ICCS & ESPU-Nurses Meeting on Friday 5, September 2025, 08:25 - 09:13
08:25 - 08:31
ICCS-S01-1 (OP)
Katie CLEARY and Joanna CLOTHIER
Evelina London Children's Hospital, Bladder, London, UNITED KINGDOM
INTRODUCTION
Taking action to reduce health inequalities is a key aim of the NHS (NHS Long Term Plan 2019). We sought to evaluate attendance of patients at our paediatric bladder service and explore factors which may contribute to clinic non-attendance (DNA).
PATIENTS AND METHODS
Retrospective, single-centre study of clinic appointments at a tertiary bladder referral centre from October 2023 – October 2024. 5030 appointments were reviewed, including virtual and face-to-face, new and follow-up appointments. Data collected included: Patient demographics and DNA rate. Secondarily, the DNA rate was explored examining the contribution of clinic- and patient-specific factors.
RESULTS
Out of 5030 total appointments, DNA rate was 9.8% (493), ranking the bladder service 8th out of 14 medical directorate subspecialties. Table 1. Demographics of population.
New patient virtual appointments had the lowest DNA (4.4%), compared to face-to-face follow-up (10.1%). DNA on Fridays and Saturdays were 1.75% higher than Monday-Thursday. DNA at 9am appointments was 9.9% compared to 6% at 4pm.
Highest rates of DNA were seen in: those travelling from within London (13.9%) versus elsewhere in UK (7%), those with the highest levels of income deprivation (IDACI decile 1+2 (13.2-13.9%) vs 9+10 decile (5.9-3.4%)) and teenagers >14 years (12%). No difference was seen between sexes.
| Parameter | Result |
| Sex | 52% female, 48% male |
| Age | 32% |
| Distance travelled to hospital | 9% surrounding London Boroughs, 20% southeast London, 71% elsewhere in UK |
| IDACI (Income deprivation affecting children index) | Equal distribution |
Table 1. Demographics of population
CONCLUSION
Our study highlights non-attendance is a common problem and can be due to clinic-specific and patient factors.
Further focus is needed to explore reasons for non-attendance amongst older teenagers and children living with income deprivation. Targeted intervention is needed to reduce health inequality and improve clinical outcomes.
08:31 - 08:37
ICCS-S01-2 (OP)
M S ANSARI and Dr Priyank YADAV
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplantation, Lucknow, INDIA
PURPOSE
In bladder bowel dysfunction (BBD) the external urinary sphincter (EUS) fails to relax at the time of voiding. The author hypothesizes that the non-relaxation of EUS alone may not be the cause of urethral abstraction. The authors here in describe that the non- relaxing-bulbospongiosus muscle may substantially contribute to LUTD.
MATERIAL AND METHODS
Study includes all children presented with LUTD and bowel symptoms (constipation / incontinence). After ruling out of any other causes of symptoms like neurogenic or structural abnormality, bladder and bowel diaries with uroflowmetry and pelvic floor EMGs were assessed. The children who continued to have persistent LUTS even after 3 months of urotherapy were further subjected to pelvic floor functional MRI (Fr MRI) and high-resolution anorectal manometry (HRAM) to study the anatomy and physiology of pelvic floor muscular components with special reference to bulbospongiosus muscle. Dysfunctional voiding score system (DVSS) was obtained at start of treatment which was also used for the monitoring of symptoms.
RESULTS
Between January 2010 and December 2024, a total of 130 children with median age of 7.5 yrs (range 3.5-12) diagnosed with BBD were included in the study. Of these 25 (19.2%) children who failed to show improvement after urotherapy were counselled for Fr MRI and high-resolution anorectal manometry. Fifteen of them accepted. The Fr MRI during voiding showed occlusive contraction of bulbospongiosus in these children. HRAM also recorded high anal pressure while making attempt at evacuation.
CONCLUSIONS
In children with LUTD one need to look beyond the abnormality of EUS. Non- relaxing-bulbospongiosus muscle may substantially contribute to the voiding disorder in children. When suspected these children should undergo more elaborate work up to achieve the best therapeutic goals.
08:37 - 08:43
ICCS-S01-3 (OP)
Alberto OCAMPO 1, Beverly SPRAY 1, Nora BROADWELL 2, Sally PUCKETT 1, Sammie T JAMES 1, Sowmya N PATIL 1 and Stephen J CANON 2
1) Arkansas Children's Hospital, Pediatric Urology, Little Rock, USA - 2) Texas Children's Hospital, Pediatric Urology, Houston, USA
PURPOSE
The objective of this study was to establish the prevalence of urinary incontinence (UI) in children and to delineate associated factors using national and local databases.
MATERIAL AND METHODS
This retrospective study utilized the Pediatric Health Information System (PHIS) database and a local cohort of children treated at our institution. PHIS was queried for all codes for UI from 2008 through 2018 in ages 5-17 years. Records in our institutional general pediatric clinic (GPC) were queried during a four-month period. Children with developmental delay and neurologic disease were excluded.
RESULTS
PHIS analysis identified 40,864 encounters for UI from 1,857,464 total patients treated yielding a prevalence of 2.2% (2.0% males and 2.5% females). Patients with UI were more likely to be female (n=22,843; 55.9%). Mean age was 9.5 (SD=3.2). Prevalence of associated factors were constipation (n=7560; 18.5%), bowel incontinence (n=695; 1.7%), urinary tract infection (n=2983; 7.3%), and bladder dysfunction (n=2820; 6.9%).
GPC analysis identified 67 encounters from 3393 total patients, yielding a prevalence of 2.0%. Patient demographics mirrored PHIS (female, n=36; 54.4%; mean age 9.2 (SD = 2.7)). Prevalence of associated comorbidities were constipation (n=21; 31.3%), bowel incontinence (n=2; 3.0%), and urinary tract infection (n=1; 1.5%).
CONCLUSIONS
Analysis of the PHIS database and local cohort identified prevalence of UI in children was approximately 2.2%, more common in females, and was associated with constipation, UTI, and bladder dysfunction.
08:43 - 08:49
ICCS-S01-4 (OP)
Anderson LUIZ PIMENTEL FERREIRA 1, Viviane VELOSO 2, Juliana COSTA 2, Felipe SANTOS MARIMPIETRI 2, Manuela FERREIRA GUIMARÃES 2, Liz RIBEIRO FARIA 2, Taynna COSTA 2, José MURILLO B. NETTO 2, Herbert LEÃO DA SILVA SANTOS 2, Maria LUIZA VEIGA 1, Ana Aparecida NASCIMENTO MARTINELLI BRAGA 1, Glicia ESTEVAM DE ABREU 1 and Ubirajara BARROSO 3
1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BRAZIL - 2) Salvador, BRAZIL - 3) Escola Bahiana de Medicina e Saúde Pública and Hospital Universitário Professor Edgar Santos, Salvador, BRAZIL
PURPOSE
A study conducted in Aarhus showed that BBD symptoms are related to toilet dissatisfaction and postponement of restroom use(Jørgensen et al.,2021). To our knowledge there is no information regarding this issue in developing countries. By knowing information concerning facilities that could help children void properly, could be a starting point for the implementation of public health policies. Therefore, we evaluated the voiding behavior of children and adolescents in public and school environments.
MATERIAL AND METHODS
This population-based study was conducted in two Brazilian cities. Urinary symptoms were evaluated by the DVSS, constipation by Rome IV Criteria. Participants were asked about the frequency they avoid going to the bathroom out of home and at school and the reasons for this avoidance behavior. Children with neurological, chronic, or anatomical conditions were excluded.
RESULTS
The sample comprised 402 children and adolescents, with median age 8 years, IQR;6-10), 208(51.7%) were female. Among them, 45(11.2%) had constipation, 49(12.2%) LUTS, and 34(8.5%) BBD. In schools, 303(75.4%) reported bathrooms located inside the classroom or on the same floor, while 99(24.6%) indicated they were on another floor. A total of 161(40%) avoided using the bathroom. In these 161 participants, the reasons to do so included the teacher prohibition(136;84,5%), unpleasant odor(26;16.2%), shame(19;11.8%) and facility occupancy(12;7.4%). We found association between urgency and prohibiting going (p=0.002) and unpleasant odor (p=0.005). 298(74.1%) participants avoided using public restrooms, the majority due to poor hygiene(175;58.7%). Avoiding using public restrooms was associated with holding maneuvers(p=0.001) and urgency(p=0.0001).
CONCLUSIONS
Environmental and social factors influence voiding behavior in children and adolescents.
08:49 - 08:55
ICCS-S01-5 (OP)
Agata LAKOMY-GAWRYSZEWSKA 1, Katarzyna JÓZEFOWICZ 2, Ilona CHUDZIK 1, Andrzej GOŁĘBIEWSKI 3, Aleksandra ŻUROWSKA 1 and Michal MATERNIK 4
1) Medical Univeristy of Gdansk, Pediatrics, Nephrology and Hypertension, Gdansk, POLAND - 2) Medical Univeristy of Gdansk, Division of Physical Therapy, Gdansk, POLAND - 3) Medical Univeristy of Gdansk, Pediatric Surgery and Urology, Gdansk, POLAND - 4) Medical Univeristy of Gdansk, Pediatrics, Nephrolgy and Hypertension, Gdansk, POLAND
PURPOSE
Among the conditions underlying childhood daytime incontinence, the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (pTENS) is a well-established therapy for OAB treatment in children; however, confounding factors, such as constipation, may influence the treatment effect.
MATERIAL AND METHODS
A total of 57 patients (43 girls and 14 boys) with OAB, with a mean age of 10.8 years were enrolled in this study. Nineteen participants fulfilled the criteria for constipation (Group A), and 38 were free from this symptom (Group B). Both groups were similar regarding age and severity of symptoms.
The pTENS treatment lasted for 4 months, twice daily, with 1-hour sessions. Results were evaluated using a 14-day bladder diary (episodes of daytime incontinence, enuresis, and urgency) at two time points: at 4 months (end of active therapy) and at 10 months (6 months after cessation of therapy).
RESULTS
Before treatment, in Group A, daytime incontinence occurred 7.27/14 days, enuresis 7,67/14d, and urgency episodes 6.22/14d. After 4 months of treatment, the occurrence of symptoms decreased significantly (p < 0.05) to 4,44/14d, 4.61/14d, and 3.28/14d, respectively. Six months after treatment cessation, the effect remained stable at 4,28/14d, 3,94/14d, and 1,56/14d.
Before treatment, in Group B, respective symptoms occured 6.9/14d, 5,38/14d, and 7.69/14d. After 4 months of treatment, symptoms decreased significantly (p < 0.05) to 3,41/14d, 2,95/14d, and 3.28/14d. Six months after treatment cessation, the effect remained stable at 2,82/14d, 2,44/14d, and 2,38/14d.
Comparing the treatment effect of pTENS after 4 months of active treatment and 6 months after treatment cessation, there were no statistical differences between Group A and Group B.
CONCLUSIONS
Four months of pTENS treatment for OAB is effective in reducing symptoms and does not differ between children with and without constipation, both immediately after therapy and 6 months after treatment cessation.
08:55 - 09:01
ICCS-S01-6 (OP)
Wouter VAN DORT 1, Jennifer VAN DE STREEK 2, Anka NIEUWHOF 3, Rogier SCHROEDER 1 and Laetitia DE KORT 4
1) UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS - 2) University of Twente, Technical Medicine, Enschede, NETHERLANDS - 3) UMC Utrecht, Urotherapy and Psychology, Utrecht, NETHERLANDS - 4) UMC Utrecht, Urology, Utrecht, NETHERLANDS
PURPOSE
Uroflowmetry interpretation in children is often inconsistent with a high variability among and within observers. Automated assessment will result in a consistent classification, which is helpful in clinical practice, as well as for research purposes. In this study, a machine learning algorithm was developed to distinguish normal from abnormal uroflowmetry patterns, as a first step in full automated uroflowmetry curve assessment.
MATERIAL AND METHODS
Uroflowmetry measurements from children who completed a 10-day inpatient urotherapy program were retrospectively analyzed. Excluded were voided volumes < 100ml. The curves were classified as either normal (bell or tower shaped) or abnormal (all others). A random forest classifier algorithm was used as machine learning model, while applying a 5-fold cross-validation. The result of the machine learning was reviewed by two independent experts.
RESULTS
After balancing of the dataset, resulting in an equal number of normal and abnormal uroflowmetry curves, 470 curves were finally included. The mean accuracy of the machine learning model on the test dataset was 0.89. The experts agreed in 86.0-87.9% with the machine learning classification. The agreement between the experts was good, with an intraclass correlation coefficient of 0.829. Curves with minor fluctuations or a high maximum flowrate were most prone for misclassification by the machine learning algorithm.
CONCLUSIONS
This study demonstrates the potential of a machine learning model in the automated classification of uroflowmetry curves. The same method can be used to extend towards other curve shape descriptors.
09:01 - 09:07
ICCS-S01-7 (OP)
Turker ALTUNTAS 1, Cagri Akin SEKERCI 2, Banu ISBILEN BASOK 3, Mesut FIDAN 3, Onur Can OZKAN 1, Selcuk YUCEL 4, Kamil CAM 1 and Tufan TARCAN 1
1) MARMARA UNIVERSITY SCHOOL OF MEDICINE, UROLOGY, Istanbul, TÜRKIYE - 2) Marmara University Pendik Training and Research Hospital, Paediatric Urology, Pendik Istanbul, TÜRKIYE - 3) TEPECIK TRAINING AND RESEARCH HOSPITAL, BIOCHEMISTRY, Izmir, TÜRKIYE - 4) MARMARA UNIVERSITY SCHOOL OF MEDICINE, Peadiatric Urology, Istanbul, TÜRKIYE
PURPOSE
Overactive bladder (OAB) and its relationship with biomarkers have been increasingly studied. Bladders with detrusor overactivity are known to secrete higher levels of Adenosine Triphosphate (ATP) from their urothelium and cholinergic nerve endings. This prospective study aimed to investigate the diagnostic, treatment, and follow-up value of urinary ATP in children with OAB, a topic previously explored only in adults and neurogenic cases.
MATERIAL AND METHODS
58 children with OAB and 28 healthy controls were included. In the OAB group, midstream urine samples were collected before and one month after anticholinergic treatment. Samples were centrifuged, stored at -80°C, and analyzed using an ELISA kit. ATP levels were compared between the OAB and control groups, as well as pre- and post-treatment levels in the OAB group. Correlations between urinary ATP levels and lower urinary system parameters were also evaluated.
RESULTS
The OAB group included 29 males and 29 females, with a median age of 7 years. The control group’s median age was 10 years. Urinary ATP levels were significantly higher in the OAB group (12.15 ng/mg creatinine) compared to controls (9.92 ng/mg, p=0.04). However, no significant change was observed in ATP levels after treatment (p=0.84), nor was there a correlation between ATP levels and LUS parameters.
Comparison of Urinary ATP in Control and OAB Groups
|
OAB Group (n=58) |
Control Group (n=28) |
P value | |
|
ATP (ng/mg cre) Median (min-max) |
12,15 (2,48-170,62) | 9,92 (3,09-29,95) | 0,04 |
Comparison of Urinary ATP at Baseline and Post-Treatment in the OAB Group
|
Baseline (n=30) |
Post-Treatment (n=30) | P value | |
|
ATP (ng/mg cre) Median (min-max) |
25,44 (2,48-170,62) | 18,05 (3,51-96,28) | 0,84 |
CONCLUSIONS
Urinary ATP appears to be a potential biomarker for diagnosing OAB in children. However, its role in treatment and follow-up requires further investigation with larger and more diverse patient groups.