ESPU Meeting on Saturday 22, April 2023, 08:40 - 09:15
08:40 - 08:43
S22-1 (OP)
Ece Zeynep SAATÇI 1, Hali̇l TUĞTEPE 2, Aygül KÖSEOĞLU 1, Tuğçe ATALAY 1 and Ebru KAYA MUTLU 3
1) Uropelvic Solutions Clinic, Pelvic Floor Rehabilitation, Ataşehi̇r, TURKEY - 2) Private Tugtepe Pediatric Urology Center, Ataşehi̇r, TURKEY - 3) Bandırma 17 Eylül University, Division of Physiotherapy and Rehabilitation, Balıkesir, TURKEY
PURPOSE
Lower urinary system dysfunctions (LUTD) are voiding dysfunctions without anatomical or neurological involvement. Symptoms are standardized by the International Children’s Continence Society (ICCS). There are a few studies associating patients' and parents' quality of life (QoL) with cognitive and school performance. The aim of this study is to evaluate the QoL of children with LUTD and to compare parent and child perspectives.
MATERIAL AND METHODS
43 patients (Group 1) and 43 healthy (Group 2) children aged 5-12 years who were diagnosed with LUTD for the first time participated in the study. In order to evaluate QoL of the participants, the child and parent forms of the Pediatric QoL Inventory (PedsQL) for the age groups of 5-7 and 8-12 were applied. The scale has 23 questions in total. It’s results were analyzed for the scales four sub-parameters which are, physical health (PHS), emotional functioning (EFS), social functioning (SOC-FS), and school functioning (SFS).
RESULTS
According to the “Independent-Samples T” test results, a statiscally significant difference was found among the groups at the PedsQL-Child forms PHS, EFS, SFS sub-parameters. There was also a statiscally significant difference among the groups at PedsQL-Parent forms EFS, SOC-FS, and SFS sub-parameters as well (p=0.004, p=0.001, p=0.001, p=0.001, p=0.001, p=0.017, respectively). It was determined that the QoL levels of the LUTD group were lower in all sub-parameters of the scale compared to the healthy group.
CONCLUSIONS
LUTD; negatively affects children's physical and emotional functionality and academic achievement. Parents of children with LUTD perceive their children's QoL to be lower in terms of emotional functioning and school functioning. Health professionals should be informed about the effects on QoL of children with LUTD and should follow an interdisciplinary approach to mitigate the negative effects of psychological consequences on both the child and the parents.
08:43 - 08:46
S22-2 (OP)
Shayel BERCOVICH, Roy MORAG, Bezalel SIVAN and David BEN MEIR
Schneider Children's Medical Center; affiliated to Sackler Faculty of Medicine, Tel Aviv University, Urology, Petach Tikva, ISRAEL
PURPOSE
EMG uroflowmetry is an essential phase of pressure flow evaluation. The ICCS guidelines affirm that 6Fr or 7Fr catheters do not obstruct the urethra. Given different results at our institution, we evaluated the accuracy of EMG uroflowmetry in children utilizing a urethral catheter.
MATERIAL AND METHODS
A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018-7/2022 was employed. Urination curves and pelvic floor muscle activity were compared in an invasive and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark.
RESULTS
104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value<0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the invasive and non-invasive tests, respectively. Invasive EMG uroflowmetry demonstrated a specificity of 39% (95% CI 23-57) and PPV of 61% (95% CI 53-67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value=0.5).
CONCLUSIONS
The accuracy of invasive EMG uroflowmetry in children, primarily in boys, compared to the non-invasive test, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment.
08:55 - 08:58
S22-3 (OP)
José Murillo B. NETTO 1, Lidyanne I. SILVA 1, Oliveira LILIANA F. 2, Hanny M. FRANCK 1, Gustavo B. CAMILO 3, André A. FIGUEIREDO 1 and José BESSA JR. 4
1) Universidade Federal de Juiz de Fora (UFJF), Surgery/Urology, Juiz De Fora, BRAZIL - 2) Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Physiotherapy, Juiz De Fora, BRAZIL - 3) Universidade Federal de Juiz de Fora (UFJF), Anatomy, Juiz De Fora, BRAZIL - 4) Universidade Estadual de Feira de Santana (UEFS), Urology, Juiz De Fora, BRAZIL
PURPOSE
Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, with voiding urgency as its main manifestation. Parasacral Transcutaneous Electral Nerve Stimulation (PTENS) is a safe, well-tolerated, and side-effect-free alternative treatment; however, the treatment protocols described require several weekly sessions, which makes adherence to treatment difficult.
This study aims to evaluate the effectiveness of ENTP performed with single weekly sessions compared to that performed with three sessions per week, in the treatment of OAB in children.
MATERIAL AND METHODS
This is a non-inferiority randomized controlled trial, in which 20 children were allocated into two groups: GE1 (urotherapy and ENTP 1x/week) and GE2 (urotherapy and ENTP 3x/week). In both groups, 20 sessions of PTENS were performed, lasting twenty minutes each, with a frequency of 10Hz and pulse width of 700ms. The children were assessed and reassessed at the end of the 20 sessions using the voiding diary for three consecutive days.
RESULTS
No significant differences were found between the groups after treatment regarding the variables studied: urinary frequency (p=0.18), maximum voiding volume (p=0.08), urinary urgency (p=0.99) and urinary incontinence (p=0.36).
CONCLUSIONS
PTENS performed once or three times a week is effective in the treatment of OAB, and the protocol performed with single weekly sessions is not inferior to the treatment performed three times a week.
08:58 - 09:01
S22-4 (OP)
S. Kerem OZEL 1, Burhan AKSU 2, Murat MUTUS 3, Nilufer GOKNAR 4, Cengiz CANDAN 4 and Cigdem ULUKAYA DURAKBASA 1
1) Istanbul Medeniyet University Faculty of Medicine, Pediatric Surgery Division of Pediatric Urology, Istanbul, TURKEY - 2) Pendik Yeni Yuzyil Hospital, Pediatric Surgery, Istanbul, TURKEY - 3) Istinye University Faculty of Medicine, Pediatric Surgery, Istanbul, TURKEY - 4) Istanbul Medeniyet University Faculty of Medicine, Pediatric Nephrology, Istanbul, TURKEY
PURPOSE
In the literature, there is no data comparing biofeedback treatment with parasacral TENS (PTENS) as the primary approach in children with dysfunctional voiding (DV). The aim of this prospective, randomised, clinical study was to compare the effectiveness of biofeedback treatment, PTENS therapy and dual combination in DV.
MATERIAL AND METHODS
Patients who were diagnosed as DV were randomly selected for biofeedback (BF), PTENS and BF with PTENS. Standard urotherapy was applied to all patients. Patients were evaluated with uroflowmetry, residual urine levels and a validated objective symptom scoring system (ICIQ-CLUTS) before and after treatment. Late follow up symptom evaluations were also done.
RESULTS
42 patients were randomised (BF n:13, BF+PTENS n:15, PTENS n:14). Mean age of 37 girls and 5 boys was 9,07±2,7 years. The post-void residual urine volume was found to be 46,68±64,35 ml before treatment and 26,36±66,14 ml after treatment in BF group (p=0,037). Whereas, in PT group, this value was 54,5±48,96 ml before and 1,36±5,08 ml after treatment (p=0,005). A statistically significant difference was not observed in uroflowmetric data. The long-term follow-up time was 23,11±0,78 months for BF group and 17,6±1,51 months for PT group. In PT group, the difference between the symptom score in pre-treatment period and the long-term period was still significant (p=0,002). The ICIQ-CLUTS score was significantly lower after TENS treatment compared to the score after biofeedback treatment (14,5±3,59 vs 17,46±3,23 p=0,018).
CONCLUSIONS
PTENS treatment seems to be more effective as a primary treatment in patients with DV in the short and long-term compared to biofeedback treatment. It may be more advantageous to use this treatment in patients who can not cooperate, with inadequate motivation or mental retardation. Due to these superiorities, PTENS should be kept in mind in patients with DV.
09:01 - 09:04
S22-5 (OP)
Catarina ROSIER 1, Glicia ESTEVAM 2, Maria Luiza VEIGA 2, Maria Fernanda SILVA 2, Ana Aparecida BRAGA 2, Maria Thais CALASANS 2 and Ubirajara BARROSO 2
1) Center of Urinary Disorders in Children (CEDIMI) - Bahiana School of Medicine, Salvador, BRAZIL - 2) Bahiana School of Medicine, Center of Urinary Disorders in Children (CEDIMI), Salvador, BRAZIL
PURPOSE
To evaluate the influence of electrical current intensity (ECI) on Functional Constipation (FC) in patients treated with parasacral TENS.
MATERIAL AND METHODS
A retrospective analysis of children diagnosed with BBD, aged between 3 and 17 years, who completed twenty 3x/week sessions of parasacral TENS plus urotherapy was performed. A biphasic electric current of frequency equal to 10Hz and pulse width of 700µs was applied through two electrodes positioned bilaterally in the parasacral region. The ICE was specific for each patient's motor and sensory thresholds. FC was assessed pre- and post-treatment using Rome IV criteria.
RESULTS
Thirty-seven children with a mean age of 8.08 ± 2.87 years were studied, 20 (54.1%) of whom were female. At the end of treatment, 27 (73%) patients were not constipated. The total, maximum, minimum, and median ECI amplitude were 17.94 (IQR 12.84 - 23.24), 26 (IQR 8.6 - 32), 10 (IQR 7 - 15), and 14 (IQR 11 - 17.5), respectively. There was a difference between the medians of the ECI in the resolution and non resolution of the symptoms: total (19.81 IQR 14.26 - 23.74, p = 0.01), maximum (29 IQR 22 - 34 X 17.5 IQR 15 - 23.75, p = 0.002), and minimal (11 IQR 7 - 15 X 7.5 IQR 4.75 - 9.25, p = 0.02). The amplitude was not different between the groups (p = 0.05). There was no association/correlation between sex/age and the ICE range.
CONCLUSIONS
Higher ECI is associated with FC resolution in children with BBD treated with parasacral TENS. Age and sex are not related to ICE