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, 10:45 - 11:22


10:45 - 10:48
S16-1: Withdrawn (video presentation not uploaded)
 

10:48 - 10:51
S16-2 (SO)

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.


10:51 - 10:54
S16-3: Withdrawn (author request)
 

10:54 - 10:57
S16-4 (SO)

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.


10:57 - 11:00
S16-5 (SO)

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.


11:00 - 11:10
Discussion
 

11:10 - 11:13
S16-6 (SO)

PARASACRAL TRANSCUTANEOUS ELECTROSTIMULATION IN TREATMENT OF BOWEL AND BOWELL DYSFUNCTION: A RANDOMIZED CLINICAL TRIAL

Glicia ABREU 1, Leonardo SOUZA 2, Ananda NUNES 3, Maria Luiza VEIGA 3, Eneida DOURADO 1 and Ubirajara BARROSO JR. 4
1) Bahiana School of Medicine, Urology, Salvador, BRAZIL - 2) Bahiana School of Medicine, Uroloy, Salvador, BRAZIL - 3) Bahiana School of Medicine, Physical Therapy, Salvador, BRAZIL - 4) Federal University of Bahia, Urology, Salvador, BRAZIL

PURPOSE

To test the hypothesis that parasacral transcutaneous ENS (TENS) applied in children/adolescents with BBD is associated with clinical improvement and to analyze the effect of rectal diameter on this response.

MATERIAL AND METHODS

This is a randomized, blinded clinical trial. Inclusion criteria: Children and adolescents diagnosed with BBD. Exclusion criteria: Patients with anatomical or neurological changes in the urinary tract, unable to undergo treatment three times a week, using anticholinergic drugs or laxatives. The sample was divided into two groups: Control group (CG=urotherapy + scapular-sham electrotherapy) and treatment group (TG=urotherapy + parasacral TENS). DVSS and Rome IV criteria was applied for lower urinary tract symptoms and constipation evaluation, respectively. Pelvic ultrasonography measured the rectal diameter.

RESULTS

Forty patients were studied: 20 patients in CG and 20 patients in TG (mean age of 8.4± 2.8years), 52.5% male. The mean rectal diameter was 2.9 ± 0.9 cm. Both groups showed improvement of DVSS after interventions (∆CG = -7.7 X ∆ GT = - 8.9; p = 0.49). In intragroup evaluation, TG showed a marked improvement in enuresis after treatment (p = 0.03). TG showed significant improvement in constipation compared to CG after intervention (80% X 20%, p <0.001). The measurement of rectal diameter before and after treatment did not influence the presence and intensity of LUTS before and after treatment, and it is also not a predictive factor for post-treatment CF maintenance.

CONCLUSIONS

Parasacral TENS is effective as an initial therapeutic approach in children and adolescents with BBD, particularly with regard to CF. Although electrostimulation promotes the improvement of LUTS, this result does not differ from isolated behavioral treatment. Rectal diameter did not influence response to treatment. This is the first randomized clinical trial to test the effect of TENS on BBD.


11:13 - 11:16
S16-7 (SO)

A COMPARISON OF TWO SUBJECTIVE INSTRUMENTS USED TO EVALUATE THE OUTCOME OF CHILDREN TREATED FOR OVERACTIVE BLADDER

Ananda NACIF 1, José DE BESSA JR. 2, Ana Aparecida BRAGA 3, Maria Luiza VEIGA 4 and Ubirajara BARROSO JR. 5
1) Bahiana School of Medicinea, Physical Therapy, Salvador, BRAZIL - 2) State University of Feira de Santana, Urology, Salvador, BRAZIL - 3) Bahiana School of Medicineaa, Psychology, Salvador, BRAZIL - 4) Bahiana School of Medicineaa, Physical Therapy, Salvador, BRAZIL - 5) Federal University of Bahia, Urology, Salvador, BRAZIL

PURPOSE

The treatment of overactive (OAB) bladder in children is measured subjectively by different instruments, being the Visual Analogue Scale (VAS) and the Dysfunctional Voiding Symptom Score (DVSS) the most used. The success rate after treatment might varied according to instruments used. The aim of this study is to analyze the correlation between these two instruments used to assess the treatment outcome of children with OAB.

MATERIAL AND METHODS

This study includes children between 4-17 years old with OAB diagnosis who underwent 20 sessions of transcutaneous (TENS) our percutaneous (PENS) eletrical nerve stimulations. The Dysfunctional Voiding Symptom Score (DVSS) was applied before and after treatment and calculated the percentage of improvement. At the end of the last session, the percentage of improvement was assessed using the Visual Analogue Scale (VAS) (0-100%) by physiotherapy and medical students separately.

RESULTS

We evaluated 49 subjects, 28 boys, with an age of 7.12 ± 2.7 years. The Bland-Altman plot showed good agreement between VAS physiotherapists and medical students, showing a variation(bias) of 8.4%. Also we observed a significant correlation between percentage of DVSS improvements and VAS(r = 0,39 p= 0,01). Furthermore VAS showed good discriminatory accuracy in identifying who had a complete response (100%) with the area under the ROC curve of 75% [61-89]CI95%. VAS≥80 had a sensitivity of 89% and a specificity of 55% in this scenario

CONCLUSIONS

Conclusion: VAS is a reproductible instrument and can be used as a tool in the evaluation of the improvement of urinary symptoms after treatment in children with OAB, Although some discordance with the DVSS is expect.


11:16 - 11:22
Discussion