ESPU-Nurses Meeting on Thursday 9, June 2022, 10:20 - 11:20
10:20 - 10:30
SN2-1 (OP)
Bieke SAMIJN 1, Catherine RENSON 2, Johan VANDE WALLE 2, Erik VAN LAECKE 2, Ann RAES 2, Piet HOEBEKE 2 and Anne-Françoise SPINOIT 2
1) Ghent University, Ghent, BELGIUM - 2) Ghent University Hospital, Ghent, BELGIUM
PURPOSE
Standard urotherapy is considered first-line treatment for LUTS in functional disorders. The objective of the study is to investigate the effectiveness of group therapy or voiding class on symptom reduction and quality of life in children with LUTS. Group therapy could shorten waiting lists and lower costs. Additionally, positive effects of contact with peers could be present.
MATERIAL AND METHODS
A prospective cohort study is conducted including children, aged five to twelve, with LUTS. Voiding class takes place 4-6 weeks after recruitment and is followed with a follow-up consultation 6-8 weeks after voiding class. During voiding class children receive standard urotherapy following ICCS guidelines in groups of four children. Data is collected before and after voiding class through a frequency-volume chart for three days, a bladder diary for fourteen nights and the validated Dutch Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSSDES) and Pediatric urinary incontinence Quality of life (PIN-Q) questionnaires. Data will be compared with a paired student's t-test. A power of 0.80 requires a sample size of 83 children.
RESULTS
The study, initially planned in 2020, suffered delay because of COVID-19. It is to be conducted between 2021 and 2022. Twenty-six children have been included in the study, of which twenty-one went to voiding class and thirteen had their last follow-up contact. Recruitment is ongoing and preliminary results will be present within the next months.
CONCLUSIONS
We hypothesize that voiding class can have a positive effect on symptoms and quality of life due to effectiveness of standard urotherapy combined with social and peer effect.
10:30 - 10:40
SN2-2 (OP)
Annemarth LAMBREGTS 1, Anka NIEUWHOF-LEPPINK 1, Aart KLIJN 1 and Rogier Paul Joseph SCHROEDER 2
1) University medical centre Utrecht, Pediatric urology, Utrecht, NETHERLANDS - 2) UMC Utrecht, Urology, Utrecht, NETHERLANDS
PURPOSE
Overactive bladder (OAB) with urinary incontinence can be unresponsive to specific urotherapy and antispasmodic medication. Due to its successful outcomes in the treatment of neurogenic bladder, intravesical botulinum-A toxin (BTX-A) became a possible solution for children refractory to treatment.
MATERIAL AND METHODS
The charts of children diagnosed with refractory non-neurogenic OAB who underwent BTX-A treatment in our centre since 2011 were retrospectively analysed. The functional bladder volume (FBV) is expressed as a percentage of the expected bladder capacity (EBC) for age. A multivariate logistic regression was used to identify predictors of the response on urinary incontinence.
RESULTS
Fifty children (41 boys) with a median age of 9.9 years were included. In the short term, there was a significant increase in FBV after initial BTX-A treatment from a median of 52.9% to 70% (p= 0.000). Both in the short (< 6 months = 72%) and long term (6-12 months = 46%) showed improvement of continence. Male gender and small baseline FBV predict a positive outcome on continence in the long term. The most prevalent complications were urinary tract infections occurring in five cases (10%).
Outcomes of BTX-A injections on urinary incontinence are highly variable. BTX-A will enable children to better inhibit their OAB. The effectiveness of urotherapy training will therefore most probably be higher. An appropriate population seems to be children with severe OAB symptoms, confirmed detrusor overactivity in urodynamic study and reduced bladder volume refractory to both specific urotherapy and combined medication. Boys with a small baseline FBV appear to respond better.
CONCLUSIONS
In refractory OAB children, BTX-A injections are safe and effective in enlarging bladder volume and reducing OAB symptoms, particularly in the first six months after injection. In the long term BTX-A plus postoperative urotherapy shows improved continence in 46%.
10:40 - 10:50
SN2-3 (OP)
Frank-Jan VAN GEEN 1, Eline VAN DE WETERING 2, Anka NIEUWHOF-LEPPINK 3, Aart KLIJN 4 and Laetitia DE KORT 1
1) UMC Utrecht, Urology, Utrecht, NETHERLANDS - 2) Radboudumc, Urology, Nijmegen, NETHERLANDS - 3) Wilhelmina Children's Hospital, Medical Psychology and Urology, Utrecht, NETHERLANDS - 4) Wilhelmina Children's Hospital, Pediatric Urology, Utrecht, NETHERLANDS
PURPOSE
Dysfunctional voiding (DV), defined as contractions of the urethral sphincter or pelvic floor musculature during the bladder emptying phase, is a common condition in children. However, the long-term course of childhood dysfunctional voiding into adulthood is unknown. The objective of this study is therefore to explore how childhood DV develops into adulthood, in order to improve our transitional care.
MATERIAL AND METHODS
A cross-sectional follow-up was performed in an existing cohort of females who had specific urotherapy from January 2000 to June 2003 for childhood DV with daytime urinary incontinence (DUI) and/or urinary tract infections (UTI's). The main outcome measurement of this study was a staccato or intermittent urinary flow pattern on current uroflowmetry measurement, possibly indicating persistent or recurrent DV.
RESULTS
A total of 30 patients participated in this study, with a mean duration of 20.8 years after urotherapy. Because of pregnancy, 5 patients were excluded. In 40% (n=10) of cases a staccato or interrupted urinary flow pattern was found on current measurement. Of these participants 90% (n=9) reported UTI's and 50% (n=5) still experienced DUI complaints. In the group with a bell shaped-curve, 64% (n=7) reported UTI's and 73% (n=8) DUI complaints. The impact of existing lower urinary tract symptoms (LUTS) was scored as high in both groups.
CONCLUSIONS
Our results show that 40% of females still have DV according to ICS criteria, despite conservative treatment in childhood. Interestingly, most participants did not seek medical care despite the described impact of current LUTS on quality of live.
10:50 - 11:00
SN2-4 (OP)
Ece Zeynep SAATCI 1, Halil TUGTEPE 2, Aygul KOSEOGLU 3, Tugce ATALAY 3 and Ebru KAYA MUTLU 4
1) Private Tugtepe Pediatric Urology Center, Institude of Graduate Studies Istanbul University-Cerrahpasa, Division of Bladder & Bowel Dysfunction, Division of Physiotherapy and Rehabilitation,, Istanbul, TURKEY - 2) Private Tugtepe Pediatric Urology Center, Istanbul, TURKEY - 3) Private Tugtepe Pediatric Urology Center, Division of Bladder & Bowel Dysfunction, Istanbul, TURKEY - 4) Bandirma 17 Eylul University, Faculty of Health Sciences, Physiotherapy and Rehabilitation, Balikesi̇r, TURKEY
INTRODUCTION
The thalamus, pons, bulbar and reticular formation areas are responsible for the control mechanism of continence also postural stability and control. Therefore, it is thought that trunk muscles and lower extremity alignment related to postural stability may be adversely affected in children. In current clinical practice, posture and balance changes have been noticed during physiotherapy assessments in children and adolescents with incontinence. This study aimed to examine trunk and lower extremity biomechanics among children with lower urinary system dysfunction (LUTD).
MATERIAL AND METHODS
Voluntary participants meeting inclusion criteria were divided into two groups: LUTD group (n=43) and control group (n=43). No treatment applied to participants and same evaluation methods used in both groups. Strength and endurance of trunk muscles, posture and pelvic floor muscle activity of participants was evaluated with stabilizer pressurized biofeedback unit, Sit-ups and Modified Push-ups Test; trunk flexors and extensor endurance tests, Posture Screen Mobileapp and Beighton Score for generalized hypermobility; and NeuroTrac-Myoplus4Pro device, respectively.
RESULTS
It was found that LUTD group had weaker transversus abdominis muscle (p=0.001) and less trunk muscle endurance (p=0.004, p=0.08). Also curvatures of head (p=0.001), shoulder (p=0.018) and hip (p=0.002) and displacement of knees (p=0.002) were increased. Beighton’s score of LUTD group (p=0.037) was higher.
CONCLUSIONS
Consequently, alterations were found in trunk and lower extremity biomechanics of LUTD group compared to healthy children. It was demonstrated that transversus abdominis muscle strength, trunk muscle endurance and some posture parameters were lower than the control group. Therefore, biomechanical evaluation of the trunk and lower extremities by physiotherapists in children with LUTD is important for the treatment method to be planned.
11:00 - 11:10
SN2-5 (OP)
Aygul KOSEOGLU 1, Tugce ATALAY 1, Ece Zeynep SAATCI 1, Melis UNAL 1 and Halil TUGTEPE 2
1) Private Tugtepe Pediatric Urology Center, Division of Bladder & Bowel Dysfunction, Istanbul, TURKEY - 2) Private Tugtepe Pediatric Urology Center, Istanbul, TURKEY
INTRODUCTION
The most common known cause of dysfunctional voiding (DV) is involuntary activation of the internal urethral sphincter during voiding demonstrated by EMG-uroflowmetry. There is no clinical trial demonstrated the function of PFM muscle in DV. Our aim is to investigate the function and activation of the PFM of children with DV from the perspective of the pelvic floor physiotherapist.
MATERIAL AND METHODS
32 children diagnosed with DV as a result of medical history, EMG-uroflowmetry and PVR findings were included in the study. The PFM function of all children was evaluated by external palpation of the external anal sphincter by pelvic floor physiotherapist. The muscle is functional, non-functional, overactive, and underactive according to the PFM ability to relax and contract.
RESULTS
In the EMG-uroflowmetry of 27 (84.4%) children, involuntary PFM activation was observed during voiding. We found non-functional in 5 (15.6%), overactive in 19 (59.4%), and underactive PFM function in 3 (9.4%) of these children with PFM activation on uroflowmetry. In addition, we determined 1 (3.1%) non-functional, 2 (6.3 %) overactive and 2 (6.3 %) underactive PFM in 5 (15.6%) children without EMG activation in uroflowmetry.
|
|
Function of PFM |
||||
|
|
NF |
AA |
UA |
Total |
|
|
EMG activation in uroflowmetry |
Present |
5(15.6%) |
19 (59.4%) |
3 (9.4%) |
27 (84.4%) |
|
Absent |
1 (3.1%) |
2 (6.3 %) |
2 (6.3 %) |
5 (15.6%) |
|
|
Total |
6 (18.8%) |
21 (65.6%) |
5 (15.6) |
32 (100%) |
|
CONCLUSIONS
When diagnosing dysfunctional voiding, evaluation of PFM function by physiotherapists will be very valuable in determining the treatment plan. Thus, it will be distinguished which children will need relaxation on the PFM and which will need a strengthening program. Therefore, we think that there will be subgroups of DV in the future according to PFM function.
11:10 - 11:20
SN2-6 (OP)
P.G. VAN LEUTEREN 1 and P DIK 2
1) Novioscan, Nijmegen, NETHERLANDS - 2) Wilhelmina Children's Hospital UMC Utrecht, Department of Pediatric Urology, Utrecht, NETHERLANDS
INTRODUCTION
In 2018, a wearable ultrasonic bladder sensor, the SENS-U (Novioscan, the Netherlands), was introduced to support (pediatric) urologists, pediatricians, urotherapists and nurses in their treatment of urinary incontinence by continuously monitoring the bladder filling status and providing personalized notifications. To discuss the clinical impact of the SENS-U in the treatment of children with different types of urinary incontinence, we present a first series of international cases.
PATIENTS AND METHODS
From July until November 2020, medical professionals of several international medical institutions were contacted and asked to share their experiences with the SENS-U, as a potential new adjunct tool for both diagnostic- and treatment purposes for children with urinary incontinence, both from a clinical - and user perspective.
RESULTS
In total, case reports of 21 patients (11 boys, 10 girls, mean ± SD: 9.0 ± 2.0 years [range: 5-12 years]) were retrieved from five medical institutions in the Netherlands and Belgium. Nine patients (43%) used the SENS-U in their clinical treatment, nine (43%) patients participated into a user evaluation, and three (14%) took part in a clinical study. Results show that the SENS-U is used for multiple pediatric applications i.e. treatment of (day/night) urinary incontinence (33%), supporting intermittent catheterization (24%), preventing residual volume (or others) (24%), and teaching central inhibition to suppress bladder overactivity (19%).
CONCLUSION
The first steps are taken towards a broader implementation of the SENS-U, indicating potential clinical benefits such as an increased sense of urgency by direct biofeedback, a reduced number of wetting accidents and residual volume(s), an increased appropriateness of catheterization attempts, a potential support for central inhibition, and overall becoming more independent. Moreover: technological opportunities were identified which enabled us to increase the SENS-U's clinical implementation, such as an automated voiding diary facility e.g. which have been developed in the meanwhile.