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BLADDER SATISFACTION QUESTIONNAIRE (BSQ): A VALID, RELIABLE AND REPRODUCIBLE TOOL FOR THE PAEDIATRIC INCONTINENT POPULATION
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
cord tethering. CONCLUSIONS: Children with myelodysplasia, who have micturition reflex without urethral sphincter dyssynergia in initial urodynamic study, are at risk for deterioration of lower urinary tract function, which could relate to spinal cord tethering. Even in micturition reflex without urethral sphincter dyssynergia in initial urodynamic studies, close follow-up including urodynamic studies is necessary to prevent progressive urinary tract deterioration. Source of Funding: None
877 BLADDER SATISFACTION QUESTIONNAIRE (BSQ): A VALID, RELIABLE AND REPRODUCIBLE TOOL FOR THE PAEDIATRIC INCONTINENT POPULATION Lysanne Campeau*, Daniel Liberman, Tala Al-Afraa, Claudettte Bilodeau, Kathleen Mont-Petit, Jacgues Corcos, Mcgill University , Montreal, QC, Canada Introduction and Objective: There is a lack of satisfaction questionnaires in paediatric urology literature. Paediatric incontinence requires numerous therapeutic interventions which could be evaluated by appreciation of patient’s satisfaction since other parameters are not always easy to assess in this population. We developed a 5 item satisfaction questionnaire and are reporting on its psychometric properties Methods: The study was conducted in four phases: 1) Developmental of a relevant and concise questionnaire using consultation of incontinence experts. 2) Content Validity was assessed by administering the questionnaire to a small sample group of myelodysplastic children with incontinence, or their parents. 3) Internal Consistency assessed by administrating the questionnaire to a larger cohort of myelodysplastic children or parents.4) Test-retest reliability was assessed by readministration of the questionnaire in a second visit without any change in urological intervention. Results: 54 subjects were included (27 male, 27 female) in our study. The mean age of the cohort was 14±4 years (range= 3-21). Internal consistency using Cronbach’s alpha coefficient showed strong correlations between individual items of the questionnaire in both visits 1 and 2 (A=0.89 and 0.83), respectively, p-value (<0.05). Table 1 shows the correlation coefficients for each of the 5 question items at visit 1(*Significant at the level of 0.01 and**Significant at the level of 0.003). Using Spearman’s rank order correlation coefficients, the questionnaire was found to be sufficiently reliable in the test-retest phase of psychometric analysis (r = 0.36-0.62, p-value <0.05). A statistically significant correlation for both visits was also found when results of the tool were converted to a simple additive score (r =0.36, p <0.05). Conclusions: The bladder control satisfaction questionnaire is a short easy to use, valid, reliable and reproducible tool regarding children’s subjective satisfaction with their bladder condition. Question No Q1 Q2 Q3 Q4 Q5
Q1 1 0.72* 0.73* 0.39** 0.67*
Q2 1 0.91* 0.55* 0.67*
Q3
1 0.57* 0.67*
Q4
1 0.52*
Q5
1
Source of Funding: None
878 ENCOPRESIS AND CONSTIPATION: HOW CLOSELY ARE THEY RELATED TO VARIOUS NON-NEUROGENIC VOIDING DISORDERS AND EACH OTHER? Andrew J. Combs*, Jennifer Chan, Jason P Van Batavia, Kenneth I. Glassberg, New York, NY INTRODUCTION AND OBJECTIVE: The concept of “dysfunctional elimination syndrome” has focused pediatric urologists on the association of constipation and/or encopresis with non-neurogenic
313
voiding disorders. However, little is known regarding the association of bowel problems with specific voiding disorder (VD) types nor how often encopresis and constipation coexist. We sought to better illuminate these relationships by studying a group of our patients who presented with lower urinary tract symptomatology (LUTS). METHODS: We analyzed 214 consecutive neurologically and anatomically normal patients who presented with LUTS. All patients were analyzed with uroflowmetry/EMG and 1/3 with videourodynamics (VUDS) as well. Patients were divided into 4 different VD types based on flow/EMG findings: Type 1. dysfunctional voiding (DV) - active pelvic floor EMG during voiding +/- detrusor overactivity; Type 2. overactive bladder (OAB) - detrusor overactivity with a quiet pelvic floor during voiding; Type 3. underactive bladder (UB) - volitional infrequent voiding; and Type 4. primary bladder neck dysfunction (PBND). The incidence of constipation and encopresis for each voiding disorder was determined (see table below). RESULTS: Constipation was most often (56%) associated with DV, even though DV represented only 22% of the total group. Half (14 of 29) of the patients with encopresis had no constipation. All but 1 of 29 encopretics (and all 14 of those with encopresis alone) had urgency and daytime incontinence. Of patients with constipation 71% (39 of 55) had urgency and daytime incontinence. CONCLUSIONS: In our experience, encopresis is associated with constipation only half of the time. When present, it almost always occurs in conjunction with more severe irritative symptoms, in particular incontinence. It even responds more rapidly to anticholinergics than does urinary incontinence. Constipation is most often associated with DV.
Source of Funding: None
879 DIAGNOSIS AND MANAGEMENT OF NON-NEUROGENIC VOIDING DISORDERS: NON-INVASIVE UROFLOWMETRY WITH PELVIC FLOOR ELECTROMYOGRAPHY IS THE WAY TO “GO” Andrew J Combs*, Jason P Van Batavia, Agnes Bayer, Richard Schlussel, Kenneth I. Glassberg, New York, NY INTRODUCTION AND OBJECTIVE: Many centers treat lower urinary tract symptomathology (LUTS) based on symptoms and questionnaires (sometimes with simple uroflows) despite the fact that irritative and obstructive symptoms often overlap between various voiding disorders (VD). We instead screen with a non-invasive uroflow with simultaneous EMG. When EMG lag time measurements are also utilized (interval between quieting of EMG and start of flow) the diagnostic capabilities are extended, eg. detrusor overactivity has a short lag time (<1 sec) and primary bladder neck dysfunction (PBND) a prolonged one (>6 sec). METHODS: We reviewed all normal children undergoing a flow/ EMG as part of their initial work-up for LUTS during a 1 year period and divided them into four VD types based on flow/EMG findings: Type 1. DV - active pelvic floor EMG during voiding +/- staccato flow; Type 2a. lag time proven overactive bladder (LOAB) - quiet pelvic floor during voiding and shortened lag time; Type 2b. non-lag time proven OAB (NLOAB) - quiet pelvic floor without demonstratable short lag time but in whom we suspected detrusor overactivity on the basis of symptomatology (ie, urgency and incontinence); Type 3. underactive bladder (UB) - volitional
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
cord tethering. CONCLUSIONS: Children with myelodysplasia, who have micturition reflex without urethral sphincter dyssynergia in initial urodynamic study, are at risk for deterioration of lower urinary tract function, which could relate to spinal cord tethering. Even in micturition reflex without urethral sphincter dyssynergia in initial urodynamic studies, close follow-up including urodynamic studies is necessary to prevent progressive urinary tract deterioration. Source of Funding: None
877 BLADDER SATISFACTION QUESTIONNAIRE (BSQ): A VALID, RELIABLE AND REPRODUCIBLE TOOL FOR THE PAEDIATRIC INCONTINENT POPULATION Lysanne Campeau*, Daniel Liberman, Tala Al-Afraa, Claudettte Bilodeau, Kathleen Mont-Petit, Jacgues Corcos, Mcgill University , Montreal, QC, Canada Introduction and Objective: There is a lack of satisfaction questionnaires in paediatric urology literature. Paediatric incontinence requires numerous therapeutic interventions which could be evaluated by appreciation of patient’s satisfaction since other parameters are not always easy to assess in this population. We developed a 5 item satisfaction questionnaire and are reporting on its psychometric properties Methods: The study was conducted in four phases: 1) Developmental of a relevant and concise questionnaire using consultation of incontinence experts. 2) Content Validity was assessed by administering the questionnaire to a small sample group of myelodysplastic children with incontinence, or their parents. 3) Internal Consistency assessed by administrating the questionnaire to a larger cohort of myelodysplastic children or parents.4) Test-retest reliability was assessed by readministration of the questionnaire in a second visit without any change in urological intervention. Results: 54 subjects were included (27 male, 27 female) in our study. The mean age of the cohort was 14±4 years (range= 3-21). Internal consistency using Cronbach’s alpha coefficient showed strong correlations between individual items of the questionnaire in both visits 1 and 2 (A=0.89 and 0.83), respectively, p-value (<0.05). Table 1 shows the correlation coefficients for each of the 5 question items at visit 1(*Significant at the level of 0.01 and**Significant at the level of 0.003). Using Spearman’s rank order correlation coefficients, the questionnaire was found to be sufficiently reliable in the test-retest phase of psychometric analysis (r = 0.36-0.62, p-value <0.05). A statistically significant correlation for both visits was also found when results of the tool were converted to a simple additive score (r =0.36, p <0.05). Conclusions: The bladder control satisfaction questionnaire is a short easy to use, valid, reliable and reproducible tool regarding children’s subjective satisfaction with their bladder condition. Question No Q1 Q2 Q3 Q4 Q5
Q1 1 0.72* 0.73* 0.39** 0.67*
Q2 1 0.91* 0.55* 0.67*
Q3
1 0.57* 0.67*
Q4
1 0.52*
Q5
1
Source of Funding: None
878 ENCOPRESIS AND CONSTIPATION: HOW CLOSELY ARE THEY RELATED TO VARIOUS NON-NEUROGENIC VOIDING DISORDERS AND EACH OTHER? Andrew J. Combs*, Jennifer Chan, Jason P Van Batavia, Kenneth I. Glassberg, New York, NY INTRODUCTION AND OBJECTIVE: The concept of “dysfunctional elimination syndrome” has focused pediatric urologists on the association of constipation and/or encopresis with non-neurogenic
313
voiding disorders. However, little is known regarding the association of bowel problems with specific voiding disorder (VD) types nor how often encopresis and constipation coexist. We sought to better illuminate these relationships by studying a group of our patients who presented with lower urinary tract symptomatology (LUTS). METHODS: We analyzed 214 consecutive neurologically and anatomically normal patients who presented with LUTS. All patients were analyzed with uroflowmetry/EMG and 1/3 with videourodynamics (VUDS) as well. Patients were divided into 4 different VD types based on flow/EMG findings: Type 1. dysfunctional voiding (DV) - active pelvic floor EMG during voiding +/- detrusor overactivity; Type 2. overactive bladder (OAB) - detrusor overactivity with a quiet pelvic floor during voiding; Type 3. underactive bladder (UB) - volitional infrequent voiding; and Type 4. primary bladder neck dysfunction (PBND). The incidence of constipation and encopresis for each voiding disorder was determined (see table below). RESULTS: Constipation was most often (56%) associated with DV, even though DV represented only 22% of the total group. Half (14 of 29) of the patients with encopresis had no constipation. All but 1 of 29 encopretics (and all 14 of those with encopresis alone) had urgency and daytime incontinence. Of patients with constipation 71% (39 of 55) had urgency and daytime incontinence. CONCLUSIONS: In our experience, encopresis is associated with constipation only half of the time. When present, it almost always occurs in conjunction with more severe irritative symptoms, in particular incontinence. It even responds more rapidly to anticholinergics than does urinary incontinence. Constipation is most often associated with DV.
Source of Funding: None
879 DIAGNOSIS AND MANAGEMENT OF NON-NEUROGENIC VOIDING DISORDERS: NON-INVASIVE UROFLOWMETRY WITH PELVIC FLOOR ELECTROMYOGRAPHY IS THE WAY TO “GO” Andrew J Combs*, Jason P Van Batavia, Agnes Bayer, Richard Schlussel, Kenneth I. Glassberg, New York, NY INTRODUCTION AND OBJECTIVE: Many centers treat lower urinary tract symptomathology (LUTS) based on symptoms and questionnaires (sometimes with simple uroflows) despite the fact that irritative and obstructive symptoms often overlap between various voiding disorders (VD). We instead screen with a non-invasive uroflow with simultaneous EMG. When EMG lag time measurements are also utilized (interval between quieting of EMG and start of flow) the diagnostic capabilities are extended, eg. detrusor overactivity has a short lag time (<1 sec) and primary bladder neck dysfunction (PBND) a prolonged one (>6 sec). METHODS: We reviewed all normal children undergoing a flow/ EMG as part of their initial work-up for LUTS during a 1 year period and divided them into four VD types based on flow/EMG findings: Type 1. DV - active pelvic floor EMG during voiding +/- staccato flow; Type 2a. lag time proven overactive bladder (LOAB) - quiet pelvic floor during voiding and shortened lag time; Type 2b. non-lag time proven OAB (NLOAB) - quiet pelvic floor without demonstratable short lag time but in whom we suspected detrusor overactivity on the basis of symptomatology (ie, urgency and incontinence); Type 3. underactive bladder (UB) - volitional