ESPU-Nurses Meeting on Friday 10, June 2022, 11:05 - 11:40
11:05 - 11:12
SN4-1 (PP)
Lola BLADT 1, Charlotte SCHIPPERS 2, Regan WATTS 2, Gunter DE WIN 3 and Alexandra VERMANDEL 3
1) Minze Health, Research and Development, Antwerp, BELGIUM - 2) University of Antwerp, Product Development, Antwerp, BELGIUM - 3) Antwerp University Hospital, Urology, Edegem, BELGIUM
PURPOSE
Toilet training (TT) is a complex and emotional process with an abundance of supporting materials. The aim of this study was to investigate the emotions experienced during TT and the preferred supporting material.
MATERIAL AND METHODS
We used an online survey to gather data from parents who have experience with TT. Input from in-depth interviews with parents was used for the survey design.
RESULTS
Overall, 93 parents aged 25–52 years (mean 33.3, SD 4.7) completed the survey. A mix of positive and negative emotions during TT was experienced by parents; 65.6% reported joy and 34.4% stress. On the other hand, their impression of the child’s emotions was predominantly positive, such as joy, victory and confidence, reported by 66.7%, 54.8% and 51.6%, respectively. To inform themselves about TT, the majority (65.6%) used the internet, followed by the advice of others (44.1%) and books (22.6%). Information provided by government organizations (14.0%) and TT apps (4.3%) was rarely used. Most parents (60.2%) preferred a simple potty, mainly because of its easy accessibility for the child, mobility and good posture support. Others preferred the toilet with or without a seat reducer, as reported by 20.4% and 14.0%, respectively. The main reasons were imitation behavior and the parents’ view on learning immediately what must be used eventually. Finally, a small group (5.4%) preferred special potties, like interactive music potties.
CONCLUSIONS
The results reflect a mix of positive and negative emotions experienced by parents and predominantly positive emotions experienced by children during TT. The internet was the main source for TT information, and simple potties were preferred most.
11:12 - 11:19
SN4-2 (PP)
Melis UNAL 1, Ece Zeynep SAATCI 1, Tugce ATALAY 1, Aygul KOSEOGLU 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 etiology of Primary Nocturnal Enuresis (PNE) is stil uncertain. Bladder control during sleep is achieved through inhibition by activating the striated and smooth pelvic floor muscles (PFM) while inhibiting the detrusor muscle. This neural reflex arc is thought damaged in PNE leading to impaired inhibition of detrusor muscle and lack of activation of PFM. Therefore, the aim of the study is to investigate PFM function and the effect of combined PFM rehabilitation (PFMR) in children with PNE.
MATERIAL AND METHODS
18 (6 MNE, 12 NMNE) children diagnosed with PNE as a result of medical history. PFM muscle functions were evaluated by external palpation from the external anal sphincter by the physiotherapist before and after the treatment. Combined PFMR sessions lasting 75 minutes, including urotherapy, alarm theraphy, diaphragm breathing and core exercises, myofascial techniques, and biofeedback training interventions were applied to the children once a week. The sessions were continued until the children's symptoms disappeared. DVSS score and enuresis episodes were evaluated before and after treatment.
RESULTS
The mean age of patient was 9 years old. The PFM function of 8 (66.6%) patients with NMNE were underactive, respectively 2 (16.6%) functional, 1 (8.3%) non-functional and 1 (8.3%) overactive. Whereas, 3 (50%) patients with MNE were underactive and the other 3 (50%) were functional. After the treatment, the PFM functional of all patients were functional. The avarage number of PFMR session was 9.28.
|
Symptoms |
Before treatment |
After treatment |
P |
|
DVSS score |
10.06 |
0.22 |
0.001 |
|
Frequency of enuresis episodes (day/week) |
6.06 |
0.56 |
0.001 |
|
PFM Activation |
|||
|
Work Average (µV) |
8.47 |
11.51 |
0.001 |
|
Average Deviation (%) |
36.93 |
26,4 |
0.001 |
CONCLUSIONS
The demostrating the PFM fuction by physiotherapist will be play a role in increasing the effectivenesss of the treatment. PFM rehabilitation seems very effective method in the treatment of NE.
11:19 - 11:26
SN4-3 (PP)
Ece Zeynep SAATCI 1, Melis UNAL 1, Tugce ATALAY 1, Aygul KOSEOGLU 1 and Halil TUGTEPE 2
1) Private Tugtepe Pediatric Urology Center, Division of Bladder & Bowel Dysfunction, İstanbul, TURKEY - 2) Private Tugtepe Pediatric Urology Center, Istanbul, TURKEY
INTRODUCTION
Bowel dysfunction includes both constipation and fecal incontinence. Children who don’t have good coordination of their pelvic floor muscles (PFM) during urination may lack the same coordination for the evacuation of feces. Also, these children may have increased PFM tonus. We aimed to investigate the effectiveness of combined pelvic floor muscle rehabilitation (PFMR) by pelvic floor physiotherapists in children with bowel dysfunction.
MATERIAL AND METHODS
16 (7 girls; 9 boys) children diagnosed with bowel dysfunction because of history and physical examination. PFM functions were evaluated by external palpation from the external anal sphincter by the physiotherapist before and after the treatment. Combined PFMR sessions lasting 75 minutes, including urotherapy, diaphragm breathing and core exercises, myofascial techniques and biofeedback training interventions were applied to the children once a week. The sessions were continued until the children's symptoms disappeared. Rectal diameter by USG was measured and weekly defecation frequency was questioned before and after the treatment.
RESULTS
The mean age of patient was 8,4 and the avarage of PFMR session numbers 7,2. We found non-functional in 1 (6.3%), overactive in 14 (87.5%) and underactive PFM function in 1 (6.3%) of these children before treatment. After the treatment, PFM function in 14 (87.5%) children was functional, while 2 (12.5%) children were still overactive. While the mean rectum diameter (mm) before treatment was 38,1, the mean rectum diameter after treatment was calculated as 27 (p=0.001). The weekly defecation frequency was 3 before treatment and 6.8 after treatment (p=0.007).
CONCLUSIONS
Combined PFMR performed by pelvic floor physiotherapists seems to be very effective treatment in children with bowel dysfunction when the focus is on relaxing the appropriate PFM’s.
11:26 - 11:33
SN4-4 (PP)
Nao IGUCHI 1, M. I˙rfan DÖNMEZ 1, Alonso CARRASCO 2, Duncan WILCOX 3, Anna MALYKHINA 1 and Nicholas COST 3
1) University of Colorado Denver, Surgery, Aurora, USA - 2) Children's Mercy Kansas City, Surgery, Kansas City, USA - 3) Children's Hospital Colorado and University of Colorado Hospital, Surgery, Aurora, USA
PURPOSE
Cytotoxic chemotherapy is the foundation for treating the wide variety of childhood malignancies. One common chemotherapy used in children, doxorubicin is well known to cause cardiotoxicity mainly through oxidative stress. Studies suggested that doxorubicin impairs skeletal and smooth muscle function in patients. In this study, we aim to investigate the impact of systemic doxorubicin administration on detrusor smooth muscle (DSM) function, especially when administered at a young age.
MATERIAL AND METHODS
Using IACUC approved protocols, the effects of doxorubicin on the detrusor smooth muscle and bladder function were assessed in BALB/cJ mice that received 6 weekly intravenous injections of doxorubicin (3mg/kg) or saline (control group). Bladder histology,in vitro evaluation of detrusor contractility, and gene expression studies were performed at 1 week after the last treatment.
RESULTS
Systemic doxorubicin administration resulted in DSM hypertrophy and a significant attenuation of DSM contractility followed by a slower relaxation compared to the control group. Gene expression analyses reveled that unlike doxorubicin-induced cardiotoxicity, the bladders from doxorubicin-administered animals showed no changes in oxidative stress markers, instead, downregulation of large conductance/big potassium (BK) channel and altered expression of myosin light chain kinase coincided with reduced myosin light chain phosphorylation indicating that doxorubicin-induced DSM dysfunction is mainly myogenic.
CONCLUSIONS
The results indicate that in vivo doxorubicin exposure caused DSM dysfunction by dysregulation of the contractile-relaxation mechanisms through molecular pathways different from oxidative stress. Since many of the cancer late effects occur years after therapy, our findings suggest increasing awareness that childhood cancer survivors treated with doxorubicin may be at increased risk of bladder dysfunction and accordingly monitor those patients closely.
11:33 - 11:40
SN4-5 (PP)
Nao IGUCHI 1, Sarah HECHT 2, Duncan WILCOX 3, Anna MALYKHINA 1 and Nicholas COST 4
1) University of Colorado Denver, Surgery, Aurora, USA - 2) Doernbecher Children's Hospital, Oregon Health & Science University, Pediatric Urology, Portland, USA - 3) Children's Hospital Colorado, Surgery, Aurora, USA - 4) Children's Hospital Colorado and University of Colorado Hospital, Surgery, Aurora, USA
PURPOSE
Vincristine is the most common chemotherapy agents used in pediatric oncology. Despite well-known vincristine-induced peripheral neuropathy (VIPN), the potential impact of VIPN on lower urinary tract (LUT) function remains undefined. This study aims to investigate the effects of systemic vincristine exposure in childhood on LUT function by using a juvenile murine model.
MATERIAL AND METHODS
Using IACUC approved protocols, CD-1 mice (3.5-wk-old) received an intraperitoneal injection of 0.5 mg/kg of vincristine (experimental group) or saline (control group) twice per week for 4 weeks. Physiological recordings of LUT and detrusor function were conducted by cystometry in conscious and unrestrained mice and an in vitro organ bath at 5 weeks after the last treatment. Changes in gene expression in the bladders and the lumbosacral dorsal root ganglia (Ls-DRG) were examined.
RESULTS
Cystometry revealed that vincristine exposure induced increased functional bladder capacity, micturition volume and non-void contractions. Vincristine exposure also caused sexual dimorphic changes; in females, increased intravesical pressure at micturition and downregulations of a major player in bladder afferent firing, Htr3b, in the bladders, and Cav1.2 in the Ls-DRG, while male mice displayed detrusor overactivity, upregulations of IL-2, Trpa1 and Itga1 in the bladders and neuroinflammation-related genes in the Ls-DRG. These results suggest that that systemic vincristine exposure caused sensory neuropathy via sex-dimorphic mechanisms, leading to altered LUT function.
CONCLUSIONS
Systemic vincristine exposure in juvenile mice affected LUT function via sex-dimorphic mechanisms, which may clinically present as gender-specific signs of LUT dysfunction. A recent survey study of childhood cancer survivors from our group has implicated vincristine and/or doxorubicin exposure in LUT dysfunction with differences observed between male and female patients. Thus, follow-up urological assessment would benefit to pediatric cancer patients treated with these chemotherapeutic agents.