ESPU Meeting on Saturday 20, April 2024, 10:50 - 11:35
10:50 - 10:53
S24-1 (OP)
Lucas MORATILLA-LAPEÑA 1, Borja NAVA 1, María SARMIENTO 1, María SAN BASILIO 1, Arturo ALMEYDA 1, Virginia AMESTY 2, Roberto LOBATO 2, Susana RIVAS 2, Isabel GARCÍA 3, Maria José MARTÍNEZ-URRUTIA 2, Jesús MINGORANCE 3 and Pedro LÓPEZ-PEREIRA 3
1) Hospital Universitario La Paz, Pediatric Surgery, Madrid, SPAIN - 2) Hospital Universitario La Paz, Pediatric Urology, Madrid, SPAIN - 3) Hospital Universitario La Paz, Molecular Biology, Madrid, SPAIN
PURPOSE
Overactive bladder (OAB) is a frequent disease affecting up to 10% of healthy children, however, its cause is not entirely clear, being associated with neurological alterations in the micturition mechanism. Recent articles in adults focus on the importance of the microbiome in the development of lower urinary tract symptoms. The aim of our study is to find out if there is variation in urinary microbiome in paediatric patients with OAB and whether it is involved in the pathogenesis.
MATERIAL AND METHODS
Prospective cohort study of male children with diagnosis of OAB and matched controls between 5-11 years, during 2020-2023. Urinary samples were collected. Samples were sent for conventional urine culture and urinary microbiome study using Nanopore kit and sequenced in the MinION system using FLONGLE cells. Exclusion criteria were urinary tract infection, antibiotic during the last month, dysfunctional voiding, surgery of the urinary tract and use of anticholinergic drugs.
RESULTS
We studied 15 males with OAB and 8 controls. Age was similar between groups (9,19 ± 2,19 vs 8,35 ± 2,92;p=0,386). Among all children, most frequent bacteria in urinary microbiome were Campylobacter urealyticus (32%), Ezakiella massiliensis (22%) and Peptoniphilus harei (20%) with an increase in the alpha-diversity index in OAB patients, which was no significant. Nevertheless, when we analysed the urotypes, we saw more prevalence of Streptococcus, Sthapylococcus and Anaerococcus in OAB patients with no growth of them in control patients.
CONCLUSIONS
Increase of alpha diversity and opportunistic bacteria population in the microbiome in OAB patients may be implicated in the pathogenesis of the disease as the cause of OAB symptoms.
10:53 - 10:56
S24-2 (OP)
Sang Woon KIM
Yonsei university college of medicine, Department of urology, Seoul, REPUBLIC OF KOREA
PURPOSE
We performed this meta-analysis to assess the association between overweight and lower urinary tract symptoms(LUTs) in children and adolescents.
MATERIAL AND METHODS
We conducted extensive searches on the PubMed, Cochrane Library to identify all articles. We make the searching strategy combining the Mesh term and specific words to target the article which is related to obesity, overweight and LUTs in pediatrics and adolescent including "obesity", “overweight", "body mass index", "enuresis", “wetting”, "urination", “lower urinary tract symptoms” and “lower urinary tract dysfunction".
RESULTS
11 studies with 48,293 patients were included. Among them, There are 8 studies related to enuresis, 3 studies related to overactive bladder (urgency and urge incontinence). Patients with obesity had higher rate of enuresis (odd ratio [OR] =4.02; 95% CI, 3.15-5.13; p< 0.001). Obese children were more likely to have overactive bladder than normal children (OR =4.86; 95% CI, 3.83-6.18; p<0.001), and the prevalence of daytime urinary incontinence was also higher in obesity (OR =15.60; 95 CI, 3.91-62.26; p<0.001).
CONCLUSIONS
The study suggested that obesity may be one of the risk factors for LUTs in children and adolescents. The correlation between enuresis and obesity has been confirmed, and a stronger correlation between obesity and overactive bladder (or daytime urinary incontinence) has been demonstrated.
10:56 - 10:59
S24-3 (OP)
Aneta PIOTROWSKA-GALL 1, Małgorzata WÓJCIK 2, Aneta CYGAN 3, Ewa SZCZUDLIK 2, Anna STĘPNIEWSKA 2, Barbara DOBROWOLSKA-GLAZAR 4 and Rafał CHRZAN 4
1) Collegium Medicum, Jan Kochanowski University in Kielce; Paediatric Institute, Jagiellonian University; University Children's Hospital of Krakow, Department of Paediatric Urology, Urodynamic and Urotherapy Unit, Kielce, POLAND - 2) Paediatric Institute, Jagiellonian University; University Children's Hospital of Krakow, Department of Paediatric and Adolescent Endocrinology, Chair of Paediatrics; Interclinical Center for the Treatment of Childhood Obesity, Kraków, POLAND - 3) University Children's Hospital, Department of Paediatric Urology, Urodynamic and Urotherapy Unit, Kraków, POLAND - 4) Paediatric Institute, Jagiellonian University; University Children's Hospital of Krakow, Department of Paediatric Urology, Urodynamic and Urotherapy Unit, Kraków, POLAND
INTRODUCTION
The aim of this study was to evaluate the prevalence of lower urinary tract (LUT) symptoms among children with obesity.
PATIENTS AND METHODS
In this prospective clinical study, children undergoing evaluation for overweight and obesity complications in the endocrinology setting were assessed for LUT and bowel function using a bespoke questionnaire covering the whole spectrum of symptoms according to the ICCS definitions. Ambiguous or incomplete questionnaire responses were clarified through phone interviews with guardians. Patients were recruited form a single center between March 13th and October 6th, 2023.
RESULTS
A total of 101 children participated in the study. The median age was 13.5 years (range 8-17 years; SD 2.4), with a median BMI of 32.5 (range 22.6-48.8; SD 5.2), and a median BMI z-score of 2.2 (range 1.2-2.8; SD 0.4). The cohort comprised 46 boys and 55 girls.
LUT dysfunction was detected in 28 (27,7%) patients, necessitating further evaluation in an outpatient urology clinic. Daily incontinence was observed in 18 cases (17,8%), enuresis in 5 (4.9%), and remaining 5 (4.9%) exhibited multiple symptoms as a result of LUT disorder (e.g., frequent UTIs, urgency, holding manoeuvres, abnormal voiding frequency or urinary stream).
Notably, there was a statistically significant difference in age (p=0.04) and fat percentage (p=0.01) among children with obesity who also had LUT disorders.
CONCLUSIONS
This preliminary study shows that children with obesity may be at an elevated risk for lower urinary tract dysfunction. These findings necessitate further investigation with comprehensive urological assessments.
10:59 - 11:02
S24-4 (OP)
Kimihiko MORIYA 1, Yoko NISHIMURA 2, Masafumi KON 2, Taiju HYUGA 1, Kazutoshi CHO 3, Atsuko ARAKI 4, Takahiko MITSUI 5, Reiko KISHI 4 and Nobuo SHINOHARA 2
1) Jichi Medical University and Children's Medical Center Tochigi, Pediatric Urology, Shimotsuke, JAPAN - 2) Hokkaido University, Renal and Genitourinary Surgery, Sapporo, JAPAN - 3) Hokkaido University, Obstetrics and Gynecology, Sapporo, JAPAN - 4) Hokkaido University, Center for Environmental and Health Sciences, Sapporo, JAPAN - 5) University of Yamanashi Graduate School of Medical Science, Urology, Chuo, JAPAN
PURPOSE
Gender difference in the incidence of bladder-bowel dysfunction or chronic constipation has been reported, though exact reason of the difference is obscure. Because there is dimorphic brain development between genders as well as anatomical difference in the pelvic organs, we speculated that the difference in development of central nerve system may have some impact on defecation. In the present study, impact of sexual dimorphic brain development on bowel function was investigated.
MATERIAL AND METHODS
Survey sheets including Pre-school Activities Inventory (PSAI) and defecation frequency (days/week) were sent to 1503 children' mothers who agreed to participate when children became 3 years old. PSAI is a questionnaire in which parents indicate their child's involvement in various sex-type behaviors and in which higher scores was designed to represent masculine-typical behavior. Relationship between status of DF and score of PSAI were investigated using Chi square test, Student's t test and linear regression analysis.
RESULTS
Among 990 children who returned the survey sheets (65.9%), 818 children (435 boys and 383 girls) were available for analysis. Score of PSAI was significantly higher in boys (56.8+/-8.2) than in girls (29.4+/-8.6) (p<0.0001). Sore of PSAI in girls with 4 or more days of defecation was significantly higher than those with less than 4 (29.8±8.6 vs 26.5±8.2, p=0.01). A linear regression analysis revealed a positive relationship that as defecation frequency increased, score of PSAI was higher in girls even after adjusted by presence of elder sisters or elder brothers or age at survey (β(95%CI): 0.014 (0.005 , 0.023), p=0.003). These difference were not observed in boys.
CONCLUSIONS
The present study demonstrated that defecation frequency was related to behavioral sexual dimorphism in girls. These findings suggest that factors affecting developing sexual dimorphic brain development may also affect the bowel function and risk of constipation.
11:15 - 11:18
S24-5 (OP)
Reyhan KAYGUSUZ BENLI 1, Ece Zeynep SAATÇI 2 and Halil TUĞTEPE 3
1) Demiroğlu Bilim University, Division of Physiotherapy and Rehabilitation, Istanbul, TURKEY - 2) Uropelvic Solutions Pelvic Floor Rehabilitation Center, Pelvic Floor Rehabilitation, Ataşehir, TURKEY - 3) Private Tugtepe Pediatric Urology Center, Pediatric Urology, Ataşehir, TURKEY
PURPOSE
Lower urinary tract disorders and constipation are common symptoms of bladder and bowel dysfunction(BBD) although several studies have shown that children with BBD also have challenges with social and behavioral development,motor coordination,and development. However, no studies have examined fine motor skills or performance in children with BBD. This study aimed to compare hand dexterity and upper extremity performance of children with BBD and healthy controls.
MATERIAL AND METHODS
The study included 38 healthy children(22 girls,16 boys) and 34 children with BBD(21 girls,13 boys) diagnosed by a pediatric urologist between the ages of 5-12 years.Age, gender, physical activity level and body mass index(BMI) were recorded.The Nine-hole peg test(NHPT) was used to assess hand dexterity and the T-shirt wearing test was used to assess upper extremity performance.
RESULTS
The demographical data of both groups were similar(p>0.005).Physical activity duration was significantly lower in children with BBD than in healthy children(p=0.001).There were statistically significant differences between the dominant and non-dominant hand NHPT times and T-shirt wearing times of healthy controls and the BBD group(p=0.08;p=0.07 and p=0.030,respectively).
|
Variable |
Healthy Group(n=38) Mean(SD) |
BBD(n=34) Mean(SD)
|
p* |
|
Age(year) |
8.53(0.98) |
7.94(1.98) |
0.550 |
|
Gender n(G/B) |
22/16 |
21/13 |
0.738 |
|
Weight(kg) |
25.18(5.05) |
29.74(12.73) |
0.455 |
|
BMI(kg/m2) |
15.11(1.64) |
16.81(3.54) |
0.087 |
|
PA duration(h/day) |
4.01(1.48) |
1.78(2.21) |
0.001** |
|
NHPT Dominant hand(sn),Min-Max |
21.63(2.97) (17-28) |
24.82(5.72) (13.48-39.83) |
0.008* |
|
NHPT Non-dominant hand(sn),Min-Max |
24.10(3.11) (18-31) |
26.54(4.43) (14.58-34.45) |
0.007*
|
|
T-shirt Wearing Time(sn),Min-max
|
9.88(3.74) (4-23) |
12.41(5.45) (5.3-25.0) |
0.030 |
|
T-shirt Removing Time(sn),Min-max |
8.58(4.31) (3.0-21.0) |
7.58(4.14) (2.68-22.86) |
0.432 |
(Mann Whitney U Test,*p<0,05 ;**p<0,01)
CONCLUSIONS
Children with BBD had lower hand dexterity and upper extremity performance than healthy controls.We think that a multidisciplinary approach and follow-up programs are critical in increasing the functional abilities of children with BBD and their accompanying conditions.
11:18 - 11:21
S24-6 (OP)
Ebru KAYA MUTLU 1, Ece Zeynep SAATÇI 2 and Halil TUĞTEPE 2
1) Bandırma Onyedi Eylül University, Faculty of Health Science, Division of Physiotherapy and Rehabilitation, Bandirma, TURKEY - 2) Private Tugtepe Pediatric Urology Center, Istanbul, TURKEY
PURPOSE
Some studies in the literature have revealed that poor foot biomechanics (flat feet and hyperpronation) can affect the alignment of the pelvis in adults and potentially cause pelvic floor dysfunction. Our aim is to evaluate foot posture between children with Lower Urinary System Dysfunction (LUTD) and healthy children and to examine the existence of a relationship between foot posture and pelvic floor muscle activation.
MATERIAL AND METHODS
Voluntary participants meeting inclusion criteria were divided into two groups: LUTD group (n=43) and control group (n=43). Foot posture and pelvic floor muscle activity of participants was evaluated with Foot Posture Index (FPI-6) and NeuroTrac-Myoplus4Pro device, respectively.
RESULTS
There was a significant difference between the LUTD group and the control group and FPI-6. The FPI-6 right and left mean values of the LUTD group were 4.37 and 4.32, while the healthy group was 1.81 and 1.13. No relationship was found between FPI-6 values and pelvic floor muscle activation values between the two groups (p>0.05).
CONCLUSIONS
The high FPI-6 score in the group with LUTD is an indicator of increased pronation in these children. Pronation at the ankle, which is the last link of the lower extremity chain; Disposition of the knee and hip joint may cause increased flexibility. We recommend that when evaluating children, we should approach the body as a whole, not just focusing on the pelvic floor muscles, and that future studies should include larger sample groups.
11:21 - 11:24
S24-7 (OP)
Murat DAYANÇ 1, Aslı ÖZTÜRK 1 and Hasan Cem IRKILATA 2
1) Private Dayanc Urology Center, Ankara, TURKEY - 2) Private Medicana Hospital, İstanbul, TURKEY
PURPOSE
Lower urinary tract dysfunction (LUTD) is a common problem in children. Besides bladder and rectum dynamics, pelvic floor muscle activities (PFMA) play an important role in the pathophysiology of lower urinary tract dysfunction (LUTD) in children. In this study, we aimed to determine the contraction and relaxation functions of PFMA in children with LUTD.
MATERIAL AND METHODS
Among 79 children diagnosed with LUTD, 19 were intermittent, 33 were staccato, and 27 were bell shaped voiding patterns during uroflowmetry. PFMA were measured using superficial electrodes in the postvoid period, which is the resting phase of the pelvic floor muscles. During the measurement, 5 seconds of contraction and 5 seconds of relaxation were performed, and the average values of the 50-second period were recorded.
RESULTS
The mean PFMA values in the contraction and relaxation periods according to the voiding pattern are shown in the Table. The relaxation function was lower in children who voided intermittently and staccato than those with bell curve, and there was statistical significance between those who voided staccato and bell curve (p=0.001) . Contraction function was worst in children who voided intermittently, better in staccato voiders, and best in those who voided bell curve, and the difference between intermittent and bell-shaped voiding was statistically significant (p=0.013). When the difference between contraction and relaxation (contraction amplitude) was evaluated, both intermittent and staccato voiding had statistically significantly less contraction amplitude than bell curve voiders (p=0.001; p=0.002).
CONCLUSIONS
PFMA measurement is a noninvasive and easy method that can be used to evaluate pelvic floor contraction and relaxation functions and to understand the pathophysiological mechanism. In children with dysfunctional voiding, as the voiding pattern worsens by shifting from staccato to intermittent, pelvic floor muscle contraction and relaxation ability decreases