602 PARENTAL BELIEFS ABOUT NOCTURNAL ENURESIS: CAUSES, TREATMENTS, AND WHETHER A PROVIDER CAN HELP

Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012

THE JOURNAL OF UROLOGY姞

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603 VESICOURETERAL REFLUX IN CHILDREN WITH LOWER URINARY TRACT CONDITIONS: DOES TARGETED TREATMENT MAKE A DIFFERENCE? Angela M. Fast*, Shannon N. Nees, Jason P. Van Batavia, Andrew J. Combs, Kenneth I. Glassberg, New York, NY

Source of Funding: CNPQ - Conselho Nacional de Desenvolvimento Cientı´fico e Tecnolo´gico (National Council of Scientific and Technological Development)

602 PARENTAL BELIEFS ABOUT NOCTURNAL ENURESIS: CAUSES, TREATMENTS, AND WHETHER A PROVIDER CAN HELP. Bruce Schlomer*, Esequiel Rodriguez, Neal Patel, Dana Weiss, Hillary Copp, San Francisco, CA INTRODUCTION AND OBJECTIVES: Nocturnal enuresis (NE) is a common condition seen by pediatric urology providers. Understanding parental opinions and concerns regarding the etiology and treatment of NE may be useful for counseling and developing NE educational material for parents. METHODS: A self-administered survey conducted over 10 months in a pediatric urology tertiary referral center queried parental opinions and knowledge on NE in children, including perceived etiologies and home behavioral treatments. Parents of children who were being seen for NE or voiding dysfunction were excluded. We assessed for associations between demographic characteristics and parental beliefs and performed multivariable logistic regression to identify factors associated with parents reporting they would seek medical care for NE in a child over 5 years old. RESULTS: Of 216 survey respondents, 77% were female. The most common causes for NE reported by parents were: the child is a deep sleeper (56%), unknown (39%), and the child is too lazy to get up to go to the bathroom (26%). The majority (86%) of parents reported they would treat with home behavioral therapy, including: having child void prior to sleep (77%), limiting fluid intake at night (71%), and rewarding child for dry nights (39%). Few parents reported that they would use a bedwetting alarm (6%) or reprimand the child for wet nights (2%). Fifty-five percent of parents reported they would seek medical care for NE. On multivariable analysis, parents who were female (OR 2.2, 95% CI 1.01-4.9) and had a graduate education level (OR 4.5 95% CI 1.7-11.9) were more likely to report they would seek medical care for NE in a child over 5 years old. The most frequent responses for not seeking medical care were: the child will eventually outgrow bedwetting (27%), I am not aware of good treatments (25%), and bedwetting is not a significant medical problem (20%). CONCLUSIONS: Roughly half of parents reported they would seek medical care for NE in a child over 5 years old with female sex of the parent and graduate education level associated with an increased odds of seeking medical care. A lack of awareness of available treatments, such as a bedwetting alarm or medication, was one of the main reasons parents reported they would not seek medical care for NE. Results from this survey may help with counseling parents and preparing educational materials about NE. Source of Funding: None

INTRODUCTION AND OBJECTIVES: There is a known association between non-neurogenic lower urinary tract (LUT) conditions and vesicoureteral reflux (VUR). Whether VUR is secondary to a LUT condition or coincidental is controversial. We determined our rate of VUR resolution in patients with LUT conditions using targeted treatment (TT) for the specific underlying condition. METHODS: We reviewed all patients diagnosed with a LUT condition and VUR from 2001 to 2011. VUR was diagnosed by video urodynamics (VUDS) or voiding cystourethrogram (VCUG) and graded according to the International Grading System. LUT conditions were diagnosed by uroflow/electromyography and/or VUDS and all patients were managed with TT. Definitions of these conditions and specific therapies for each are listed in Table 1. VUR status following TT was reassessed by VUDS or VCUG. RESULTS: VUR was identified in 44 ureters in 33 patients (30F, 3M; mean age: 6.56; range: 2-12; mean follow-up: 2.9 years). VUR resolved with TT in 16 of 33 patients (48%) and 22 of 44 ureters (50%) (Table 2). Mean time of VUR resolution on TT was 1.9 years. VUR also decreased by 2 or more grades in 4 (9%) ureters, including 1 grade IV and 1 grade V ureter. VUR was most frequently seen with DV (25 of 44 (57%) ureters). Resolution was similar for all grades of VUR and resolved most often in DV (15 of 25 (60%) ureters) as compared to IDOD (6 of 16; 38%) or DUD (1 of 3; 33%). CONCLUSIONS: 50% of VUR associated with LUT conditions resolved with TT, exceeding the 31% reported in the 2010 AUA guidelines. Most VUR was associated with DV and had higher rates of resolution with TT compared to other conditions. The following two observations suggest that VUR seen in association with LUT conditions differs from primary VUR: 1. unlike primary VUR, there were no differences in the resolution rate of VUR between grades I through V and 2. unlike primary grade V reflux, grade V reflux in patients with LUT conditions resolved in some patients. These findings support the contention that VUR in association with LUT conditions likely represents secondary rather than primary reflux. Table 1. Definitions and of non-neurogenic LUT conditions LUT Condition Definition Primary TT* Biofeedback 1. Dysfunctional voiding (DV): Active pelvic floor EMG during voiding, ⫹/associated detrusor overactivity 2. Idiopathic detrusor overactivity disorder (IDOD):

Detrusor overactivity, shortened EMG lag time, ie. ⬍ 2 sec, quiet EMG during voiding

Anticholinergics

3. Detrusor underutilization disorder (DUD):

Volitional infrequent voiding, large bladder capacity, quiet EMG during voiding

Timed voiding

4. Primary bladder neck dysfunction (PBND):

Impaired bladder neck opening, prolonged EMG lag time, ie ⬎ 6 sec, quiet EMG during voiding

Alpha blocker

*Additional therapies (ie. timed voiding and anticholinergics) were added as indicated.