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Effect Of Transcutaneous Neuromodulation On Overactive Bladder Symptoms In Children
ESPUN Programme 2009
S99
PURPOSE
RESULTS
To investigate systematically the length of the urethra in girls presenting with LUTS and to determine changes of length during growth.
Mean age of the patients was 7, 79 years (0-15). Average urethral length was 25,68 mm. Minimal length in this group was a length of 9 mm, measured in a 5 year old girl with epispadias. Maximum measured length was 40 mm in a 15 year old girl. Five girls, (4.09%) aged 1-10 years (mean age 6 years) had extremely short urethras with measured length resp. 9, 12 (twice) and 14(twice) mms. One of these had epispadias, 4 had normal genitalia. Four had therapy resistant urinary incontinence, 1 was too young to evaluate continence. A gradual increase in average urethral length for age was
MATERIAL AND METHODS A group of 122 consecutive girls presenting at a tertiary referral clinic for pediatric urinary incontinence or recurrent urinary tract infections had their urethral length measured by perineal ultrasound. The urethra was measured with the patient in supine position without anesthesia.
measured from 23 mms at birth to 32 at age 15 years.
CONCLUSIONS Urethral length in girls can be measured accurately by ultrasound and the average length is approximately 25 mm’s. Girls with extremely short urethras causing therapy resistant incontinence can easily be detected by ultrasound and selected for different treatment options. Mean urethral length in girls increases from 23 mm at birth to 32 mm at puberty.
# S03-3 (O) ADEQUATE FLUID INTAKE, AN IMPORTANT FACTOR IN THE TREATMENT OF URINARY INCONTINENCE IN CHILDREN SUFFERING MENTAL AND/OR MOTOR DISABILITY Dirk DE BEULE1, Catherine RENSON2, Piet HOEBEKE2 and Erik VAN LAECKE2 1
Ghent university hospital, Urology, Gent, BELGIUM, 2Ghent university hospital, Paediatric urology, Gent, BELGIUM
PURPOSE Urinary incontinence in mental and or motor disabled children is a common problem. Literature about therapy is scarce. In a prospective study the effect of urotherapy, particularly adequate fluid intake in these patients was evaluated.
MATERIAL AND METHODS In a prospective study, 111 children, 66 boys and 45 girls, mean age 9.1 years, were included. Twenty-two were motor disabled, 16 were mental disabled and 73 suffered mental- and motor disability. All patients were put on a fluid intake schedule of 1500 ml/m2 body surface. The mean follow-up
was 22.9 months (12-30 months). Patients were evaluated with a diary, uroflow and bladderscan.
RESULTS Forty-four children (39.6%) were dry at inclusion, 41 (36.9%) suffered urinary incontinence day and night, 11 (9.9%) were urinary incontinent during the day and 15 (13.5%) suffered nocturnal enuresis. In 18 children anticholinergics were started. Eleven of them became dry. The other children only got an adequate fluid intake schedule. Eight patients (7.2%) dropped out of the study. In the end 69 children (67%) were completely dry day and night, 14 (13.6%) remained urinary incontinent during
day and night, 5 (4.9%) suffered urinary incontinence during the day and 15 (14.6%) suffered nocturnal enuresis. Seventy tree children (65.8%) drank at least 25% less than the physiologically necessary quantity. Initially 62 (55.9%) had a small bladdercapacity for age. This number decreased to 24 (21.6%) at the end of the study period.
CONCLUSIONS Adequate fluid intake is an important part of urotherapy in the treatment of urinary incontinence in mental and / or motor disabled children.
# S03-4 (O) EFFECT OF TRANSCUTANEOUS NEUROMODULATION ON OVERACTIVE BLADDER SYMPTOMS IN CHILDREN Charlotte ARFWIDSSON1, Monika DOROSZKIEWICZ1, Helena ANTONSSON2, Inger JANSSON3, Agneta LUNDH4, ˚LKLINT4 and Ulla SILLE ´N5 Malin STA The Queen Silvia Childrens Hospital, Urotherapeutic Unit, Go¨teborg, SWEDEN, 2SA¨S, Bora˚s, Urotherapeutic unit, Bora˚s, SWEDEN, 3NA¨L, Urotherapeutic Unit, Trollha¨ttan, SWEDEN, 4KSS Sko¨vde, Urotherapeutic Unit, Sko¨vde, SWEDEN, 5The Queen Silvia Childrens Hospital, PUNC, Go¨teborg, SWEDEN 1
PURPOSE
MATERIAL AND METHODS
The aim was to investigate if transcutaneous neuromodulation (TENS) can be an effective complement to standard urotherapy, in the treatment of children with overactive bladder (OAB).
60 children (33 boys) with symptoms of OAB were included at a median age of 8 years. They were randomized into two groups. Group 1 was treated with standard urotherapy alone and group 2 with
a combination of standard urotherapy and TENS. Stimulation variables were 10 Hz and 30 mA, and the stimulation was applied 20 minutes, twice every day. Surface electrodes were placed on the back at the level of the sacral roots. The treatment
S100 period was 12 weeks. The effect variables were taken from 3-days voiding diary.
RESULTS Subjective experience showed a clear improvement (p<0.0001) in both group 1 (73%) and group 2 (81%), but with no difference between the groups. This subjective experience was supported by
ESPUN Programme 2009 objective findings: Leakage was improved in 81% (from 2.1 to 0.7 n/day) and 79% (from1.6 to 0.4 n/day) in group 1 and group 2, respectively. Totally 60% had no leakage at the end of the study, with no difference between the groups. The decrease in number of voiding in group 1 (-1.3 n/day) and group 2 (-1.4 n/day) did not differ, but the decrease from start to end of the study totally was sign (p 0.006). Interestingly, the
14 patients that were previously treated had a poorer treatment result in both groups.
CONCLUSIONS TENS does not seem to have any additional beneficial effect on incontinence and frequency of voiding in children with the OAB, beside standard therapy.
# S03-5 (O) THE EFFECT OF HIGHER OR LOWER VOIDED VOLUME TO VOIDING PATTERNS Sevilay HEBCAN1 and Murat DAYANC2 1
Gulhane Military Medical, Urology, Ankara, TURKEY, 2Guhane Military Medical, Urology, Ankara, TURKEY
PURPOSE To evaluate voiding patterns in children with LUTD have voided volume in uroflowmetry (UF) higher or lower level than expected bladder capasity.
system). A total of 60 children with were voided 10% less or more than expected bladder capasity. Their voiding patterns were examined.
bladder capasity who had normal voiding pattern before. Thirteen of these 22 children had (+) EMG activity and remaining 9 0f them had (-) EMG activity.
RESULTS CONCLUSIONS
MATERIAL AND METHODS Expected bladder capasity was estimated with formula [(age+2)x30ml.]. Voided volumes were assessed during UF which was performed under typical conditions in seperate rooms (MMS 5000 urodynamics
There were not seen any differences in voiding patterns in 38 of 60 children when it was compared with previous voiding patterns which was voided with expected bladder capasity. There were seen staccato voiding pattern in 22 of 60 children had voided volume 10% more than expected
The abnormal voiding patterns in UF with 10% higher expected bladder capasity should be reevaluated with appropriate voided volume. The effect of voided volume higher than expected bladder capasity on EMG needs future investigations.
# S03-6 (O) A COMPREHENSIVE EVALUATION OF CHILDREN EXPERIENCING PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) FOR OVERACTIVE BLADDER (OAB) REFRACTORY TO BEHAVIOUR AND PHARMACOLOGICAL TREATMENTS Sarah DOYLE1, Andrea CARPENTER2, Fiona MCANDREW1 and Caroline SANDERS3 1
Alder Hey Children’s NHS Foundation Trust, Urology, Liverpool, UNITED KINGDOM, 2Alder Hey Children’s Foundation NHS Trust, Urology, Liverpool, UNITED KINGDOM, 3Alder Hey Children’s NHS Trust, Urology, Liverpool, UNITED KINGDOM
PURPOSE To report the impact and tolerability of PTNS and the effect on the child’s reported quality of life.
MATERIAL AND METHODS Prospective data from 8 children (M:F 1:7; mean age 12 years 3 months) with OAB demonstrated on urodynamics. PTNS was performed weekly for 30 minutes over 12 weeks. Symptoms (voiding diary, dry pie chart) objective measures (uriflow, post void residual (PVR), needle pain score, urge
score, PinQ score) and child’s thoughts about the experience were recorded.
RESULTS The number of days per week of incontinence ranged from 2-7 (mean 4 days) two had nocturnal enuresis (NE), one sporadic NE, none had faecal incontinence. Seven had urge/frequency and 2 had a history of symptomatic UTI within last 6 months. Four of the eight children with incontinence became dry, 1 significantly improved. Three children had no improvement 2/3 had recurrent UTI. Noninvasive uriflow and PVR were not
statistically significant before and after treatment. Pre-treatment patient age, sex and frequency of wetting were not predictive of outcome. PinQ score changed demonstrating an improvement in QoL. Pain scores were low or absent in all children. Qualitative themes included improved confidence and positive fun experiences. There were no reported side effects or adverse events.
CONCLUSIONS PTNS for children that have failed previous standard treatments is safe and well tolerated. It is not reported as painful and
S99
PURPOSE
RESULTS
To investigate systematically the length of the urethra in girls presenting with LUTS and to determine changes of length during growth.
Mean age of the patients was 7, 79 years (0-15). Average urethral length was 25,68 mm. Minimal length in this group was a length of 9 mm, measured in a 5 year old girl with epispadias. Maximum measured length was 40 mm in a 15 year old girl. Five girls, (4.09%) aged 1-10 years (mean age 6 years) had extremely short urethras with measured length resp. 9, 12 (twice) and 14(twice) mms. One of these had epispadias, 4 had normal genitalia. Four had therapy resistant urinary incontinence, 1 was too young to evaluate continence. A gradual increase in average urethral length for age was
MATERIAL AND METHODS A group of 122 consecutive girls presenting at a tertiary referral clinic for pediatric urinary incontinence or recurrent urinary tract infections had their urethral length measured by perineal ultrasound. The urethra was measured with the patient in supine position without anesthesia.
measured from 23 mms at birth to 32 at age 15 years.
CONCLUSIONS Urethral length in girls can be measured accurately by ultrasound and the average length is approximately 25 mm’s. Girls with extremely short urethras causing therapy resistant incontinence can easily be detected by ultrasound and selected for different treatment options. Mean urethral length in girls increases from 23 mm at birth to 32 mm at puberty.
# S03-3 (O) ADEQUATE FLUID INTAKE, AN IMPORTANT FACTOR IN THE TREATMENT OF URINARY INCONTINENCE IN CHILDREN SUFFERING MENTAL AND/OR MOTOR DISABILITY Dirk DE BEULE1, Catherine RENSON2, Piet HOEBEKE2 and Erik VAN LAECKE2 1
Ghent university hospital, Urology, Gent, BELGIUM, 2Ghent university hospital, Paediatric urology, Gent, BELGIUM
PURPOSE Urinary incontinence in mental and or motor disabled children is a common problem. Literature about therapy is scarce. In a prospective study the effect of urotherapy, particularly adequate fluid intake in these patients was evaluated.
MATERIAL AND METHODS In a prospective study, 111 children, 66 boys and 45 girls, mean age 9.1 years, were included. Twenty-two were motor disabled, 16 were mental disabled and 73 suffered mental- and motor disability. All patients were put on a fluid intake schedule of 1500 ml/m2 body surface. The mean follow-up
was 22.9 months (12-30 months). Patients were evaluated with a diary, uroflow and bladderscan.
RESULTS Forty-four children (39.6%) were dry at inclusion, 41 (36.9%) suffered urinary incontinence day and night, 11 (9.9%) were urinary incontinent during the day and 15 (13.5%) suffered nocturnal enuresis. In 18 children anticholinergics were started. Eleven of them became dry. The other children only got an adequate fluid intake schedule. Eight patients (7.2%) dropped out of the study. In the end 69 children (67%) were completely dry day and night, 14 (13.6%) remained urinary incontinent during
day and night, 5 (4.9%) suffered urinary incontinence during the day and 15 (14.6%) suffered nocturnal enuresis. Seventy tree children (65.8%) drank at least 25% less than the physiologically necessary quantity. Initially 62 (55.9%) had a small bladdercapacity for age. This number decreased to 24 (21.6%) at the end of the study period.
CONCLUSIONS Adequate fluid intake is an important part of urotherapy in the treatment of urinary incontinence in mental and / or motor disabled children.
# S03-4 (O) EFFECT OF TRANSCUTANEOUS NEUROMODULATION ON OVERACTIVE BLADDER SYMPTOMS IN CHILDREN Charlotte ARFWIDSSON1, Monika DOROSZKIEWICZ1, Helena ANTONSSON2, Inger JANSSON3, Agneta LUNDH4, ˚LKLINT4 and Ulla SILLE ´N5 Malin STA The Queen Silvia Childrens Hospital, Urotherapeutic Unit, Go¨teborg, SWEDEN, 2SA¨S, Bora˚s, Urotherapeutic unit, Bora˚s, SWEDEN, 3NA¨L, Urotherapeutic Unit, Trollha¨ttan, SWEDEN, 4KSS Sko¨vde, Urotherapeutic Unit, Sko¨vde, SWEDEN, 5The Queen Silvia Childrens Hospital, PUNC, Go¨teborg, SWEDEN 1
PURPOSE
MATERIAL AND METHODS
The aim was to investigate if transcutaneous neuromodulation (TENS) can be an effective complement to standard urotherapy, in the treatment of children with overactive bladder (OAB).
60 children (33 boys) with symptoms of OAB were included at a median age of 8 years. They were randomized into two groups. Group 1 was treated with standard urotherapy alone and group 2 with
a combination of standard urotherapy and TENS. Stimulation variables were 10 Hz and 30 mA, and the stimulation was applied 20 minutes, twice every day. Surface electrodes were placed on the back at the level of the sacral roots. The treatment
S100 period was 12 weeks. The effect variables were taken from 3-days voiding diary.
RESULTS Subjective experience showed a clear improvement (p<0.0001) in both group 1 (73%) and group 2 (81%), but with no difference between the groups. This subjective experience was supported by
ESPUN Programme 2009 objective findings: Leakage was improved in 81% (from 2.1 to 0.7 n/day) and 79% (from1.6 to 0.4 n/day) in group 1 and group 2, respectively. Totally 60% had no leakage at the end of the study, with no difference between the groups. The decrease in number of voiding in group 1 (-1.3 n/day) and group 2 (-1.4 n/day) did not differ, but the decrease from start to end of the study totally was sign (p 0.006). Interestingly, the
14 patients that were previously treated had a poorer treatment result in both groups.
CONCLUSIONS TENS does not seem to have any additional beneficial effect on incontinence and frequency of voiding in children with the OAB, beside standard therapy.
# S03-5 (O) THE EFFECT OF HIGHER OR LOWER VOIDED VOLUME TO VOIDING PATTERNS Sevilay HEBCAN1 and Murat DAYANC2 1
Gulhane Military Medical, Urology, Ankara, TURKEY, 2Guhane Military Medical, Urology, Ankara, TURKEY
PURPOSE To evaluate voiding patterns in children with LUTD have voided volume in uroflowmetry (UF) higher or lower level than expected bladder capasity.
system). A total of 60 children with were voided 10% less or more than expected bladder capasity. Their voiding patterns were examined.
bladder capasity who had normal voiding pattern before. Thirteen of these 22 children had (+) EMG activity and remaining 9 0f them had (-) EMG activity.
RESULTS CONCLUSIONS
MATERIAL AND METHODS Expected bladder capasity was estimated with formula [(age+2)x30ml.]. Voided volumes were assessed during UF which was performed under typical conditions in seperate rooms (MMS 5000 urodynamics
There were not seen any differences in voiding patterns in 38 of 60 children when it was compared with previous voiding patterns which was voided with expected bladder capasity. There were seen staccato voiding pattern in 22 of 60 children had voided volume 10% more than expected
The abnormal voiding patterns in UF with 10% higher expected bladder capasity should be reevaluated with appropriate voided volume. The effect of voided volume higher than expected bladder capasity on EMG needs future investigations.
# S03-6 (O) A COMPREHENSIVE EVALUATION OF CHILDREN EXPERIENCING PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) FOR OVERACTIVE BLADDER (OAB) REFRACTORY TO BEHAVIOUR AND PHARMACOLOGICAL TREATMENTS Sarah DOYLE1, Andrea CARPENTER2, Fiona MCANDREW1 and Caroline SANDERS3 1
Alder Hey Children’s NHS Foundation Trust, Urology, Liverpool, UNITED KINGDOM, 2Alder Hey Children’s Foundation NHS Trust, Urology, Liverpool, UNITED KINGDOM, 3Alder Hey Children’s NHS Trust, Urology, Liverpool, UNITED KINGDOM
PURPOSE To report the impact and tolerability of PTNS and the effect on the child’s reported quality of life.
MATERIAL AND METHODS Prospective data from 8 children (M:F 1:7; mean age 12 years 3 months) with OAB demonstrated on urodynamics. PTNS was performed weekly for 30 minutes over 12 weeks. Symptoms (voiding diary, dry pie chart) objective measures (uriflow, post void residual (PVR), needle pain score, urge
score, PinQ score) and child’s thoughts about the experience were recorded.
RESULTS The number of days per week of incontinence ranged from 2-7 (mean 4 days) two had nocturnal enuresis (NE), one sporadic NE, none had faecal incontinence. Seven had urge/frequency and 2 had a history of symptomatic UTI within last 6 months. Four of the eight children with incontinence became dry, 1 significantly improved. Three children had no improvement 2/3 had recurrent UTI. Noninvasive uriflow and PVR were not
statistically significant before and after treatment. Pre-treatment patient age, sex and frequency of wetting were not predictive of outcome. PinQ score changed demonstrating an improvement in QoL. Pain scores were low or absent in all children. Qualitative themes included improved confidence and positive fun experiences. There were no reported side effects or adverse events.
CONCLUSIONS PTNS for children that have failed previous standard treatments is safe and well tolerated. It is not reported as painful and