30th ESPU Congress - Lyon, France - 2019

S1: FUNCTIONAL VOIDING DISORDERS 1

Moderators: Alexandra Vermandel (Belgium), Angela Downer (UK)

ESPU-Nurses Meeting on Thursday 25, April 2019, 09:20 - 10:00


09:20 - 09:30
S1-1 (LO)

SENS-Uâ„¢: CLINICAL EVALUATION OF A FULL BLADDER NOTIFICATION - A FEASIBILITY STUDY

P.G. VAN LEUTEREN, A.J. NIEUWHOF-LEPPINK, T.P.V.M. DE JONG and P DIK
Wilhelmina Children's Hospital UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS

PURPOSE

Urinary incontinence is a common problem in school-age children. Recently, a new, wearable ultrasonic bladder sensor became available, the SENS-U™ Bladder Sensor. The SENS-U is a small, wearable ultrasound sensor, which continuously monitors the bladder filling and provides a personalized notification when it is time to go to the toilet. In this study, the aim is to examine the performance of the SENS-U as a full-bladder-based notification system in active children during inpatient bladder training.

PATIENTS AND METHODS

In this study, children (6-16 years) were included who were admitted for an inpatient bladder training program. Parallel to one training-day, the child would wear the SENS-U to estimate the filling status (i.e. every 30 s) and inform the patient when the bladder was almost full. When the child received a full-bladder notification, the child was taught to inform the urotherapist / researcher, in order to determine the level of response.

RESULTS

15 patients (boys/girls: 7/8) [mean age: 11.5 ± 1.7 years] were included. Based on a personalized volume-based threshold, the SENS-U notified these children of a full bladder with a median notification rate of 92.9% (IQR: 61.7 – 100%). In the remaining cases, children voided before the threshold was reached (e.g. defecation). Children responded positively to the notification of the SENS-U, resulting in a median level of response equal to 100% (IQR: 100% - 100%).

CONCLUSIONS

The SENS-U™ Bladder Sensor was able to monitor the natural bladder filling in active children, while moving freely, and to notify them of a full bladder with a median notification rate of 92.9% (based on a personalized volume-based threshold) and a median level of response equal to 100%. Future research will focus on investigating the effect of the SENS-U in clinical practice and in response to training.


09:30 - 09:40
S1-2 (LO)

VIDEO-URODYNAMICS: A CHILD'S PERSPECTIVE

Kay WILLMOTT, Anne WRIGHT, Massimo GARRIBOLI and Joanna CLOTHIER
Evelina London Children's Hospital, Paediatric nephro-urology, London, UNITED KINGDOM

PURPOSE

To understand from the child’s perspective the discomfort and emotions felt during video-urodynamic investigation (VUD). To identify whether there is a difference in placement of catheter discomfort between those regularly catheterising and those not catheterising and between genders.

MATERIAL AND METHODS

Single-centre, prospective, age-appropriate anonymised questionnaire study performed on consecutive VUD in paediatric patients aged 5-11 years, over 5 month period.

Questionnaire completed by child immediately following investigation.

Specific questions regarding discomfort related to all aspects of VUD recorded, mean overall score presented. Wong-Baker FACES pain rating scale used for 5-7 years and visual analogue score for 8-11 years, scoring 1-10 (10 most discomfort). Emotions were recorded by use of emoticons in 5-7 years and by visual analogue scale in 8-11 years, scoring 1-10.

Mann-Whitney test used to assess for any differences in discomfort between those regularly catheterising and not, and between genders.

RESULTS

54 patients completed the questionnaire.

5-7 year group: 14 questionnaires (age 6.14 years, 65% male, 21% neuropathic). Pain score 3.2/10. Emotions expressed (more than 1 choice possible): 57% scared, 43% worried, 29% embarrassed, 21% ok, 29% happy.

8-11 year group: 40 questionnaires (age 9.3 years, 70% male, 18% neuropathic). Pain score 2.1/10. Emotions expressed values: scared 4.3/10, worried 4.3/10, embarrassed 2.4/10, ok 6.6/10, happy 6/10.

No statistical difference was found for discomfort in placement of bladder or rectal line between children regularly catheterising or not (p=0.105 and p=0.78) nor between males and females (p= 0.53 and p=0.51).

CONCLUSIONS

Despite a natural belief that VUD is an invasive and intrusive test, our result suggest that children between 5 and 11 years of age experience low levels of discomfort.

No difference was found for catheter placement between child’s current catheterising status or between genders.


09:40 - 09:50
S1-3 (LO)

VIDEO-URODYNAMICS: ADOLESCENT'S PERSPECTIVE

Kay WILLMOTT, Anne WRIGHT, Massimo GARRIBOLI and Joanna CLOTHIER
Evelina London Children's Hospital, Paediatric nephro-urology, London, UNITED KINGDOM

PURPOSE

To understand from the adolescent’s  perspective the discomfort and emotions felt during video-urodynamic investigation (VUD). To identify whether there is a difference in placement of catheter discomfort between those regularly catheterising and those not catheterising and between genders

MATERIAL AND METHODS

Single-centre, prospective, anonymised questionnaire study performed on consecutive VUD in paediatric patients aged 12-19 years, over 5 month period.

Questionnaire completed immediately following investigation.

Specific questions regarding discomfort related to all aspects of the study recorded and emotions felt during the study, using Likert scale, 1-5 (5 high). Patient asked to rate experience  vs expectation 1-5 (5 much worse than expected).Values expressed as median.

Mann-Whitney test used to assess for any differences in discomfort between those regularly catheterising and not, and between genders.

RESULTS

35 questionnaires completed (14 years, 50% male, 3% neuropathic).

Pain score: bladder catheter placement 1.5/5, rectal line 2/5, holding a void 3/5, voiding 1/5, EMG stickers 1/5, removal of bladder catheter 2/5, removal of rectal line 2/5. Overall score 2.0.

Emotions: Anxious 3/5, frightened 2/5, embarrassed 2/5. Overall experience 2/5 (better than expected).

Only 3 patients performing catheterisation in the group so insufficient numbers to compare. No significant difference between males and females for discomfort during bladder (p= 0.11) and rectal line placement (p=0.39).

CONCLUSIONS

Adolescents express low levels of discomfort during VUD. The experience is slightly better than the expectation. Anxiety, fear and embarrassment are regularly experienced at low level and need to be considered. Males and females expressed same level of discomfort with catheter placement.


09:50 - 10:00
S1-5 (LO)

GOOD PREPARATION AND PROPER PLACEMENT, THE SUCCES OF CORRECT VIDEO URODYNAMICS IN PHYSICAL HEALTHY CHILDREN

Sigrid VAN DE BORNE, Karen DE BAETS, Stefan DE WACHTER and Gunter DE WIN
Antwerp University Hospital, Urology, Edegem, BELGIUM

PURPOSE

Video urodynamics helps to diagnose OAB, acontractile bladder, bladder-neck dysfunctions in children. Procedure performed in children between 0-17 years old can be stressful due to circumstances. A good diagnose depends on a correct execution of the videourodynamics. In order to prevent useless examination, specific actions can be performed beside a good understanding of the urodynamic technique.

MATERIAL AND METHODS

Starting with a serene child only has advantages, to divert the child, a film is chosen with participation of the child. Size of catheter is chosen by the age of the child especially with boys. Children <12 years old CH6, 24 cm, and > 12 CH 7, 40 cm. Proper starting position and covered genitals can be helpful. Control of an empty bladder trough the urodynamic-catheter and proper fixation, leaving the meatus open. EMG fixated on the perineum, correct sitting posture to relax the muscles while voiding. Filling rate chosen by age to avoid unnecesarry detrusoroveractivity and poor compliance. Knowledge of the pathology for a correct RX position to avoid unnecesarry radiation.
In traumatic patients we can use Kalinox or suprapubic lines.

RESULTS

Taking into account all aforementioned steps, urodynamics can be successful performed in 90% of the cases.

CONCLUSIONS

A thorough videourodynamic evaluation starts with a proper preparation and placement of the leads, the radiographic device and a serene and quietly child. A proper therapy can be started.