ESPU-Nurses Meeting on Saturday 25, September 2021, 10:40 - 11:20
Christina CHALMERS 1, Joshua CHAMBERLIN 2, Sarah HOLZMAN 1, Carol DAVIS-DAO 1, Amanda MACARAEG 1, Linda BEQAJ 1, Ahmed ABDELHALIM 3, Ranim MAHMOUD 4, Heidi STEPHANY 1, Kai-Wen CHUANG 1, Elias WEHBI 1 and Antoine KHOURY 1
1) CHOC Children's and University of California, Irvine, Pediatric Urology, Orange, USA - 2) Loma Linda University Children's Hospital and CHOC Children's, Pediatric Urology, Loma Linda, USA - 3) Mansoura University, Urology, El Mansoura, EGYPT - 4) Mansoura University, Pediatrics, El Mansoura, EGYPT
Patients with neurogenic bladder are at risk of developing bladder and renal deterioration secondary to increased intravesical pressures. Home bladder manometry provides a low-cost and simple method to evaluate bladder pressures. We have shown previously that home manometry measurements predict urodynamic pressures. Urology nurses are the primary source for home manometry education, and we have developed an instructional video as an educational supplement.
MATERIAL AND METHODS
For home manometry, patients are asked to catheterize with a full bladder in supine position. A ruler and catheter are used to measure pressure as the distance from the pubis to the height of urine in the upright catheter. For patients with high pressures, a catheter extender was provided. After urology nurse instruction, home manometry measurements were collected and compared with hydronephrosis on ultrasound. ROC curves and AUC were calculated to correlate home manometry pressures with high-grade hydronephrosis (SFU grades 3-4).
Included were 78 patients with a total of 107 home manometry measurements. Fifty six percent were female, median age at follow-up was ten (range 0-21) years. Home manometry mean bladder pressures greater than 20 cm water predicted the presence of high-grade hydronephrosis (sensitivity 86%, specificity 86%). Based on home manometry, mean bladder pressure was highly predictive of high-grade hydronephrosis (AUC 0.88).
Home manometry provides an easy screening tool for patients with neurogenic bladder to identify those requiring more aggressive management, without additional cost or morbidity. The addition of an instructional video supplements urology nurse teaching and provides patients and families with a convenient home resource.
Maryellen KELLY 1, Eileen SHERBURNE 2, Joy KERR 3, Patricia BEIERWALTES 4, Colleen PAYNE 5, Heather DORRIES 5, Kelly BLACK 5 and Judy THIBADEAU 6
1) Duke University, Surgery, Durham, USA - 2) Children's Hospital of Wisconsin, Physical Medicine and Rehabilitation, Milwaukee, USA - 3) Children's Hospital of Philadelphia, Urology, Philadelphia, USA - 4) Minnesota State University, Nursing, Mankato, USA - 5) None, Louisville, USA - 6) Spina Bifida Association, Arlington, USA
Individuals with spina bifida have neurogenic bowel, characterized by constipation and/or fecal incontinence. Accepted definitions of constipation in the literature are not clinically representative of individuals with neurogenic bowel. The lack of a disease-specific consensus of constipation in this population has inhibited progress towards improved bowel management research. We aimed to generate a consensus definition of constipation in individuals with neurogenic bowel secondary to spina bifida.
MATERIAL AND METHODS
A multi-disciplinary group, comprised of clinicians, caregivers of individuals with spina bifida, and adults with spina bifida, were tasked with creating a consensus definition for constipation. Published literature and experience from experts and patients within the group were used to create the definition. Consensus was reached.
The group determined constipation is best defined by considering positive and negative indicators of bowel function. A properly functioning bowel can be defined by the following positive indicators: no appetite change, proper weight gain, mushy/creamy stool consistency, no acute changes to stooling pattern. Conversely, a constipated bowel should be considered when the following negative indicators are present: abdominal distension, irritability, poor appetite/change in appetite, change in stooling pattern, change in stool consistency (pellet looking, or very loose), straining to pass stool, bubbly liquid stool, vomiting, blood in the stool, change in urinary continence (leakage of urine or urinary retention), increased urinary tract infections.
The proposed definition, which is a constellation of signs for constipation unique to individuals with neurogenic bowel secondary to spina bifida, should be considered for use in clinical and academic environments.
Katie SABIN 1, Massimo GARRIBOLI 2, Hannah WARD 3, Melinda EDWARDS 3, Emma HULL 3, Sophie WALLACE-HADRILL 4, Anne WRIGHT 5 and Jo CLOTHIER 5
1) Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, Paediatric Psychology Services, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, Paediatric Urology Service, London, UNITED KINGDOM - 3) Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, Paediatric Psychology Service, London, UNITED KINGDOM - 4) Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, Paediatric Renal and Urology Service, London, UNITED KINGDOM - 5) Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, Paediatric Nephrology Service, London, UNITED KINGDOM
The challenges of implementing long term interventions, such as CIC are well documented, however, the impact on family relationships and functioning are less well understood.
MATERIAL AND METHODS
Employing a mixed methods design, semi-structured interviews explored the impact and experience of CIC at the individual, dyadic and systemic level. Interview responses regarding impact on school, social, family relationships and daily function were coded by degree of impact, according to parent and child report.
A total of 70 parents and 36 children including 16 (44.4%) females and 20 (55.6%) males with a mean age of 10.6 ± 3.45 years, were interviewed. The majority of parents reported little or no impact, with 5% reporting significant negative impact using CIC. 70% of parents and 81% of children reported either no or an enhanced parent-child relationship. The most significant negative impact of CIC was on daily routine.
Children (or parent proxy) QOL measures using the PedsQL and SDQ self-report version, gave mean scores of 71.29 and 12.41 respectively (a significant positive correlation to parent proxy scores of 63.17 and 12.64). Normative SDQ data suggests our sample has a ‘slightly raised' impact score. PedsQL normative data suggests children using CIC have a slightly lower QOL.
Although our QOL measures suggest a lower QOL for children using CIC, our results indicate this is linked to the challenges regarding daily routine rather than other aspects of family life, including the relationships within the family.