ESPU Meeting on Saturday 22, April 2023, 09:15 - 09:55
09:15 - 09:18
S23-1 (OP)
Ozgun ERINCIN 1 and Sibel TIRYAKI 2
1) Tepecik Training and Research Hospital, Pediatric Surgery, Izmir, TURKEY - 2) Tepecik Research and Training Hospital, Division of Pediatric Urology, Izmir, TURKEY
PURPOSE
The complex etiology of monosymptomatic enuresis is not yet fully understood. Lifestyle modifications constitute an important part of treatment. The aim of this study is to evaluate the relation of daily life habits and the presence of monosymptomatic enuresis.
MATERIAL AND METHODS
A questionnaire about daily life habits including 21 questions about bedtime, dinner time, snacking after dinner, and digital screen exposure was conducted. The results were compared between children with and without enuresis. Patients with bladder bowel dysfunction and diseases that may affect urine output were excluded.
RESULTS
The study included 70 cases with and 70 cases without monosymptomatic enuresis. Univariate analysis showed that enuresis was related to age (p<0.001), family history (p<0.001), water consumption mostly during night hours (p=0.001), eating dinner two hours before bedtime (p=0.049), duration between dinner and bedtime (p=0.005), duration of playing with a cellphone (p=0.048), duration between last screenplay and bedtime (p<0.001) and sleeping using a digital screen (p=0.009). Enuresis was present in 24 of 35 children who slept using a digital screen and in 46 of 105 children who did not. On the other hand, duration of playing with a cellphone was shorter and duration between last screenplay and bedtime was longer in children without enuresis. Logistic regression analysis demostrated that age (RR 8.3 (3.9-17.8)), family history (RR 8.5 (3.8-19)), and sleeping using a digital stimulus (RR 2.7 (14-7.8)) were independent risk factors for enuresis.
CONCLUSIONS
Our method of data collection limits the relibility of the results but our preliminary study showed lack of relationship between enuresis and eating or fluid consumption habits. Sleeping using a digital screen was found to be an independent risk factor, but the effect of other blue light exposure parameters were inconsistent. Further data is required.
09:21 - 09:24
S23-3 (OP)
Ana Flavia CASTRO, Glicia Estevam DE ABREU, Bruna VENTURINI, Eliakim MASSUQUETO, Maria Thais CALASANS and Ubirajara BARROSO
ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLICA, SALVADOR, BRAZIL, Salvador, BRAZIL
PURPOSE
The aim is to estimate the prevalence and impact of LUTS in enuresis and to characterize determining factors of this condition.
MATERIAL AND METHODS
Cross-sectional population-based study, which included enuretic individuals aged 5-17 years. Participants with at least 1 symptom according to Dysfunctional Voiding Scoring System (DVSS) were considered to have NON-MONOSYMPTOMATIC ENURESIS) NME. NME group was divided into Overactive Bladder (OAB), Voiding Postponement (VP) and Others (O). Complaints of infrequent voiding and holding maneuvers characterized VP. Patients with urgency, excluding VP, were categorized as having OAB. Those who did not fit diagnosis through symptoms were classified as Other, for example, complaints of dysuria.
RESULTS
84 participants were included. 71.4% presented NME. Daytime symptoms included holding maneuvers (71.7%), urgency (68.3%), incontinence (26.7%), urinary frequency (10%), effort to urinate (1,7%) and dysuria (1,7%). Enuresis was associated with holding maneuvers (p=0.029) and urgency (p=0.041). Urgency was a predictive factor of a more severe enuresis (OR= 5,6, p=0.047). According to the type of LUTD, OAB was present in 38 (63.3%) patients, VP in 8 (13.3%) and O in 14 (23.3%). Primary NME was associated with OAB and secondary NME, with VP and O. There were association between enuresis severity and LUTD type (p=0.002); higher prevalence of patients with OAB having >3 wet nights/week.
CONCLUSIONS
NMSE prevalence was 71% of enuretic population. Urgency was the only symptom associated independently with enuresis severity, being a predictive factor of >3x enuresis. Holding maneuvers is associated a less severe enuresis. A higher prevalence of patients with OAB had severe enuresis.
09:35 - 09:38
S23-4 (OP)
Ana Flávia CASTRO 1, Gabriel CID 1, João DIAS 1, Andrew KIRSCH 2, Maria Thais CALASANS 1 and Ubirajara BARROSO 3
1) ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLICA, SALVADOR, BRAZIL, Salvador, BRAZIL - 2) CHILDREN'S HEALTHCARE OF ATLANTA, EMORY UNIVERSITY, GEORGIA, UNITED STATES, Georgia, USA - 3) ESCOLA BAHIANA DE MEDICINA E SAÚDE PÚBLICA, SALVADOR, BRAZIL, UROLOGY, Salvador, BRAZIL
PURPOSE
SoluuTM is a novel device for enuresis that consists of a humidity sensor and electrode pads that will deliver transcutaneous electrical nerve stimulation (TENS) to the pelvic floor. Bedwetting is mitigated when the moisture sensor is activated by urine, TENS triggered, and simultaneous perineal muscle contraction occurs. Our aim is to evaluate the effectiveness of SoluuTM in primary monosymptomatic enuresis (PME) therapy in a randomized clinical trial. Herein, we present our preliminary results.
MATERIAL AND METHODS
Randomized clinical trial, which included patients with PME, aged 6-17 years, having > 8 wet nights/month. Patients were randomized into 2 groups: SoluuTM plus urotherapy and urotherapy alone. Endpoints considered for successful outcome included 14 consecutive dry nights, without relapses during 90 days of treatment, as well as decreased mean number of dry nights.
RESULTS
A total of 16 participants were included: 6 patients underwent treatment with SoluuTM and urotherapy and 10 urotherapy alone. Therapeutic success was observed in 5 (83.3%) patients in the SoluuTM plus urotherapy; only 1 (10%) patient in urotherapy group achieved 14 consecutive dry nights, but there was a recurrence 20 days later, not constituting therapeutic success (p=0.001). Median number of wet nights/week during the study period in urotherapy group was 4 (IQ 0.75-6), while in SoluuTM plus urotherapy group it was 0 (IQ 0-1.25) (p=0.041). There were no complications were seen in the SoluuTM group.
CONCLUSIONS
In this preliminary, short term follow up study, SoluuTM plus urotherapy was more effective than urotherapy alone, thus supporting its use in treating nocturnal enuresis.
09:38 - 09:41
S23-5 (OP)
Spencer SHANE 1, Jordan GITLIN 1, Amelia PANTAZIS 1, Alexander FANG 1 and Israel FRANCO 2
1) NYU Langone Hospital - Long Island, Mineola, NY, Pediatric Urology, New Hyde Park, USA - 2) Yale School of Medicine, Pediatric urology, New Haven, USA
PURPOSE
DDAVP is well accepted as first-line medical therapy for nocturnal enuresis (NE). If DDAVP is ineffective, combination therapy of DDAVP + oxybutynin (Oxy) or DDAVP + imipramine (Imp) has been used. This study assessed the efficacy of adjunct therapy with either Imp or Oxy in the management of NE patients (pts) who failed DDAVP treatment.
MATERIAL AND METHODS
A retrospective chart review of pts with NE was performed. All pts who were prescribed DDAVP, Oxy, and Imp over 14 years for NE were included. Two cohorts were examined; group A (A) was treated with DDAVP and Oxy, and group B (B) was treated with DDAVP and Imp. Pretreatment measurement of Vancouver Symptom Score (VSS) was used to compare groups as well as the VSS question “I wet my bed at night” with 4: I wet my bed every night, 3: 4-5 nights per week, 2: 1-2 nights per week, 1: 3-4 nights per month, and 0: never. ICCS criteria for continence success was utilized to determine outcomes. Statistical analysis was performed with SPSS.
RESULTS
2521 pts were identified who were prescribed one of the 3 medications. 72 pts (mean age of 9.8 ± 2.8 yrs), of which 48 were male and 24 female of which 58 were prescribed both DDAVP and Imp (B), 23 DDAVP and Oxy (A), and 9 transitioned from group A to group B. Mean pretreatment VSS showed no difference between the groups. Both groups had failed therapy with DDAVP alone. When comparing groups, it was found that B reduced wet nights significantly more than A (VSS wet night score 0.7 vs 2.3 respectively). Complete response rate was 68% vs 5% (OR= 42.5, p < 0.001) (Imp vs Oxy respectively).
CONCLUSIONS
A combination of DDAVP and Imp is more effective with a complete response rate that was 42.5 times greater than DDAVP and oxybutynin.
09:41 - 09:44
S23-6 (OP)
José Murillo NETTO 1, Liliana F. OLIVERIA 2, Lidyanne I. SILVA 1, Kayleigh G. GUIMARÃES 1, Jéssika CARDOSO 1, André C. P. RIBEIRO 3, André C. P. RIBEIRO 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), Surgery, Juiz De Fora, BRAZIL - 4) Universidade Estadual de Feira de Santana (UEFS), Urology, Juiz De Fora, BRAZIL
PURPOSE
Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) has been widely used in the treatment of overactive bladder with excellent results. Its use in the treatment of Enuresis is still subject to further studies. To evaluate the clinical response of TENS associated with behavioral therapy in children with primary monosymptomatic enuresis compared to behavioral treatment alone.
MATERIAL AND METHODS
This prospective controlled clinical trial enrolled 72 children over 5 years of age with primary enuresis treated in our Enuresis Clinic. Children were divided into 2 groups, control group (CG), treated with behavioral therapy and scapular stimulation, and experimental group (EG), treated with behavioral therapy and PTENS. In both groups, 20 sessions were performed, three times a week on alternative days, for twenty minutes each, with 10Hz frequency, 700μS pulse width and intensity determined by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4) and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for 3 consecutive months.
RESULTS
Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 35,.9%, at T1 49,4%, at T2 54%, at T3 54%, at T4 54,4% and 57,5% at T5; while in GC these percentages were 27,6%, 39,2%, 37.5%, 35,7%, 36,2% and 36,2%, respectively.
CONCLUSIONS
PTENS associated with behavioral therapy improves the percentage of dry nights in children with primary monosymptomatic enuresis, although no patient had complete resolution of symptoms in this study.