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Unal B, Pisirici P, Koseoglu Kurt A, Tugtepe H. Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial. J Pediatr Urol 2024:S1477-5131(24)00181-5. [PMID: 38641452 DOI: 10.1016/j.jpurol.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. OBJECTIVE This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP. METHOD A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n = 27) and Manual Therapy (MG; n = 27) groups. TENS application was performed 2 sessions in a week for 20 min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5 × 5 cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20 min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used. RESULTS The decrease in the episodes of incontinence was higher in the TG (p = 0.037; p < 0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p = 0.683; p > 0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p = 0.001; p < 0.01). CONCLUSION Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.
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Affiliation(s)
- Betul Unal
- Bahçeşehir University, Graduate Education Institute, Physiotherapy and Rehabilitation Doctoral Program, Istanbul, Turkiye
| | - Pelin Pisirici
- Bahçeşehir University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkiye.
| | - Aygul Koseoglu Kurt
- Bahçeşehir University, Graduate Education Institute, Physiotherapy and Rehabilitation Doctoral Program, Istanbul, Turkiye
| | - Halil Tugtepe
- Private Tugtepe Pediatric Urology Center, Division of Bladder and Bowel Dysfunction, Istanbul, Turkiye
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Silvestri R. Sleep-Related Urologic Dysfunction. Sleep Med Clin 2024; 19:169-176. [PMID: 38368063 DOI: 10.1016/j.jsmc.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
This article reports on the epidemiology, prevalence, and physiopathology of sleep-related urinary dysfunction, a new syndromic category proposed by the recently revised ICSD-3-TR classification. Sleep enuresis, whether primary or secondary, monosymptomatic or plurisymptomatic, will be reviewed in terms of risk factors, comorbidity, and diagnostic and therapeutic indications. A definition of nocturia and its impact on patients' health, quality of life, and mortality will follow. Finally, the impact of urge incontinence on various medical and neurologic disorders will be discussed. Special emphasis will be placed on the possible association of this parasomnia with several sleep disorders and poor, fragmented sleep.
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Affiliation(s)
- Rosalia Silvestri
- Sleep Medicine Center, UOSD of Neurophysiopathology and Movement Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Parodi S, Kendall HJ, Terrone C, Heesakkers JPFA. What Is in the Pipeline on Investigational Neuromodulation Techniques for Lower Urinary Tract Dysfunction: A Narrative Review. Neuromodulation 2024; 27:267-272. [PMID: 37865890 DOI: 10.1016/j.neurom.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient's quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative review was then performed. RESULTS Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm. CONCLUSIONS Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.
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Affiliation(s)
- Stefano Parodi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; University Medical Center, Maastricht, The Netherlands.
| | | | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Barmadisatrio, Wiyogo IO, Kloping YP. The role of interferential current electrical stimulation in pediatric urology: A systematic review of randomized controlled trials. Surg Neurol Int 2023; 14:404. [PMID: 38053700 PMCID: PMC10695463 DOI: 10.25259/sni_615_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2023] Open
Abstract
Background In recent years, interferential current (IFC) electrical stimulation has been studied as a novel treatment for various lower urinary tract dysfunctions in children. As the findings of multiple studies may vary, we aimed to evaluate the current view on IFC in pediatric urology problems based on the findings of randomized clinical trials (RCTs). Methods We performed a systematic search in the Embase, Medline, and SCOPUS databases in accordance with the latest Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies comprised studies evaluating IFC for lower urinary tract problems in children. The studies' quality was assessed using the Cochrane risk of bias (RoB) tool 2. Results A total of 125 articles were initially obtained, among which 40 articles were duplicates. There were six eligible RCTs with an overall low RoB. All subjects underwent 10-18 sessions of treatment. The outcomes measured consisted of the alleviation of symptoms and urodynamic parameters. The trials reported that 61-90% of patients responded positively to the treatment. Both IFC and transcutaneous electrical nerve stimulation generated improvements in the subjects. However, overall the IFC group showed better immediate and short-term improvement. Conclusion IFC is a promising therapy for bladder dysfunction and enuresis in children. More comparative RCTs are required in the future to quantitatively determine the superiority of IFC to other alternatives. The safety aspects of the treatment should also be studied further before it can be used in a clinical setting as the standard and protocol for children are still unclear.
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Affiliation(s)
- Barmadisatrio
- Department of Surgery Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia
| | - Illona Okvita Wiyogo
- Department of Surgery Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia
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Malhotra NR, Siegal AR, Lange SM, Cervantez D, White HK, Hannon A, Schaeffer AJ, Lau GA. At-home use of parasacral transcutaneous electrical nerve stimulation for pediatric voiding dysfunction: a randomized controlled trial to assess its safety and feasibility. Front Pediatr 2023; 11:1219887. [PMID: 37670742 PMCID: PMC10475593 DOI: 10.3389/fped.2023.1219887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Treating pediatric voiding dysfunction involves behavioral changes that require significant time or medications that are often avoided or discontinued due to side effects. Using parasacral transcutaneous electrical nerve stimulation (PTENS) has shown to have reasonable efficacy, but the safety and feasibility of its off-label use for pediatric voiding dysfunction are not well-established. Concerns have also been raised over treatment adherence. In-home therapy might improve adherence compared with office-based therapy; however, no studies have evaluated in-home feasibility to date. This study aims to assess the safety and feasibility of off-label use of PTENS for pediatric voiding dysfunction. Materials and methods A single-institution prospective, randomized controlled study was conducted from March 2019 to March 2020. Participants aged 6-18 years diagnosed with voiding dysfunction, overactive bladder, or urinary incontinence were eligible for the study. Those with known neurologic disorders, implanted electrical devices, anatomic lower urinary tract abnormality, and recurrent urinary tract infections and those taking bladder medications were excluded. Children with primary monosymptomatic nocturnal enuresis were also excluded due to previous work suggesting a lack of efficacy. Participants were randomly assigned to receive 12 weeks of urotherapy alone (control) or urotherapy plus at-home PTENS treatment. Families were contacted weekly to assess for adverse events (AEs) and treatment adherence. The primary and secondary outcomes were safety, defined as the absence of AEs and treatment adherence, respectively. Results A total of 30 eligible participants were divided into two groups, with 15 participants in each arm. The median age was 9.4 years (interquartile range: 7.7-10.6). In total, 60% were male. Baseline demographics and urotherapy compliance were similar between the two groups. With PTENS use, two AEs were reported, including mild pruritus at the pad site and discomfort when removing pads, while no AEs were noted in the control group. In total, 60% of patients completed three 30-min sessions per week, and all participants were able to complete treatment sessions for at least 10 weeks, involving 30 min of PTENS treatment each time. Conclusion This randomized controlled study confirms that at-home use of PTENS is feasible with reasonable treatment adherence and minimal AEs. Future collaborative, multi-institutional studies may better determine the efficacy of this treatment modality.
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Affiliation(s)
- Neha R. Malhotra
- Department of Urology, Mount Sinai Hospital, New York, NY, United States
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
| | | | - Suzanne M. Lange
- Department of Urology, University of Utah Hospital, Salt Lake City, UT, United States
| | - DeeAnn Cervantez
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
| | - Heidi K. White
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
| | - AnnMarie Hannon
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
| | - Anthony J. Schaeffer
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
| | - Glen A. Lau
- Department of Pediatric Urology, Primary Children’s Hospital, Salt Lake City, UT, United States
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Ebert KM, Terry H, Ching CB, Dajusta DG, Fuchs ME, Jayanthi VR, McLeod DJ, Alpert SA. Effectiveness of a Practical, At-Home Regimen of Parasacral Transcutaneous Electrical Nerve Stimulation in Pediatric Overactive Bladder. Urology 2022; 165:294-298. [PMID: 35065988 DOI: 10.1016/j.urology.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe and evaluate efficacy of a more practical, at-home regimen of parasacral transcutaneous electrical nerve stimulation (TENS) for pediatric overactive bladder (OAB). METHODS We prospectively enrolled patients with OAB. INCLUSION CRITERIA age 5-13 years and willingness to try TENS. EXCLUSION CRITERIA urinary tract anatomic abnormalities, current use of OAB medications, neurologic condition, and elevated post-void residual. Patients were instructed to complete 20-minute sessions 2x/day for one month. RESULTS We enrolled 21 patients (3 male, 18 female; median age 9.9 years). We had complete VSS data on 17 patients and frequency-volume chart data on 12 patients. Median % of TENS sessions completed was 98%. CONCLUSION In our cohort of medically-refractory OAB pediatric patients, nearly half reported subjective improvement with our regimen, despite modest objective improvement. Our compliance rates suggest this regimen is practical but may be best used as an adjunct to other therapies.
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Affiliation(s)
- Kristin M Ebert
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114.
| | - Heather Terry
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Christina B Ching
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Daniel G Dajusta
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Molly E Fuchs
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Venkata R Jayanthi
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Daryl J McLeod
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
| | - Seth A Alpert
- Nationwide Children's Hospital, Division of Urology, 700 Children's Drive, Columbus, OH 43205, 614-722-3114
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Ghogare A, Pole R, Vankar G. A clinical review of enuresis and its associated psychiatric comorbidities. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Pedersen N, Breinbjerg A, Thorsteinsson K, Hagstrøm S, Rittig S, Kamperis K. Transcutaneous electrical nerve stimulation as add-on therapy in children receiving anticholinergics and/or mirabegron for refractory daytime urinary incontinence: A retrospective cohort study. Neurourol Urodyn 2021; 41:275-280. [PMID: 34618378 DOI: 10.1002/nau.24812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
AIMS To investigate if children with daytime urinary incontinence (DUI) and overactive bladder (OAB) refractory to standard urotherapy and medicinal treatment, would experience improvement in symptoms after add-on treatment with transcutaneous electrical nerve stimulation (TENS). METHODS Children were retrospectively enrolled from tertiary referral centers at Aarhus and Aalborg University Hospitals. All data were retrieved from the patients' journals. All children were prescribed TENS as an add-on treatment to the highest-tolerable dose of medicinal treatment in a standardized regime of 2 h a day for around 3 months. Primary endpoints were the number of wet days per week (WDPW) and incontinence episodes per day. Effect of treatment was defined as greater or equal to 50% reduction in the frequency of DUI episodes. Secondary endpoints were to establish predictive factors for the effect of treatment using logistic regression. RESULTS Seventy-six children diagnosed with DUI and OAB refractory to treatment with standard urotherapy and pharmacological treatment, at the age of 5-16 years were included from February 2017 to February 2020. A reduction in WDPW (from 6.31 [5.86-6.61] to 4.27 [3.45-4.90], p < 0.05) and incontinence episodes per day (from 2.45 [1.98-2.91] to 1.43 [1.07-1.80], p < 0.05) was observed. Twelve patients became completely dry. At 6 months follow-up, seven of the 12 complete responders had relapsed while five remained dry. A history of constipation before TENS was a predictor of poor treatment response (p = 0.016). CONCLUSIONS TENS as add-on to anticholinergic treatment seems effective in a number of children with treatment-refractory DUI.
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Affiliation(s)
- Natashja Pedersen
- Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Breinbjerg
- Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Thorsteinsson
- Department of Child and Adolescent Health, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hagstrøm
- Department of Child and Adolescent Health, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Rittig
- Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
| | - Konstantinos Kamperis
- Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
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O'Sullivan H, Kelly G, Toale J, Cascio S. Comparing the outcomes of parasacral transcutaneous electrical nerve stimulation for the treatment of lower urinary tract dysfunction in children: A systematic review and meta-analysis of randomized controlled trials. Neurourol Urodyn 2021; 40:570-581. [PMID: 33410536 DOI: 10.1002/nau.24601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
AIMS Despite published evidence in recent decades suggesting improvement in lower urinary tract symptoms (LUTS) with the use of parasacral transcutaneous electrical nerve stimulation (PTENS), no consensus guidelines for therapy exist. This study systematically reviews the literature to assess the effect of PTENS in children with LUTS. METHODS A database search conducted up to December 2019 included Medline, EMBASE, and the Cochrane Library. From the literature review, 6 randomized controlled studies (234 participants) comparing PTENS and standard treatment (urotherapy/anticholinergics) were considered. From each study, the success rates were available for PTENS and the control group. The ratio of success rates was computed-that is, the risk ratio (RR) and the risk difference (RD). RESULTS The overall success rate with PTENS was 1.92 times that of children undergoing standard urotherapy alone (RR: 1.92, 95% confidence interval [CI: 1.02, 3.61]) and 1.56 for those undergoing either urotherapy alone or with pharmacotherapy (anticholinergics; RR: 1.56, 95% CI [1.04, 2.40]). No difference in the success rate was found when PTENS was used in patients failing previous treatment (urotherapy and pharmacological therapy; RR: 0.175, 95% CI [0.02, 1.45]). CONCLUSIONS Current evidence suggests that PTENS is beneficial in children with LUTS. The chance of success is 1.92 times that of children undergoing standard urotherapy. However, in children who have failed urotherapy and pharmacological therapy, PTENS monotherapy has a limited role and should be an adjunct. Literature shortcomings included small numbers of patients, differing inclusion criteria, and PTENS protocols. A need exists for quality multicenter randomized controlled trials to prove the efficacy of PTENS in children with LUTS.
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Affiliation(s)
- Hugh O'Sullivan
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland
| | - Gabrielle Kelly
- School of Mathematics and Statistics, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - James Toale
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland
| | - Salvatore Cascio
- Department of Paediatric Urology, Childen's Health Ireland Crumlin, Dublin, Ireland.,University College Dublin, Dublin, Ireland
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Southwell BR. Electro‐Neuromodulation for Colonic Disorders—Review of Meta‐Analyses, Systematic Reviews, and RCTs. Neuromodulation 2020; 23:1061-1081. [DOI: 10.1111/ner.13099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Bridget R. Southwell
- Surgical Research Group Murdoch Children's Research Institute Melbourne Australia
- Department of Urology Royal Children's Hospital Melbourne Australia
- Department of Paediatrics University of Melbourne Melbourne Australia
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Nieuwhof-Leppink AJ, Schroeder RPJ, van de Putte EM, de Jong TPVM, Schappin R. Daytime urinary incontinence in children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:492-501. [DOI: 10.1016/s2352-4642(19)30113-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 01/21/2023]
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Ladi-Seyedian SS, Sharifi-Rad L, Nabavizadeh B, Kajbafzadeh AM. Traditional Biofeedback vs. Pelvic Floor Physical Therapy-Is One Clearly Superior? Curr Urol Rep 2019; 20:38. [PMID: 31147796 DOI: 10.1007/s11934-019-0901-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Pelvic floor physical therapy is a worldwide accepted therapy that has been exclusively used to manage many pelvic floor disorders in adults and children. The aim of this review is to suggest to clinicians an updated understanding of this therapeutic approach in management of children with non-neuropathic voiding dysfunction. RECENT FINDINGS Today, pelvic floor muscle training through biofeedback is widely used as a part of a voiding retraining program aiming to help children with voiding dysfunction which is caused by pelvic floor overactivity. Biofeedback on its own, without a pelvic floor training component, is not an effective treatment. Biofeedback is an adjunct to the pelvic floor training. In the current review, we develop the role of pelvic floor physical therapy in management of children with non-neuropathic voiding dysfunction and compare it with biofeedback therapy alone.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.,Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
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Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial. Int Neurourol J 2018; 22:295-304. [PMID: 30599501 PMCID: PMC6312976 DOI: 10.5213/inj.1836142.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/25/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods Ninety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.
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Influence of the Short-term Intake of High Doses of Solifenacin and Trospium on Cognitive Function and Health-Related Quality of Life in Older Women With Urinary Incontinence. Int Neurourol J 2018; 22:41-50. [PMID: 29609422 PMCID: PMC5885132 DOI: 10.5213/inj.1834996.498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/27/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to investigate the safety and the effects of elevated doses of solifenacin and trospium on cognitive function and health-related quality of life (HRQoL) in elderly women receiving treatment for urinary incontinence. Methods The study included 312 women aged 60–83 years (mean age, 69.4 years). All participants had scored at least 24 points on the Mini-Mental State Examination (MMSE) scale, and all of them had been diagnosed with urge urinary incontinence (UUI) or mixed urinary incontinence (MUI). The women were randomly assigned to 3 groups: group A, individuals who were simultaneously administered solifenacin at a high dosage of 20 mg per day and trospium at a high dosage of 60 mg per day; group B, persons taking solifenacin and trospium at the usual dosage of 10 and 30 mg per day, respectively; and group C, persons who received a placebo. Participants’ cognitive status was assessed by the MMSE, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale III, Colour Trails Test, and California Verbal Learning Test scales. The HRQoL assessment was performed using the Medical Outcomes Study 36-Item Health Survey. Results The cognitive function parameters did not differ at the start and end of the study across the groups (P>0.05). Additionally, the cognitive function parameters did not differ significantly within each group between the start and end of the study (P>0.05). The values of most HRQoL parameters regarding the functional state of the lower urinary tract (LUT) after the termination of treatment significantly improved in groups A and B (P<0.05). A significant correlation between cognitive status and HRQoL or LUT parameters was absent (r<0.3), while the correlations between HRQoL and LUT parameters were r=0.31–0.83, P<0.05. Conclusions The use of elevated doses of solifenacin and trospium did not increase the risk of cognitive impairment in women with UUI and MUI. The combination of solifenacin and trospium at a double dosage may be recommended to elderly women with treatment-resistant symptoms of UUI and MUI. However, the safety of combining antimuscarinic drugs in women with an increased volume of residual urine requires further study.
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Transcutaneous Electrical Nerve Stimulation in Children with Monosymptomatic Nocturnal Enuresis: A Randomized, Double-Blind, Placebo Controlled Study. J Urol 2017; 198:687-693. [DOI: 10.1016/j.juro.2017.04.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
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Borch L, Hagstroem S, Kamperis K, Siggaard CV, Rittig S. Transcutaneous Electrical Nerve Stimulation Combined with Oxybutynin is Superior to Monotherapy in Children with Urge Incontinence: A Randomized, Placebo Controlled Study. J Urol 2017; 198:430-435. [PMID: 28327453 DOI: 10.1016/j.juro.2017.03.117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We evaluated whether combination therapy with transcutaneous electrical nerve stimulation and oxybutynin results in a superior treatment response compared to either therapy alone in children with urge incontinence. MATERIALS AND METHODS In this placebo controlled study 66 children with a mean ± SD age of 7.3 ± 1.6 years who were diagnosed with urge incontinence were randomized to 3 treatment groups. Group 1 consisted of 22 children undergoing transcutaneous electrical nerve stimulation plus active oxybutynin administration. Group 2 included 21 children undergoing active transcutaneous electrical nerve stimulation plus placebo oxybutynin administration. Group 3 consisted of 23 children undergoing active oxybutynin administration plus placebo transcutaneous electrical nerve stimulation. The children received active or placebo transcutaneous electrical nerve stimulation over the sacral S2 to S3 outflow for 2 hours daily in combination with 5 mg active or placebo oxybutynin twice daily. The intervention period was 10 weeks. Primary outcome was number of wet days weekly. Secondary outcomes were severity of incontinence, frequency, maximum voided volume over expected bladder capacity for age, average voided volume over expected bladder capacity for age and visual analogue scale score. RESULTS Combination therapy was superior to oxybutynin monotherapy, with an 83% greater chance of treatment response (p = 0.05). Combination therapy was also significantly more effective than transcutaneous electrical nerve stimulation monotherapy regarding reduced number of wet days weekly (mean difference -2.28, CI -4.06 to -0.49), severity of incontinence (-3.11, CI -5.98 to -0.23) and daily voiding frequency (-2.82, CI -4.48 to -1.17). CONCLUSIONS Transcutaneous electrical nerve stimulation in combination with oxybutynin for childhood urge incontinence was superior to monotherapy consisting of transcutaneous electrical nerve stimulation or oxybutynin, although the latter only reached borderline statistical significance. Furthermore, transcutaneous electrical nerve stimulation was associated with a decreased risk of oxybutynin induced post-void residual urine greater than 20 ml.
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Affiliation(s)
- Luise Borch
- Center for Child Incontinence, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aalborg University Hospital, Aalborg (SH), Denmark.
| | - Soeren Hagstroem
- Center for Child Incontinence, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aalborg University Hospital, Aalborg (SH), Denmark
| | - Konstantinos Kamperis
- Center for Child Incontinence, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aalborg University Hospital, Aalborg (SH), Denmark
| | - C V Siggaard
- Center for Child Incontinence, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aalborg University Hospital, Aalborg (SH), Denmark
| | - Soeren Rittig
- Center for Child Incontinence, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aalborg University Hospital, Aalborg (SH), Denmark
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Abstract
Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures. Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.
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Affiliation(s)
- Sophie Ramsay
- Division of Urology, CHU de Québec-Université Laval, Quebec City, QC Canada
| | - Stéphane Bolduc
- Division of Urology, CHU de Québec-Université Laval, Quebec City, QC Canada;; CRCHU de Québec-Université Laval, Quebec City, QC, Canada and Axe Médecine Régénératrice
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Borch L, Rittig S, Kamperis K, Mahler B, Djurhuus JC, Hagstroem S. No immediate effect on urodynamic parameters during transcutaneous electrical nerve stimulation (TENS) in children with overactive bladder and daytime incontinence-A randomized, double-blind, placebo-controlled study. Neurourol Urodyn 2016; 36:1788-1795. [PMID: 27868230 DOI: 10.1002/nau.23179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/30/2016] [Indexed: 11/08/2022]
Abstract
AIM To evaluate the immediate effect on natural fill urodynamic parameters and bladder function during transcutaneous electrical nerve stimulation (TENS) in children with overactive bladder (OAB) and daytime urinary incontinence (DUI). MEETHODS In this double-blind, placebo-controlled study, 24 children with severe OAB and DUI (mean age 8.5 ± 1.2 years) underwent 48-h natural fill urodynamics. After 24 h of baseline investigation, the children were randomized to either active continuous TENS (n = 12) or placebo TENS (n = 12) over the sacral S2-S3 outflow. The urodynamic recordings were analyzed manually for three different bladder contraction patterns resulting in a void. The number of bladder contractions not leading to a void was also calculated. Maximum voided volume (MVV) and average voided volume (AVV) were identified for both the baseline and the intervention day. RESULTS We found that TENS had no immediate objective effect on bladder capacity. The difference (before minus after treatment) in MVV/EBC in the active TENS group = 0.03 ± 0.23 versus placebo TENS group = -0.01 ± 0.10 (P = 0.61). Also, there was no significant difference in the proportion of different bladder contraction types between the two groups. TENS did not significantly influence the number of bladder contractions not leading to a void. Results are presented as mean ± SD. CONCLUSION There is no immediate objective effect of TENS on bladder activity assessed by natural fill urodynamics in children with OAB and DUI.
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Affiliation(s)
- Luise Borch
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Soeren Rittig
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Konstantinos Kamperis
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Mahler
- Department of Pediatrics, Center for Child Incontinence, Aarhus University Hospital, Aarhus, Denmark
| | | | - Soeren Hagstroem
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
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Arda E, Cakiroglu B, Thomas DT. Primary Nocturnal Enuresis: A Review. Nephrourol Mon 2016; 8:e35809. [PMID: 27703953 PMCID: PMC5039962 DOI: 10.5812/numonthly.35809] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 04/30/2016] [Indexed: 01/27/2023] Open
Abstract
Context Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. Enuresis nocturna is defined as the inability to hold urine during the night in children who have completed toilet training. It is termed as being “primary” if no continence has ever been achieved or “secondary if it follows at least 6 months of dry nights. The aim of this review was to assemble the pathophysiological background and general information about nocturnal enuresis. Evidence Acquisition This review was performed by evaluating the literature on nocturnal enuresis published between 1970 and 2015, available via PubMed and using the keywords “nocturnal enuresis,” “incontinence,” “pediatric,” “review,” and “treatment.” Results Children with nocturnal enuresis produce urine at higher rates during the night, and may have lower bladder capacities. Some children with nocturnal enuresis may also have daytime urgency, frequency, and urinary incontinence. Treatment includes aggressive treatment of accompanying constipation or urinary tract infections, behavioral changes, and medical therapy. Alarm therapy remains the first-line treatment modality for primary nocturnal enuresis. High rates of patient compliance and relapse mean that alternative treatments remain on the agenda. Conclusions Nocturnal enuresis is a common problem that has multifaceted effects on both the child and the family. Due to multiple etiologic factors, nocturnal enuresis is still not clearly defined.
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Affiliation(s)
- Ersan Arda
- Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
| | - Basri Cakiroglu
- Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
- Corresponding author: Basri Cakiroglu, Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey. Tel: +90-2165241300, Fax: +90-2165241323, E-mail:
| | - David T. Thomas
- Maltepe University Medical School, Department of Pediatric Surgery, Istanbul, Turkey
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Current Treatment Options for Nonneurogenic Overactive Bladder in Children. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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