- Email: [email protected]
Systematic Measurement Of Urethral Length In Girls With Luts
S98 pressure at that time point is measured in cm water and bladder volume (ml) is noted. During regular videourodynamic investigations this method was compared to the standard methodology in 22 patients. For a pilot clinical study we included 5 children with MMC, aged 0-3 years, who were on CIC. Bladder pressure was measured at home during the first morning catheterization by the parents, daily for the first two weeks and twice weekly thereafter.
ESPUN Programme 2009 RESULTS
CONCLUSIONS
The home bladder pressures deviated <10% from the videourodynamic pressures. In the home situation bladder pressure was easily measured by the parents. The homemeasured bladder pressure showed the expected day-to-day variation related to bladder filling. Because of the fixed time of measurement variation over a longer period was small.
The home bladder pressure equipment allows reliable measurement of the bladder pressure by the parents. The high frequency allows feedback to the physician on the response of bladder pressure to (changes in) treatment and thereby facilitates finetuning of the treatment (medication dose or CIC frequency). In addition, weekly feedback to the parents about the effects of bladder therapy on the bladder pressures of their child increases compliance to therapy.
SESSION III: FUNCTIONAL VOIDING DISORDERS
# S03-1 (O) UROTHERAPY IN CHILDREN: QUANTITATIVE MEASUREMENTS OF DAYTIME URINARY INCONTINENCE PRE- AND POST TREATMENT Marianne MULDERS1, Barbara KORTMANN2, Hanny COBUSSEN-BOEKHORST2, Robert DE GIER2 and Wouter FEITZ2 1 University Medical Center, Pediatric Urology, Nijmegen, NETHERLANDS, 2Radboud University Medical Centre Nijmegen, Pediatric Urology, Nijmegen, NETHERLANDS
PURPOSE To quantitatively assess the effectiveness of urotherapy for children with daytime urinary incontinence, according to the definitions of the International Children’s Continence Society.
MATERIAL AND METHODS We performed a retrospective review of 122 children (age: mean 9, range 5-14 yrs) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria were neurologic abnormalities. Therapy is based on cure of daytime incontinence, regulate fluid intake and voiding frequency, and increase maximum voided volume once a normal voiding pattern was obtained. In 98/122 children (80%) daytime urinary incontinence was present as a predominant
symptom and in 42/98 cases (43%) combined with a history of recurrent UTI’s. Therapy was given by an experienced nurse practitioner and consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regular defecation were made. All patients received a personal and monitoring booklet. Before and at the end of the training patients were evaluated for number and severity of daytime wet accidents per week. We used a scoring system to grade the severity of incontinence.
RESULTS Using the ICCS definitions of treatment outcome, success rate was determined: of all children with daytime urinary
incontinence 78% responded to the urotherapy: 38 children (42%) had a full response: they all became dry during daytime, 8 (9%) showed good response, 24 (27%) showed partial response, 20 (22%) had no response and in 8 cases objective data were missing after training. Additional benefit was evident in improvement of accompanying voiding symptoms, such as voiding frequency and flow pattern.
CONCLUSIONS Urotherapy is successful for the treatment of daytime urinary incontinence in children, with a response of 78% of our cases with an intensive outpatient training protocol. Further study towards long-term efficacy will be performed.
# S03-2 (O) SYSTEMATIC MEASUREMENT OF URETHRAL LENGTH IN GIRLS WITH LUTS Tom P.V.M. DE JONG1, Meike HIRDES2, Aart J. KLIJN3, Pieter DIK3, Rafal CHRZAN3 and Marianne VIJVERBERG4 1
Children’s Hospitals UMC Utrecht and AMC Amsterdam, Pediatric Urology, Utrecht, NETHERLANDS, 2University Children’s Hospital UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS, 3University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Pediatric Urology, Utrecht, NETHERLANDS, 4University Children’s Hospital, Urotherapy, Utrecht, NETHERLANDS
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
ESPUN Programme 2009 RESULTS
CONCLUSIONS
The home bladder pressures deviated <10% from the videourodynamic pressures. In the home situation bladder pressure was easily measured by the parents. The homemeasured bladder pressure showed the expected day-to-day variation related to bladder filling. Because of the fixed time of measurement variation over a longer period was small.
The home bladder pressure equipment allows reliable measurement of the bladder pressure by the parents. The high frequency allows feedback to the physician on the response of bladder pressure to (changes in) treatment and thereby facilitates finetuning of the treatment (medication dose or CIC frequency). In addition, weekly feedback to the parents about the effects of bladder therapy on the bladder pressures of their child increases compliance to therapy.
SESSION III: FUNCTIONAL VOIDING DISORDERS
# S03-1 (O) UROTHERAPY IN CHILDREN: QUANTITATIVE MEASUREMENTS OF DAYTIME URINARY INCONTINENCE PRE- AND POST TREATMENT Marianne MULDERS1, Barbara KORTMANN2, Hanny COBUSSEN-BOEKHORST2, Robert DE GIER2 and Wouter FEITZ2 1 University Medical Center, Pediatric Urology, Nijmegen, NETHERLANDS, 2Radboud University Medical Centre Nijmegen, Pediatric Urology, Nijmegen, NETHERLANDS
PURPOSE To quantitatively assess the effectiveness of urotherapy for children with daytime urinary incontinence, according to the definitions of the International Children’s Continence Society.
MATERIAL AND METHODS We performed a retrospective review of 122 children (age: mean 9, range 5-14 yrs) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria were neurologic abnormalities. Therapy is based on cure of daytime incontinence, regulate fluid intake and voiding frequency, and increase maximum voided volume once a normal voiding pattern was obtained. In 98/122 children (80%) daytime urinary incontinence was present as a predominant
symptom and in 42/98 cases (43%) combined with a history of recurrent UTI’s. Therapy was given by an experienced nurse practitioner and consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regular defecation were made. All patients received a personal and monitoring booklet. Before and at the end of the training patients were evaluated for number and severity of daytime wet accidents per week. We used a scoring system to grade the severity of incontinence.
RESULTS Using the ICCS definitions of treatment outcome, success rate was determined: of all children with daytime urinary
incontinence 78% responded to the urotherapy: 38 children (42%) had a full response: they all became dry during daytime, 8 (9%) showed good response, 24 (27%) showed partial response, 20 (22%) had no response and in 8 cases objective data were missing after training. Additional benefit was evident in improvement of accompanying voiding symptoms, such as voiding frequency and flow pattern.
CONCLUSIONS Urotherapy is successful for the treatment of daytime urinary incontinence in children, with a response of 78% of our cases with an intensive outpatient training protocol. Further study towards long-term efficacy will be performed.
# S03-2 (O) SYSTEMATIC MEASUREMENT OF URETHRAL LENGTH IN GIRLS WITH LUTS Tom P.V.M. DE JONG1, Meike HIRDES2, Aart J. KLIJN3, Pieter DIK3, Rafal CHRZAN3 and Marianne VIJVERBERG4 1
Children’s Hospitals UMC Utrecht and AMC Amsterdam, Pediatric Urology, Utrecht, NETHERLANDS, 2University Children’s Hospital UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS, 3University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Pediatric Urology, Utrecht, NETHERLANDS, 4University Children’s Hospital, Urotherapy, Utrecht, NETHERLANDS
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