ESPU-Nurses Meeting on Thursday 18, April 2024, 09:20 - 10:20
09:20 - 09:30
SN1-1 (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.
09:30 - 09:40
SN1-2 (OP)
Amy DE ROUBAIX 1, Bieke SAMIJN 2, Dorine VAN DYCK 3, Griet WARLOP 1 and Lynn BAR-ON 1
1) Ghent University, Ghent, BELGIUM - 2) University Ghent, Ghent, BELGIUM - 3) Université libre de Bruxelles, Jette, BELGIUM
INTRODUCTION
A connection between developmental coordination disorder (DCD) and impaired toilet training, lower urinary tract symptoms (LUTS) and functional bowel problems is regularly observed in clinical practice, but scientific research is lacking.
MATERIAL AND METHODS
Current results are part of a larger study investigating the impact of DCD on the child and its family. Parents of children aged 4 to 18 years with movement difficulties consistent with DCD were invited to complete an online survey inquiring five different domains. The results concerning toilet training and incontinence will be presented.
RESULTS
Data was collected from the parents of 491 children with a mean age of 10.4 years and 75 % being male. Around 60% had one or more co-occurring conditions, with ADHD and ASD being the most common. In 48% of the children, parents reported difficulties during toilet training with a longer training period and more relapse in comparison to peers and siblings. Parents attributed this to difficulties with bladder awareness, getting to the toilet timely and wiping of the buttocks, accompanied with stool retention behaviour. No significant difference was seen when comparing children with and without co-occurring conditions. Stool problems after four years old was present in 24 % of the children. At five years of age, 28 % of the children exhibited daytime urinary incontinence and 40 % of the children had enuresis.
CONCLUSIONS
Parents report impaired toilet training and incontinence problems in nearly half of children with DCD and clinicians should be aware of these problems. More studies are required to investigate cause and scope of these problems.
09:40 - 09:50
SN1-3 (OP)
Bieke SAMIJN 1, Catherine RENSON 2, Johan VANDE WALLE 2, Erik VAN LAECKE 2, Ann RAES 2, Lien DOSSCHE 2, Piet HOEBEKE 2 and Anne-Françoise SPINOIT 2
1) University Ghent, Ghent, BELGIUM - 2) Ghent University Hospital, Ghent, BELGIUM
PURPOSE
First-line treatment for functional LUTS is standard urotherapy. The aim of the study is to evaluate effectiveness of group standard urotherapy or voiding class.
MATERIAL AND METHODS
A prospective study was conducted between 2021 and 2023, including children with incontinence, aged five to twelve. Children attend voiding class in groups of four and are evaluated after eight weeks. Data is collected through bladder diaries and the validated Dutch VSSDES and PIN-Q questionnaires. Adherence was evaluated by means of the amount of documents filled in before and after voiding class.
RESULTS
Fifty-eight children were included in the study (Mean age 7.3y, 71% male). 41 % of the children had combined daytime incontinence and enuresis, 55 % had isolated enuresis and 4 % had isolated daytime incontinence. Eight weeks after voiding class a transition was seen with less children experiencing combined daytime incontinence and enuresis (35 %) and two children becoming completely dry (4 %). A statistically significant decrease in the VSSDES (p = 0.008) and adherence (p < 0.001) was found. VSSDES and PINQ score exhibited higher scores before and after training in children with neurodevelopmental disorders, with PINQ scores reaching statistically significant differences (p < 0.05). Twenty-two children initially presented with a small bladder capacity and demonstrated a significant increase in bladder capacity after training (52 % vs 68 %; p = 0.001).
CONCLUSIONS
Group standard urotherapy is effective for symptom reduction after eight weeks of training. Adherence and neurodevelopmental disorders could be influencing factors and should be taking into consideration.
09:50 - 10:00
SN1-4 (OP)
Melis UNAL 1, Elif USTUN 2 and Halil TUGTEPE 3
1) Uropelvic Solutions Pelvic Floor Rehabilitation Center, Istanbul, TÜRKIYE - 2) Yeditepe University, Physiotherapy and Rehabilitation, Istanbul, TÜRKIYE - 3) Tugtepe Pediatric Urology Clinic, Istanbul, TÜRKIYE
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.
10:00 - 10:10
SN1-5 (OP)
Reyhan KAYGUSUZ BENLI 1, Ece Zeynep SAATÇI 2 and Halil TUĞTEPE 3
1) Demiroğlu Bilim University, Division of Physiotherapy and Rehabilitation, Istanbul, TÜRKIYE - 2) Uropelvic Solutions Pelvic Floor Rehabilitation Center, Pelvic Floor Rehabilitation, Ataşehir, TÜRKIYE - 3) Private Tugtepe Pediatric Urology Center, Pediatric Urology, Ataşehir, TÜRKIYE
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.
10:10 - 10:20
SN1-6 (OP)
Benjamin WHITTAM, Hannah DILLON, Rosalia MISSERI, Martin KAEFER, Kirstan MELDRUM, Joshua ROTH, Pankaj DANGLE, Richard RINK and Konrad SZYMANSKI
Riley Hospital for Children at IU Health, Indianapolis, USA
PURPOSE
Children with voiding dysfunction (VD), such as incontinence or urinary frequency, may report lower quality of life (QOL) compared to their peers. We aimed to understand 1) how QOL captured using existing instruments correlates with VD severity (cross-sectional) and 2) how QOL changes with changing VD symptoms (prospective). We hypothesized that large differences in symptoms would correlate with large differences/changes in bladder-specific QOL but small differences/changes in generic QOL.
MATERIAL AND METHODS
We recruited children 8-18 years old with VD at a pediatric urology clinic (June to October 2023). VD included daytime incontinence, enuresis, frequency, urgency, and dysuria. We excluded children with severe developmental delay, anatomical urological abnormalities, or history of urologic surgery. We captured demographics, symptoms (Vancouver Dysfunction Voiding Symptom Score, DVSS), and QOL (child-reported PinQ and Kidscreen-10). We calculated Pearson correlations and QOL differences corresponding with 20-point DVSS differences (cross-sectional), and we assessed changes in scores at 3 months using non-parametric tests (prospective).
RESULTS
Sixty children (33 girls) at a median age of 12 years old participated. The most common reason for appointment was "urine accidents at night." Mean DVSS score was 14.8, similar to previous studies (weighted mean: 15.0, p=0.89). PinQ scores had a moderate positive correlation with DVSS scores (r=0.40) with a 20-point DVSS difference corresponding to a 16% PinQ difference. Kidscreen-10 scores had a moderate negative correlation with DVSS scores (r=-0.40) with a 20-point DVSS difference corresponding to a 16% Kidscreen-10 difference. Among 16 children who completed 3 month questionnaires, DVSS improved by a median 4.3 points (+8%, p=0.01), PinQ worsened by 1 (1.3%, p=0.74) and Kidscreen worsened by 1.3 (1.3%, p=0.45).
CONCLUSIONS
Preliminary results indicate that previously published QOL questionnaires likely have a similar insensitivity to detect changes in QOL as VD symptoms improve. A new, patient-centered, highly specific, and sensitive health-related quality of life tool is needed for pediatric urology.