34th ESPU Congress in Naples, Italy

SN4: NEUROPATHIC BLADDER

Moderators: Hanny Cobussen (NL), Anka Nieuwhof-Leppink (NL)

ESPU-Nurses Meeting on Thursday 18, April 2024, 15:10 - 15:30


15:10 - 15:20
SN4-1 (OP)

NON-INVASIVE EVALUATION OF INCONTINENCE IN CHILDREN WITH CEREBRAL PALSY

Bieke SAMIJN 1, Christine VAN DEN BROECK 2, Frank PLASSCHAERT 3, Mathilde JOOS 2 and Erik VAN LAECKE 3
1) University Ghent, Ghent, BELGIUM - 2) Ghent University, Ghent, BELGIUM - 3) Ghent University Hospital, Ghent, BELGIUM

PURPOSE

Urinary incontinence and LUTS are common in patients with cerebral palsy (CP). Although recommended in typically developing children, non-invasive uroflow measurement is not routinely used in children with CP. The objective of the study is to investigate uroflowmetry in children with CP.

MATERIAL AND METHODS

A cross-sectional observational study is conducted including children with CP between five and twelve years old. Children are evaluated using uroflowmetry and the validated Dutch Vancouver Symptom Score for Dysfunctional Elimination Syndrome questionnaire.

RESULTS

Forty-five children were included, with a mean age of 8,3 years old and 58 % being male. 24 children (53%) were dry and 21 (47%) children were incontinent. A bell-shaped curve was most frequently seen and demonstrated by 19 (42%) children. A significant difference of flow pattern (p < 0.01) was noted between continence status, with more than 50 % of the dry children demonstrating a bell shaped curve and children with combined daytime incontinence and enuresis demonstrating only pathologically shaped curves. Within this last group, half of them could not void despite having a filled bladder. Voided volume as percentage of expected bladder capacity for age tended to be lower (36.3 % vs. 61.8 %; p = 0.04) in children with incontinence. 

CONCLUSIONS

Non-invasive uroflow measurement could be useful in children with CP. Depending results, redirection to invasive urodynamic evaluation can be necessary. Special attention should be given to those who have combined daytime incontinence and enuresis and cannot void on uroflowmetry.


15:20 - 15:30
SN4-2 (OP)

EFFICACY OF PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) IN CHILDREN WITH DYSFUNCTIONAL VOIDING: ARE MOTOR AND SENSORY RESPONSE RELATED TO TREATMENT EFFECTIVENESS?

Maria Laura SOLLINI 1, Maria Luisa CAPITANUCCI 2, Chiara PELLEGRINO 2, Tiziana SERANI 2, Tiziana LORETI 2, Giada GERVASI 2 and Giovanni MOSIELLO 2
1) University of Rome Tor Vergata, Clinical Sciences and Translational Medicine, Department of Physical and Rehabilitation Medicine, Rome, ITALY - 2) Bambino Gesù Children Hospital, Department of Neuro-Urology and Continence Surgery, Rome, ITALY

PURPOSE

Percutaneous Tibial Nerve Stimulation (PTNS) is well tollerated in children and is used to treat dysfunctional voiding (DV). Electrical stimulation performed by PTNS determines a sensory and a motor response, that is not always present, particularly in children. Aim of the study is investigate results of PTNS treatment in relation to toes' plantar flexion.

MATERIAL AND METHODS

We retrospectively evaluated patients affected by LUTS with a diagnosis of DV arrived at our center and subject to PTNS treatment from September 2021 to June 2022. All patients performed 12 sessions, 30 minutes, of PTNS, once a week. At the end of treatment all children have been evaluated regarding improvement of urological symptoms.

RESULTS

We enrolled 11 children (6 M - 5 F; 11,6±3 yrs), 10 affected by DV and 1 affected by neurogenic bladder resulting from transverse myelitis. All patients completed the sessions without reporting discomfort or pain. While sensory response was reported by each patient, motor response was present only in 6/11 children (54,5%). An improvement of symptoms at the end of treatment was referred in 3 of them. About 5 patients (45,5%) without motor response, 4 of them referred benefit from treatment. An improvement of LUTS was referred by 7/11 children (63,6%).

CONCLUSIONS

In our small group, PTNS results seem to be not correlated with motor response. Future studies are required including urodynamic examination during PTNS, comparing the use of PTNS and Transcutaneous tibial nerve stimulation, and a special focus on role of plantar toe flexion in neurogenic patients.