ESPU-Nurses Meeting on Thursday 20, April 2023, 10:40 - 11:00
Canan SEYHAN 1, Asli OZTURK 2, Rabia ASIK 2, Hasan Cem IRKILATA 3, Giray ERGIN 4 and Murat DAYANÇ 2
1) Health Science University, Ankara, TURKEY - 2) Private Dayanc Urology Center, Ankara, TURKEY - 3) Private Davraz Yasam Urology Center, Isparta, TURKEY - 4) Private Koru Hospital, Urology, Ankara, TURKEY
Lifting and waking are described as waking the children from sleep and taking them to the bathroom to pass urine. Traditionally these methods have been used by families to manage bedwetting. The aim of this study is to examine the relationship between the lifting and waking methods used by families and pelvic floor muscle activity in children with primary monosymptomatic nocturnal enuresis (PMNE).
MATERIAL AND METHODS
A total 48 voluntary children with PMNE and their families were included. The families were questioned about the presence of night lifting and the frequency of night lifting. Pelvic floor muscle findings were measured externally with the Modified Oxford Scale and superficial electromyography. Mean contraction and relaxation values were recorded in a 50-second measurement, which included 5 seconds of contraction and 5 seconds of relaxation with EMG.
It was noted that 41 of 48 families (85%) lifted their child with PMNE to urinate at night, while 7 families (14%) did not. The frequency of lifting during the night was found 1.95± 1.09 (Mean± SD). There was a positive correlation between the frequency of night lifting and the mean relaxation value of pelvic floor muscle (p<0.05), there was no correlation between the Modified Oxford Scale and the mean contraction value (p>0.05).
Lifting and waking can cause unwelcome results. Sleepy micturition may block the child from waking up when the bladder is full and micturating in a controlled manner. According to our findings, lifting and waking have a negative effect on pelvic floor relaxation of children.
Alejandro ROSSI 1, Emma Molyneux MOLYNEUX 2, Amit MANIYAR 2, Akinlabi AJAO 1, Julie SMITH 3, Kate ROLLASON 4, Kathryn SIDDLE 5, Ellen BULLMAN 6, Nicola SMITH 7, Massimo GARRIBOLI 7, Anupam LALL 8, Harriet CORBETT 9 and Anju GOYAL 1
1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester Children's Hospital, Paediatric Radiology, Manchester, UNITED KINGDOM - 3) Alder Hey Children's Hospital, Department of Paediatric Radiology, Liverpool, UNITED KINGDOM - 4) Alder Hey Children's Hospital, Paediatric Radiology, Liverpool, UNITED KINGDOM - 5) Great North Children's Hospital, Royal Victoria Infirmary, Paediatric Radiology Department,, Newcastle Upon Tyne, UNITED KINGDOM - 6) Evelina Children's Hospital, Paediatric Radiology, London, UNITED KINGDOM - 7) Evelina Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 8) Great North Children's Hospital, Royal Victoria Infirmary, Paediatric Urology Department, Newcastle Upon Tyne, UNITED KINGDOM - 9) Alder Hey Children's Hospital, Paediatric Surgery, Liverpool, UNITED KINGDOM
Bladder volumes(BV) estimation with automated bladder scanner(BS) is integral to assessment of Lower Urinary Tract dysfunction in nurse-led clinics. We observed high Post Void Residual recordings (PVR) with Bladdder Scanner in children where standard ultrasound scan (US) had shown satisfactory emptying. Automated BS are designed to look for fluid and when there is minimal PVR, it tends to pick up other fluid-filled structures such as bowel loops or artefacts caused by bowel gas. Thus, we designed a multicentre prospective observational study comparing BS volumes with US volumes.
MATERIAL AND METHODS
Four centres participated. Pre and post-void BV were measured in patients attending for abdominal ultrasonography in radiology departments using both BS and US. Patients with known abnormal shaped bladders were excluded.
Ninety-nine patients (52% female, mean age of 9.2 years(range: 2-17 years)) were included.
Pre-void BS volumes ranged from 1-734mls(median: 126mls) and US from 5-653mls(median: 121mls). The intraclass correlation coefficient (ICC) was high(0.88 (p<0.001)), indicating that measurements were concordant suggesting high degree of reliability.
Post-void BS volumes ranged from 0-153mls(median: 18mls) and US from 0-74mls(median: 7mls). The ICC was lower(0.46 (p<0.001)), indicating that the measurements were discordant and reliability was poor.
BS and US have high concordance when the bladder is full but poor discordance on PVR assessment,with the BS giving a false high volume due to wrong interpretation of artefacts as fluid signal. This will lead to false assessment of emptying ability and should be kept in mind when making management decisions based on PVR assessments by BS.
Lottie PEERDEMAN 1, Keetje DE MOOIJ 2 and Anka NIEUWHOF-LEPPINK 3
1) WILHELMINA CHILDREN'S HOSPITAL part of UMC UTRECHT,, MEDICAL PSYCHOLOGY, UROTHERAPY, UROLOGY, Utrecht, NETHERLANDS - 2) WILHELMINA CHILDREN'S HOSPITAL part of UMC UTRECHT, UROLOGY, Utrecht, NETHERLANDS - 3) WILHELMINA CHILDREN'S HOSPITAL part of UMC UTRECHT, Utrecht, NETHERLANDS
This case report describes adjustments in urotherapy program treatment taking into account the patient's age, autism spectrum disorder, anxiety as well as his emotional development.
An 11-year-old boy was referred to a third line center with refractory day- and nighttime incontinence (daily), urgency and diagnosed with an overactive bladder.
The standard program was personalized in cooperation with the parents, teachers and healthcare professionals who are involved in the boy.
Some examples of adjustments we made are:
A shift from the clinical program to a training in his safe and predictable home environment. Adding pictograms to the daily training schedule. Furthermore preparations and additional visits to the urotherapist were necessary to prepare the patient. Use of a timer watch to teach timed voiding and he wore an alarm pants for 5 days. Extending the training program to reinforce learned skills. There was regularly coaching, by telephone, email and in the outpatient clinic.
Daytime incontinence reduced from daily to once a week. He urinates at set times, however he remains dependent on the timer watch. Independence of patient was increased thus giving psychological relief to him and the family
The outcome demonstrates that customized care takes time and requires a focused commitment and time investment from everyone.
Liesbeth Lilian DE WALL 1, Anka NIEUWHOF-LEPPINK 2, Eline VAN DE WETERING 3, Evelien LEIJN 4, Marleen TROMPETTER 5, L.M.O DE KORT 6, Wout F FEITZ 3 and Renske SCHAPPIN 7
1) Radboud UMC, Paediatric Urology, Nijmegen, NETHERLANDS - 2) Wilhelmina Children's Hospital Utrecht, Department of Medical Psychology and Social Work, Utrecht, NETHERLANDS - 3) Radboudumc, Department of Urology, Radboudumc, Nijmegen, The Netherlands, NETHERLANDS - 4) Top voor kinderen, Pediatrics, Arnhem, NETHERLANDS - 5) Isala Clinics, Deparment of Urology, Zwolle, NETHERLANDS - 6) Wilhelmina Children's Hospital Utrecht, Department of Urology, Utrecht, NETHERLANDS - 7) ErasmusMc, Department of dermatology, Rotterdam, NETHERLANDS
Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined.
MATERIAL AND METHODS
This is a multicenter clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6-16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice, are eligible. Four centers, two academic hospitals and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups; urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training or urotherapy with a SHAM device for 3 weeks.
The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM-device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control group.
To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy.