5th Joint Meeting of ESPU-SPU - Virtual

S15: FUNCTIONAL VOIDING DISORDERS AND ENURESIS 1 (parallel session, room 2)

Moderators: Yazan Rawashdeh (Denmark)

ESPU-SPU Meeting on Saturday 25, September 2021, 10:00 - 10:36


10:00 - 10:03
S15-1 (SO)

★ A PROSPECTIVE AND RANDOMISED TRIAL OF EFFICACY AND SAFETY OF TRANSDERMAL OXYBUTYNIN VERSUS ORAL OXYBUTYNIN IN THE MANAGEMENT OF CHILDREN WITH OVERACTIVE BLADDER

Ahmet SEVINÇ 1, Ahmet ŞAHAN 1, Orkunt ÖZKAPTAN 1, Alkan ÇUBUK 1, Alper KAFKASLI 1, Cengiz ÇANAKÇI 1 and Onur TELLI 2
1) Kartal Dr. Lütfi Kırdar Training and Research Hospital, Urology, İstanbul, TURKEY - 2) Kartal Dr. Lütfi Kırdar Training and Research Hospital, Pediatric Urology, İstanbul, TURKEY

PURPOSE

Gold standard management of pediatric overactive bladder is oral oxybutynin. However, it can have significant side effects andcould be difficult withadministration. In this study wesought to establish ourexperience with transdermaloxybutynin patches (TOP) as a viable alternative to oral oxybutynin.

MATERIAL AND METHODS

A total of 90 children, diagnosedwith overactive baldder (OAB) with minimum follow-up of 3 months  aged 6-16 years oldwere randomly assigned in thisprospective study. Patientsidentified had trialled TOP or oral oxybutynin for greater than 6 weeks and were followed. A previously validated symptomscoring was collected to define improvement or resolution of lower urinary tract symptomsprevious and after bothtreatments.

RESULTS

The mean age of the study groupwas 10.6 (range 6 to 16). %62 of the study group was female.Group 1 consist of children whoreceived oral oxybutinin (n=42) and group 2 consist of childrenreceived TOP (n=41). Seven participants lost follow-up. The mean age was 9.6 years in group1 and 11.2 years in group 2. There was no significantdifference with age, sex bladder capacity  and Qmax betweengroups. Before treatments, meansymptom score was 15.6 in oral oxybutinin group and 16.4 in group 2. Mean symptom scorewas 6.5 in oral oxybutinin groupand 5.2 in group 2 aftertreatment. There was no significant difference in symptomscore between groups beforeand after the treatments. The main side effect were reported as constipation and gastrointestinaldisturbances 19% and flushing11% in oral medication group. Of those treated with TOP reportedskin irritation 14% and rednessor itch 19%.

CONCLUSIONS

Our data suggest that TOP is a viable alternative for children withoveractive bladder compared tooral formulations of oxybutynin. Both treatments have minimal side effects. The most significantlimiting factors for TOP is skin irritation These findings highlightthe potential benefit of transdermal drug delivery in the pediatric setting.


10:03 - 10:06
S15-2 (SO)

SAFETY AND EFFICACY OF DOXAZOSIN USE IN CHILDREN WITH POOR BLADDER EMPTYING

David KEENE
Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM

PURPOSE

Doxazosin is a selective alpha blocker. Cain et al. (J Urol 2003;170;1514-5) described its use in children to improve bladder emptying. Our aim was to assess a wider group of patients including those currently taking anticholinergic medications and post bladder surgery.

MATERIAL AND METHODS

Children with poor bladder emptying and urinary symptoms (infections, wetting) were started on doxazosin 1mg once daily. Poor bladder emptying was defined as post void residuals (PVR) persistently greater than 10% of pre-void volume on bladder scan without excessive drinking or high pre-void bladder volumes. Blood pressure was taken 30 minutes post dose. Doxazosin dosage was increased to 2mg if PVRs failed to improve after 6 months.  Data collected prospectively 2017-2019, median (IQR).

RESULTS

63 patients were included in the study; 53 primary bladder dysfunction, 10 patients had previous bladder surgery. Minor side effects were reported in 7 patients (11%). 30 patients also took anticholinergic medications. The starting PVR was 37.8% (24.4-54.6) in the primary bladder dysfunction group, and 49.0% (27.1-56.7) in the previous bladder surgery group.

Post-treatment the PVR reduced significantly (p<0.0001) in the primary bladder dysfunction group to 10.6% (0-23.8)*. No difference in efficacy was seen between patients taking or not taking anticholinergic medications (p=0.89).

Underlying conditions

Primary bladder dysfunction

Previous bladder surgery

N of patients

53

10 (6 bladder exstrophy, 4 post ureteric reimplantation)

Age (yrs)

9.0 (7.1-11.0)

6.9 (3.4-10.3)

Symptoms

48 wetting, 5 UTIs

5 wetting, 5 UTI

Side effects

7 (3 headaches, 2 anxious, 1 nausea, 1 lost urinary control)

0

Pre-treatment PVR (%)

37.8 (24.4-54.6)*

52.5 (27.8-63.4)**

Post-treatment PVR (%)

10.6 (0-23.8)*

24.0 (10.0-25.0)**

Anticholinergic medications

26 patients (49%)

4 patients (40%)

*p<0.0001,*p=0.08

CONCLUSIONS

Doxazosin significantly improved bladder emptying in children with primary bladder dysfunction. Its efficacy was not limited by co-administration of anticholinergic medications. Previous bladder surgery may not restrict its use.


10:06 - 10:09
S15-3 (SO)

BIOFEEDBACK VERSUS METHYLPHENIDATE FOR THE MANAGEMENT OF GIGGLE INCONTINENCE IN CHILDREN. A PROSPECTIVE STUDY FROM TWO CENTERS.

Anthony KALLAS CHEMALY 1, Paul-Henri TORBEY 2, Bassam EID 2, Fouad AOUN 3, Darwich SERHAL 4, Marie-Thérèse MERHEJ 4, Alain KHALAF 5, Ghazi SAKR 5 and Maroun MOUKARZEL 3
1) Hôtel-Dieu de France University Hospital, Paediatric Urology, Saint-Joseph University, Faculty of Medicine, Beirut, LEBANON - 2) Hôtel-Dieu de France University Hospital, Paediatrics, Saint-Joseph University, Faculty of Medicine, Beirut, LEBANON - 3) Hôtel-Dieu de France University Hospital, Urology, Saint-Joseph University, Faculty of Medicine, Beirut, LEBANON - 4) Mount Lebanon Hospital, Gharios Medical Center, Paediatrics, Hazmieh, LEBANON - 5) Mount Lebanon Hospital, Gharios Medical Center, Urology, Hazmieh, LEBANON

PURPOSE

Giggle incontinence (GI) is an embarrassing problem related to involuntary loss of urine during laughter. Pathophysiology remains unclear. The aim of our study is to evaluate success of biofeedback compared to methylphenidate (MPH) for the treatment of GI in children.

MATERIAL AND METHODS

Between 2015 and 2018, we prospectively enrolled 56 children complaining of GI. Patients with LUTS such as urgency or urge incontinence, UTI, enuresis, genito-urinary anomalies, constipation, treatment during the last three months and abnormal psychological evaluation were excluded. Patients were divided into two groups. Group A received biofeedback sessions once weekly. Group B were treated with MPH at a dose of 0.2 to 0.5 mg/kg daily. Response rate was defined according to the ICCS guidelines and evaluated at two months and at one year from treatment. MPH side effects were reported.

RESULTS

During this 3-year period, 41 patients were included (23 in group A and 18 in group B) with a follow-up of one year. The two groups were homogenous according to age, sex, weight and severity of GI. After two months from treatment, biofeedback showed better response (91% vs 44% as complete responders, p=0.002, 9% vs 50% as partial responders, p=0.005, and 0% vs 6% as non-responders, p=0.4 in group A and B respectively). All patients in group A had continued success after a maximum of 12 sessions. 37% of patients with complete response in group B had recurrence of GI remaining refractory to MPH treatment. Partial and non-responders in group B were switched to biofeedback treatment resulting in continued success after 12 sessions. MPH side effects such as decreased appetite and difficulty in falling asleep were reported in 22% of patients and were a cause of drug withdrawal in one child.

CONCLUSIONS

Treatment of GI is achieved with biofeedback sessions in a short period of time. MPH mostly offers a partial response and is associated with side effects. Biofeedback should be considered first line treatment for GI in children.


10:09 - 10:12
S15-4: Withdrawn (author request)
 

10:12 - 10:15
S15-5 (SO)

ARE CHILDREN WITH FOOD ALLERGIES MORE LIKELY TO HAVE IRRITATIVE LOWER URINARY TRACT SYMPTOMS?

Belinda LI 1, Madeleine M. SHERBURN 2, Sunny D. BELL 3, Alice M. ROTHMAN 3, Tara M. HUSS 3, Jill E. STEIGELFEST 3, Mark E. RAWLS 3, Rachel L. MACE 3, Stacy L. DORRIS 3 and Abby S. TAYLOR 1
1) Vanderbilt University Medical Center, Pediatric Urology, Nashville, USA - 2) Vanderbilt University Medical Center, Nashville, USA - 3) Vanderbilt University Medical Center, Pediatrics, Nashville, USA

PURPOSE

Food allergies are among the most common health problems in children. There are anecdotal reports in the literature on food allergies manifesting as lower urinary tract symptoms (LUTS), inviting the question of whether or not a mast cell-mediated process as seen in interstitial cystitis may exist. Our objective was to investigate the association between food allergies and LUTS. We hypothesized that children with food allergies are more prone to irritative LUTS.

MATERIAL AND METHODS

Children (6-17 years old) presenting for routine visits to university pediatric allergy and general clinics were invited to participate. The food allergy group had documented positive skin prick tests and/or serum IgE tests. A control group without food allergies was recruited for comparison. The Vancouver Symptom Score (VSS), a validated questionnaire for diagnosing dysfunctional elimination syndrome in children, and PinQ questionnaire, a quality of life assessment tool for children with bladder dysfunction, were prospectively administered to participants. Both utilize Likert-based response formats.

RESULTS

A total of 26 children with food allergies and 57 without agreed to participate. There were no significant differences between groups in age, gender, or race. Nuts were the most common allergy. There was no difference in VSS between the allergy group (mean 7.7±2.4, median 8) and the control group (mean 8.3±4.2, median 8) (p=0.828). Using the VSS cut-off score of 11 indicating dysfunctional elimination, 4 children (15%) with food allergies and 15 controls (26%) had a score ≥11 (p=0.339). The two populations showed no differences in responses to any of the 13 questions in the VSS when assessed individually. Finally, there was no difference in PinQ scores, with a median score of 0 (IQR 0-2) in both groups.

CONCLUSIONS

We found no significant association between food allergies and reported LUTS in children. Our future work will extend to include seasonal allergies to further stratify additional patients.


10:15 - 10:18
S15-6 (SO)

WHAT IF VOIDING DIARY WAS DONE FOR ONLY ONE DAY?

Hanny M. FRANCK 1, Liliana F. OLIVEIRA 2, Lidyanne I. SILVA 1, Ana Carolina S. GUEDES 1, Thamires M. S. ANDRADE 1, André A. FIGUEIREDO 1, Jose BESSA JR. 3 and Jose Murillo NETTO 1
1) Universidade Federal de Juiz de Fora (UFJF), Surgery/Urology, Juiz De Fora, BRAZIL - 2) Universidade Federal de Juiz de Fora (UFJF) / Faculdade de Ciência Médicas e da Saúde de Juiz de Fora, Surgery/Urology, J, BRAZIL - 3) Universidade Estadual de Feira de Santana (UEFS), Surgery/Urology, Juiz De Fora, BRAZIL

PURPOSE

Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Recording all voiding and drinking episodes demands a great effort from parents and VD is often not done properly. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days and only one study has confirmed that  both are similar. We hypothesized that one day voiding diary would be enough for evaluating and guiding treatment in children with Lower Urinary Tract Symptoms (LUTS).

MATERIAL AND METHODS

Children aged 5 to 14 years presenting with overactive bladder (OAB) and primary monosymptomatic enuresis (PME) were oriented to fulfill a 3-day VD as part of their evaluation. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to maximum voided volume (MaxVV), mean voided volume (MedVV), frequency, and night volume (NV) which include diaper weight plus first void in PME and first void in OAB children

RESULTS

98 children 8.23 ± 2,26 years old (53% males) were included. Of them, 59 had PME and 30 OAB. MedVV (1dVD: 91.9 ml; 2dVD: 94.8 ml; 3dVD: 93.4 ml) (p=0.13), frequency (1dVD: 6.8/day; 2dVD: 6.6/day; 3dVD: 6.6/day) (p=0.96), and VN (1dVD: 269.0 ml; 2dVD: 280.5 ml; 3dVD: 275.3 ml) (p=0.36) were similar regardless how many days the voiding episodes were recorded. Only MaxVV was higher by a mean of only 23 ml on 2dVD (202.2±73.3 ml) compared to 1dVD (179.2±76.5 ml) (p<0.01). MaxVV was 187.2 in 3dVD.

CONCLUSIONS

Although MaxVV was lower by a small volume in 1dVD we believe that for non-compliant families a 1dVD is enough for evaluating children with LUTS


10:18 - 10:36
Discussion