to the adapted constipation scoring system was classified as mild for scores of 1-10, moderate for scores 11-20, and severe for scores 21-30. RESULTS Of 128 patients with LUTS, 71 (55.5%) were female. Lower urinary tract dysfunction was detected in 107 patients (83.6%) and was more common in girls. Functional constipation was present in 80 patients (62.5%). Constipated children had higher constipation scores and DVSS, with both scores increasing with the severity of FC. Correlation was moderate between the constipation score and the DVSS (þ = 0.5, p < 0.001) and was strong between positivity for a greater number of Rome IV criteria and the constipation score (þ = 0.7, p < 0.001). Most of the constipated patients had mild or moderate FC, while in 30 non-constipated patients, the constipation score indicated mild FC. DISCUSSION Patients from a specialist center are more likely to have more severe medical problems, and this may have influenced the correlation between the scores. The modifications made to the constipation scoring system require a future validation study. Nevertheless, this study provides new data on urinary dysfunction and its association with FC and highlights the need to investigate occult bowel symptoms that could affect the treatment of urinary dysfunction. CONCLUSION The intensity of FC as measured by the modified constipation scoring system correlated with the severity of the urinary symptoms in children/adolescents with LUTS/LUTD. In constipated patients, there was a correlation between the modified constipation scoring system and the Rome IV criteria. In non-constipated patients, the constipation scoring system identified symptoms/signs of bowel dysfunction not picked up by the Rome IV criteria. Finally, constipation score modified for use in children and adolescents could be important for research purpose and particularly having a prognostic importance.
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Affiliation(s)
- G E de Abreu
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - A P Dias Souto Schmitz
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - E R Dourado
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - U Barroso
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Federal University of Bahia, Salvador, Bahia, Brazil.
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Nardone R, Versace V, Sebastianelli L, Brigo F, Golaszewski S, Christova M, Saltuari L, Trinka E. Transcranial magnetic stimulation and bladder function: A systematic review. Clin Neurophysiol 2019; 130:2032-7. [PMID: 31541980 DOI: 10.1016/j.clinph.2019.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed at assessing the usefulness of motor evoked potentials (MEPs) for exploring the integrity of striated sphincters and pelvic floor motor innervation in normal subjects and of repetitive transcranial magnetic stimulation TMS (rTMS) in patients with neurogenic bladder dysfunction. METHODS A systematic literature search was conducted using PubMed and Embase. RESULTS We identified, reviewed and discussed 11 articles matching the inclusion criteria. CONCLUSIONS The assessment of MEPs could represent a useful tool in the investigation of patients with urologic disorders. High frequency rTMS can improve detrusor contraction and/or urethral sphincter relaxation in patients with multiple sclerosis and bladder dysfunction. Low frequency (LF) rTMS seems to be an effective treatment of neurogenic lower urinary tract dysfunctions in subjects with Parkinson's disease and possibly other neurodegenerative disorders. Furthermore, rTMS might have the potential to restore bladder and bowel sphincter function after incomplete spinal cord injury. LF rTMS could also relieve some symptoms of bladder pain syndrome and chronic pelvic pain. SIGNIFICANCE The clinical applicability of MEPs appears to be questionable, since a poor reproducibility was detected for all pelvic floor muscles. The use of rTMS in this field is emerging and the results of a few preliminary studies should be replicated in controlled, randomized studies with larger sample sizes.
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Bentellis I, Amarenco G, Gamé X, Jericevic D, El-Akri M, Voiry C, Freton L, Hascoet J, Alimi Q, Kerdraon J, Brucker BM, Peyronnet B. Diagnosis and treatment of urinary and sexual dysfunction in hereditary TTR amyloidosis. Clin Auton Res 2019; 29:65-74. [PMID: 31452024 DOI: 10.1007/s10286-019-00627-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 08/02/2019] [Indexed: 01/08/2023]
Abstract
Purpose We aimed to review the current knowledge on the epidemiology, diagnosis, and management of urinary and sexual dysfunction in patients with TTR amyloidosis (ATTR). Methods We performed a review of the literature, screening for randomized controlled trials, prospective and retrospective series, position papers, and guidelines on urinary and sexual dysfunction in ATTR patients published in PubMed and Embase. Results Lower urinary tract dysfunction is present in up to 83% of patients with ATTR. Voiding symptoms are the most common, reported in 34.8−87.5% of patients, while urinary tract infections are reported in up to 50%. Urinary incontinence is observed in 16.7−37.5% of the ATTR population, mostly due to decreased urethral resistance. Sexual dysfunction affects over 40% of ATTR patients, with erectile dysfunction and sexual arousal disorder being the most common symptoms in male and female patients, respectively. In addition to a thorough clinical examination, invasive pressure-flow urodynamic testing is a cornerstone in the assessment of ATTR lower urinary tract dysfunction. The most common finding is detrusor underactivity and intrinsic sphincter deficiency. Poor bladder compliance can also be observed in patients, due to amyloid deposits on the bladder wall. Urinary tract imaging may be of interest to rule out upper urinary tract deterioration. Given the paucity of data in the ATTR population, treatment should be tailored to the individual patient. Conclusion Urinary and sexual dysfunction are highly prevalent in ATTR patients. Comprehensive assessment and multidisciplinary management are keys to avoiding upper urinary tract damage and improving patients’ quality of life.
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Dourado ER, de Abreu GE, Santana JC, Macedo RR, da Silva CM, Rapozo PMB, Netto JMB, Barroso U. Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study. J Pediatr Urol 2019; 15:376.e1-376.e7. [PMID: 31471270 DOI: 10.1016/j.jpurol.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND An association has been found between lower urinary tract dysfunction (LUTD) and emotional and behavioral problems, particularly in cases of urinary incontinence. Other associated symptoms and the coexistence of functional constipation require further investigation. OBJECTIVE To assess whether emotional and behavioral problems are more common in children and adolescents with LUTD. STUDY DESIGN A multicenter, cross-sectional, population-based study conducted in public places. Parents answered questions on urinary and psychological symptoms in their children aged 5-14 years. Children/adolescents with neurological problems or anatomical urinary tract abnormalities were excluded. The Dysfunctional Voiding Scoring System was used for assessing urinary symptoms, the Rome III Diagnostic Criteria for evaluating bowel symptoms, and the Strengths and Difficulties Questionnaire (SDQ) for evaluating emotional and behavioral problems. RESULTS Of the 806 children/adolescents included, 53% were female. The mean age was 9.1 ± 2.7 years. The prevalence of LUTD was 16.4%. Overall, 26.2% had abnormal scores in the overall SDQ scale, 29.2% in the emotional problems subscale, and 30% in the conduct problems subscale. Of the children with LUTD, 40.5% screened positive for emotional/behavioral problems, with a significant association being found for the overall SDQ scale (P < 0.001) and for the emotional problems (P < 0.001), conduct problems (P < 0.001), and hyperactivity (P = 0.037) subscales. Urinary urgency, urinary incontinence, and voiding postponement were significantly associated with a greater prevalence of abnormalities in the overall SDQ score (P = 0.05; P = 0.004, and P = 0.012, respectively). Bladder and bowel dysfunction was an aggravator of emotional and behavioral problems, with more intense symptoms, both in the overall SDQ scale and in the subscales. In the multivariate analysis, the factors independently associated with the presence of emotional and behavioral problems were LUTD (odds ratio [OR] = 1.91), constipation (OR = 1.7), studying in a government-funded school (OR = 2.2), and poor education of the head of the family (OR = 1.9). CONCLUSIONS Children and adolescents with LUTD have more emotional and behavioral problems, with bladder and bowel dysfunction being an aggravating factor for this association.
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Affiliation(s)
- E R Dourado
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - G E de Abreu
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - J C Santana
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - R R Macedo
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - C M da Silva
- Federal University of Juiz de Fora, SUPREMA, Juiz de Fora, Brazil
| | - P M B Rapozo
- Federal University of Juiz de Fora, SUPREMA, Juiz de Fora, Brazil
| | - J M B Netto
- Federal University of Juiz de Fora, SUPREMA, Juiz de Fora, Brazil
| | - U Barroso
- Clinic for Urinary Disorders in Childhood (CEDIMI), Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil.
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Hu M, Lai S, Zhang Y, Liu M, Wang J. Sacral Neuromodulation for Lower Urinary Tract Dysfunction in Spinal Cord Injury: A Systematic Review and Meta-Analysis. Urol Int 2019; 103:337-343. [PMID: 31362290 DOI: 10.1159/000501529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the intervention effect of sacral neuromodulation (SNM) in the treatment of lower urinary tract dysfunction after spinal cord injury (SCI). METHODS We selected relevant studies published between January 1, 1971 and November 15, 2018 by searching the PubMed, EMBASE, Cochrane databases. The outcome was assessed as follows: patients who had at least 50% improvement in bladder diary variables (number of leakages, pad use, number of voids, number of catheterizations, and so on). All analyses were performed with R software (version 3.5.1). We used Cochran's Q test and I2 statistics to evaluate the heterogeneity. RESULTS A total of 8 articles met all inclusion criteria for the systematic review. According to the Oxford Centre for Evidence-Based Medicine hierarchy, the evidence levels ranged from 2b to 4. During the test phase of SNM, we considered 108 patients. During the test phase, the merged success rate was 45% (95% CI 36-55%, p = 0.23, I2 = 31%). Overall, 99 patients were considered during the permanent implantation phase of SNM; the mean follow-up time ranged from 8.4 to 61.3 months, and the merged success rate of the permanent SNM phase was 75% (95% CI 64-83%, p = 0.46, I2 = 0%). All the reported adverse events were resolved. CONCLUSIONS Based on current evidence, the success rate of the test phase of SNM for LTUD in SCI patients was low, but in the permanent phase, the success rate of SNM was optimistic. In the future, well-designed randomized controlled trial with adequate sample sizes and power are necessary to validate the efficacy and safety of SNM.
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Affiliation(s)
- Maolin Hu
- Peking University Fifth School of Clinical Medicine, Beijing, China.,Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Shicong Lai
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jianye Wang
- Peking University Fifth School of Clinical Medicine, Beijing, China, .,Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China,
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Somoza Argibay I, Méndez Gallart R, Casal Beloy I, García González M. [Urinary incontinence and lower urinary tract dysfunction prevalence in schoolchildren: risk factors]. Cir Pediatr 2019; 32:145-149. [PMID: 31486307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Recently, many papers report an increase of pediatric lower urinary tract dysfunction (LUTD), which affects 10-15% of schoolchildren. Recent life style and dietary changes have been postulated as the cause of that high prevalence. There is a lack in epidemiological investigations about bowel and bladder dysfunctions and the risk factors. We aim to know the LUTD prevalence and the main risk factors. We carry out an observational and transversal investigation with a representative sample of our pediatric schoolchildren (N=1,069). We used a questionnaire about toilet training habits, social, familiar, and dietary data. We also used the PLUTSS (Pediatric Lower Urinary Tract Symptoms Score) questionnaire after validation of the Spanish version. The logistic regression analysis determined the main risk factors of DTUI. Results showed that boys get toilet trained later than girls (2.41 vs. 2.25) and the rate of incontinence is greater than girls when they start on the school. 31.9% of children remove their diapers to get into school. The prevalence was 15% for diurnal urinary incontinence and 12.2% nocturnal, DTUI 8.3%, constipation 20%, faecal incontinence 2.8%, ITUs 12.4%, retention habits 39.8%. 28.7% of children with DTUI refer psychological affectation. The main independent predictors were: male sex (OR 1.87), younger children (OR 0.78), forced toilet training (OR 2.14), constipation (OR 1.61) and holding habits (OR=3.87). This study showed a high prevalence of bladder in our pediatric population. Male gender, voiding postposition, early schooling or constipation were the main risk factors. The knowledge of the bladder and bowel dysfunction prevalence and the toilet training habits in our Community lets us to conclude school, family and primary care recommendations. This will let to prevent this so much prevalent disease.
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Affiliation(s)
| | - R Méndez Gallart
- Servicio de Cirugía Pediátrica. Complexo Hospitalario de Santiago de Compostela
| | - I Casal Beloy
- Servicio de Cirugía Pediátrica. Complexo Hospitalario A Coruña
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Bentellis I, El-Akri M, Hascoet J, Alimi Q, Mathieu R, Vincendeau S, Kerdraon J, Voiry C, Manunta A, Peyronnet B. Determinants and prognostic value of post-operative maximum urethral closure pressure after artificial urinary sphincter in men. World J Urol 2020; 38:1303-9. [PMID: 31346759 DOI: 10.1007/s00345-019-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the determinants and prognostic value of post-operative maximum urethral closure pressure (MUCP) after AUS implantation in male patients. METHODS The charts of all male patients who had an AUS implantation between 2008 and 2018 at a single center were reviewed retrospectively for an exploratory study. A post-operative urethral profilometry was performed systematically as part of routine daily practice over the study period to assess the post-operative MUCP with the AUS consecutively closed (c-MUCP) and opened (o-MUCP). The difference between c-MUCP and the manufacturer's theoretical pressure objective determined by the pressure regulating balloon (PRB) was calculated (diff-th-MUCP). The primary endpoint was social continence at 3 months defined as 0-1 protection/day. RESULTS Ninety patients were included. The median age was 71 years, and the median follow-up was 50 months. The etiology of incontinence was radical prostatectomy in 84% of cases, and endoscopic prostate surgery in 6.6% of patients. There were 74.4% of patients who were socially continent at 3 months. The c-MCUP was significantly higher in the continent group (53 [42.2, 60.2] vs 62 [58, 70] p = 0.02). The diff-th-MUCP did not differ significantly between the two groups (18 [0, 23] vs 1 [- 2, 7.7] p = 0.29). The c-MUCP was not statistically associated with the risk of revision and/or explantation. CONCLUSION The MUCP after AUS implantation in male patients often differs from the manufacturer's pressure objective. The postoperative c-MUCP might be significantly associated with functional outcomes suggesting that it might be a valuable tool for treatment decision-making. This should be confirmed by larger studies.
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Hsu CK, Chang HH, Yang SSD. The aging effects on phenylephrine-induced relaxation of bladder in mice. Tzu Chi Med J 2019; 32:26-29. [PMID: 32110516 PMCID: PMC7015013 DOI: 10.4103/tcmj.tcmj_178_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/20/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022] Open
Abstract
Objective: We have demonstrated that phenylephrine (PE) activates the capsaicin-sensitive nerves, and then activates capsaicin-sensitive nerves to release an unknown substance that facilitates the release of norepinephrine (NE) from adrenergic nerves. Subsequently, NE stimulates β-ARs in the detrusor muscle in mice, leading to neurogenic relaxation of the urinary bladder (UB). Materials and Methods: We examined if there existed sensory-motor dysfunction in UB of aging mice. To investigate the change of PE-induced detrusor relaxation in aging male-C57BL/6 mice (12- vs. 24-month-old mice), UB strips from mice were isolated, cut into strips, and mounted in the organ bath. Results: The UB strip contractility responding to various agents was estimated using tissue bath wire myography. Acetylcholine (ACh) and KCl-induced UB strips contraction was not significantly different between 24- and 12-month mice. NE-induced UB strips relaxation was significantly lower in 24-month than 12-month mice. Denuded bladder strips showed similar decreased relaxation response to NE. This NE-induced relaxation was inhibited by silodosin and lidocaine. PE did not induce contraction in UB strips of aging mice. In contrast, PE-induced relaxation was weaker in 24-month than 12-month mice. Conclusion: Our results suggested that the PE-induced relaxation was age related. Aging seemed to lead the sensory-motor dysfunction. More animal and human studies are required to prove this concept and its clinical usefulness in the future.
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Affiliation(s)
- Chun-Kai Hsu
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Hsi-Hsien Chang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Tutolo M, Ammirati E, Van der Aa F. What Is New in Neuromodulation for Overactive Bladder? Eur Urol Focus 2018; 4:49-53. [PMID: 29773501 DOI: 10.1016/j.euf.2018.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
Abstract
We reviewed the available studies on efficacy and safety of percutaneous tibial nerve stimulation (PTNS) and sacral nerve modulation (SNM) for overactive bladder (OAB) symptoms not responsive to conservative treatments. We limited our search to randomized trials, in English, with at least 20 adult patients, and 6 mo and 12 wk of follow-up for SNM and PTNS, respectively, published between January 1998 and December 2017. Therapeutic success ranges from 61% to 90% for SNM and from 54% to 79% for PTNS. Both techniques are effective and safe, with no life-threatening adverse effects. PTNS is a less invasive technique that gives good results in short time with fewer side effects. PATIENT SUMMARY Sacral nerve modulation and percutaneous tibial nerve stimulation are effective and safe in patients with overactive bladder syndrome not responsive to standard medical therapy.
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Bamoudou N, Desvergee A, Leroy F, Parienti JJ, Ruet A. [ Lower Urinary Tract Dysfunction (LUTD) in institutionalized handicapped adults]. Prog Urol 2019; 29:235-245. [PMID: 30685407 DOI: 10.1016/j.purol.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the prevalence and the management of the lower urinary tract dysfunction (LUTD) in institutionalized handicapped adults. MATERIALS AND METHODS Descriptive transversal observational study. Epidemiological study. RESULTS In this study realized in 150 residents of 6 nursing homes for adult, the prevalence of LUTD in institutionalized handicapped adults was 88.67% (133/150). This prevalence was 91.36% (74/81) for women versus 85.51% (59/69) for men, (P=0.260); 93.33% (14/15) in medical housing units [foyer d'accueil médicalisé (FAM)] versus 88.15% (119/135) in specialized housing units [maison d'accueil spécialisé (MAS)], (P=1); 80% (52/65) for those who walked without technical support, 89.47% (17/19) for those who walked with technical support, 98.08% (51/52) for the wheelchair users who were not able to walk, and 92.86% (13/14) for those who were not able to walk or to use wheelchair, (P=0.004); 69.81% (37/53) for those who were able to signal the need to void versus 98.97% (96/97) for those who were not able, (P=0.0000003); 76.92% (50/60) for those who were able to realize the transfers independently, versus 97.65% (83/85) for those who were not able, (P=0.0002); 67.39% (31/46) for those who could dress and undress by themselves versus 98.08% (102/104) for those who could not, (P=0.0000002); 77.27% (17/22) for water intake>2L, 91.67% (55/60) between 1.5 and 2L, 87.5% (49/56) between 1 and 1.5L, and 100% (12/12) for water intake<1L, (P=0.170). The LUTD were more frequent in people with physical disability (OR=10.70[1.53-75.09], P=0.017), in those with mental disability (OR=5.85[1.39-24.67], P=0.016), and in those with urological comorbidity (OR=9.70[1.25-75.55], P=0.03). For the management of the LUTD, the prevalence of expert medical advice was 9.77%, 24.81% (33/133) for the further examination, 16.54% (22/133) for rehabilitation treatment, 6.77% (9/133) for drug treatment, 2.26% (3/133) for surgical treatment, and 82.71% (110/133) for medical device. CONCLUSION In this study, the prevalence of LUTD in institutionalized handicapped adults was 88.67%. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Bamoudou
- Service de médecine physique et de réadaptation (MPR), centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
| | - A Desvergee
- Service de médecine physique et de réadaptation (MPR), centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
| | - F Leroy
- Service de médecine physique et de réadaptation (MPR), centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Réseau et service pour une vie autonome (RSVA) Normandie, 2, rue Jean-Perrin, campus Effiscience, bâtiment Innovaparc, 14460 Colombelles, France.
| | - J-J Parienti
- Unité biostatistique et recherche clinique (UBRC), centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
| | - A Ruet
- Service de médecine physique et de réadaptation (MPR), centre hospitalier universitaire de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
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Marciano RC, Cardoso MGF, Vasconcelos MA, Paula JJ, Pinho NC, Oliveira AC, Oliveira EA, Lima EM. Behavioral disorders and impairment of quality of life in children and adolescents with lower urinary tract dysfunction. J Pediatr Urol 2018; 14:568.e1-568.e7. [PMID: 30190220 DOI: 10.1016/j.jpurol.2018.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is a broad term describing the full spectrum of disorders in any of the stages of bladder function-storage or voiding LUTD is a clinical condition associated with emotional and behavioral disorders in children. This cross-sectional study aimed to investigate the association of emotional and behavioral symptoms and their impact on the quality of life (QoL) in children and adolescents with LUTD. METHODS Eighty-eight patients and their parents enrolled in an interdisciplinary program for children and adolescents with LUTD were included in the analysis. Child Behavior Checklist (CBCL) was used to estimate the prevalence of behavioral and emotional problems through the assessment of 14 items. Pediatric Quality of Life Inventory (versions for parents and children) was applied in the versions for parents and children to evaluate the QoL. The Pediatric Quality of Life Inventory-PedsQL, version 4.0-was applied separately for parents and patients. The association of clinical variables and aspects related to QoL of patients were evaluated through non-parametric correlations (Spearman) and multiple linear regression analysis. RESULTS According to CBCL's clinical scores, 56% of the patients showed total behavioral problems, 55% internalizing, and 38% externalizing. When comparing the conditions of LUTD and the CBCL scores, patients with voiding postponement had the lowest rates of total problems (P = 0.036). Children and adolescents with LUTD who also had enuresis showed a higher frequency of externalizing problems (P = 0.001), especially aggressive behavior (P = 0.013). Scores of patients with LUTD were significantly lower in all domains of QoL than normative data. Presence of behavioral problems was associated with worse QoL in all evaluated aspects. The total QoL was most influenced by the CBCL school competence scale according to the regression model analysis. CONCLUSIONS The study findings suggest the relevance of evaluation of behavioral and social repercussions of LUTD to improve the multidisciplinary approach for this condition in pediatric population.
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Affiliation(s)
- R C Marciano
- Department of Psychiatry, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - M G F Cardoso
- Department of Psychology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - M A Vasconcelos
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - J J Paula
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - N C Pinho
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - A C Oliveira
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - E A Oliveira
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - E M Lima
- Division of Pediatric Nephrourology, School of Medicine, Hospital Das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Abstract
PURPOSE OF REVIEW To present the available literature pertaining to the management of lower urinary tract symptoms (LUTS) after pelvic radiation (RT) in female patients treated for pelvic malignancy. RECENT FINDINGS Recent publications have focused on isolating de novo RT-induced LUTS in women from other contributors to urinary symptoms such as pelvic surgery and chemotherapy. There is a paucity of literature on the treatment of RT-related changes to urinary function. The treatment of pelvic malignancies in women alters voiding function. RT contributes to the deterioration of voiding function. More study is needed to evaluate the efficacy of available therapies.
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Affiliation(s)
- Laura S Leddy
- Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY, 10065, USA.
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Al-Azzawi IS, Al-Tamimi MAJ. The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction. Arab J Urol 2018; 16:391-396. [PMID: 30534437 PMCID: PMC6277263 DOI: 10.1016/j.aju.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022] Open
Abstract
Objectives To present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate. Patients and methods In this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables. Results The mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure. Conclusion SNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.
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Abstract
PURPOSE OF REVIEW Urinary dysfunction is a common entity in patients undergoing radical pelvic surgery for non-urologic malignancies. These dysfunctions may manifest as lower urinary tract symptoms (LUTS) or signs such as urinary retention or leakage. Review of current literature is performed to describe the differing urinary dysfunctions that manifest after colorectal resection, hysterectomy, and sacrectomy. RECENT FINDINGS Conventional radical surgery for pelvic malignancies often will result in debilitating functional problems. As advances in surgical techniques and management options become more available, patients can have better functional outcomes, specifically in the lower urinary tract. Nerve-sparing techniques as well as vascular preservation are becoming more important to preserve function as patient survival is improving. Additionally, newer methods are being explored, such as nerve stimulation for those who are unable to empty adequately. This article also addresses different management options for specific voiding dysfunction that may result from pelvic surgery. Preventative strategies such as nerve preservation during surgery are an important concept to prevent urinary dysfunction. The goal to good functional outcomes includes maintaining reservoir compliance and capacity as well as allowing proper outlet for voiding. We discuss different modalities to help achieve a functional lower urinary tract for patients with lower urinary tract dysfunction after pelvic surgery.
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Affiliation(s)
- Felix Cheung
- Department of Urology, NYU Winthrop University, Mineola, NY, 11501, USA.,Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jaspreet S Sandhu
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Urology, Weil Cornell Medical College, New York, NY, 10065, USA.
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Wang MK, Chuang KW, Li Y, Gaither T, Brakeman P, Gonzalez L, Brennan J, Baskin LS. Renal function outcomes in pediatric patients with symptomatic reflux into the transplanted kidney treated with redo ureteroneocystostomy. J Pediatr Urol 2018; 14:275.e1-275.e5. [PMID: 29605164 DOI: 10.1016/j.jpurol.2018.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Asymptomatic post-renal transplant reflux is common but only 5-10% patients are diagnosed with vesico-ureteral reflux in the setting of post-transplant febrile urinary tract infections, requiring redo ureteroneocystostomy (redo-UNC). Here we report the renal function outcomes of 37 such patients, stratified by lower urinary tract (LUT) status. OBJECTIVE We hypothesized that those with pre-transplant LUT dysfunction would have lower glomerular filtration rate (GFR) on follow-up. STUDY DESIGN Using procedure codes, 37 patients who underwent renal transplant followed by redo-UNC for transplant reflux at our institution between 1991 and 2014 were identified. Patient characteristics and GFR levels from four different time points were recorded. Comparisons were made between those with and without LUT dysfunction, using Fisher's exact, Wilcoxon rank sum, or signed-rank tests. Generalized estimating equations were constructed to account for the clustered nature of GFR within each LUT group and to assess their change over time. RESULTS Twelve patients (32%) had pre-transplant LUT dysfunction. The proportion of males in this group was significantly higher (75% vs. 32%, p = 0.032), and there was no statistical difference towards presenting earlier with post-transplant reflux (1.4 vs. 2.3 years, p = 0.087). After an average of 4.9 years, the median GFRs were similar between the two groups (53 mg/dL vs. 58 mg/dL, p = 0.936). There was no significant difference in GFR at this last follow-up time point in patients with and without LUT dysfunction. DISCUSSION Vesicoureteral reflux in the setting of renal transplantation is common and doesn't often require repair. In our series, we found that those with LUT dysfunction did not present statistically sooner with symptomatic transplant reflux. Longer-term follow-up did show a decline in GFR but did not reveal a difference in GFR in patients' with and without LUT dysfunction. CONCLUSIONS Pediatric post-transplant GFR after open redo ureteral reimplant decreases over time in similar fashion in patients with symptomatic reflux regardless of whether they have LUT dysfunction or normal anatomy. Vigilance should apply to the recognition, treatment, and follow-up of all symptomatic transplant reflux regardless of LUT status.
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Affiliation(s)
- Mary K Wang
- Department of Urology, University of California, San Francisco, CA, USA.
| | - Kai-Wen Chuang
- Department of Urology, University of California, San Francisco, CA, USA
| | - Yi Li
- Department of Urology, University of California, San Francisco, CA, USA
| | - Thomas Gaither
- Department of Urology, University of California, San Francisco, CA, USA
| | - Paul Brakeman
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Lynette Gonzalez
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Jessica Brennan
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Laurence S Baskin
- Department of Urology, University of California, San Francisco, CA, USA
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Tutolo M, Ammirati E, Heesakkers J, Kessler TM, Peters KM, Rashid T, Sievert KD, Spinelli M, Novara G, Van der Aa F, De Ridder D. Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature. Eur Urol 2018; 73:406-418. [PMID: 29336927 DOI: 10.1016/j.eururo.2017.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 11/03/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment. OBJECTIVE To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments. EVIDENCE ACQUISITION A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up. EVIDENCE SYNTHESIS Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effects in patients submitted to PTNS. CONCLUSIONS Neuromodulation gives good results and is a safe therapy for patients with overactive bladder or chronic nonobstructive urinary retention with long-lasting efficacy. Moreover, PTNS has been shown to have good success rates and fewer side effects compared with SNM. These data have to be confirmed with long-term follow-up. PATIENT SUMMARY Sacral neuromodulation can improve low urinary tract symptoms in selected patients; it appears to be a safe therapy for nonresponders to standard medical therapies. Percutaneous tibial nerve stimulation (PTNS) is a less invasive technique that gives good results in short time with fewer side effects. However, we must consider that PTNS has not been tested in the long term and results are lower if compared with SNM.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Enrico Ammirati
- Department of Urology, Ospedale San Giovanni Battista, Turin, Italy
| | - John Heesakkers
- Department of Urology 610, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Tina Rashid
- Functional Urology and Gender Services, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Karl-Dietrich Sievert
- University of Rostock Urology Clinic, Rostock, Germany; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Michele Spinelli
- Spinal Unit, Division of Neurourology, A. Zanollo Center for Sacral Area Disfunction, Ospedale Niguarda, Milan, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Clothier JC, Wright AJ. Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment. Pediatr Nephrol 2018; 33:381-94. [PMID: 28567611 DOI: 10.1007/s00467-017-3679-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Fernández-Ibieta M, Rojas Ticona J, Villamil V, Guirao Piñera MJ, López García A, Zambudio Carmona G. Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations. Actas Urol Esp 2017; 41:596-601. [PMID: 28366522 DOI: 10.1016/j.acuro.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/26/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. PATIENTS AND METHODS A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. RESULTS We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints). CONCLUSIONS The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps») can experience a greater diagnostic yield or positive predictive value.
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Arlen AM, Cooper CS, Leong T. Role of body mass index in school-aged children with lower urinary tract dysfunction: Does weight classification predict treatment outcome? J Pediatr Urol 2017; 13:454.e1-454.e5. [PMID: 28483466 DOI: 10.1016/j.jpurol.2017.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lower urinary tract (LUT) dysfunction comprises a large percentage of pediatric urology referrals. Childhood obesity is a major health concern, and has been associated with voiding symptoms. We assessed the impact of body mass index (BMI) on treatment outcomes of children presenting with LUT or bladder-bowel dysfunction (BBD). STUDY DESIGN Children aged 5-17 years diagnosed with non-neurogenic LUT dysfunction and no prior urologic diagnoses were identified. Patient demographics including BMI, lower urinary tract symptoms, constipation, medical and psychologic comorbidities, imaging, and treatment outcomes were evaluated. BMI was normalized by age and gender according to percentiles: underweight < 5th, healthy 5th to <85th, overweight 85th to <95th, and obese > 95th percentile. Uni- and multivariate analyses were performed to identify predictors of treatment response. RESULTS During an 18-month period, 100 children (54 girls, 46 boys) met the inclusion criteria. The mean age at diagnosis was 7.7 ± 2.4 years, and mean length of follow-up 15.3 ± 13.1 months. Sixty-nine patients were a normal weight, 22 were overweight, and nine were obese. Fifteen percent of the children had complete treatment response, 63% partial response, and 22% non-response. On univariate analysis, children with elevated BMI (p = 0.04) or history of urinary tract infection (p = 0.01) were statistically more likely to not respond to treatment. Controlling for all other variables, children with BMI > 85th percentile had 3.1 times (95% CI 1.11-8.64; p = 0.03) increased odds of treatment failure (Table). DISCUSSION BBD management includes implementation of a bowel program and timed voiding regimen, with additional treatment modalities tailored on the basis of the prevailing symptoms. We observed that school-aged children with a BMI ≥ 85th percentile were over three times more likely to experience treatment failure when controlling for all other patient characteristics including constipation and a history of urinary tract infection. Limitations of the study include the relatively small sample size, lack of uroflow with electromyography to confirm the presence or the absence of detrusor sphincter dyssynergia, and inconsistent anticholinergic dosing. CONCLUSIONS Nearly one-third of school-aged children presenting to our institution with LUT or BBD were overweight or obese when normalized for age and gender. Children with LUT dysfunction and elevated BMI are significantly less likely to experience treatment response.
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Affiliation(s)
- Angela M Arlen
- Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Christopher S Cooper
- Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Traci Leong
- Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA
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Fraga LGA, Sampaio A, Boa-Sorte N, Veiga ML, Nascimento Martinelli Braga AA, Barroso U. Obesity and lower urinary tract dysfunction in children and adolescents: Further research into new relationships. J Pediatr Urol 2017; 13:387.e1-387.e6. [PMID: 28434632 DOI: 10.1016/j.jpurol.2017.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunction (LUTD) involves faults in the filling and emptying phases of bladder function in toilet-trained children with no previous infection or any other obvious pathology. Lower urinary tract dysfunction is associated with conditions such as vesicoureteral reflux, recurrent urinary infection, behavioral alterations and decreased quality of life. The literature suggests an association between LUTD and obesity; however, the association between each individual symptom and obesity has yet to be evaluated. OBJECTIVE To evaluate the association between excess weight and LUTD in children and adolescents in a community-based sample. STUDY DESIGN This cross-sectional study included 423 children and adolescents aged 5-17 years, and randomly selected in public places and schools between May and July 2015. The participants and their mothers completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire, except for the questions on constipation and with the addition of a question on enuresis. They also completed the Rome III questionnaire, in which two positive responses defined the presence of constipation. Participants were classified as being of normal weight, overweight or obese, which was based on the BMI-for-age indicator. RESULTS Mean age was 9.7 years (SD 2.9), with girls comprising 50.6% of the sample and adolescents 52.5%. The prevalence of LUTD was 7.1%, with 13.5% of participants being overweight and 12.1% obese (Figure). Constipation was present in 5.9% of participants and enuresis in 10.8%. In the multivariate analysis, three factors were independently and significantly associated with a positive DVSS: age <10 years (β = 0.76; 95% CI: 0.34-1.18), constipation (β = 1.79; 95% CI: 0.88-2.70) and obesity (β = 0.89; 95% CI: 0.25-1.52). DISCUSSION Only bladder filling symptoms were associated with obesity. This may be explained by the fact that both obese individuals and those with emptying symptoms were shown to have activation alterations in the same brain regions. One limitation of this study was the use of questionnaires alone to diagnose LUTD and constipation. CONCLUSION Only the bladder-emptying symptoms of LUTD appear to be associated with obesity. This hypothesis may serve as a basis for future studies.
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Affiliation(s)
- L G A Fraga
- CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil
| | - A Sampaio
- CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil
| | - N Boa-Sorte
- CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil
| | - M L Veiga
- CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil
| | | | - U Barroso
- CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil.
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50
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Van Batavia JP, Combs AJ, Fast AM, Glassberg KI. Overactive bladder (OAB): A symptom in search of a disease - Its relationship to specific lower urinary tract symptoms and conditions. J Pediatr Urol 2017; 13:277.e1-277.e4. [PMID: 28527720 DOI: 10.1016/j.jpurol.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The ICCS defines OAB by the subjective symptom of urgency; detrusor overactivity (DO) is only implied. While no other symptom is required, OAB can also be associated with urinary frequency, decreased functional bladder capacity, and incontinence. OBJECTIVE We sought to determine how often these associated findings occur in OAB and what if any uroflow/EMG-defined conditions are found to be associated with it. METHODS The charts of 548 children (231M, 318F; mean age 9.0 years, range 3-20) who presented sequentially with urgency (OAB), over a period of 2 years, were reviewed paying particular attention to whether or not there was a history of frequency and/or daytime incontinence in addition to the urgency. All patients had been previously diagnosed with one of the following four lower urinary tract (LUT) conditions based on specific uroflow/EMG findings: 1. dysfunctional voiding (DV; active pelvic floor EMG during voiding); 2. idiopathic detrusor overactivity disorder (IDOD; OAB with a short EMG lag time (<2 s), and quiet pelvic floor EMG during voiding); 3. detrusor underutilization disorder (DUD; willful infrequent voiding with %EBC >125%, quiet EMG during voiding); and 4. primary bladder neck dysfunction (PBND; prolonged EMG lag time (>6 s), quiet EMG during voiding, and depressed uroflow curve). Mean %EBC was compared between patients with urgency alone and those with urgency plus other symptoms. Any association with gender was analyzed. RESULTS Urgency was accompanied by either frequency or daytime incontinence in 91% of the children (summary Table). Daytime incontinence was reported in 398 (72.6%) and frequency in 268 (48.9%). Mean %EBC was 80.9. Females were more likely to report daytime incontinence (76.7% vs. 66.7%, p = 0.02) and frequency was found more often in males (63.6% vs. 38.1%, p < 0.001). %EBC was less in males (70.0 vs. 88.8, p < 0.001). The majority of patients with urgency were diagnosed with IDOD (62%), while 15% had DV, 5% PBND, 3% DUD, and in 15%, the uroflow/EMG was not diagnostic. CONCLUSIONS %EBC was usually normal or mildly increased in OAB when urgency is the only symptom but significantly decreases with each additional LUTS. OAB is more common in girls and they tend to have a lower incidence of frequency, more incontinence, and >%EBC than boys. Because urgency in an anatomically and neurologically normal child is the only required criterion for diagnosing OAB, it must be realized that OAB can be associated with any of a number of objectively defined LUT conditions. Thus OAB appears to be a symptom, not a condition, that is often associated with other symptoms.
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Affiliation(s)
- Jason P Van Batavia
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Andrew J Combs
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Angela M Fast
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
| | - Kenneth I Glassberg
- Department of Urology, Columbia University Medical Center, College of Physicians & Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA.
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