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Eliezer DD, Samnakay N, Starkey MR, Deshpande AV. Effectiveness of standard urotherapy (basic bladder advice) and combination therapies in managing bladder dysfunction in children with treated behavioral disorders: Results of a prospective cohort (DABBED) study. Low Urin Tract Symptoms 2021; 13:490-497. [PMID: 34313379 DOI: 10.1111/luts.12400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
AIMS We evaluated the efficacy of standard urotherapy and combination therapies in treatment of bladder dysfunction in children with treated behavioral disorders. METHODS Prospective study of children (6-16 years) with bladder dysfunction and behavioral disorders was conducted between March 2018-2020. Eligible children were initially offered standard urotherapy and those with no response at 3 months were offered combination therapies. Symptomatic response, changes in Akbal score and PinQ score were reported at 6 months and outcomes were correlated to behavioral diagnoses and medications. RESULTS Thirty-nine consecutive children (male = 27, mean age [SD] 10.3 [±2.0] years) were recruited, of whom 29 completed the study (five lost to follow-up, three non-compliant to treatment, two excluded). Thirty-four (87%) children had attention deficit/hyperactivity disorder. Monosymptomatic nocturnal enuresis (n = 11) and non-monosymptomatic enuresis (n = 17) were the commonest diagnoses. Following 3-month review, 14 (38%) children continued to receive standard urotherapy, while 15 (41%) children were transitioned to combination therapy. At 6-month review, complete/partial response was seen in 62% (23/37) and no response in 16% (6/37); with 32% (12/37) responding to standard urotherapy alone. Akbal symptom scores (15.9-11.5; P < 0.01) and PinQ scores (26.0-19.5; P = 0.008) improved significantly at 6-month follow-up. Type of underlying behavioral disorder(s) or medications for behavioral disorder did not influence the outcomes. CONCLUSION This study confirms that children with underlying behavioral disorders are able to have a good response to the appropriate therapy for their bladder dysfunction with a third of children responding to standard urotherapy alone.
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Affiliation(s)
- Dilharan D Eliezer
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Naeem Samnakay
- Department of Surgery, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Malcolm R Starkey
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Aniruddh V Deshpande
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Urology Unit, Department of Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW This review will be covering dysfunctional voiding, its diagnosis, and treatment options. This will focus primarily on dysfunctional voiding rather than all lower urinary tract dysfunction and we will focus on some of the newer findings and progress within this disease. RECENT FINDINGS Dysfunctional voiding is the inappropriate sphincter and pelvic floor constriction during voiding in an otherwise neurologically normal child. This has a wide spectrum of symptoms and can lead to a number of complications such as chronic kidney disease and poor quality of life if not appropriately addressed. Dysfunctional voiding is diagnosed with a careful examination and history with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis. Urotherapy and biofeedback are the first and second-line treatments respectively and lead to significant improvement or cure in the majority of patients. For refractory patients, additional therapy options include use of α-blockers, botulinum injection, and electroneurostimulation, though the majority of the literature surrounding the use of these therapies consists of small studies with heterogenous causes of voiding dysfunction. SUMMARY Dysfunctional voiding is a common urologic complaint that has many excellent options for improving the patient's voiding issues and should be considered in patients with voiding dysfunction.
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Abstract
The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day- and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems.What is New:• This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.
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Ferrafiat V, Soleimani M, Chaumette B, Martinez A, Guilé JM, Keeshin B, Gerardin P. Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed. Front Psychiatry 2020; 11:724. [PMID: 32774309 PMCID: PMC7388897 DOI: 10.3389/fpsyt.2020.00724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Few studies have investigated pharmacologic treatment for pediatric post-traumatic stress disorder (PTSD). Prazosin, an alpha-1 adrenergic receptor antagonist, has been studied and demonstrated to be efficacious in an adult population for PTSD related sleep disturbances; however, in the pediatric population, data is limited to case reports and retrospective case series. This study prospectively assessed the safety and effects of Prazosin on PTSD symptoms in a pediatric sample. METHODS Since 2016, 18 patients with PSTD under the age of 15 admitted in a child and adolescent psychiatric unit were challenged with prazosin as part of a treatment protocol. PTSD symptoms and adverse effects were collected weekly and prospectively assessed each month with validated clinical scales. All data were retrospectively analyzed. This treatment protocol and the evaluation of clinical data were approved by our Ethical committee for research on preexisting data at the University Teaching Hospital of Rouen. RESULTS Among the 18 patients (10 girls and 8 boys), 13 (72%) had experienced sexual abuse and 5 (28%) family violence. After 1 month of treatment with a mean prazosin dose of 2.16 ( ± 0.6) mg/day, the CGI-S score significantly decreased from 5.3 ( ± 0.9) to 2.9 ( ± 0.7) (improvement of 43%). The mean total UCLA-PTSD-RI score significantly decreased 11.4 points ( ± 5.4) during the first week and 37.9 ( ± 16) during the first month, leading to an improvement of 20% and 67%, respectively. The improvement was significant irrespective of trauma exposure or sex. No adverse effects were reported except for one patient (hypotension). CONCLUSION Consistent with prior case reports and retrospective reviews, our retrospective analysis of data prospectively and systematically assessed among 18 patients suggests that prazosin is well-tolerated and associated with improvement in symptoms for pediatric PTSD.
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Affiliation(s)
- Vladimir Ferrafiat
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Maryam Soleimani
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Boris Chaumette
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Audrey Martinez
- Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Jean-Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens University Hospital, Picardie Jules Verne University, Amiens, France.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,INSERM U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardie-Jules Verne (UPJV), Amiens, France
| | - Brooks Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Priscille Gerardin
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
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Buckley BS, Sanders CD, Spineli L, Deng Q, Kwong JSW. Conservative interventions for treating functional daytime urinary incontinence in children. Cochrane Database Syst Rev 2019; 9:CD012367. [PMID: 31532563 PMCID: PMC6749940 DOI: 10.1002/14651858.cd012367.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In children, functional daytime urinary incontinence is the term used to describe any leakage of urine while awake that is not the result of a known underlying neurological or congenital anatomic cause (such as conditions or injuries that affect the nerves that control the bladder or problems with the way the urinary system is formed). It can result in practical difficulties for both the child and their family and can have detrimental effects on a child's well-being, education and social engagement. OBJECTIVES To assess the effects of conservative interventions for treating functional daytime urinary incontinence in children. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains studies identified from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 11 September 2018). We also searched Chinese language bibliographic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang. No language restrictions were imposed. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-randomised, multi-arm studies, cross-over studies and cluster-randomised studies that included children aged between 5 and 18 years with functional daytime urinary incontinence. DATA COLLECTION AND ANALYSIS Two review authors independently screened records and determined the eligibility of studies for inclusion according to predefined criteria. Where data from the study were not provided, we contacted the study authors to request further information. Two review authors assessed risk of bias and processed included study data as described in the Cochrane Handbook for Systematic Reviews of Interventions. Where meta-analysis was possible, we applied random-effects meta-analysis using the Mantel-Haenszel method for dichotomous outcomes. MAIN RESULTS The review included 27 RCTs involving 1803 children. Of these, six were multi-arm and one was also a cross-over study. Most studies were small, with numbers randomised ranging from 16 to 202. A total of 19 studies were at high risk of bias for at least one domain. Few studies reported data suitable for pooling due to heterogeneity in interventions, outcomes and measurements.Individual conservative interventions (lifestyle, behavioural or physical) versus no treatmentTranscutaneous electrical nerve stimulation (TENS) versus sham (placebo) TENS. More children receiving active TENS may achieve continence (risk ratio (RR) 4.89, 95% confidence interval (CI) 1.68 to 14.21; 3 studies; n = 93; low-certainty evidence).One individual conservative intervention versus another individual or combined conservative interventionPelvic floor muscle training (PFMT) with urotherapy versus urotherapy alone. We are uncertain whether more children receiving PFMT with urotherapy achieve continence (RR 2.36, 95% CI 0.65 to 8.53, 95% CI 25 to 100; 3 studies; n = 91; very low-certainty evidence).Voiding education with uroflowmetry feedback and urotherapy versus urotherapy alone. Slightly more children receiving voiding education with uroflow feedback and urotherapy may achieve continence (RR 1.13, 95% CI 0.87 to 1.45; 3 studies; n = 151; low-certainty evidence).Urotherapy with timer watch versus urotherapy alone. We are uncertain whether urotherapy plus timer watch increases the number of children achieving continence compared to urotherapy alone (RR 1.42, 95% CI 1.12 to 1.80; 1 study; n = 58; very low-certainty evidence).Combined conservative interventions versus other combined conservative interventionsTENS and standard urotherapy versus PFMT with electromyographic biofeedback and standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.11, 95% CI 0.73 to 1.68; 1 study; n = 78; very low-certainty evidence).PFMT with electromyography biofeedback and standard urotherapy versus PFMT without feedback but with standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.05, 95% CI 0.72 to 1.52; 1 study; n = 41; very low-certainty evidence).Individual conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)PFMT versus anticholinergics. We are uncertain whether more children receiving PFMT than anticholinergics achieve continence (RR 1.92, 95% CI 1.17 to 3.15; equivalent to an increase from 33 to 64 per 100 children; 2 studies; n = 86; very low-certainty evidence).TENS versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 0.81, 95% CI 0.05 to 12.50; 2 studies; n = 72; very low-certainty evidence).Combined conservative interventions versus non-conservative interventions (pharmacological or invasive, combined or not with any conservative interventions)Voiding education with uroflowmetry feedback versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportion of children achieving continence (RR 1.02, 95% CI 0.58 to 1.78; 1 study; n = 64; very low-certainty evidence). AUTHORS' CONCLUSIONS The review found little reliable evidence that can help affected children, their carers and the clinicians working with them to make evidence-based treatment decisions. In this scenario, the clinical experience of individual clinicians and the support of carers may be the most valuable resources. More well-designed research, with well-defined interventions and consistent outcome measurement, is needed.
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Affiliation(s)
- Brian S Buckley
- University of the PhilippinesDepartment of SurgeryManilaPhilippines
| | - Caroline D Sanders
- University of Northern British ColumbiaSchool of Nursing3333 University WayPrince GeorgeBritish ColumbiaCanadaV7M 2A9
| | - Loukia Spineli
- Hannover Medical SchoolDepartment of Obstetrics, Gynecology and Reproductive Medicine, Midwifery Research UnitCarl‐Neuberg‐Straße 1HannoverGermany30625
| | - Qiaoling Deng
- Zhongnan Hospital of Wuhan UniversityClinical Laboratory169 Donghu RoadWuhanHubei ProvinceChina430071
| | - Joey SW Kwong
- United Nations Population FundAsia and the Pacific Regional Office4th Floor, United Nations Service BuildingRajdamnern Nok AvenueBangkokThailand10200
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Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, Rittig S, De Gennaro M, Jackson E, Fonseca E, Nieuwhof-Leppink A, Austin P. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol 2018; 33:2207-2219. [PMID: 28975420 DOI: 10.1007/s00467-017-3799-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. METHODS A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. RESULTS BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. CONCLUSIONS This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.
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Affiliation(s)
- Stephen Yang
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Michael E Chua
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan
- Department of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Anne Wright
- Department of Paediatric Nephrourology, Evelina Children's Hospital, London, UK
| | - Per Brandström
- Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Department of Pediatrics, Aarhus University, Aarhus, Denmark
| | - Mario De Gennaro
- Department of Urology, Bambino Gesù Children's Hospital of Rome, Rome, Italy
| | - Elizabeth Jackson
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eliane Fonseca
- Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Paul Austin
- Department of Urology, St Louis Children's Hospital, St. Louis, MO, USA
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Shirazi M, Jahnabadi Z, Hekmati P. Use of baclofen in children with dysfunctional voiding: a preliminary report. Cent European J Urol 2018; 71:315-319. [PMID: 30386653 PMCID: PMC6202619 DOI: 10.5173/ceju.2018.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/02/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The aims of the present study were to examine the effectiveness and safety of baclofen in children with dysfunctional voiding (DV). Material and methods Thirty children with primary DV were enrolled. Patients underwent history taking, complete physical examination, urine analysis and culture, ultrasonography of the urinary system, a uroflowmetry study and post urine residue analysis. The Dysfunctional Voiding Symptom Score (DVSS) questionnaire was completed and other related symptoms were recorded. Oral baclofen was started for the study group at a dose of 1 mg/kg in 3 divided doses. Ultrasonography, a uroflowmetry study and questionnaire were repeated 3 months later. Results We observed a mean decrease of 14.67 ml in post void residual urine (PVRU) after 3 months. After usage of baclofen, increase in Qmax (5.74), increase in mean flow rate (8.2 vs. 11.3), and an average decrease of 12.3 in the DVSS questionnaire (p <0.001) were also observed. The number of voluntary voiding and wetting episodes were significantly decreased after treatment with baclofen (p = 0.001). Three main complaints of the patients were urgency (p = 0.001), dysuria (p = 0.004) and straining (p = 0.004) and all were significantly decreased after medical therapy with baclofen. Conclusions Baclofen may be useful in treatment of pediatric dysfunctional voiding. It was well tolerated among our patients with a remarkable reduction in their symptoms.
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Affiliation(s)
- Mehdi Shirazi
- Shiraz University of Medical Sciences, Namazee Hospital, Department of Urology, Shiraz, Iran
| | - Zahra Jahnabadi
- Shiraz University of Medical Sciences, Namazee Hospital, Department of Urology, Shiraz, Iran
| | - Pooya Hekmati
- Shiraz University of Medical Sciences, Namazee Hospital, Department of Urology, Shiraz, Iran
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Abstract
Neurogenic bladder (NB) is a nonspecific term that may describe conditions ranging from areflectic noncontractile bladder to detrusor overactivity. The most common cause of NB in children is the presence of dysraphic malformations. Urodynamic evaluations make it possible to describe bladder dysfunctions and to plan a therapeutic strategy for each patient. In a child with NB there are two major dangerous functional problems seen in urodynamic investigations: high intravesical pressure in the storage phase and high pressure during urination. The basic goals of urologic treatment for a child with NB are the protection of the urinary tract from complications and improvement of continence. Treatment for a child with NB is usually conservative, and focuses on achieving safe bladder pressures during storage with reliable emptying, via voiding or catheterization. The two most important forms of conservative treatment are clean intermittent catheterization and pharmacological treatment of functional disorders. Some drugs are used in the treatment of functional disorders in children with NB, but none of the drugs are officially approved for small children and babies.
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Affiliation(s)
- Paweł Kroll
- Neuro-urology Unit, Pediatric Surgery and Urology Clinic, Ul. Pamiątkowa 2/42, 61-512, Poznań, Poland.
- Poznan University of Medical Sciences, Poznań, Poland.
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Telli O, Hamidi N, Kayis A, Suer E, Soygur T, Burgu B. Can the success of structured therapy for giggle incontinence be predicted? Int Braz J Urol 2016; 42:334-8. [PMID: 27256188 PMCID: PMC4871395 DOI: 10.1590/s1677-5538.ibju.2014.0560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 09/09/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.
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Affiliation(s)
- Onur Telli
- Department of Paediatric Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Nurullah Hamidi
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Aytac Kayis
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Evren Suer
- Department of Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Tarkan Soygur
- Department of Paediatric Urology, School of Medicine, Ankara University, Ankara, Turkey
| | - Berk Burgu
- Department of Paediatric Urology, School of Medicine, Ankara University, Ankara, Turkey
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11
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Kakizaki H, Kita M, Watanabe M, Wada N. Pathophysiological and Therapeutic Considerations for Non-Neurogenic Lower Urinary Tract Dysfunction in Children. Low Urin Tract Symptoms 2016; 8:75-85. [PMID: 27111618 DOI: 10.1111/luts.12123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/17/2015] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
Non-neurogenic lower urinary tract dysfunction (LUTD) in children is very common in clinical practice and is important as an underlying cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in affected children. LUTD in children is caused by multiple factors and might be related with a delay in functional maturation of the lower urinary tract. Behavioral and psychological problems often co-exist in children with LUTD and bowel dysfunction. Recent findings in functional brain imaging suggest that bladder bowel dysfunction and behavioral and psychiatric disorders in children might share common pathophysiological factors in the brain. Children with suspected LUTD should be evaluated properly by detailed history taking, validated questionnaire on voiding and defecation, voiding and bowel diary, urinalysis, screening ultrasound, uroflowmetry and post-void residual measurement. Invasive urodynamic study such as videourodynamics should be reserved for children in whom standard treatment fails. Initial treatment of non-neurogenic LUTD is standard urotherapy comprising education of the child and family, regular optimal voiding regimens and bowel programs. Pelvic floor muscle awareness, biofeedback and neuromodulation can be used as a supplementary purpose. Antimuscarinics and α-blockers are safely used for overactive bladder and dysfunctional voiding, respectively. For refractory cases, botulinum toxin A injection is a viable treatment option. Prudent use of urotherapy and pharmacotherapy for non-neurogenic LUTD should have a better chance to cure various problems and improve self-esteem and quality of life in affected children.
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Affiliation(s)
- Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masaki Watanabe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Chien C, Wu HY. Young rats exhibit an age- and sex-dependent bladder response to alpha-antagonists but not beta-agonists. J Pediatr Urol 2016; 12:92.e1-8. [PMID: 26897326 DOI: 10.1016/j.jpurol.2015.11.005] [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: 09/12/2015] [Accepted: 11/06/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Previous studies have suggested that the onset of alpha- (α) and beta- (β) adrenergic receptor activity is delayed in young animals. The use of alpha1- (α1-) antagonists for dysfunctional voiding, and beta3- (β3-) agonists for overactive bladder in younger children may not be indicated if maturation is required before bladder and urethral adrenergic receptors are active. OBJECTIVE To determine the sex- and age-dependent responses of the bladder and external urethral sphincter (EUS) to α- and β-adrenergic agents in neonatal and young adult rats. MATERIALS AND METHODS A total of 72 naïve Sprague-Dawley rats (36 female, 36 male) and 15 bladder-reduced (BR) female Sprague-Dawley rats underwent cystometry and EUS electromyography at 3, 6, and 9 weeks of life. Following administration of WAY 100,635 (0.3 mg/kg, serotonergic receptor antagonist), the non-selective α-agonist phenylephrine (0.3 mg/kg), α-antagonist phentolamine (1-3 mg/kg), β-agonist isoprenaline (3 mg/kg) and β-antagonist propranolol (3 mg/kg) were delivered intravenously. The maximum intravesical pressure (IVP), pressure threshold (PT), intermicturition interval (IMI), contraction duration (CD), burst amplitude and burst frequency were compared after each drug. RESULTS The α-antagonist phentolamine lowered the IVP in 9-week-old males without lowering the PT. In contrast, the β-agonist isoprenaline lowered the IVP in both males and females of all ages, also without affecting the PT. Isoprenaline was also effective at shortening the CD in females, suggesting more effective bladder emptying. The α-agonist phenylephrine increased the IVP in 3-week-old and 6-week-old females and 3-week-old males, but this effect was blocked by pretreatment with phentolamine. The β-antagonist propranolol increased the PT in both males and females, and shortened the IMI in females, which was consistent with retention. Phenylephrine increased the burst duration in 9-week-old naïve females, while isoprenaline increased the burst amplitude and duration in 9-week-old BR females. CONCLUSIONS In the neonatal rat, both α- and β-adrenergic receptors actively regulate bladder function by 3 weeks of life, but the desired effect of decreasing IVP by α-antagonists was delayed until 9 weeks in male rats. In contrast, β-agonists were effective at decreasing IVP in both male and female rats of all ages, which suggests that they are better agents for enhancing bladder emptying in female and young male rats.
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Affiliation(s)
- China Chien
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hsi-Yang Wu
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
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Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bagli D, Bower WF, Renson C, Kawauchi A, Yang SSD. Treatment of daytime urinary incontinence: A standardization document from the International Children's Continence Society. Neurourol Urodyn 2015; 36:43-50. [DOI: 10.1002/nau.22911] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
| | - Erik Van Laecke
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Stuart B. Bauer
- Department of Urology; Boston Children's Hospital; Harvard Medical School; Boston Massachusetts
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Germany
| | - Darius Bagli
- Division of Urology; Hospital for Sick Children and Department of Surgery; University of Toronto; Toronto Ontario
| | - Wendy F. Bower
- Department of Rehabilitation; The Royal Melbourne Hospital; Melbourne Australia
| | - Catherine Renson
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| | - Stephen Shei-Dei Yang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
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Lin CD, Kuo HC, Yang SSD. Diagnosis and Management of Bladder Outlet Obstruction in Women. Low Urin Tract Symptoms 2015; 8:30-7. [PMID: 26789540 DOI: 10.1111/luts.12094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/28/2014] [Accepted: 01/07/2015] [Indexed: 02/05/2023]
Abstract
Bladder outlet obstruction (BOO) should be considered when a woman complains of voiding difficulty, abdominal straining to void, or refractory storage symptoms. Diagnosis of female BOO is not straightforward and usually requires invasive (video)urodyanmic study. A diagnostic algorithm is recommended for making optimal diagnosis. Female BOO can be classified as having anatomical and functional origins, and each contains several sub-classifications. Literatures published between 1988 and 2013 were reviewed and summarized for the diagnosis and therapy in each subtype of female BOO.
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Affiliation(s)
- Chia-Da Lin
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, New Taipei, Taiwan.,Department of Urology, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.,Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Stephen S-D Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, New Taipei, Taiwan.,Department of Urology, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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Lee LC, Koyle MA. The Role of Bladder and Bowel Dysfunction (BBD) in Pediatric Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Pediatric urinary incontinence: Classification, evaluation, and management. AFRICAN JOURNAL OF UROLOGY 2014. [DOI: 10.1016/j.afju.2013.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Amira PA, Dušan P, Gordana ML, Sandra T, Ivaniševic I. Bladder control training in girls with lower urinary tract dysfunction. Int Braz J Urol 2013; 39:118-26; discussion 127. [PMID: 23489504 DOI: 10.1590/s1677-5538.ibju.2013.01.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years. MATERIALS AND METHODS 72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns. RESULTS BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DVI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients. CONCLUSION Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, while presence of nocturnal enuresis may be a negative predictor of the training effect.
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Troubles mictionnels de l’enfant : du diagnostic au traitement. Arch Pediatr 2012; 19:1239-42. [DOI: 10.1016/j.arcped.2012.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/13/2012] [Accepted: 08/08/2012] [Indexed: 11/19/2022]
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Doxazosin Versus Tizanidine for Treatment of Dysfunctional Voiding in Children: A Prospective Randomized Open-labeled Trial. Urology 2012; 79:428-33. [DOI: 10.1016/j.urology.2011.10.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/14/2011] [Accepted: 10/21/2011] [Indexed: 11/20/2022]
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Thom M, Campigotto M, Vemulakonda V, Coplen D, Austin PF. Management of lower urinary tract dysfunction: a stepwise approach. J Pediatr Urol 2012; 8:20-4. [PMID: 21377425 DOI: 10.1016/j.jpurol.2011.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate management patterns of lower urinary tract (LUT) dysfunction and establish a treatment algorithm to guide pediatric healthcare providers. METHODS 390 children with non-neurogenic LUT dysfunction were followed over 7 months; 115 patients were excluded due to incomplete data. Children were categorized based on presenting complaints and pelvic ultrasound into three groups: daytime urinary incontinence (UI) with complete emptying (CE), UI with incomplete emptying (IE), or IE without UI. Every child underwent behavioral modification (BM) including timed voiding, double voiding, deep breathing, and treatment of constipation if present. BM failures received secondary treatment including medications (alpha blockers, anticholinergics), physical therapy, and/or botulinum toxin type A injection of the external sphincter at a dose of 100 units. RESULTS BM improved symptoms in 152 (55%): 68% (46% dry), 49% (27% dry), and 59% (29% dry) from the three groups, respectively. Of the 45% who showed no change in symptoms, 98 (80%) improved with addition of medication, the majority (89) after starting alpha blocker therapy. Children with IE responded better to alpha blockers, 83 (77%) compared to 38% with CE, whereas those with CE demonstrated more symptom resolution with anticholinergics, 6 (38%) compared to 13% of those with IE. Only 6 (2%) patients were refractory to non-operative treatment with all showing improvement after injection of botulinum toxin type A, 4 (67%) of whom became completely dry. CONCLUSION Diagnosis of UI and/or IE with stratification of children into particular symptom groups appears beneficial in determining the appropriate therapy for children with LUT dysfunction.
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Affiliation(s)
- Matthew Thom
- Pediatric Urology, Washington University in St Louis, St. Louis Children's Hospital, 4990 Children's Place, Suite 1120, Box 8242, St. Louis, MO 63110, USA.
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Yang SSD, Chiang IN, Lin CD, Chang SJ. Advances in non-surgical treatments for urinary tract infections in children. World J Urol 2011; 30:69-75. [PMID: 21614468 DOI: 10.1007/s00345-011-0700-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/07/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE With growing antibiotics failure due to emerging resistance of bacteria, non-surgical management of pediatric UTI plays a more important role because of its non-invasive characteristics and little adverse effects. METHODS We searched the Pubmed for management of UTI in children other than surgical correction and antibiotics using terms: risk factor, prepuce/phimosis, steroid cream/steroid, behavioral therapy, urotherapy, biofeedback/pelvic floor exercise, adrenergic antagonist, anticholinergics, diet/dietary, dysfunctional voiding/dysfunctional elimination syndrome, constipation, dietary, clean intermittent catheterization, probiotics/lactobacillus, cranberry, vitamin supplement, breastfeeding, breast milk, with infant/child/children/pediatrics/pediatrics and urinary tract infection. RESULTS The proposed non-surgical management of pediatric UTI included behavioral modification (timed voiding and adequate fluids intake), topical steroid for phimosis, nutrient supplements (breast milk, cranberry, probiotics, and vitamin A), biofeedback training for dysfunctional voiding, anticholinergics for reducing intravesical pressure, alpha-blockers in dysfunctional voiding and neurogenic bladder, and intermittent catheterization for children with large PVR. CONCLUSION The published reports usually included small number of patients and were lacking of randomization and controlled group. Further well-designed studies are warranted to support the concepts of non-operative management for pediatric UTI.
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Affiliation(s)
- Stephen Shei-Dei Yang
- Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, No. 289 Chienkuo Road, Xindian City, Taipei, 231, Taiwan
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Placebo-controlled trials in pediatric urology: a cautionary view from an ethical perspective. J Pediatr Urol 2010; 6:435-42. [PMID: 20347616 DOI: 10.1016/j.jpurol.2010.02.208] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 02/16/2010] [Indexed: 12/23/2022]
Abstract
The ethical dispute regarding placebo-controlled trials is discussed in this review. Important issues, such as clinical equipoise, fiduciary obligation and middle ground theory, are examined in the context of pediatric urology clinical research. After reviewing the literature, the authors summarize specific indications for placebo-controlled trials in pediatric urology, and emphasize that physicians have ethical and moral obligations to patients, in the sense that one should carefully plan and conduct such trials in order to gain clinically important information without exposing children to undue risks.
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Chase J, Austin P, Hoebeke P, McKenna P. The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children's Continence Society. J Urol 2010; 183:1296-302. [PMID: 20171678 DOI: 10.1016/j.juro.2009.12.059] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE We present a consensus view of members of the International Children's Continence Society on the management of dysfunctional voiding in children. MATERIALS AND METHODS Discussions were held by the board of the International Children's Continence Society and a multi-disciplinary core group of authors was appointed. The draft document review process was open to all International Children's Continence Society members via the web site. Feedback was considered by the core authors and, by agreement, amendments were made as necessary. RESULTS Guidelines on the assessment, and nonpharmacological and pharmacological management of dysfunctional voiding are presented. CONCLUSIONS The final document is not a systematic literature review. It includes relevant research when available as well as expert opinion on the current understanding of dysfunctional voiding in children.
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Affiliation(s)
- Janet Chase
- Monash Medical Centre Paediatric Continence Clinic, Melbourne, Australia
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Van Batavia JP, Combs AJ, Horowitz M, Glassberg KI. Primary bladder neck dysfunction in children and adolescents III: results of long-term alpha-blocker therapy. J Urol 2009; 183:724-30. [PMID: 20022041 DOI: 10.1016/j.juro.2009.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Primary bladder neck dysfunction is a nonneurogenic voiding disorder frequently overlooked in pediatrics. The diagnosis classically is made by videourodynamics but can also be made with noninvasive uroflow studies with pelvic floor electromyography. We report our long-term results using alpha-blocker therapy in patients with primary bladder neck dysfunction. MATERIALS AND METHODS We reviewed 51 neurologically normal children (mean age 11.6 years, range 3.5 to 17.8) meeting criteria for primary bladder neck dysfunction who underwent alpha-blocker therapy for at least 1 year. All patients were symptomatic with abnormal flow parameters and an electromyogram lag time of 6 seconds or more on initial uroflow/electromyography. Pretreatment and on-treatment uroflow/electromyogram studies were performed in all patients. Average and maximum uroflow rates, electromyogram lag times and post-void residual volumes were compared. RESULTS After a mean followup of 46.2 months (range 12 to 124) mean average and maximum uroflow rates improved from 7.0 to 12.4 cc per second and from 12.4 to 20.3 cc per second, respectively, while mean electromyogram lag time decreased from 30.8 to 5.8 seconds (all p <0.01). Of the patients 85% reported subjective symptomatic relief. A total of 15 patients (29%) stopped alpha-blocker therapy for various reasons, none related to side effects. Repeat off-treatment uroflow/electromyogram studies showed that measured parameters reverted to pretreatment values (all p <0.05). Eight of these 15 patients eventually resumed alpha-blocker therapy, while only 3 remained asymptomatic off of the alpha-blocker. CONCLUSIONS alpha-Blocker therapy continues to benefit children with primary bladder neck dysfunction even after 3 years of treatment. Few patients can come off of alpha-blocker therapy without returning to their pretreatment state, suggesting the condition is likely chronic in most patients.
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Affiliation(s)
- Jason P Van Batavia
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA
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Effect of Tamsulosin on Systemic Blood Pressure and Nonneurogenic Dysfunctional Voiding in Children. J Urol 2009; 181:817-22; discussion 822. [DOI: 10.1016/j.juro.2008.10.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Indexed: 11/24/2022]
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Kang JH. Diagnosis and therapy for functional urinary incontinence in childhood. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.11.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ju Hyung Kang
- Department of Pediatrics, College of Medicine, Eulji University, Daejeon, Korea
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Abstract
PURPOSE OF REVIEW To update the physician regarding the use of alpha-adrenergic antagonists in the management of various pediatric urologic problems. RECENT FINDINGS The use of alpha-adrenergic antagonist for the treatment of pediatric urologic disorders has expanded greatly over the past decade. This review summarizes the current use of these medications in the treatment of pediatric voiding dysfunction, neurogenic bladder, chronic lower urinary tract symptomatology, idiopathic urethritis, and the passage of ureteral calculi. SUMMARY Currently alpha antagonist therapy although not useful in the primary treatment of voiding dysfunction is equivalent in potency to biofeedback therapy for the treatment of recalcitrant voiding dysfunction. In the management of neurogenic bladder and chronic lower urinary tract symptomatology, alpha antagonists working alone or in conjunction with anticholinergic medications will improve clinical symptoms, increase bladder compliance, and decrease detrusor instability. In addition, alpha antagonists may decrease the intensity and duration of symptoms in patients with idiopathic urethritis. Compared with placebo, alpha-adrenergic antagonists will also aid significantly in the spontaneous passage of distal ureteral calculi, thereby reducing the need for surgical intervention and analgesia. The findings noted above significantly expand the clinical usefulness of alpha antagonist therapy within the field of pediatric urology.
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Affiliation(s)
- Douglas A Husmann
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2006; 16:310-3. [PMID: 16770134 DOI: 10.1097/01.mou.0000232056.97213.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Urinary incontinence is a common primary care problem. With the proper understanding of normal and abnormal bladder function, pediatricians can create a protocol that will benefit most children seen with this condition. Emphasis should be placed on primary therapy: establishing healthy dietary habits, treating constipation, maintaining appropriate hygiene, and developing a regular voiding pattern. When the initial evaluation identifies an anatomic abnormality or when primary therapy fails, referral to a pediatric urologist is warranted.
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Affiliation(s)
- C D Anthony Herndon
- Section of Pediatric Urology, Division of Urology, Department of Surgery, University of Alabama at Birmingham, Children's Hospital, 1600 7th Avenue S, Birmingham, AL 35233-1711, USA.
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Abstract
PURPOSE OF REVIEW This review will focus on the diagnosis and management of voiding dysfunction in neurologically and anatomically normal children. The discussion will highlight recent developments and research in the clinical approach as well as the etiology and classification of these disorders. RECENT FINDINGS Voiding dysfunction in children encompasses a wide spectrum of clinical entities, recently classified collectively as dysfunctional elimination syndromes. Voiding dysfunction typically presents after toilet training and may originate from behavioral issues that arise around this time in childhood development. The spectrum of disorders includes urge syndrome, dysfunctional voiding with an uncoordination between the detrusor and urinary sphincter, and enuresis. Clinical symptoms may vary from mild incontinence to severe disorders with endpoints of irreversible bladder dysfunction with vesicoureteral reflux, urinary tract infection and resulting nephropathy. Diagnosis relies heavily on a good history and physical examination, but also includes radiologic and urodynamic evaluation. Treatment generally consists of medical therapy, primarily with anticholinergics as well as behavioral therapy to modify learned voiding patterns that contribute to the voiding dysfunction. SUMMARY This overview of voiding dysfunction in children outlines the established approaches to its diagnosis and treatment and highlights the most recent developments in the field.
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Affiliation(s)
- Adam S Feldman
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
Daytime wetting is a common problem with various causes that can usually be identified through a careful history, thorough physical examination, and urinalysis. Conservative approaches to therapy have a successful outcome in most children. Invasive diagnostic imaging studies and pharmacologic or surgical intervention are necessary only for carefully selected children.
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Affiliation(s)
- W Lane M Robson
- The Childrens' Clinic, Suite 111, 4411 16th Avenue NW, Calgary, Alberta T3B OM3, Canada.
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