5th Joint Meeting of ESPU-SPU - Virtual

S16: FUNCTIONAL VOIDING DISORDERS AND ENURESIS 2 (parallel session, room 2)

Moderators: Anne-Françoise Spinoit (Belgium)

ESPU-SPU Meeting on Saturday 25, September 2021, 10:40 - 11:10


10:40 - 10:43
S16-1 (PP)

USING PATIENT QUESTIONNAIRE AND UTI HISTORY TO BETTER INFORM DECISION MAKING FOR OBTAINING RENAL BLADDER ULTRASOUND (RBUS) IN CHILDREN WITH LUTS

Ethan SAMAT, Amanda BERRY, Dana WEISS, Stephen ZDERIC and Jason VAN BATAVIA
Children's Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA

PURPOSE

RBUS in the evaluation of children with lower urinary tract symptoms (LUTS), can detect bladder wall thickening, post-void residual volumes, and anatomic abnormalities. Predicting which pediatric patients would benefit from RBUS is challenging as the vast majority demonstrate normal imaging. In this study, we assess the utility the LUTS survey score and urinary tract infection (UTI) history for predicting abnormalities on RBUS. We hypothesized that higher scores and positive UTI history would be associated with higher probability of RBUS abnormality.

MATERIAL AND METHODS

We retrospectively reviewed our IRB-approved registry of 333 consecutive patients initially seen between 5/2014-1/2016 who received an RBUS for LUTS. RBUS results were divided into clinically significant abnormalities and insignificant and matched to the patient’s initial Dysfunctional Voiding Symptom Score (DVSS) and UTI history. Exclusion criteria were neurogenic bladder, and patients with previously known urologic abnormalities (prior to LUTS).

RESULTS

Patients with both a DVSS>15 and a positive UTI history had an 18% chance of significant findings on RBUS compared to 0.6% chance for those with neither criteria (Fisher = 0.0029). Patients with at least one of the two criteria had an 8.2% chance compared to patients with neither criteria (Fisher = 0.0008). 

CONCLUSIONS

LUTS score and UTI history can be used to help determine when to obtain an RBUS in the initial evaluation of children with LUTS. RBUS should rarely be obtained for non-neurogenic LUTS patients without UTI history whose scores are below 15.


10:43 - 10:46
S16-2 (PP)

BRUXISM IN CHILDREN WITH BLADDER BOWEL DYSFUNCTION

Yelda PEKBAY 1, Emrah TOPBAŞ 1, Asli OZTURK 1, Irem SERIM 1, Hasan Cem IRKILATA 2 and Murat DAYANC 1
1) Private Pediatric Urology Center of Prof Dr Murat Dayanc, Pediatric Urology, Ankara, TURKEY - 2) Private Davraz Yasam Hospital, Urology, Isparta, TURKEY

PURPOSE

Bruxism is a grinding or clenching of the teeth with a rhytmic or sustained contraction of the jaw muscles without patient awareness. Bladder-bowel dysfunction (BBD) symptoms such as enuresis, daytime incontinence, constipation and urinary tract infection are associated with joint hypermobility which is also a joint pathology. We aimed to investigate the relationship between bruxism and BBD in children.

MATERIAL AND METHODS

A total of 110 children with BBD symptoms were included in this study. All patients were evaluated with non-invasive diagnostic tools (Voiding diary, uroflowmetry with pelvic floor EMG, urinalysis, ultrasound and pelvic-floor physical examination). Bruxism was diagnosed by history and comfirmed with physical examination. Patients were divided into 2 groups based on the existence of bruxism (group-1 with bruxism and group-2 without bruxism) and were compared according to the demographic and clinical characteristics.

RESULTS

Bruxism was detected in 37 children (33,6%). Mean age was 8,3±2,9 in group-1 and 8,9±3 in group-2 (p=0,964). Gender distribution (M/F) was 19/18 (51%/49%) in group-1 and 44/29 (60%/40%) in group-2 (p=0,218). Daytime incontinence and urgency were statistically significantly higher in group-1. Dysfunctional voiding and bowel symptoms (constipation, soiling or fecal incontinence) were more common and enuresis was less common in children with bruxism (group-1). Additionally, pelvic floor muscle (PFM) tonus increased in group-1.

Parameters Group-1, n(%) Group-2, n(%) p Value
Daytime incontinence 24(65) 38(52) 0,013
Urgency 32(87) 46(63) 0,0001
Enuresis(MNE) 4(10,8) 19(26) 0,175
Dysfunctional voiding 16(43,2) 18(24,7) 0,035
Bowel dysfunction 23(62,2) 31(42,5) 0,052
Increased pelvic floor muscles tonus 32(87) 26(35,6) 0,0001

CONCLUSIONS

Children with bruxism are more likely to have pelvic floor dysfunctions such as dysfunctional voiding and bowel dysfunction. In addition, they have increased PFM tonus. Therefore, PFM evaluation and pelvic floor rehabilitation are crucial for children with bruxism.


10:46 - 10:49
S16-3 (PP)

TRANSCUTANEOUS ELECTRIC NERVE STIMULATION (TENS) FOR THE AT-HOME TREATMENT OF NOCTURNAL ENURESIS IN CHILDREN

Adam HOWE 1, Vinaya VASUDEVAN 2, Jessica SULTAN 2, Jovita KWAN 2, Karla GIRAMONTI 1, Paul FEUSTEL 3, Jordan GITLIN 2, Ronnie FINE 2, Barry KOGAN 1 and Lane PALMER 2
1) Albany Medical College, Surgery (Urology), Albany, USA - 2) Cohen Children's Medical Center of NY, Pediatric (Pediatric Urology), Lake Success, USA - 3) Albany Medical College, Neuroscience and Experimental Therapeutics, Albany, USA

PURPOSE

Nocturnal enuresis (NE) is a common problem encountered in children. Neuromodulation is used to treat various voiding disorders in urology. Transcutaneous electrical nerve stimulation (TENS) is a tool that can be used at home to treat NE. Our goal was to determine which location on the body is optimal for TENS as an effective and durable treatment for NE in children.

MATERIAL AND METHODS

A prospective randomized, placebo-controlled clinical trial including 128 patients aged 5-18 years presenting with monosymptomatic NE were enrolled. After one month of behavioral modifications, they were randomized to four groups: suprapubic, posterior tibial, parasacral, and should (control). Nightly TENS therapy was performed for one month. Voiding diaries recording the number of wet nights, wet scale severity score (0-3), TENS compliance, any adverse reactions, and quality of life questionnaires (PIN-Q), were collected at baseline (Month 1), during TENS therapy (Month 2), after TENS for durability assessment (Month 3), and statistically analyzed.

RESULTS

Posterior tibial TENS therapy showed the greatest response in all parameters measured compared to other groups, with significant differences in decreased wet nights and wet scale scores compared to control. These responses were found to be durable on post-treatment analysis. There were no adverse reactions in any of the groups during TENS therapy.                        

Improvements in TENS therapy compared to baseline
TENS Group PIN-Q % Wet Nights Mean Wet Scale
Shoulder (Control) 2.3 4.8 0.14
Suprapubic -0.9 7.4 0.01
Parasacral 0.5 4.6 0.2
Posterior Tibial 2.6 19.2 0.52

CONCLUSIONS

Posterior tibial TENS therapy for NE in children is effective when combined with behavioral therapy and shows a durable response when treatment is commenced. The posterior tibial site is the optimal location for TENS therapy and future studies should use this site to further investigate this novel treatment. 


10:49 - 10:52
S16-4 (PP)

ANALYSIS OF FAMILY HISTORY OF 239 PNE IN YOUNG ADULTS IN MAINLAND CHINA

Jian Guo WEN 1, Hui Jie HU 2, Zhen Wei ZHANG 3, Yu LIANG 1, Yan Yan LUO 2, Qi Feng DOU 1, Cui Ping SONG 1 and Soren RITTIG 4
1) Xinxiang Medical University, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, CHINA - 2) Xinxiang Medical University, Nursing school, Xinxiang, CHINA - 3) Xinxiang Medical University, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, CHINA - 4) Aarhus University Hospital, Department of Pediatrics and Adolescent Medicine, Aarhus, DENMARK

PURPOSE

The aims of the present study were to investigate the prevalence of genetic primary nocturnal enuresis (PNE) and its prevalence and genetic pattern of Chinese young adults.

MATERIAL AND METHODS

A total of 22,500 university students (aged 17-21 year 6,583 boys and 13,762 girls) from 23 provinces and 368 cities in mainland China were included. The survey was conducted using an anonymous questionnaire to collect the information.

RESULTS

In total,21,082 questionnaires were collected, and 20,345(89.3%) qualified for statistical analysis. 239 adolescents (88 boys and 151 girls) with PNE were identified. A total of 33.89% cases shown a family history, and the positive rates of male and female were 32.95% and 34.43%, there was no significant difference between them (P > 0.05), excluding sex chromosome inheritance. Including 24.69% of fathers, 20.99% of mothers, 4.94% of both parents, 27.16% of the siblings and 22.22% of grandfathers or (and) grandmothers. Among them,41 (17.15%) families were autosomal dominant inheritance, 22 (9.21%) families were autosomal recessive inheritance, and 176 (73.64%) families with PNE were sporadic. The prevalence of UTI, severe PNE and daytime voiding symptoms in patients with family history of PNE were significantly higher than those without (P < 0.05). However, there was no significant difference in the prevalence of sex, residence and sleep arousal disorder between the two groups (p > 0.05).

CONCLUSIONS

PNE has obvious family aggregation and a variety of genetic patterns coexist. One third of young adults PNE show a family history indicating that more active intervention should be given to those of cases in childhood.


10:52 - 10:55
S16-5 (PP)

PREVALENCE, RISK FACTORS AND PSYCHOLOGICAL EFFECTS OF PRIMARY NOCTURNAL ENURESIS IN CHINESE YOUNG ADULTS

Hui Jie HU 1, Jian Guo WEN 2, Zhen Wei ZHANG 3, Yu LIANG 2, Yan Yan LUO 1, Qi Feng DOU 2, Cui Ping SONG 2 and Soren RITTIG 4
1) Xinxiang Medical University, Nursing school, Xinxiang, CHINA - 2) Xinxiang Medical University, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, CHINA - 3) Xinxiang Medical University, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, CHINA - 4) Aarhus University Hospital, Department of Pediatrics and Adolescent Medicine, Aarhus, DENMARK

PURPOSE

The aims of the study were to investigate PNE prevalence, risk factors and effects on mental health and quality of life in young adults in mainland China.

MATERIAL AND METHODS

The survey was conducted using an anonymous questionnaire to collect the information at registration time. A total of 22,500 university students (aged 17-21 years) from 23 provinces and 368 cities in mainland China were included in this study.

RESULTS

In total, 21,082 questionnaires were collected, and 20,345 qualified for statistical analysis. The overall prevalence of PNE was 1.17%. The prevalence was 1.0% and 1.2% in students from urban and rural areas, their difference is not significant. The prevalence of PNE in individuals with genetics, urinary frequency, urgency, UI, a history of UTI and a present UTI increased significantly compared to those without these condition (P0.001). The prevalence of monosymptomatic nocturnal enuresis (MPNE) and nonmonosymptomatic nocturnal enuresis (NMPNE) was 66.1% and 33.9%. In total, 28% reported bedwetting daily, 31.6% reported one time≦weekly<7 times, and 40.4% reported one time≦monthly<4 times; 80% of PNE patients had not previously sought treatment. PNE was significantly correlated with the PSQI total score (sleep quality) (P=0.011). The self-esteem score was lower and the depression scale score was higher (P0.001) in the PNE group than in the non-PNE group.

CONCLUSIONS

In mainland China, the PNE prevalence in young adults is high and shows a significant impact on physical and mental health. Its risk factors are genetics, daytime voiding symptoms and lack of treatment.


10:55 - 11:10
Discussion