ESPU Meeting on Saturday 20, April 2024, 11:35 - 12:15
11:35 - 11:38
S25-1 (OP)
Liesbeth DE WALL 1, Elisabeth KRAGT 1, Eline VAN DE WETERING 1, Johanna COBUSSEN-BOEKHORST 1, Joyce MANTEL- VAN STEL 2, Barbara KORTMANN 1, Charlotte BOOTSMA-ROBROEKS 3 and Wout F FEITZ 1
1) Radboudumc, Amalia children's hospital, Department of Urology, Nijmegen, NETHERLANDS - 2) University Medical Center Groningen, Department of Paediatric Urology, Groningen, NETHERLANDS - 3) University Medical Center Groningen, Department of Paediatric Nephrology, Groningen, NETHERLANDS
PURPOSE
Frequency voiding charts (FVCs) are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper FVCs among children and their parents.
MATERIAL AND METHODS
A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-hour digital FVC or a 48-hour paper FVC. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child’s participation and attractiveness. Trail registry data: NTR NL9383.
RESULTS
Ninety-seven patients were randomised to either a digital (N = 53) or paper (N = 44) FVC. No significant difference in complete and accurately filled out FVCs was seen between the groups, with 35% (N = 18) for digital and 50% (N = 22) for paper,p =0.12. Subjects considered the digital application more appealing, more educative and more inviting compared to the paper chart (p< 0.05).
CONCLUSIONS
In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out FVCs. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.
11:38 - 11:41
S25-2 (OP)
Adree KHONDKER 1, Ihtisham AHMAD 1, Zwetlana RAJESH 1, Sabrina BALKARAN 2, Zizo AL-DAQQAQ 1, Jin Kyu KIM 1, Natasha BROWNRIGG 1, Abby VARGHESE 1, Michael CHUA 1, Mandy RICKARD 1, Armando LORENZO 1 and Joana DOS SANTOS 1
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) The Hospital for Sick Children, Toronto, CANADA
PURPOSE
To determine the effect of conservative adjuncts (non surgical, non pharmacological) to standard urotherapy in pediatric bladder and bowel dysfunction (BBD).
MATERIAL AND METHODS
Five databases were systematically searched (MEDLINE, EMBASE, CINAHL, Scopus, and the Cochrane Library) from study conception to June 2023. Comparative studies of conservative adjuncts versus conventional urotherapy were included. The primary outcomes included lower urinary tract symptoms, recurrent urinary tract infections (UTIs), and uroflowmetry variables.
RESULTS
Eighteen studies were included (15 RCTs and three comparative observational studies), generating a total of 1228 children with a median age at presentation of 7 years and a median follow-up of 9 months. Conservative adjuncts included home education (5 studies, 27%), biofeedback or cognitive behavioral therapy (7 studies, 39%), pelvic-floor physiotherapy or exercise-based treatment (5 studies, 27%), or miscellaneous (2 studies, 11%). When compared to urotherapy alone, conservative adjuncts were associated with reduced incontinence (OR 0.33, 95%CI 0.21, 0.51; p<0.01), reduced rates of recurrent UTI (OR 0.60, 95%CI 0.37, 0.96; p=0.03), and reduced rates of abnormal uroflowmetry (OR 0.11, 95%CI 0.06, 0.19; p<0.001). The overall risk of bias was low, moderate, and severe for 8 (44%), 8 (44%), and 2 (11%) studies, respectively.
CONCLUSIONS
Conservative adjuncts are associated with reduced urinary symptom burden, reduced rates of UTI, and reduced rates of abnormal uroflowmetry findings. These findings support the introduction of these interventions in a stepwise approach before embarking on more invasive or pharmacological strategies. Given the considerable variablity in the definition of BBD and reporting heterogeneity, well-designed prospective studies are required to validate these findings.
11:41 - 11:44
S25-3 (OP)
Melis UNAL 1, Elif USTUN 2 and Halil TUGTEPE 3
1) Uropelvic Solutions Pelvic Floor Rehabilitation Center, Istanbul, TURKEY - 2) Yeditepe University, Physiotherapy and Rehabilitation, Istanbul, TURKEY - 3) Tugtepe Pediatric Urology Clinic, Istanbul, TURKEY
PURPOSE
Nowadays in treating LUTD, alongside pharmacology and surgery, conservative and easy-to-apply methods like urotherapy and physical therapy are increasingly prominent. Among the physical therapy approaches applied are pelvic floor muscle rehabilitation(PFMR) and connective tissue massage(CTM), which has recently started to be applied. CTM is a manual skin reflex treatment that locally affects mast cells in connective tissue through short and long tractions. This study aimed to compare CTM+PFMR with PTMR alone on uroflowmetry parameters, symptoms and quality of life.
MATERIAL AND METHODS
40 children (31 boys, 9 girls), diagnosed with LUTD were divided into two groups using block randomization. Group A (G.A.) had PFMR only, supervised by a physiotherapist three times a week for eight weeks, while Group B (G.B.) had PFMR+CTM. Pre/Post-treatment uroflow parameters (volume,Qmax,Qave,flow time,EMG activation) were evaluated with EMG-Uroflowmetry,symptoms score with Dysfunctional voiding and incontinence scoring system(DVISS),and quality of life with Pediatric Incontinence Questionnaire(PIN-Q).
RESULTS
Children's physical and demographic characteristics in both groups were similar(p>0.05).When the difference analysis of the groups was made in pre/post-treatment evaluations, G.B. showed more improvement in DVISS and Pin-Q scores compared to G.A.(p=0.001; p<0.01).When comparing uroflowmetry parameters between the groups, difference was found in Qave(p=0.001; p<0.01). When the groups were evaluated within themselves as pre and post-treatment, it was found that both groups showed significant improvements in DVISS, Pin-Q scores, and uroflowmetry parameters in the post-treatment period(p=0.001; p<0.01).
CONCLUSIONS
PFMR has positive effects on uroflowmetry parameters, symptoms and quality of life when applied both alone and with CTM. CTM applied in addition to PMFR can be more effective on certain uroflow parameters,symptoms score and quality of life by restoring the balance between the sympathetic and parasympathetic systems.In LUTD children,CTM can be applied in addition to PFMR as an accessible technique without side effects.
11:55 - 11:58
S25-4 (OP)
Roseanne FERREIRA 1, Dean ELTERMAN 1, Mandy RICKARD 2, Max FREEMAN 2, Natasha BROWNRIGG 2, Abby VARGHESE 2, Michael CHUA 2, Armando J LORENZO 2 and Joana DOS SANTOS 2
1) University Health Network, Urology, Toronto, CANADA - 2) SickKids, Urology, Toronto, CANADA
PURPOSE
To present the inaugural Canadian experience using sacral neuromodulation (SNM) as therapeutic option for children with refractory bladder and bowel dysfunction (BBD).
MATERIAL AND METHODS
Patients <18y with refractory BBD were prospectively followed from 2018 to present. Preoperative evaluation included spinal MRI and videourodynamics. Refractory BBD was defined by symptom persistence after 6 months of conservative and >3 months of optimized combined medical therapy. Two-stage SNM implantation was executed with a minimum 2-week Stage-1 trial. Functional outcomes and complication rates were measured following institutional protocols.Data presented as median(range).
RESULTS
| Pt | Sex | Age at surgery | Comorbidities | Indication | UDS | Anorectal manometry | Medical therapy |
| 1 | Female | 9 | ADHD | UI,OAB | Detrusor overactivity(DO),low compliance,decreased capacity | Anticholinergic,B3 agonist,laxative | |
| 2 | Male | 8 | ADHD | UI,OAB,FI,constipation | DO,low compliance,decreased capacity | Normal | Anticholinergic,B3 Agonist, laxative,enema |
| 3 | Female | 11 | ADHD | UI,OAB,FI,constipation | Normal | B3 Agonist,alpha-blocker,laxative | |
| 4 | Male | 10 | None | UI,OAB,FI,constipation | DO,low compliance,decreased capacity | Abnormal | Anticholinergic,B3 Agonist,alpha-blocker,laxative |
| 5 | Female | 15 | None | UI,OAB,FI,constipation | DO,decreased capacity | Normal | Anticholinergic,B3 Agonist,laxative, enema |
Five patients completed Stage-2 implantation at 10years (8.2-15). Indications included urinary incontinence(UI), overactive bladder(OAB), Fecal incontinence(FI)/encopresis. All had normal spinal MRI and attempted biofeedback/pelvic floor physiotherapy(Table 1). Baseline Dysfunctional Voiding Scoring System(DVSS) score was 11.5(10-16). At 6months follow-up, only one patient required adjunct bladder medication. DVSS at 1-year follow-up was 4(0-7). Symptomatic resolution was noted in 40%(2/5) at 6 months, sustained over 12 months. Early surgical complications were reported in 1(infection) and late complications in 3(lead fracture/battery depletion/non-traumatic malfunction), requiring SNM reimplantation at 37.5 months(36-49) post-implantation.
CONCLUSIONS
SNM offers promising results for refractory BBD in Canada. The significant improvement in symptoms highlights the treatment's potential which must be balanced against the high need for revision detected at 3years. This study establishes the feasibility of introducing SNM for selected refractory pediatric patients with BBD.
11:58 - 12:01
S25-5 (OP)
Andre RIBEIRO 1, Liliana OLIVEIRA 2, Lidyane DA SILVA 2, Davi ALVES 3, Hanny FRANCK 3 and José Murillo NETTO 1
1) Hospital Universitário da Universidade Federal de Juiz de Fora, Surgery, Juiz De Fora, BRAZIL - 2) Hospital Universitário da Universidade Federal de juiz de Fora, Pediatrics, Juiz De Fora, BRAZIL - 3) Hospital Universitário da Universidade Federal de Juiz de Fora, Nursering, Juiz De Fora, BRAZIL
PURPOSE
Introduction: Upper Airway Obstruction (UAO) is a common Pediatric condition (27% of prevalence); nocturnal enuresis (NU) is related to UAO in 8 to 47% of these children. The pathophysiology of this association isn’t so clear yet, but there seems to be a conection between Brain Natriuretic Peptide and Anti Diuretic Hormone secretion throughout sleep. The aim of this study is to compare hormonal profiles and dry night diaries between two groups of enuretic children: with and without UAO, before and after airway surgery (AS) and urotherapy (UROTH).
MATERIAL AND METHODS
Methods: Comparative clinical trial between unuretic children with and without UAO, from 5 to 14 years, recruited voluntarily at enuresis outpatient in a tertiary hospital from may 2018 to august 2023. Blood samples were collected for measuremet of BNP and ADH, before and 90 to 120 days after each group therapy. We also collected a dry night diary before and after the same time in each group. Data was analized before and after therapies; after application of normality test, we applied t test / Mann- Whitney – Wilcoxon
RESULTS
Results: intergroup analysis: avarege difference between ADH pre therapy (3,75 UROTH and 5,88 AS) and dry nigths after therapy (14,20 UROTH and 22,62 AS). Intragroups analysis: in AS group we noticed na increase of BNP (116,52 ® 156,21) and dry nights (9,67 ® 22,62); in UROTH group we didn’t noticed any difference.
CONCLUSIONS
Conclusion: The hormone profile between groups is different in ADH pre therapy and in dry nights after therapy. For AS group, surgery was effective to improve number of dry nights throughout 30 days.
12:01 - 12:04
S25-6 (OP)
Canan SEYHAN 1, Asli OZTURK 1, Hasan Cem IRKILATA 2 and Murat DAYANÇ 1
1) Private Dayanc Urology Center, Ankara, TURKEY - 2) Private Medicana Hospital, İstanbul, TURKEY
PURPOSE
We evaluated pelvic floor muscle (PFM) activities before and after specific urotherapy treatment according to the frequency of enuresis in children with primary monosymptomatic nocturnal enuresis (PMNE).
MATERIAL AND METHODS
A total of 54 children over the age of 5 with PMNE were included in the study. PMNE frequency and quality of life were recorded before and after treatment.PFM activities were measured before and after treatment with the NeuroTrac MyoPlusPro device during contraction and relaxation. During PFM activities measurement, 10 consecutive repetitions of 5 seconds of contraction and 5 seconds of relaxation were performed and the average values at 50 seconds were recorded.Each patient had standard urotherapy, alarm therapy and individualized PFM rehabilitation.
RESULTS
The average age was 10.37±3.4 and the gender disturibion was 41 boys and 13 girls (Table. 1) The frequency of enuresis was 6-7 nights a week in 59% of the patients, 3-5 nights a week in 31% and 1-2 nights a week in %9.Before treatment, PFM contraction value decreased by frequency of enuresis, but it was not statistically significant (p>0.05) )(Figure 1)(Table. 2). PFM values were similar between groups (p>0.05)( Figure 1 )(Table 2).The average of individualized pelvic floor muscle rehabilitation sessions was 10.93. There was no statistically significant relationship between the number of sessions and the frequency of PMNE, age and pelvic floor muscle variables (p>0.05)(Table 1).After treatment PFM rest average, work average; frequency of enuresis, and quality life were improved (p=0.0001, p=0.0001, p=0.0001, p=0.0001, respectively)(Table 1).
CONCLUSIONS
PFM contraction strength decreases by frequency of enuresis in children with PMNE. After spesific urotherapy (standard urotherapy, alarm therapy with PFM rehabilitation), PFM contraction and relaxation improve and normalize.Randomized controlled studies are needed.