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Urotherapy In Children: Quantitative Measurements Of Daytime Urinary Incontinence Pre- And Post Treatment
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 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