30th ESPU Congress - Lyon, France - 2019

S3: NEUROPATHIC BLADDER

Moderators: Babett Jatzkowski (Sweden), Anka Nieuwhof-Leppink (Netherlands)

ESPU-Nurses Meeting on Thursday 25, April 2019, 14:00 - 14:50


14:00 - 14:10
S3-1 (LO)

OPTION FOR NON-SURGICAL TREATMENT OF STENOSIS IN CONTINENT CATHETERIZABLE CHANNELS

Laurence HERMSEN-HEILEMA 1, Pieter DIK 2 and Ellen DE BRUJN-KEMPE 2
1) Wilhelmina Children's Hospital, University Medical Center, Pediatric urology, Utrecht, NETHERLANDS - 2) Wilhelmina children's hospital, University Medical Center Utrecht, Pediatric urology, Utrecht, NETHERLANDS

PURPOSE

Introduction: Children with bladder dysfunction as in neurogenic disorder or bladder exstrophy often have to perform Clean Intermittent Catheterization (CIC). If urethral catheterization isn't possible or desirable, creating a continent catheterizable channel (CCC) can be a good option. A retrospective study done in 2017 in our centre describes the longterm follow-up of different CCC's in children (n=112). It showed e.g. that in 33% of the patients with a CCC, surgical revision was required because of stenosis.

Purpose is a treatment of stoma-stenosis in a conservative way in order to prevent or to postpone surgical intervention based on best practice.

MATERIAL AND METHODS

Several children with problems of CIC related to stenosis were treated. When dilatation with the aid of catheters in different sizes doesn't work the CCC was carefully dilated with McCrea probes in different sizes, beginning with the smallest one. If succeeded the patient received an indwelling, small size catheter without coating for one week. A week later the whole procedure was repeated, with an indwelling catheter of bigger size for another week. After three weeks the channel is ready again for CIC. The usage of Clobetasol twice a day on the tip of the catheter or on the corstop is recommended during the first two weeks from the restart of CIC.

RESULTS

Non-surgical treatment of stenosis was working well in most of the treated children. In some cases it was a temporal solution for several months and surgical treatment was still needed.

CONCLUSIONS

If you take time and be patient, it takes sense to solve the stenosis in a conservative way.


14:10 - 14:20
S3-2 (LO)

COMPLICATIONS AND PATIENT SATISFACTION WITH URETHRAL CLEAN INTERMITTENT CATHETERIZATION IN SPINA BIFIDA PATIENTS: COMPARING COATED VS. UNCOATED CATHETERS.

Tariq BURKI 1, Abdelazim ABASHER 1, Ahlam AL SHAHRANI 2, Abdul Wahab AL HAMS 1, Hanan IBRAHIM 1, Fayez AL MODHEN 2, Yasser JAMAL ALLAIL 2 and Ahmed AL SHAMMARI 2
1) King Abdullah Specialized Children Hospital, King Abdula Aziz Medical City, NGHA, Riyadh, Pediatric Urology, Riyadh, SAUDI ARABIA - 2) King Abdullah Specialized Children Hospital, King Abdula Aziz Medical City, NGHA, Riyadh, Riyadh, SAUDI ARABIA

PURPOSE

To assess complications and patient's preference in spina bifida children on CIC comparing coated vs uncoated catheters.

MATERIAL AND METHODS

We retrospective analyzed spina bifida children(age 0-16years), who were on urethral CIC for at least ≥ 6 months and had no prior bladder surgery. Ethical committee approval was taken. Information was obtained from electronic patient record and telephonic/outpatient interview. Patients were divided into uncoated (UCC) or coated hydrophilic (HCC) catheters using groups. Both groups were exposed to use catheter from other group for variable period when supplies were short. We recorded type/size of the catheter used, duration of use, person performing CIC, complications e.g. UTIs, pain/discomfort, trauma, stones, epididymitis etc. Patients satisfaction was recorded on a scale of 1-10 with their routine catheter used and their preferred catheter if they have choice. P value of <0.05 was considered significant using SPSS for data nalysis.

RESULTS

There were131 patients, 53 using UCC and 48 using HCC. There was no significant difference between any variable like age, gender, duration of CIC etc. Data analysis showed --- mean time to perform CIC UCC 9.7 min (R 3-25) vs HCC 8.8 minutes (R 4-20), discomfort/pain 8(15%) UCC vs 4 (8.3%) HCC (P=0.16), recurrent UTIs 12(22.6%) UCC vs 17(35.4%) HCC (P=0.09), median patient satisfaction UCC 8/10(3-10) vs HCC 10/10(7-10), P=0.63. When given a choice, 28/53(52.8%) in UCC and none(0%) in HCC group(P=<0.0001) preferred to change to the other type of catheter, mainly due to convenience of use of the product. Per year cost of UCC is US$ 389 vs HCC US$ 2820/patient which is 7 times costiler.

CONCLUSIONS

There is no significant difference in complications rate in patients using either UCC or HCC. The patients prefer to use HCC when given a choice mainly for convenience of use of the product but it is seven times costlier than UCC.


14:20 - 14:30
S3-3 (LO)

MICTURITION REEDUCATION IN CHILDREN WITH CEREBRAL PALSY.

Bieke SAMIJN 1, Christine VAN DEN BROECK 2, Frank PLASSCHAERT 3, Ellen DESCHEPPER 2, Piet HOEBEKE 3 and Erik VAN LAECKE 3
1) Ghent University, Rehabilitation sciences, Ghent, BELGIUM - 2) Ghent University, Ghent, BELGIUM - 3) Ghent University Hospital, Ghent, BELGIUM

INTRODUCTION

Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). The objective of the study was to investigate the effectiveness of urotherapy in children with CP. Being continent can positively influence quality of life and health status of the child.

MATERIAL AND METHODS

A prospective case-control study including 21 urinary incontinent children with cerebral palsy and 24 typically developing children with urinary incontinence was conducted between 2014 and 2018.
Children received treatment for one year with three-monthly examination. Treatment was individualized to every patient. Children started with three months of standard urotherapy. Every three months treatment was adapted to primary problems and pharmacotherapy and/or specific interventions could be added to the initial treatment strategy. Time-effects were analyzed by means of multilevel modeling.

RESULTS

Seven children with CP became dry during the day and 5 children became dry during the night. Significant time-effects (p < 0.05) in children with CP were found with a higher voided volume, lower frequency of daytime incontinence, lower amount of urine loss, lower frequency of enuresis, less lower urinary tract symptoms, better micturition pattern and less fecal incontinence after training. In general, results demonstrate effectivity rate of urotherapy is lower and changes occur slower in time in children with CP compared to typically developing children.

CONCLUSIONS

Urotherapy can be an effective long-term treatment for urinary incontinence in children with CP. Therapy should be multidisciplinary, individually adapted to child and feasible for the child and social environment.


14:30 - 14:40
S3-4 (LO)

VOLUME-DEPENDENT CATHETERIZATION WITH A WEARABLE ULTRASONIC BLADDER SENSOR - A FEASIBILITY STUDY

G DE WIN 1, S EERENS 2, K DE BAETS 1 and Paul VAN LEUTEREN 3
1) Antwerp University Hospital, Department of Urology, Edegem, BELGIUM - 2) Antwerp University Hospital, Department of Pediatrics, Edegem, BELGIUM - 3) Wilhelmina Children's Hospital UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS

PURPOSE

Time-dependent intermittent catheterization (TDIC) is an established method for voiding regulation in patients who are not able to empty their bladder properly. However, literature suggests that volume-dependent intermittent catheterization (VDIC) may be beneficial by avoiding unnecessary catheterizations (i.e. relatively empty bladder) and preventing urinary leakage (i.e. bladder over-filling). 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 the bladder is almost full.  The aim of this study is to evaluate the clinical and economic feasibility of the SENS-U in VDIC in children with a neurogenic bladder, compared to TDIC.

PATIENTS AND METHODS

We are currently including 15 children (6-12 years) with a neurogenic bladder who are on a TDIC program. The patients are submitted for a two week protocol; one week of TDIC, followed by one week of VDIC using the SENS-U (personalized notification threshold based on maximum bladder capacity). During the program, the patient keeps a voiding diary, recording fluid intake, catheterization attempts, urinary volume and periods of incontinence. The protocol starts and ends by quality of life questionnaire.  

PRELIMINARY RESULTS

The study is on-going. Based on a first case report, the SENS-U allowed the patient to stay dry during the period of use and reduce the number of catheterizations (similar volumes), compared to TDIC. In addition, this patient reported satisfaction due to the appropriateness of catheterization and the degrees of freedom he experienced while wearing the SENS-U (i.e. going to school, no monitoring of fluid-intake).

CONCLUSIONS

Preliminary results suggest that the SENS-U is a feasible approach to assist in volume-dependent intermittent catheterization by monitoring the bladder filling and providing a personalized notification when the bladder is almost full.


14:40 - 14:50
S3-5 (LO)

TRANSANAL IRRIGATION EFFECTIVENESS IN THE MANAGEMENT OF NEUROGENIC BOWEL DYSFUNCTION: IS A CAREFUL FOLLOW-UP USEFUL?

Giovanni MOSIELLO 1, Ludy LOPES DE CONCEICAO 1, Francesca MUSCIAGNA 1, Elena BERNARDI 1, Francesca DEL CONTE 1, Maria Luisa CAPITANUCCI 1, Antonio ZACCARA 1, Alberto LAIS 1, Barbara Daniela IACOBELLI 2 and Giuseppina DI SERIO 1
1) BAMBINO GESU' PEDIATRIC HOSPITAL, UROLOGY-NEURO-UROLOGY-, Rome, ITALY - 2) BAMBINO GESU' PEDIATRIC HOSPITAL, SURGERY, Rome, ITALY

PURPOSE

Today is evident that the continence management of children with spina bifida (SB) or spinal cord injury(SCI) must be  a complete management of both neurogenic bladder and bowel dysfunction (NBBD). Transanal irrigation (TAI) has beeen succesfully reintroduced in the past years for the management of bowel dysfunction. Actually TAI is considered the first line treatment, before more invasive procedure as sacral neuromodulation or Malone. TAI effectiveness has been related to a correct training and a careful follow-up. aim of our study is to investigate retrospectively the success of TAI on a long-term follow-up.

MATERIAL AND METHODS

From January 2009 to december 2016, 70 patients, aged 3-17 years, have beeen treated with TAI , using Peristeen system , Coloplast Denmark, according a defined protocol approved by our Scientific/ethical Committee.All patients presented a bowel dysfunction  due to: anorectal maflormation (ARM) 16, SB 18, SCI 9, other causes of NBBD 4. 53 patients are in follow-up in our center , while 17 were only trained to a correct use of TAI. TAI training have been performed in a 3 days module, where first irrigation have been always performed by our specialist nurse team, while the second one by the caregiver , in inpatient regimen. Patients have been evaluated using  a 10 domains questionnaire, on bowel function, satisfaction,QoL ( CHQ and SF 36). Data were evaluated by statistician.

RESULTS

About 70 patients, 6 refused to partecipate to the study, 17 are actually in treatment in other Insititutions, while 47 are in follow-up in our center. TAI has been performed for 2,5-10 years, mean 4 years. About our series 35/47 patients are still in treatment.  Evaluating the questionnaries and the scores 29/35 are higly satisfied, and 27 reported an high effectiveness of bowel function.

CONCLUSIONS

TAI is safe and effective in the treatment of bowel dysfunction on long-term . A correct training and a careful follow-up seem to be important for increasing succes and reduce drop-out.