30th ESPU Congress - Lyon, France - 2019

S2: LOWER URINARY TRACT

Moderators: Louiza Dale (UK), Helena Ekdahl (Sweden)

ESPU-Nurses Meeting on Thursday 25, April 2019, 11:45 - 12:35


11:55 - 12:05
S2-1 (LO)

A FEASIBILITY STUDY OF A UROFLOWMETER POTTY FOR TODDLERS

Lola BLADT 1, Stefan DE WACHTER 2, Alexandra VERMANDEL 2 and Gunter DE WIN 2
1) Minze Health, Antwerp, BELGIUM - 2) Antwerp University Hospital, Department of Urology, Edegem, BELGIUM

PURPOSE

Uroflowmetry is a simple and noninvasive test to evaluate lower urinary tract function. Since it requires voiding on command, the available data on pediatric uroflows –and especially toddlers- are scarce and varied. In addition, such tests can be affected by the unnatural hospital/study environment and by the lack of a proper posture on the big, currently available uroflowmeter seats. In this study, the feasibility of a novel uroflowmeter potty is assessed to obtain uroflows from toddlers.

MATERIALS AND METHODS

Uroflowmetry studies with the novel potty were performed on 10 healthy toddlers (mean age 3 years, range 2-4 years, male:7 female:3) following their normal potty training routine. Voided volume, maximum flowrate (Qmax) and uroflowcurve shape were analysed. Additionally, different potty designs were evaluated on their ergonomics.

RESULTS

20 uroflows were successfully recorded with a mean voided volume of 50.4 ml (SD 28.8 ml; range 10-147 ml) and a mean Qmax of 7.8 ml/s (SD 3.0 ml/s; range 4-14 ml/s). Analysis of the curve shape showed 50% bell-shaped, 30% interrupted and 20% plateau curves.

The design of the potty was optimized to enable a proper voiding posture - flat feet on the floor and horizontal pelvis position. An oval-shaped potty design (30x25 cm) with a 18 cm height was found most ergonomic and comfortable.

CONCLUSIONS

The uroflowmeter design possibly influences representativeness of a child’s void. The designed uroflowmeter potty is considered a comfortable and valuable tool to obtain uroflows in toddlers, enabling more research in pediatric uroflowmetry.


12:05 - 12:15
S2-2 (LO)

PELVIC FLOOR REHABILITATION IN CHILDREN WITH FUNCTIONAL LUTD: DOES IT IMPROVE OUTCOME?

Anka NIEUWHOF-LEPPINK 1, Frank-Jan VAN GEEN 2, Elise M. VAN DE PUTTE 3, Marja A.G.C. SCHOENMAKERS 4, Tom. P.V.M DE JONG 5 and Renske SCHAPPIN 6
1) Wilhelmina Children's Hospital (Part of UMCU), Medical Psychology and Social Work, Urology, Utrecht, NETHERLANDS - 2) Wilhelmina Children's Hospital (Part of UMCU), Medical Psychology and Social Work, Urology, Utrecht, NETHERLANDS - 3) Wilhelmina Children's Hospital (Part of UMCU), Pediatrics,, Utrecht, NETHERLANDS - 4) Wilhelmina Children's Hospital,(Part of UMCU), Physiotherapy, Utrecht, NETHERLANDS - 5) University Children's Hospitals UMC Utrecht and Amsterdam AMC, Pediatric Urology, Amsterdam, NETHERLANDS - 6) Wilhelmina Children's Hospital (Part of UMCU), Medical Psychology and Social Work, Utrecht, NETHERLANDS

PURPOSE

To date little is known about the clinical value of pelvic floor rehabilitation in the treatment of functional voiding disorders. Therefore, we studied the added value of pelvic floor rehabilitation by Biofeedback with Anal Balloon Expulsion (BABE) in the urotherapeutic treatment of standard therapy refractory children, with inadequate pelvic floor control and functional lower urinary tract dysfunction (LUTD).

MATERIAL AND METHODS

A retrospective chart study was conducted on children who received an inpatient cognitive bladder-training program at our pediatric incontinence university clinic.
All consecutive patients that were referred by the urologist to the physical therapist and urotherapist between 2010-2016 were considered for inclusion. A total of 40 patients were eligible with 19 patients in the study group receiving additional pelvic floor rehabilitation by BABE prior to inpatient bladder-training and 21 patient in the control group receiving solely inpatient bladder-training. Main outcome measurement was inpatient bladder-training success, at three months after completion of training.

RESULTS

Baseline characteristics demonstrate no major differences between our study and control group. Comparison of treatment outcome showed no statistically significant difference between the study and the control group (Fisher’s exact test p=0.311). From the 19 children that received additional pelvic floor rehabilitation by BABE, 15 (78.9%) accomplished a good or improved training result compared to 13 (61.9%) patients in the control group. Of the children that underwent additional pelvic floor rehabilitation by BABE, 11 (57.9%) improved pelvic floor function.

CONCLUSIONS

Children who underwent additional physical therapy, preparatory to inpatient bladder training, did not achieve a significant better training outcome than children who solely underwent inpatient bladder training. Rehabilitation of voluntary pelvic floor mobility by BABE did not influence the bladder training outcome in our institution. We conclude BABE has no additional effect on our bladder-training program.


12:15 - 12:25
S2-3 (LO)

VARIABILITY OF UROFLOWMETRIES WITHIN CHILDREN

Sam TILBORGHS 1, Stefan DE WACHTER 1, Anna BAEL 2, Karen DE BAETS 1 and Gunter DE WIN 1
1) Antwerp University Hospital, Department of Urology, Edegem, BELGIUM - 2) Antwerp Hospital Network (ZNA), Queen Paola Children's Hospital, Antwerp, BELGIUM

PURPOSE

Single measurement uroflows, obtained in an unnatural environment (hospital) often result in unreliable data, especially in children. The aim of this study is to assess the variability of uroflowmetries in children using Homeflow - a portable home-uroflowmeter, fitting on a normal toilet.

MATERIAL AND METHODS

Multiple uroflows (177) were assessed in 11 children (boys/girls: 9/2; mean age: 10,36 +/- 5,15). The variability of the maximum flow rate (Qmax) and flow curve were analysed in relation to urge, time of the day and voided volume (Vvoid).

RESULTS

We found individual ranges of the intra-subject Standard Deviation (SD) of multiple measurements of Qmax between 0,86 and 9,94 ml/sec. With a moderate intra-subject SD of 4 ml/sec, Qmax may vary by up to 12 ml/sec (3SD) due to random fluctuation alone. Variability in Qmax and flow curve shape could be dependent on time of day, urge and/or Vvoid. Qmax-Vvoid correlation of multiple uroflows in one individual are interesting to investigate and compare with conventional nomograms.

CONCLUSIONS

There was a significant intra-variability in Qmax and flow curve with each successive void. Multiple measurements influence extreme values (either outliers or unrepresentative flows), counteracting the large potential error in a single measurement. Due to this variability, comparison between single in-clinic flows in an individual is less powerful - definitely, considering the psychological effects of the hospital environment on a child. Our results underline the clinical potential of Homeflow. The cohesion of depending factors determing Qmax, Vvoid, flowcurve and urge is complex and needs more research.


12:25 - 12:35
S2-4 (LO)

BLADDER INSTILLATIONS WITH SODIUM CHONDROITIN SULFATE SOLUTION AND HYALURONIC ACID CAN BE EFFECTIVE AND SAFE TO TREAT RECURRENT UTIS IN CHILDREN

Katerina PRODROMOU 1, Maria BOBADILLA 2, Claire FERGUSON 2, Helen Fiona MACANDREW 2 and Harriett CORBETT 2
1) Alder Hey Children's Hospital, Paediatric Urology, Lancaster, UNITED KINGDOM - 2) Alderhey Children's Hospital, Liverpool, UNITED KINGDOM

PURPOSE

Bladder instillations with Sodium Chondroitin Sulfate (SCS) and Hyaluronic Acid (IHA) are used to treat interstitial cystitis / painful bladder. Benefit is also reported in adults with recurrent urinary tract infections (UTIs) but data for this indication in children is lacking. We evaluate use of bladder instillations in children with recurrent UTIs.

MATERIAL AND METHODS

Patients  identified from specialist nurse records were studied retrospectively. Patients with neuropathic bladder or bladder pain alone were excluded.

The patients were divided into two groups: recurrent UTIs (group 1) and with UTIs with bladder pain (group 2). After 5 weekly bladder instillations of SCS or IHA, patients received monthly administrations. Complete response = UTI free, partial response = reduction in UTIs by more than 50%.

RESULTS

Nineteen girls (mean age 12 years) were treated with SCS or IHA between April 2015 and March 2018. Mean follow up from last instillation was 10 months (range 3 - 32). Fourteen received SCS, 4 IHA, one received both.

Group 1 (n=11), complete response in  6 (55%) and partial in 2 (18%),  no response in 3 patients. 

Group 2 (n=8), complete response  in 6 (75%) with no response in 2 patients. 

In total, 63% had a complete response and 11% a partial response, with no difference between groups nor in the response to SCS vs IHA (p>0.05, Fishers Exact test). One patient experienced vulvovaginitis, there were no other complications.

CONCLUSIONS

For selected children bladder instillations can safely resolve or reduce UTIs.