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Mariotto A, Keene DJ, Alshafei AR, Powell J, Cserni T, Cervellione RM. Bladder Neck Surgery is not Routinely Needed to Achieve Urinary Continence in Patients with Primary Epispadias. J Pediatr Surg 2024; 59:1182-1185. [PMID: 38195356 DOI: 10.1016/j.jpedsurg.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/30/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND This study aims at investigating the continence outcome in primary epispadias patients treated at a tertiary center. The authors hypothesized that additional continence procedures following primary epispadias repair is not routinely needed. METHODS Patients treated for primary epispadias at the authors' institution between 2007 and 2019 and toilet trained, were identified from a prospective maintained database. Males underwent chordee correction, urethroplasty and glanuloplasty. Females underwent genitoplasty with reduction urethroplasty. If continence was not achieved by 4-5 years of age, pelvic floor muscle (PFM) biofeedback therapy was performed. Other continent procedures were discussed with family/patient if still incontinent. PRIMARY OUTCOME urinary continence. SECONDARY OUTCOMES PFM biofeedback therapy, continence surgery, hydronephrosis. Type of epispadias, age at repair and follow-up presented as median was also reported. RESULTS Thirty-three patients (29 males) were included. Twelve had penopubic epispadias, 13 glanular/penile, 4 duplicated urethra, 4 females. Median age at repair: 2 years (IQR 1-3), at follow-up: 8 years (IQR 6-10). Daytime continence: 100 % in penile/glanular; 33 % in penopubic and 75 % in duplicated urethra. Nighttime continence: respectively 92 %, 50 % and 100 %. 24 % of males were intermittently incontinent. All patients except one voided urethrally. One patient underwent bladder neck closure, ileocystoplasty and Mitrofanoff. One girl achieved daytime continence, 2 were intermittently incontinent, one continuously incontinent. All were enuretic. 38 % of boys and 100 % of girls had biofeedback therapy. None had hydronephrosis/renal impairment. CONCLUSIONS Most children with primary epispadias can achieve social urinary continence spontaneously or with the support of PFM biofeedback therapy. Other continence procedures should be reserved for patients who do not attain satisfactory continence. LEVEL OF EVIDENCE Treatment study - level IV.
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Affiliation(s)
- Arianna Mariotto
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom.
| | - David J Keene
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom
| | - Abdul R Alshafei
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom
| | - Jennifer Powell
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom
| | - Tamas Cserni
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom
| | - Raimondo M Cervellione
- Department of Pediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, United Kingdom
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Sollini ML, Pellegrino C, Barone G, Capitanucci ML, Zaccara AM, Crescentini L, Castelli E, Della Bella G, Scorletti F, Papetti L, Monte G, Ferilli MAN, Valeriani M, Mosiello G. Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns. CHILDREN (BASEL, SWITZERLAND) 2024; 11:601. [PMID: 38790596 PMCID: PMC11119741 DOI: 10.3390/children11050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. METHODS This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. RESULTS We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. CONCLUSIONS The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.
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Affiliation(s)
- Maria Laura Sollini
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
- Clinical Science and Translational Medicine, Tissue Engineering and Remodeling Biotechnologies for Body Function PhD School, University of Rome Tor Vergata, Via Cracovia 50, 00133 Rome, Italy
| | - Chiara Pellegrino
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Giulia Barone
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132 Genoa, Italy
| | - Maria Luisa Capitanucci
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Antonio Maria Zaccara
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Leonardo Crescentini
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Enrico Castelli
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Gessica Della Bella
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Federico Scorletti
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Michela Ada Noris Ferilli
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Giovanni Mosiello
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
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Venkatapuram P, Angulo-Lozano JC, Spinzi S, Brown-Johnson C, Phord-Toy A, Kan KM. Parental Knowledge, Beliefs, Practices, and Barriers Related to Children's Bladder Health in the School Environment. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38711264 DOI: 10.1111/josh.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Pediatric lower urinary tract symptoms (LUTS) are a set of common childhood problems. Community-level interventions that target behavioral change among children with LUTS can improve symptoms outside of the clinic environment. Parents, navigating the home and school environments, are key in supporting healthy bladder behaviors. Thus, we asked parents about their perceptions and barriers related to pediatric bladder health. METHODS English-speaking parents (n = 30) of children ages 5-10 years with and without LUTS were interviewed. Transcripts were coded iteratively by two independent coders using deductive and inductive approaches that emphasized consensus coding and peer debriefing. RESULTS Ninety-three percent of participants were women, 50% were 30-39 years old, and 60% held a graduate degree. Parents identified school-, classroom-, and child-based barriers to bladder health. These included the bathroom environment, restrictive policies for bathroom use, and anxiety on how and when to use the bathroom. CONCLUSIONS Addressing school-, classroom-, and child-based barriers is necessary to promote healthy bladder habits among children in the school environment and beyond. Recommended school-based interventions include bathroom use and sanitation policies that support students' voiding needs, teachers' professional development, and school readiness initiatives. Limitations include participation of English-speaking parents only.
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Affiliation(s)
- Pranaya Venkatapuram
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, 94304, CA
| | - Juan C Angulo-Lozano
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, 94304, CA
| | - Stav Spinzi
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, 94304, CA
| | - Cati Brown-Johnson
- Department of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Stanford, 94305, CA
| | - Ashley Phord-Toy
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, 94304, CA
| | - Kathleen M Kan
- Department of Urology, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, 94304, CA
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Breinbjerg A, Kamperis K, Thorsteinsson K, Jørgensen CS, Dossche L, Rayner J, Zhang J, Rodrigues DG, Borch L, Hagstrøm S, Tekgül S, Walle JV, Rittig S. Discontinuing absorbent pants in children with bedwetting: a randomized controlled trial. Eur J Pediatr 2024; 183:2443-2453. [PMID: 38472381 PMCID: PMC11035460 DOI: 10.1007/s00431-024-05502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
The objective of this study is to examine the effect of discontinuing wearing protective garments (absorbent pyjama pants - APP) in children with severe childhood nocturnal enuresis (NE). The study employs a multicenter, parallel, randomized controlled trial. Following a 4-week run-in period, participants were randomly allocated in a 2:1 group allocation to discontinue or continue using APP. The research was conducted across seven European pediatric incontinence centers. The study included treatment-naïve children aged 4-8 years with severe (7/7 wet nights per week) mono-symptomatic NE, who had used nighttime protection for at least 6 months prior to the study. The study consisted of a 4-week run-in period (± 7 days), where all children slept wearing APP (DryNites®). At week 4 (± 7 days), if meeting randomization criteria (7/7 wet nights during the last week of run-in), participants were randomized to continue to sleep in APP or to discontinue their use for a further 4 weeks, with the option of another 4 weeks in the extension period. The primary outcome was the difference between groups of wet nights during the last week of intervention. Quality of life (QoL) and sleep were secondary endpoints. In total, 105 children (43 girls and 62 boys, mean age 5.6 years [SD 1.13]) were randomized (no-pants group n = 70, pants group n = 35). Fifteen children (21%) in the no-pants group discontinued early due to stress related to the intervention. Children in the no-pants group experienced fewer wet nights compared to the pants group during the last week (difference 2.3 nights, 95% CI 1.54-3.08; p < 0.0001). In the no-pants group, 20% responded to the intervention, of whom 13% had a full response. Clinical improvement was detected within 2 weeks. Sleep and QoL were reported as negatively affected by APP discontinuation in the extension period but not in the core period. Conclusion: A ~ 10% complete resolution rate was associated with discontinuing APP. While statistically significant, the clinical relevance is debatable, and the intervention should be tried only if the family is motivated. Response was detectable within 2 weeks. Discontinuing APP for 4-8 weeks was reported to negatively affect QoL and sleep quality. No severe side effects were seen.Trial registration: Clinicaltrials.gov Identifier: NCT04620356; date registered: September 23, 2020. Registered under the name: "Effect of Use of DryNites Absorbent Pyjama Pants on the Rate of Spontaneous Resolution of Paediatric Nocturnal Enuresis (NE)."
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Affiliation(s)
- Anders Breinbjerg
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens blvd. 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Konstantinos Kamperis
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens blvd. 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristina Thorsteinsson
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Cecilie Siggaard Jørgensen
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens blvd. 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lien Dossche
- Department of Pediatric Nephrology, ERKNET center, Ghent University Hospital, Ghent, Belgium
| | - Juliette Rayner
- ERIC, The Children's Bowel and Bladder Charity, 36 Old School House, Kingswood Foundation, Brittania Rd, Bristol, BS15 8DB, UK
| | - Jin Zhang
- Global Product Safety, Stewardship & Medical Affairs, Kimberly-Clark Corporation, Tadworth, UK
| | - Debora Garcia Rodrigues
- Global Product Safety, Stewardship & Medical Affairs, Kimberly-Clark Corporation, Tadworth, UK
| | - Luise Borch
- Department of Pediatric and Adolescent Medicine, Gødstrup Hospital, Herning, Denmark and NIDO, Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Søren Hagstrøm
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Serdar Tekgül
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Johan Vande Walle
- Department of Pediatric Nephrology, ERKNET center, Ghent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens blvd. 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Spinzi S, Agrawal G, Sharma A, Venkatapuram P, Sharma K, Brown-Johnson C, Kan KM. Paediatricians' perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study. BMJ Paediatr Open 2024; 8:e002372. [PMID: 38569740 PMCID: PMC10989118 DOI: 10.1136/bmjpo-2023-002372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Paediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these bothersome symptoms, yet there is no formal resource to support them with the treatment of LUTS. Evaluating paediatricians' experiences is an important step in informing health promotion efforts to improve health outcomes in children. This study aims to explore paediatricians' knowledge, beliefs, practice patterns, and perceived barriers and facilitators in providing LUTS care. METHODS In this qualitative study, we conducted semistructured focus groups of paediatricians within California. Focus groups were conducted via Zoom, and participants were enrolled until thematic saturation was reached. Participants were asked about their current practices, knowledge and beliefs, barriers and facilitators to care, training and education, and responsibility for behaviour and action. Thematic analysis was performed using deductive and inductive approaches; themes were mapped through an iterative, team-based process. RESULTS 15 paediatricians, aged 30-69 years, with 13 (86.7%) women, were interviewed. Most (11, 73.3%) practised in general outpatient settings. Interviewed paediatricians recognised paediatric LUTS as a common problem that can significantly impact children's well-being. In practice, paediatricians did not actively screen for LUTS beyond the potty-training milestone due to short visit duration and competing healthcare demands. Lack of guidelines, parental mistrust and inadequate clinical education were barriers identified by paediatricians. CONCLUSIONS Paediatricians expressed a willingness to help patients but indicated several limitations to providing adequate LUTS care. Future professional development work can emphasise guideline development, early screening strategies to support timely intervention and better education for clinicians.
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Affiliation(s)
- Stav Spinzi
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Gunjan Agrawal
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Flushing Hospital Medical Center, Flushing, New York, USA
| | - Aditi Sharma
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Pranaya Venkatapuram
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Kritika Sharma
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Kathleen M Kan
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
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Zahir M, Sharifi-Rad L, Ladi-Seyedian SS, Kajbafzadeh AM. Does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction? J Pediatr Urol 2024:S1477-5131(24)00179-7. [PMID: 38604908 DOI: 10.1016/j.jpurol.2024.03.025] [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: 08/09/2023] [Revised: 02/18/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION To evaluate the possible impact of patients' sacral ratios (SRs) on response to biofeedback (BF) therapy in pediatric patients with lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS In this retrospective cohort conducted from 2016 to 2018 in our tertiary medical center, we included the medical records of all pediatric patients with LUTD who were nominated for BF due to having abnormal uroflowmetry patterns and simultaneous increase in electromyography (EMG) activity. Ten sessions of weekly animated BF were performed for each patient. All patients underwent a complete urological evaluation, uroflowmetry with simultaneous EMG and post-void residual measurement before and after treatment. SRs were calculated based on plain anteroposterior lumbosacral radiographs. Patients were then divided into normal SR (≥0.74) and low SR (<0.74) and outcomes were compared between them. RESULTS Of the total 86 patients included in our study, 48 (55.8%) had a normal SR (≥0.74), while 38 (44.2%) had a low SR (<0.74). Our data revealed that BF therapy significantly improved maximum and average urinary flow rates, urine volume, daytime urinary incontinence, enuresis, urinary urgency and constipation; irrespective of the patients' SRs (all P < 0.001). Our between-groups analyses showed that after the completion of BF, the SR ≥ 0.74 group had significantly higher maximum urinary flow rate (mean difference [95%CI]: 7.7 [5.4, 10.0], P < 0.001) (Figure) and urine volume (mean difference [95%CI]: 49.9 [19.5, 80.4], P = 0.002) and significantly lower diurnal urinary incontinence (4.2% vs. 21.1%, P = 0.020), enuresis (4.2% vs. 18.4%, P = 0.040) and constipation (2.1% vs. 23.7%, P = 0.004) compared to the SR < 0.74 group. DISCUSSION SR has been proposed as a reliable indicator of bony pelvis growth and subsequent lumbosacral neurodevelopment. Additionally, larger SR values are associated with better postoperative sphincter function in children with urological and anorectal malformations. Our results demonstrated that after completion of BF, the normal SR group had a significantly better improvement of some of the uroflowmetry indicators and LUTD-associated symptoms compared to the low SR group. CONCLUSION Our findings implied that although BF therapy is an efficient treatment for children with LUTD, irrespective of their sacral development; children with enhanced sacral development may benefit from better clinical response, especially in terms of LUTD-associated symptoms.
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Affiliation(s)
- Mazyar Zahir
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Sharifi-Rad
- Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
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Wijekoon N, Deshpande A. Treatment modalities for paediatric functional daytime lower urinary tract disorders: an updated review. Ther Adv Urol 2024; 16:17562872241241848. [PMID: 38584856 PMCID: PMC10998489 DOI: 10.1177/17562872241241848] [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: 05/21/2023] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Paediatric functional bladder disorders especially those causing daytime symptoms are a common cause of significant psychosocial and/or physical morbidity and impaired quality of life. Despite the availability of many therapeutic modalities, a significant number of children appear to be refractory to treatment and continue to have symptoms. In this review, we aim to evaluate the current evidence in the use of existing and novel therapeutic options for the management of daytime lower urinary tract disorders in children. We also aim to highlight the controversies around the terminology and diagnosis of paediatric lower urinary tract dysfunction (LUTD) and specific conditions. The article will then provide a reasonable critique of the existing and emerging treatment modalities in functional daytime LUTD in children including their mode of action, efficacy, indications, and recent advances. These include standard urotherapy, specific urotherapy comprised of biofeedback, alarm therapy and electrical neural stimulation and pharmacotherapy involving selective and non-selective anticholinergics, ß3 adrenergic agonists, alpha blockers and botulinum toxin. A better understanding of this common clinical problem may help clinicians achieve better profiling of these children's diagnoses to further enable specific, targeted treatment.
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Affiliation(s)
- Naveen Wijekoon
- Urology Unit, Department of Paediatric Surgery, The Children’s Hospital at Westmead, Corner Hawkesbury road and Hainsworth street, Westmead, NSW 2145, Australia
| | - Aniruddh Deshpande
- Urology Unit, Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, College of Health, Medicine and Well Being, University of Newcastle, NSW, Australia
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Finup JL, Bhatia VP, Perry DM, Truscott SJ, Cannon ST, O'Kelly F, Farhat WA. Personalized Pre-clinic Nursing Telemedicine Visit: An Efficient and Efficacious Approach for Bowel and Bladder Dysfunction in Children. Urology 2023; 179:158-163. [PMID: 37348658 DOI: 10.1016/j.urology.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and efficacy of a Registered Nurse (RN) led educational pre-clinic telephone call on compliance and outcomes in children with bowel and bladder dysfunction (BBD). METHODS A retrospective chart review of a prospectively applied protocol in a single academic institution was performed for children aged 4-17 presenting with BBD. All children underwent a pre-clinic RN telemedicine visit where they were educated on pathophysiology of BBD, provided personalized urotherapy and bowel recommendations and instructed to complete pre-clinic questionnaires and voiding diaries. Patients were evaluated by a provider 4weeks following RN call. Data collected included compliance with forms, bowel management and need for imaging/testing, medications, and biofeedback. Patients were considered to improve with urotherapy alone if they were discharged from urology without the need for medications and/or biofeedback. RESULTS In total, 277 patients completed an RN call and 224 patients attended a provider visit between December 2020 and June 2022. Mean age was 9.4years (3:1 Female to Male ratio). During the RN call, 154 (56%) patients had bowel management initiated. Of the 224 patients seen by a provider, 69% (n = 154) had symptom improvement or resolution with urotherapy alone. Thirty-eight patients (17%) enrolled in biofeedback with 7 (3%) completing all 8 sessions. Thirty-two patients (14%) required medication for daytime bladder symptoms. CONCLUSION Our novel RN-led pre-clinic telemedicine visit demonstrates excellent compliance and patient outcomes for children with BBD and can reduce the use of unnecessary imaging, medications, and time-consuming treatments such as biofeedback.
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Affiliation(s)
| | | | - Dana M Perry
- University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | | | | | - Walid A Farhat
- University of Wisconsin Hospitals and Clinics, Madison, WI
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von Gontard A, Kuwertz-Bröking E. [Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 51:375-400. [PMID: 37272401 DOI: 10.1024/1422-4917/a000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract: Objective: Enuresis and daytime urinary incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. This interdisciplinary guideline summarizes the current state of knowledge regarding somatic and psychiatric assessment and treatment. We formulate consensus-based, practical recommendations. Methods: The members of this guideline commission consisted of 18 professional associations. The guideline results from current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: According to the International Children's Continence Society (ICCS), there are four different subtypes of nocturnal enuresis and nine subtypes of daytime urinary incontinence. Organic factors first have to be excluded. Clinical and noninvasive assessment is sufficient in most cases. Standard urotherapy is the mainstay of treatment. If indicated, one can add specific urotherapy and pharmacotherapy. Medication can be useful, especially in enuresis and urge incontinence. Psychological and somatic comorbid disorders must also be addressed. Conclusions: The recommendations of this guideline were passed with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required especially regarding functional (nonorganic) daytime urinary incontinence.
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Affiliation(s)
- Alexander von Gontard
- Psychiatrische Dienste Graubünden, Ambulante Dienste für Kinder- und Jugendpsychiatrie, Chur, Schweiz
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, Niederlande
| | - Eberhard Kuwertz-Bröking
- Ehemals: Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Nephrologie, Münster, Deutschland
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10
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van Geen FJ, van de Wetering EHM, Nieuwhof-Leppink AJ, Klijn AJ, de Kort LMO. Dysfunctional Voiding: Exploring Disease Transition From Childhood to Adulthood. Urology 2023; 177:60-64. [PMID: 37028523 DOI: 10.1016/j.urology.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To improve our transitional care, we explored how childhood dysfunctional voiding (DV) develops into adulthood. DV is a common condition in both children and adults. However, the long-term course of childhood DV into adulthood is unknown and treatment over the ages differs. METHODS A cross-sectional follow-up was performed in a cohort of 123 females treated from 2000 to 2003 for childhood DV with urinary tract infections (UTIs) and/or daytime urinary incontinence (DUI). The main outcome was a staccato or intermittent urinary flow pattern, possibly indicating persistent or recurred DV according to the International Continence Society criteria. Flow patterns of healthy women were used to compare results. RESULTS Twenty-five patients participated in this study, with a mean duration of 20.8 years after urotherapy. In 10/25 (40%) cases, a staccato or interrupted urinary flow pattern was found on the current measurement, compared to 5/47 (10.6%) in the control group. Around 50% (5/10) of the patients with a dysfunctional flow pattern reported UTIs and 50% (5/10) experienced DUI. In the group with a normal flow pattern, 2/15 (13%) reported UTIs and 9/15 (60%) DUI. The impact of DUI on quality of life was moderate to high in both groups. CONCLUSION Our results show that 40% of females who had extensive urotherapy for DV in childhood, still have DV according to International Continence Society criteria as an adult, 56% still experience DUI, and 28% UTIs. These data should be taken into account in the counseling of patients and for guiding the process of transition into adulthood.
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Affiliation(s)
| | - Eline H M van de Wetering
- Department of Urology, UMC Utrecht, Utrecht, The Netherlands; Department of Urology, Radboudumc, Nijmegen, The Netherlands.
| | - Anka J Nieuwhof-Leppink
- Department of Medical Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Aart J Klijn
- Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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11
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Palma PL, Marzuillo P, Di Sessa A, Guarino S, Capalbo D, Marrapodi MM, Buccella G, Cameli S, Miraglia Del Giudice E, Torella M, Colacurci N, Capristo C. From Clinical Scenarios to the Management of Lower Urinary Tract Symptoms in Children: A Focus for the General Pediatrician. Healthcare (Basel) 2023; 11:healthcare11091285. [PMID: 37174827 PMCID: PMC10177757 DOI: 10.3390/healthcare11091285] [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: 03/15/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Lower urinary tract symptoms (LUTS) are a relevant problem in the pediatric population, having a very high prevalence. Diurnal incontinence and nocturnal enuresis are surely the most frequent symptoms, presenting, respectively, in up to 30% of school-age children and up to 10% of children between 6 and 7 years. Stypsis is the most common comorbidity, and it must be considered in the management of LUTS; indeed, the treatment of constipation is curative in most cases for both incontinence and enuresis. The presence or absence of diurnal symptoms in nocturnal enuresis and urgency in diurnal incontinence helps in the differential diagnosis. Urotherapy is always the first-line treatment, while oxybutynin and desmopressin (where appropriate) may help if the first-line treatment is unsuccessful. It is essential to identify conditions that are potentially dangerous for kidney and urinary tract well-being, for which LUTS can be the first manifestation. Starting from a series of clinical scenarios, we will underline the diagnostic clues behind LUTS in children and we will summarize clinical and surgical approaches for the proper management of these conditions.
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Affiliation(s)
- Pier Luigi Palma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Daniela Capalbo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Giulia Buccella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Sabrina Cameli
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Carlo Capristo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
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12
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Dai R, Deng C. Re: A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis. J Pediatr Urol 2023:S1477-5131(23)00140-7. [PMID: 37169699 DOI: 10.1016/j.jpurol.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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13
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Rezakhaniha S, Rezakhaniha B, Siroosbakht S. Limited caffeine consumption as first-line treatment in managing primary monosymptomatic enuresis in children: how effective is it? A randomised clinical trial. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001899. [PMID: 37072339 PMCID: PMC10124248 DOI: 10.1136/bmjpo-2023-001899] [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: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Evidence about the negative caffeine effect on enuresis in children remains understudied or poorly understood. The study aimed to investigate the effect of caffeine restriction on the improvement and severity of primary monosymptomatic nocturnal enuresis (PMNE). DESIGN Randomised clinical trial. SETTING Two referral hospitals in Tehran, Iran, from 2021 to 2023. PATIENTS Five hundred and thirty-four PMNE children aged 6-15 years (each group 267). INTERVENTIONS Amount of caffeine consumption was recorded by the feed frequency questionnaire and was estimated by Nutrition 4 software. Caffeine consumption per day in the intervention group was <30 mg, and in the control group, 80-110 mg. All children were asked to return 1 month later to check the recorded data. The ordinal logistic regression analysis was used to assay the effects of caffeine restriction on PMNE by relative risk (RR) at a 95% CI. MAIN OUTCOME MEASURES The effect of limited caffeine consumption on the improvement and severity of PMNE. RESULTS The mean age of the intervention and control groups was 10.9±2.3 and 10.5±2.5 years, respectively. The mean number of bed-wetting before caffeine restriction in the intervention and control group was 3.5 (SD 1.7) times/week and 3.4 (SD 1.9) times/week (p=0.91) and 1 month after intervention were 2.3 (SD 1.8) times/week and 3.2 (SD 1.9) times/week, respectively (p=0.001). Caffeine restriction significantly reduced the severity of enuresis in the intervention group. Fifty-four children (20.2%) improved (dry at night) in caffeine restriction and 18 children (6.7%) in the control group with RR 0.615 at 95% CI 0.521 to 0.726, p=0.001. The caffeine restriction significantly reduced the enuresis in children with a number-needed-to-treat benefit 7.417. It means you must treat 7.417 PMNE children with caffeine limitation to improve one child with enuresis (become dry). CONCLUSION Caffeine restriction can be helpful in reducing PMNE or its severity. Constructive limitation of caffeine is suggested as one of the first-line treatments in the management of PMNE. TRIAL REGISTRATION NUMBER IRCT20180401039167N3.
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Affiliation(s)
- Sadra Rezakhaniha
- Nutrition, Islamic Azad University Science and Research Branch Faculty of Basic Sciences, Tehran, Iran (the Islamic Republic of)
| | - Bijan Rezakhaniha
- Urology, Aja University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Soheila Siroosbakht
- Pediatrics, Aja University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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14
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Alarm-assisted urotherapy for daytime urinary incontinence in children: A meta-analysis. PLoS One 2023; 18:e0275958. [PMID: 36735674 PMCID: PMC9897563 DOI: 10.1371/journal.pone.0275958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/27/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Wearable alarm systems are frequently used tools added to urotherapy for children with both daytime and nighttime urinary incontinence. For functional daytime incontinence (DUI) specifically, the effect of alarm interventions has not been systematically reviewed. This study systematically evaluates, summarizes, reviews, and analyzes existing evidence about the effect of wearable alarm systems in urotherapy for children with functional DUI. STUDY DESIGN We completed a comprehensive literature search in August 2022 using MEDLINE/PUBMED, EMBASE, PsycINFO, Cochrane Library, Web of Science, Google Scholar, conference abstracts, and citation tracking. Clinical controlled trials at controlled-trials.com and clinicaltrials.gov were consulted, as was the National health Service Center For Reviews And Dissemination. Eligible studies including the use of noninvasive wearable alarm systems as (part of) treatment for functional DUI in children were included. The main outcome was continence after treatment. Three independent reviewers extracted data. Risk of bias was assessed using Cochrane and National Heart, Lung and Blood Institute quality assessment tools. RESULTS A total of 10 studies out of 1,382 records were included. Meta-analysis revealed a nonsignificant risk ratio of 1.4 (95% CI: 0.8-2.6) for the use of alarm systems. Urotherapy with alarm systems resulted in a 48% (95% CI: 33-62%) continence rate after treatment. CONCLUSIONS Alarm systems might be helpful as part of urotherapy for functional DUI in select cases. Adherence is problematic, and the optimal duration of the use of alarm systems is to be determined. Overall, the risk of bias was high in all studies.
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Sollini ML, Capitanucci ML, Foti C, Nocentini U, Castelli E, Mosiello G. Home pelvic floor exercises in children with non-neurogenic Lower Urinary Tract Symptoms: Is fitball an alternative to classic exercises? Neurourol Urodyn 2023; 42:146-152. [PMID: 36208111 PMCID: PMC10092819 DOI: 10.1002/nau.25060] [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: 07/21/2022] [Revised: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Biofeedback with home pelvic floor exercises were recommended as non-pharmacologic treatment for non-neurogenic Lower Urinary Tract Symptoms (LUTS) in children. Fitball is recommended to improve all-over flexibility, balance, and coordination, especially for pelvic floor. Aim of the study was to investigate efficacy of standard home pelvic floor exercises versus exercises using fitball. METHODS From April 2021 to February 2022 to all children arrived in our clinic with non-neurogenic LUTS nonresponder at urotherapy, our pelvic floor rehabilitative program was proposed. During the rehabilitation children performed: standard urotherapy, pelvic floor animated biofeedback therapy and pelvic floor exercises in a standard way and using a fitball. After the first session, patients received prescription to repeat at home the same exercises performed at hospital. Children who chose classic exercises were enrolled in group A and they who chose fitball in group B. Continence rate, pelvic floor muscles activity, adherence and satisfaction were evaluated by means of bladder diary, external pubococcygeus test and Likert-type psychometric scale (from 1 = very unsatisfied to 5 = very satisfied) respectively. RESULTS Twenty-six children affected by LUTS were enrolled: 13 in group A and 13 in B. At 4th control urinary incontinence was reduced by 72,5% in A and 71.4% in B. Pubococcygeus test increased in both groups. Adherence at home was 92% in group A and 62% in group B. Satisfaction with the treatment (4 or 5 points) was 95% in both groups. Four patients of group A and all of group B decided to maintain home exercises including fitball. CONCLUSIONS Our preliminary study shows that efficacy of home exercises, with or without fitball, is comparable. Satisfaction with fitball is high, regardless results obtained, because parents and children have learned a new, interesting and stimulating way to manage urinary problems. The opportunity to perform these exercises using fitball, it's an important finding for pediatric population.
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Affiliation(s)
- Maria Laura Sollini
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy.,Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy.,"Santa Lucia" Foundation, I.R.C.C.S., Rome, Italy
| | | | - Calogero Foti
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ugo Nocentini
- Clinical Sciences and Translational Medicine, Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy.,"Santa Lucia" Foundation, I.R.C.C.S., Rome, Italy
| | - Enrico Castelli
- Department of Neurorehabilitation, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Mosiello
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
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16
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Dönmez Mİ, Selvi I, Dereli E, Özgür K, Oktar T, Ziylan O. Maintenance biofeedback therapy for dysfunctional voiding: Does every child need it? Int J Urol 2023; 30:83-90. [PMID: 36305569 DOI: 10.1111/iju.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The aim of the present study is to analyze the long-term clinical outcomes in children who were treated with biofeedback therapy (BF) for dysfunctional voiding (DV) and to determine the need for maintenance of BF due to clinical relapse. METHODS Files of children with DV who underwent BF between 2013 and 2020 were retrospectively reviewed. Patients with neurological or anatomical problems were excluded. A total of 64 patients (52 girls, 12 boys) with a mean age of 8.89 ± 2.48 years who completed the initial BF sessions were included in the study. The demographic and clinical data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters were recorded before and after the initial BF sessions. Clinical success was regarded as the cessation of electromyography activity as well as concurrent resolution of lower urinary tract symptoms and improvement in uroflowmetry parameters. After the initial BF sessions, children who had initial success showed DV relapse at any time during follow-up received the maintenance BF sessions. Therefore, the patients with successful initial BF were divided into two groups: the group that needed maintenance BF, and the group which required no maintenance BF. RESULTS Clinical success was achieved in 48 (75.0%) of 64 children following a median of 6 sessions (range 2-8). At the follow-up, 10 (20.8%) out of 48 patients showed symptom relapse at a median of 8 months (range 2-24 months). After a median of 3.5 maintenance BF sessions (range 1-6), clinical success was observed in all patients. Both groups showed a significant DVSS decrease after initial BF, however, those who needed maintenance had significantly higher DVSS (6.80 ± 2.53 vs. 3.61 ± 1.12, p < 0.001). At admission, DVSS <17.5 (odds ratio [OR]: 4.31, p = 0.025) and post-voiding residual volume as a percentage of estimated bladder capacity for age <28.9 (OR: 5.00, p = 0.009) were found as the predictive factors for initial BF success. The need for maintenance BF was 2.56-fold higher with a DVSS above 5.5 after initial BF sessions. CONCLUSIONS Our results show that despite a clinical success rate of 75% after the initial BF, relapse can be seen within 2 years in approximately 20% of the patients. Nevertheless, maintenance of BF may provide clinical success in all patients. Relatively higher DVSS after initial BF can be used as a predictor of the need for maintenance BF.
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Affiliation(s)
- Muhammet İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismail Selvi
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Dereli
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kerime Özgür
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tayfun Oktar
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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17
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Leão S Santos H, Caldwell P, Hussong J, von Gontard A, Estevam de Abreu G, Braga AA, Veiga ML, Hamilton S, Deshpande A, Barroso U. Quality of life and psychological aspects in children with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation - A prospective multicenter study. J Pediatr Urol 2022; 18:739.e1-739.e6. [PMID: 36336620 DOI: 10.1016/j.jpurol.2022.10.011] [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: 01/24/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB). METHODS This international, multicenter, prospective cohort study involved individuals of 6-16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol. RESULTS Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Median DVSS was 11 (range 6-13.5) and 3 (range 0-7), (p < 0.001), and median ICIQ-CLUTS was 12 (range 9-14) and 9 (range 5.7-12), (p < 0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9-59.7) to 39 (range 29-53.15) following treatment (p = 0.04). Median total SDQ score before and after treatment was 17 (range 13.5-21) and 15 (range 12-21), respectively (p = 0.939). CONCLUSION Parasacral TENS was associated with a significant improvement in urinary symptoms and QoL; however, there was no change in psychological symptoms, as measured using the SDQ.
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Affiliation(s)
| | | | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Alexander von Gontard
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland; Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | | | - Maria Luiza Veiga
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil
| | - Sana Hamilton
- The Children's Hospital at Westmead, Sydney, Australia
| | - Aniruddh Deshpande
- The Children's Hospital at Westmead and John Hunter Children's Hospital, Newcastle, Australia
| | - Ubirajara Barroso
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil.
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18
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Re: Urodynamic evaluation of the efficacy of vibegron, a new β3-adrenergic receptor agonist, on lower urinary tract function in children and adolescents with overactive bladder. J Pediatr Urol 2022; 18:570-571. [PMID: 36210271 DOI: 10.1016/j.jpurol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/03/2022] [Indexed: 12/14/2022]
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Peck B, Terry D, Martin B, Matthews B, Green A. Outcomes of a pilot evaluation of a group urotherapy programme for children with complex elimination disorders: An Australian experience. J Child Health Care 2022; 26:438-447. [PMID: 34038187 DOI: 10.1177/13674935211022537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence-based interventions have continued to show positive effects on both reducing symptoms and helping children with elimination disorders achieve continence and manage troubling psychological distress. Despite this, there is a group of children who do not respond to standard treatments and are classified as having a complex elimination disorder. As a means of addressing the broader clinical challenge and implications of complex elimination disorders, a team of clinicians in Germany developed the Urinary and Faecal Incontinence Training Program for Children and Adolescents. A pilot investigation was undertaken to apply the Urinary and Faecal Incontinence Training Program for Children and Adolescents programme to children aged 6-12 years in an Australian context who met the complex elimination disorder diagnostic criteria, to determine if any subsequent change in the measures of life quality and general well-being was achieved. Findings suggest a reduction in the frequency of the child's symptoms and improvements in family quality of life measures. Qualitatively, children and parents perceived that their child's ability to now respond to stimuli and in so doing avert severe accidents was a major outcome of the programme and was able to increase a child's sense of acceptance of incontinence, improve levels of self-efficacy and increase self-awareness.
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Affiliation(s)
- Blake Peck
- School of Health, 1458Federation University, Ballarat, VIC, Australia
| | - Daniel Terry
- School of Health, 1458Federation University, Ballarat, VIC, Australia
| | - Benita Martin
- 72558Ballarat Health Services, Queen Elizabeth Centre, Grampians Regional Continence Service, Ballarat, VIC, Australia
| | - Belinda Matthews
- 72558Ballarat Health Services, Queen Elizabeth Centre, Grampians Regional Continence Service, Ballarat, VIC, Australia
| | - Andrea Green
- 72558Ballarat Health Services, Queen Elizabeth Centre, Grampians Regional Continence Service, Ballarat, VIC, Australia
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20
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de Wall LL, Nieuwhof-Leppink AJ, van de Wetering EHM, Leijn E, Trompetter M, de Kort LMO, Feitz WF, Schappin R. Study protocol for a parallel-group randomized controlled multi-center trial evaluating the additional effect of continuous ultrasound bladder monitoring in urotherapy for children with functional daytime urinary incontinence (SENS-U trial). Trials 2022; 23:648. [PMID: 35964045 PMCID: PMC9375366 DOI: 10.1186/s13063-022-06600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Lower urinary tract dysfunction or functional urinary incontinence is a common condition with a prevalence up to 21% between 6 and 8 year-old children. It is associated with an impaired quality of life, lower self-esteem, and social stigmatization. Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined. Methods/design This is a multi-center clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6 and 16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice are eligible. Four centers, two academic hospitals, and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups: urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training, or urotherapy with a SHAM device for 3 weeks. The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control (care as usual) group. Discussion To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy. Trial registration ISRCTN44345202. Registered on March 2022
Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06600-6.
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Affiliation(s)
- L L de Wall
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E H M van de Wetering
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.,Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital Utrecht, Utrecht, The Netherlands
| | - E Leijn
- TOP voor Kinderen Practice, Arnhem, The Netherlands
| | - M Trompetter
- Department of Urology, Isala Clinics, Zwolle, The Netherlands
| | - L M O de Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W F Feitz
- Department of Urology, Division of Pediatric Urology, Radboud University Medical Center, Amalia Children's Hospital, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
| | - R Schappin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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Samijn B, Van den Broeck C, Plasschaert F, Pascal A, Deschepper E, Hoebeke P, Van Laecke E. Incontinence training in children with cerebral palsy: A prospective controlled trial. J Pediatr Urol 2022; 18:447.e1-447.e9. [PMID: 35732572 DOI: 10.1016/j.jpurol.2022.05.014] [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: 12/22/2020] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment. OBJECTIVE To investigate the effectiveness of incontinence training with urotherapy in children with CP. STUDY DESIGN A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis. RESULTS Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p < 0.001), frequency of daytime incontinence (p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct toilet posture (p = 0.034) and fecal incontinence (p = 0.026). DISCUSSION Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended. CONCLUSIONS Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.
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Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | - Frank Plasschaert
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | | | - Piet Hoebeke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
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22
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Deng C, Dai R, Peng Q. Letter to the Editor re "can lockdown and homeschooling change the outcome of urotherapy for lower urinary tract dysfunction in children?". J Pediatr Urol 2022; 18:544-545. [PMID: 35781185 DOI: 10.1016/j.jpurol.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Qiang Peng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
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23
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Ergun R, Ozturk NI, Sekerci CA. The effect of duration between sessions on biofeedback treatment in children with dysfunctional voiding. Low Urin Tract Symptoms 2022; 14:387-392. [PMID: 35808986 DOI: 10.1111/luts.12456] [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: 05/14/2022] [Revised: 06/10/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Biofeedback is an effective treatment in children with standard urotherapy-resistant dysfunctional voiding (DV). However, the duration of the session intervals is not standardized. We aimed to compare the effectiveness of daily and weekly sessions of biofeedback treatments. METHODS The data of children who received biofeedback due to DV between March 2018 and May 2019 were retrospectively evaluated. The children were divided into two groups, one with daily and the other with weekly sessions. The voiding patterns in uroflowmetry (UF), maximum flow rate (Qmax), electromyography activity, postvoid residual volume (PVR), the ratio of voided volume to expected bladder capacity (EBC) (%), and Dysfunctional Voiding and Incontinence Scoring System (DVISS) were compared between the two groups. RESULTS A total of 45 children (39 girls [86.6%] and 6 boys [13.3%]) were included in the study. The daily group consisted of 27 (60%) children and the weekly group of 18 (40%). Qmax, PVR, number of abnormal UF patterns, voiding volume/EBC, and DVISS scores were similar between the two groups before treatment. Voiding parameters improved statistically significantly in both groups following biofeedback, but there was no difference between the two groups. A statistical difference was found between the results of DVISS after treatment (P = .03). CONCLUSION Both types of biofeedback treatment (daily and weekly) are effective methods that improve voiding parameters and DVISS values in children with DV. Therefore, the duration between sessions can be determined according to the suitability of the patient and the biofeedback unit.
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Affiliation(s)
- Raziye Ergun
- Pediatric Urology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Naime Ipek Ozturk
- Pediatric Surgery, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Cagri Akin Sekerci
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey
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24
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Borgström M, Bergsten A, Tunebjer M, Hedin Skogman B, Nevéus T. Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial. Arch Dis Child 2022; 107:570-574. [PMID: 35074830 PMCID: PMC9125372 DOI: 10.1136/archdischild-2021-323488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis. DESIGN Randomised, controlled trial. SETTING Paediatric outpatient ward, regional hospital. PATIENTS Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence. INTERVENTIONS Three groups, each during 8 weeks: (A) basic bladder advice-that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group). MAIN OUTCOME MEASURES Reduction in enuresis frequency during week 7-8 compared with baseline. RESULTS The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls. CONCLUSIONS Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin. TRIAL REGISTRATION NUMBER NCT03812094.
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Affiliation(s)
- Malin Borgström
- Center for Clinical Research Dalarna, Falun, Sweden,Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Amadeus Bergsten
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Maria Tunebjer
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Barbro Hedin Skogman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden,Institution of Medical and Health Sciences, Örebro University, Örebro, Sweden
| | - Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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25
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Deng C, Chen Y, Dai R. Re: Safety and short-term efficacy of mirabegron in children with valve bladder: a pilot study. Pediatr Surg Int 2022; 38:949-950. [PMID: 35362797 DOI: 10.1007/s00383-022-05120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
Overactive bladder (OAB) is a common lower urinary tract dysfunction syndrome. A stepwise approach is a prudent choice. Urotherapy is recommended by the International Children's Continence Society (ICCS) as the first-line treatment for OAB.
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Affiliation(s)
- Changkai Deng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Yue Chen
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
| | - Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, China
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26
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Sumboonnanonda A, Sawangsuk P, Sungkabuth P, Muangsampao J, Farhat WA, Piyaphanee N. Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study. BMC Pediatr 2022; 22:288. [PMID: 35581653 PMCID: PMC9110931 DOI: 10.1186/s12887-022-03360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital - Thailand's largest national tertiary referral center. METHODS: Children aged 4-12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA). RESULTS A total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03). CONCLUSIONS BBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.
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Affiliation(s)
- Achra Sumboonnanonda
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Punnarat Sawangsuk
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Patharawan Sungkabuth
- Pediatric Nursing Division, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Janpen Muangsampao
- Pediatric Nursing Division, Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Walid A Farhat
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Nuntawan Piyaphanee
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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27
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Peck B, Terry D, Martin B, Matthews B, Green A. Group‐urotherapy for children with complex elimination disorder: An Australian study. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2022. [DOI: 10.1111/ijun.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Blake Peck
- Institute of Health and Wellbeing Federation University Ballarat Australia
| | - Daniel Terry
- Institute of Health and Wellbeing Federation University Ballarat Australia
| | - Benita Martin
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
| | - Belinda Matthews
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
| | - Andrea Green
- Ballarat Health Services Queen Elizabeth Centre, Grampians Regional Continence Service Ballarat Australia
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28
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Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W. Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades. Front Pediatr 2022; 10:856630. [PMID: 35463874 PMCID: PMC9024248 DOI: 10.3389/fped.2022.856630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.
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Affiliation(s)
- Loes Oomen
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Charlotte Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatrics, Pediatric Nephrology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Cornelissen
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Liesbeth de Wall
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Wout Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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29
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Nevéus T. Problems with enuresis management-A personal view. Front Pediatr 2022; 10:1044302. [PMID: 36405838 PMCID: PMC9671946 DOI: 10.3389/fped.2022.1044302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Much has happened since the end of the era when enuresis was blamed on the parents or the children themselves. Still, there are large gaps in our knowledge and large parts of modern enuresis management guidelines are (still) not based on firm evidence. In this review I will question the following commonly made assumptions regarding enuresis evaluation and treatment: •It is important to subdivide enuresis according to the presence of daytime symptoms•Voiding charts are crucial in the primary evaluation of the enuretic child•All children with enuresis need to be screened for behavioral or psychiatric issues•Concomittant daytime incontinence needs to be successfully treated before addressing the enuresis•Concomittant constipation needs to be successfully treated before addressing the enuresis•Urotherapy is a first-line treatment against enuresis In this review I will argue that much of what we do with these children is based more on experience and well-meant but poorly supported assumptions than on evidence. Some advice and therapies are probably ineffective whereas for other treatments we lack reliable predictors of treatment response. More research is obviously needed, but awaiting new results enuresis management could be substantially simplified.
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Affiliation(s)
- Tryggve Nevéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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30
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von Gontard A, Hussong J, Yang SS, Chase J, Franco I, Wright A. Neurodevelopmental disorders and incontinence in children and adolescents: Attention-deficit/hyperactivity disorder, autism spectrum disorder, and intellectual disability-A consensus document of the International Children's Continence Society. Neurourol Urodyn 2021; 41:102-114. [PMID: 34586694 DOI: 10.1002/nau.24798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/28/2021] [Accepted: 07/10/2021] [Indexed: 12/14/2022]
Abstract
AIMS Neurodevelopmental disorders (NDs) are incapacitating disorders, which begin early in life, are mainly caused by genetic and neurobiological factors, and show a tendency to persist. They are associated with higher rates of incontinence in children and adolescents, including nocturnal enuresis, daytime urinary incontinence, fecal incontinence, and constipation. Without diagnosis and treatment, they will interfere with incontinence treatment leading to less favorable outcomes. The aim of this International Children's Continence Society (ICCS) document is to provide an overview of the three most important NDs, that is, attention-deficit/hyperactivity disorder, autism spectrum disorder (ASD), and intellectual disability (ID). METHODS This consensus paper was commissioned by the ICCS. A selective, nonsystematic review was performed. Guidelines, reviews, and selected studies were included. The recommendations are consensus-based. RESULTS ADHD is the most common ND with special relevance in clinical practice. ASD and ID are less common, but more severe disorders than ADHD. Basic principles of the assessment and treatment of NDs are provided. Incontinence is common among patients with NDs. Specific modifications and practical approaches in the treatment of incontinence in children with NDs are outlined. CONCLUSIONS Incontinence in children and adolescents with NDs is common. Effective treatment of incontinence should be adapted and modified to the specific needs of patients with NDs. A multiprofessional approach is recommended.
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Affiliation(s)
- Alexander von Gontard
- Department of Urology, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Stephen S Yang
- Department of Urology, Taipei Tzu Chi Hospital and Buddhist Tzu Chi Universtiy, New Taipei, Taiwan
| | - Janet Chase
- Victorian Children's Continence Clinic, Melbourne, Victoria, Australia
- Paediatric Gastroenterology, Victoria Royal Children's Hospital, Melbourne, Australia
| | - Israel Franco
- Children's Bladder and Continence Program, Yale School of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Anne Wright
- Children's Bladder Clinic, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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31
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Yang SS, Tsai JD, Kanematsu A, Han CH. Asian guidelines for urinary tract infection in children. J Infect Chemother 2021; 27:1543-1554. [PMID: 34391623 DOI: 10.1016/j.jiac.2021.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >105 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B). Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7-14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III-V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).
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Affiliation(s)
- Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, Medical Foundation, New Taipei, Taiwan; Buddhist Tzu Chi University, Hualien, Taiwan.
| | - Jeng-Daw Tsai
- Department of Medicine, Mackay Medical College, Taiwan; Department of Pediatric Nephrology, MacKay Children's Hospital, Taiwan; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | | | - Chang-Hee Han
- Department of Urology, Uijeongbu ST. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
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32
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Radojicic Z, Milivojevic S, Koricanac I, Lazovic JM, Laketic D, Radojicic O, Milic N. Low compliance contribute to insufficient Desmopressin response of primary monosymptomatic nocturnal enuresis and the role of voiding school. BMC Pediatr 2021; 21:244. [PMID: 34016082 PMCID: PMC8136157 DOI: 10.1186/s12887-021-02714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS To evaluate the impact of compliance on the therapeutic effects of Desmopressin, as well as the importance of establishing the voiding school for low-compliance children in primary monosymptomatic enuresis treatment. METHODS Eighty-nine patients with primary monosymptomatic enuresis treated with Desmopressin were observed during the 2017-2020 at University Children's Hospital Belgrade, Serbia. The average patients age was 7.7 ± 2.4 years; 65 (73%) were boys and 24 (27%) % were girls. After the 3 months of Desmopressin treatment, the effect of therapy was evaluated according to the compliance. After the treatment, low-compliance patients and their parents were suggested to visit a voiding school. RESULTS A significant decrease in the median enuresis frequency was noticed during the Desmopressin treatment (25.0 (20.0-26.0) vs 10.0 (2.0-17.0) per month, before vs after treatment, respectively) (p < 0.001). Patients with low compliance had a poorer response to Desmopressin (p < 0.001). An median enuresis reduction in the good compliance group was 92.3% (86.7 -95%), while in the low compliance group was 28.6% (16.7-43.3%). After attending voiding school, there was a significant increase in compliance (p < 0.001), associated with an median percent decrease in enuresis of 84.0% (75.0-95.5%) (p < 0.001). CONCLUSION Compliance considerably influences the beneficial effects of Desmopressin. Patients with poor therapeutic effects should be evaluated for compliance and introduced to voiding school.
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Affiliation(s)
| | | | | | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darko Laketic
- Institute of anatomy "Niko Miljanic", Faculty of medicine, Belgrade, Serbia
| | - Ognjen Radojicic
- Clinic for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, Mayo Clinic, Rochester, USA
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