Research advances of sacral neuromodulation in the management of pediatric neurogenic bladder / 现代泌尿外科杂志

Pediatric neurogenic bladder (PNB) is defined as dysfunction of the detrusor and/or urethral sphincter due to myelodysplasia or spinal cord injury, manifesting as impaired urination or defecation, which seriously affects the patients’ quality of life. The main indication for sacral neuromodulation (SNM) is overactive bladder syndrome, which presents as refractory urinary frequency and urgency, urgency incontinence and non-obstructive urinary retention. Age more than 16 years are also recommended for this technique. Previous studies have revealed that SNM could significantly improve the outcome of refractory bladder bowel dysfunction. This paper reviews the advances of the application of SNM in the treatment of pediatric neurogenic bladder so as to provide reference for pediatricians.

Research progress on voiding dysfunction in children / 中国小儿急救医学

Voiding dysfunction is common in children.The clinical manifestations include frequent micturition, urgent urination, micturition pain, delayed micturition, urinary incontinence, and enuresis.There may be only one symptom or multiple clinical manifestations at the same time, which is closely related to defecation dysfunction.Without timely diagnosis and treatment, in addition to affecting the quality of life, it often causes renal function damage and can even be life-threatening.Therefore, we should pay attention to the diagnosis and treatment of voiding dysfunction in children.

Urodynamic assessment of voiding dysfunction associated with anorectal malformation / 中华实用儿科临床杂志

Anorectal malformation (ARM) accounts for the first place of digestive tract malformations in children, with the incidence of 1/5 000-1/1 500 in newborns.ARM is typically manifested as anal stenosis or anal atresia with or without fistulas and persistent cloaca.Genitourinary malformation is the most common malformation associated with ARM, with the incidence ranging 26%-55%.There were 35%-50% of ARM children develop spinal cord peripheral abnormalities or neurogenic lower urinary tract dysfunction, which usually causes voiding dysfunction associated with ARM.Urodynamic study is the best method to analyze the changes of lower urinary tract function, which can provide an objective classification for bladder and urethral function and guide the formulation of precision treatment plan and therapeutic efficacy during the follow-up period.This study aims to review the cause of voiding dysfunction asso-ciated with ARM and its urodynamic changes.

Urodynamic Manifestations of Severe Urination Disorders Caused by Multiple System Atrophy / 中国康复理论与实践

Objective:To explore the clinical characteristics of urination disorders in multiple system atrophy (MSA). Methods:The clinical data and imaging urodynamic examination of twelve MSA patients with severe urination disorders from June, 2013 to March, 2021 were retrospectively analyzed. Results:Among twelve cases, there were eight cases with acontractile detrusor, one case with detrusor overactivity, one case with detrusor-sphincter dyssynergia, one case with filling detrusor hyperactivity and voiding-phase dyssynergia (DO+DSD), and one case with normal urodynamics. Conclusion:The clinical symptoms of MSA are complex, and the early diagnosis is difficult. Electrophysiological and MRI examinations can be helpful for diagnosis.

Impact of surgical treatment for locally recurrent rectal cancer on the quality of life of patients / 中华胃肠外科杂志

Objective: To investigate the impact of surgical treatment on quality of life in patients with locally recurrent rectal cancer (LRRC). Methods: A descriptive case series study was performed. The complete clinical data of 62 patients who met the diagnostic criteria of LRRC and treated by surgical procedures in Huashan Hospital of Fudan University from January 2012 to November 2019 were analyzed retrospectively. All the patients were followed up at least 12 months. Assessments of urinary function, sexual function, mobility function of lower limb and quality of life were documented. Patients with distant metastasis and surgical history of the urinary system were excluded. According to the criteria of Memorial Sloan Kettering Cancer Center (MSKCC), recurrence were divided into central (n=27), anterior (n=20), posterior (n=7), and lateral (n=8) subtypes. Baseline characteristics, surgical procedures and short-term complications were analyzed. International prostate symptom score (IPSS) and grade of voiding dysfunction were used to evaluate the urinary function. Higher score of IPSS and higher grade of voiding dysfunction indicated worse voiding function. Sexual function for both genders was assessed preoperatively and postoperatively. International index of erectile function-5 (IIEF-5) was used for assessment of male patients and higher score indicated better function. Female sexual function index (FSFI) was used in females and higher score indicated better function. Short-form health survey with 36 items (SF-36), yielding an 8-scale profile of functional health (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, emotional health and mental health) was used to evaluate the quality of life. The higher score indicated the better quality of life. Results: All the operations of 62 patients completed successfully and R0 resection rate was 88.7% (55/62). Postoperative surgical complications occurred in 16 cases (25.8%), including 3 patients of Clavien-Dindo classification III. At postoperative 3-month, 42 patients without ileum cystectomy or ureterostomy suffered from different grade of voiding dysfunction. IPSS increased significantly after the surgery (before surgery: 12.36±4.75, after surgery: 18.40±4.77, t=-9.128, P<0.001). There was no significant difference among the subtypes (P>0.05). At postoperative 12-month, IIEF-5 decreased from 14 (0~25) to 9 (0~19) in males (Z=-5.174, P<0.001) and FSFI deceased from 8.4 (2.0-27.0) to 2.0 (2.0-18.4) in females (Z=-3.522, P<0.001). Scores of physical functioning and role-physical decreased significantly [physical functioning: before surgery 70 (35-85), after surgery 65 (30-80), Z=-3.685, P<0.001; role-physical: before surgery 50 (0-50), after surgery 25(0-75), Z=-4.065, P<0.001], while those of social functioning role-emotional and mental health increased significantly after the surgery [social functioning: before surgery 44 (22-78), after surgery 56 (0-89), Z=-3.509, P<0.001; role-emotional: before surgery 17 (0-100), after surgery 33 (0-100), Z=-2.439, P=0.015; mental health: before surgery 40 (36-76), after surgery 52 (24-80), Z=-3.395, P<0.001]. All surgical procedures decreased the voiding function of LRRC patients and the sexual function of male patients (all P<0.01). However, only total pelvic exenteration and posterior pelvic exenteration decreased FSFI in female patients [before surgery: 8.4 (2.0-27.0) after surgery: 2.0 (2.0-18.4), Z=-2.810, P=0.005]. Conclusions: Multi-visceral resection in LRRC patients may damage voiding and sexual function. However, successful and effective surgical treatment can improve the psychosocial health of LRRC patients.

Postnatal bladder dysfunction

Background: Voiding difficulty and urinary retention is a common phenomenon in immediate postpartum period. Absolute or relative failure to empty the bladder resulting from decreased bladder contractility (magnitude or duration) or increased bladder outlet resistance or both are defined as voiding dysfunction. It needs high index of suspicion or else can go undiagnosed and can lead to magnitude of problems. The study aims to calculate the incidence of dysfunction of bladder in postnatal women and to study risk factors associated with development of bladder dysfunction and management strategies in cases of bladder dysfunction.Methods: Authors did a prospective observational study in a tertiary care hospital. 200 postpartum women were screened for complaints of voiding dysfunction within 6 hours of removal of catheter in post caesarean patients and of normal vaginal delivery. Authors found that the voiding dysfunction was relatively common with an incidence of 20.20%. Following risk factors were analyzed: parity, mode of delivery, pain at suture site, baby weight, para-urethral tear.Results: Postpartum voiding dysfunction was found to be relatively common with statistically significant association found for pain at suture site and para urethral tear. Intra partum events contributed to voiding dysfunction. 93% of patients who with voiding dysfunction could be managed conservatively, and only 7% had to undergo intervention in the form of re catheterization.Conclusions: The early identification and treatment can reduce the pain and discomfort. Majority of the cases resolves with conservative management and nursing staff plays a key role in early detection of the symptoms.

The Effect of Hyaluronic Acid in Preventing Recurrence of Anterior Urethral Stricture after Endoscopic Internal Urethrotomy- A Single Centre, Randomised Controlled, Single Blind Study

BACKGROUNDHyaluronidase instillation during OIU may decrease the incidence of urethral stricture recurrence.13 The exact mechanism is not known in urethral stricture, but it is used as antifibrotic agent in hypertrophic scar, keloid, and pulmonary fibrosis. Intralesional injection decreases fibroblast proliferation, collagen, and glycosaminoglycan synthesis and suppresses proinflammatory mediators in wound healing process.14 This study was conducted to see the benefits of HA for preventing recurrence of anterior urethral stricture after urethrotomy.METHODSAfter obtaining the clearance from ethical committee, 70 patients satisfying the inclusion criteria were recruited & randomly divided into 2 groups: Group A (35 patients, experimental group) received hyaluronic acid (HA) instillation & Group B (35 patients, Control group) received lubricant lignocaine after EIU. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), & 24 weeks (V3) after surgery. The recurrence rate was evaluated by protocol analysis based on number of patients who completed the study. Preoperative characteristics, including the site & length of urethral stricture, were evaluated by intent-to-treat analysis. RESULTSAmong 70 patients, only 30 patients in group A & 30 patients in group B had completed the study. Significant improvement noted in both groups after surgery in every parameter with recurrence in Group A 9.43% & in Group B 22.92% (p <0.05) at V3. IPSS score at V3 were obstructive: Group A - 4.03±0.65, Group B – 5.16±1.84 (p=0.0024), Irritative: group A – 2.8±0.60, Group B – 3.33±1.19 (p=0.033). At V3 follow up Qmax: Group A – 22.40±3.21, Group B – 18.13±3.56 (p=0.0001); Qavg: Group A – 11.43±1.72, Group B – 10.43±2.2 (p=0.048); PVRV: Group A – 10.16 ± 13.81, Group B – 19.33±15.90 (p=0.020); Degree of satisfaction: Group A – 2.11 ± 0.38, Group B – 1.76±0.49 (p=0.0031).CONCLUSIONSHA instillation during EIU decreases the incidence of urethral stricture recurrence & improves degree of satisfaction in long term follow up without any side effect.

Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review / Uroterapia no tratamento de crianças e adolescentes com disfunção vesical e intestinal: revisão sistemática

ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.

RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.

Role of Anticholinergic, Uroselective α 1D/1A Blocker, Combination of Two Drugs and Placebo in Treatment of Ureteral Stent Related Discomfort and Urinary Symptoms

Introduction: The ureteral stent placement has become a partof urological clinical practice to relieve ureteral obstructioncaused by variety of urological condition since 1967. Studyaimed to access the role of anticholinergic (Tolterodine),uroselective α 1D/1A blocker (Naftopidil) alone and incombination to evaluate DJ stent related discomfort or pain,lower urinary tract symptoms and impact on quality of life.Materials and methods: This was a randomized double blindplacebo controlled comparative prospective clinical studyconducted between May 2013 to February 2015 to access therole of anticholinergic (Tolterodine), uroselective α 1D/1Ablocker (Naftopidil) alone and in combination to evaluate DJstent related discomfort or pain, lower urinary tract symptomsand impact on quality of life.Result: Total of 280 patients were enrolled for the study. 33patients were excluded. We found Naftopidil and combinationto be significanty better for pain score, combination beingmore effective for storage symptoms, voiding symptoms andquality of life scores.Conclusion: Combination of Tolterodine and Naftopidil canbe recommended for relief of stent related discomfort andurinary symptoms.

Post void residue in women with pelvic organ prolapse: a prospective observational study

Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.

Renal Scarring in Children with Primary Vesicoureteral Reflux Disease

Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure

Progress of contrast-enhanced voiding ultrasonography in diagnosis of vesicoureteric reflux in children / 中国医学影像技术

Vesicoureteric reflux (VUR) is an important association of pediatric urinary tract infection in children. Contrast-enhanced voiding urosonography (CeVUS) has proven to be a safe and reliable imaging technique for detecting children VUR. The advancements of CeVUS in evaluation of children VUR were reviewed in this article.

Emotional Stress Facilitates Micturition Reflex: Possible Inhibition by an α₁-Adrenoceptor Blocker in the Conscious and Anesthetized State / 대한배뇨장애요실금학회지

PURPOSE: To test the hypothesis that naftopidil prolongs intercontraction intervals in rats undergoing chronic stress as observed in previous animal models, voiding behavior and bladder function were measured and analyzed. METHODS: Female Sprague-Dawley rats weighing 200–230 g were exposed to repeated variate stress (RVS) for 1 week, chronic variable mild stress for 2 weeks, or simple mild stress for 1 week. Voiding behavior was assessed in metabolic cages. Voiding frequency and urine output were measured, and changes of these values were compared for the different types of stress. Micturition reflex was analyzed using unconscious cystometry. Naftopidil was administered orally at 30 mg/kg/day for 2 weeks. RESULTS: Unexpectedly, no stress-exposed rats exhibited increased micturition frequency compared to the normal nonstressed control. However, intercontraction intervals were shortened with each type of stress in the unconscious condition, especially by RVS (P<0.01). Naftopidil prolonged the shortened intervals. CONCLUSIONS: Although voiding behavior appears approximately normal in rats chronically exposed to emotional stress, internal bladder function can be affected. With anesthesia, micturition intervals were moderately shortened by emotional stress and clearly improved by naftopidil. Therefore, naftopidil appears to act at the spinal level at least.

Alpha-1 Adrenergic Receptor Blockers for the Treatment of Lower Urinary Tract Symptoms in Women: A Systematic Review and Meta-Analysis / 대한배뇨장애요실금학회지

PURPOSE: To assess the effectiveness of alpha-1 adrenergic receptor blockers (α1-blockers) in the treatment of female lower urinary tract symptoms (LUTS). METHODS: A literature search was conducted using the PubMed/MEDLINE, Embase, and Cochrane Library databases. Fourteen studies with 1,319 patients were ultimately included. The study comprised 2 analyses: a comparison of urinary symptom scores, maximal flow rate (Qmax), and postvoid residual (PVR) urine volume before and after α1-blocker administration in 8 prospective, open-label studies and 5 randomized clinical trials (RCTs); and an evaluation of the same variables in α1-blocker and placebo groups in 4 RCTs.

Effect of bladder overdistention on uroflowmetry and post-void residual urine in children with enuresis / 中华实用儿科临床杂志

Objective@#To explore the effect of bladder overdistention on uroflowmetry and post-void residual urine(PVR)in children with primary nocturnal enuresis (PNE).@*Methods@#A total of 136 children with PNE from March 2015 to June 2018 at Department of Pediatric Urodynamic Center, the First Affiliated Hospital of Zhengzhou University were enrolled, aged 5-14 years, with mean age of (7.96±2.48) years old.Uroflowmetry and PVR measurement were performed in the condition of over and no urinary distention, respectively.According to the initial urinary voided volume (VV), the children were divided into 3 groups, 25 mL≤ VV<50 mL(group 1), 50 mL≤VV<100 mL(group 2), and VV≥100 mL(group 3). The VV, maximum flow rate (Qmax), average flow rate (Qave), urine flow time, and PVR were compared interms of condition between the groups.Different types of flow curve were analyzed simultaneously.@*Results@#In the condition of bladder over distention, the VV, Qmax, Qave, urinary flow time and PVR of children were higher than those with no overdistention[group 1: (168.25±103.23) mL vs.(34.04±7.03) mL, (17.76±11.13)mL/s vs.(8.23±2.72) mL/s, (9.56±4.13) mL/s vs.(4.30±1.55) mL/s, (20.24±15.13) s vs.(8.64±4.27) s, (3.90±3.55) mL vs.(1.50±2.55) mL; group 2: (168.65±80.66) mL vs.(68.04±15.13) mL, (16.41±5.18) mL/s vs.(14.61±5.29) mL/s, (9.86±3.56) mL/s vs.(8.14±2.29) mL/s, (18.75±10.73) s vs.(9.41±3.47) s, (5.98±8.59) mL vs.(2.77±6.41) mL; group 3: (280.24±102.00) mL vs.(181.50±66.22) mL, (22.73±8.21) mL/s vs.(20.42±6.25) mL/s, (12.57±3.68) mL/s vs.(11.00±3.22) mL/s, (23.46±10.65) s vs.(17.01±6.90) s, (3.78±6.26) mL vs.(2.09±3.21) mL], and the differences were all significant(all P<0.05). Excluding physiological pseudomorphism, urinary flow curves of 114 children with initial urinary intention and excessive voiding were obtained.The incidence of Staccato urinary flow curve was significantly higher than that with no distention [6.14%(7/114 cases) vs.21.93%(25/114 cases), χ2=14.45, P<0.05].@*Conclusions@#Bladder overdistention induced significant influence on the uroflowmetry and PVR.

Paediatric Urinary Tract Infection: Microbiologic Profile and Antibiotics Sensitivity in Children Presenting with UTI

Background: This study was designed to determine the microbiologic profile and Antibiotics Sensitivity in Children presenting with UTI. Materials & Methods: This hospital based prospective study was conducted in 28 patients Patients from 2 months to 12 years were admitted to the pediatric ward and visited in outpatient department (OPD) with diagnosis of UTI based on history with routine and microscopic examination of urine were considered for this study. The UTI investigation protocol recommended ultrasound, voiding cystourethrography (VCUG), and DMSA scan. Clinical and laboratory parameters at the index infection, including highest measured temperature, highest C-reactive protein (CRP), bacterial findings, and the number of febrile recurrences, were recorded. Results: Fever was the most common symptom accounting for 76.4% of patients with nausea and vomiting (42.8%), dysuria (53.6%), abdominal pain (57.1%) and anorexia (46.4%). Urine analysis was done in all suspected cases of UTI. Among all urine samples 60.7% had WBC >10/hpf, followed by 87 (28.6%) which had WBC between 6-10/hpf. Only 6 (10.7%) had WBC 5 or less. Among all urine analyses 68 (57.1%) Conclusion: E. coli (82%) was the most common organism found followed by Klebsiella pneumonia (12%), Proteus mirabilis (5%)and 1% were other pathogens like Enterococcus species (Table 4, Fig 1). All isolated E. coli was sensitive to Imipenem, Nalidixic acid, Netilmicin and Vancomycin. E. coli were 80-90% sensitive to Amikacin, Ceftriaxone, Cefuroxime, Ofloxacin, Gentamicin and Nitrofurantoin.

Evaluación y tratamiento del niño con síntomas del tracto urinario inferior (LUTS) / Evaluation and management of children with lower urinary tract symptoms (LUTS)

RESUMEN La disfunción miccional es un trastorno del llenado o vaciado de la vejiga en niños sin alteraciones neurológicas o anatómicas. Los síntomas del tracto urinario inferior (LUTS, por la sigla en inglés de Lower urinary tract symptoms) son un motivo frecuente de consulta con el pediatra, el nefrólogo o el urólogo pediatra, e incluso con el neurólogo y el psicólogo infantil. Se le considera una enfermedad relativamente benigna lo que en ocasiones genera desinterés entre médicos y familiares y lleva a consultas tardías e interpretación inadecuada de los síntomas. Manifestaciones como urgencia, incontinencia, enuresis, goteo posmiccional, infecciones urinarias, vulvovaginitis recurrente y constipación, en un niño sin enfermedad neurológica, deben hacer pensar al médico en disfunción miccional para enfocar oportunamente el diagnóstico, restablecer la calidad de vida del paciente, evitar las infecciones urinarias y el daño renal subsecuente e irreversible secundario a un diagnóstico tardío. Las recomendaciones actuales hacen énfasis en un enfoque menos invasivo, tratamiento conservador, manejo de la constipación y reentrenamiento vesical. Este artículo discute la evaluación, el diagnóstico y el tratamiento correctos de niños con LUTS.

SUMMARY Voiding dysfunction is a disorder of the bladder filling or emptying in children without neurological or anatomical disorders. Lower urinary tract symptoms (LUTS) are a frequent reason for consulting the pediatrician, nephrologist or pediatric urologist, and even the neurologist and child psychologist. It is considered a relatively benign disease that sometimes generates disinterest among doctors and families, leading to late consultation and inadequate interpretation of symptoms. Urgency, incontinence, enuresis, post-void dribbling, urinary tract infections, recurrent vulvovaginitis and constipation in children without neurological disease should lead to consider the possibility of voiding dysfunction, in order to recognize it timely, restore the quality of life, prevent urinary tract infection and the irreversible kidney damage secondary to delayed diagnosis. Current recommendations emphasize on a less invasive approach, conservative treatment, management of constipation and bladder retraining. This article discusses the correct assessment, diagnosis and management of children with LUTS.

Comparison of the voiding pattern in toilet-trained Filipino children with urinary tract infection with and without vesicoureteral reflux: A prospective study

OBJECTIVES@#Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in children andremains a dilemma that is commonly seen by physicians. Unrecognized VUR associated with UTImay lead to long term effects on renal function and overall patient health. To date, there is no currentstudy on voiding patterns of children presenting as recurrent UTI with and without VUR. In thisstudy, the authors aim to determine if there is a difference in the voiding pattern of toilet trainedFilipino children with UTI between those with and without VUR and to see if there is associationbetween these parameters with the degree of VUR.@*MATERIALS AND METHODS@#The study employed a prospective research design. Population consisted ofpediatric patients seen in the clinic diagnosed as a case of UTI documented with positive urineculture. Voiding cystourethrogram was done to determine presence or absence of VUR. The procedurewas done by a single Urologist at a single institution. The patients were then subdivided into 2 groups,the first group consisted of patients with UTI with VUR and another group had those with UTI butwithout VUR. A subanalysis was done to determine association depending on the degree of reflux.Logistic regression analysis, chi-square test and ANOVA were used to determine if there was anystatistically significant difference between the two groups.@*RESULTS@#A total of 223 pediatric patients with ages ranging from 2 years to 17 years with mean age of9.5 years with documented urinary tract infection were noted. Among these, only 140 patientsunderwent VCUG hence included in the study. It consists of 57 male patients (40%) and 83 femalepatients (59%). Among these patients, 65 patients (46%) had vesicoureteral reflux and 75 patients(53%) had no vesicoureteral reflux. Each patient's voiding parameters such as bladder wall thickness,bladder capacity, postvoid residual, Qmax and voiding pattern were noted and compared betweengroups. A subanalysis was also done to determine any association of these parameters to the degree ofreflux.@*CONCLUSION@#In the present series, bladder capacity was the only parameter found to be statisticallydifferent between those with and those without VUR. Furthermore, this difference was only seenamong those with grades 3, 4 and 5 refluxes. Future study must be carried out to determine its clinicalsignificance. Physicians must be vigilant and must have a high index of suspicion in dealing withpatients with episodes of febrile UTI. To date, voiding cystourethrogram is still the gold standard todiagnose this disease entity.

Voiding pattern of toilet-trained Filipino children with recurrent urinary tract infection and without urinary tract infection

OBJECTIVES@#The objectives of this study were to compare the voiding pattern of toilet-trained patientswith and without recurrent UTI, to describe the voiding pattern of toilet-trained patients withoutUTI aged 2 to 15 years old and to describe the voiding pattern of toilet trained patients with recurrentUTI aged 2 to 15 years old.@*MATERIALS AND METHODS@#A total of 80 toilet-trained Filipino children divided into two groups with 40each were included. R-UTI group consisted of patients aged 2 to 15 years old who presented withrecurrent UTI. The control (No-UTI) group consisted of children aged 2 to 15 years old without anyurinary symptoms and without history of urinary tract infection. Parents completed a 72-hour bladderchart at home. All participants answered Farhat's DVSS. Patients underwent uroflowmetry,uroflowmetry with EMG and post void residual assessment (PVR). Qmax, uroflowmetry pattern,bladder wall thickness and PVR were recorded and analyzed using independent t-test.@*RESULTS@#The mean age of subjects with UTI was 6.32 ± 2.77 years and those in the control group havea mean age 6.67 ± 2.77 years old. Of patients of R-UTI group the following were statisticallysignificant compared to No-UTI : Constipation (48% vs 15%), mean frequency of voiding volumesgreater than 125% of the estimated bladder capacity (EBC) at daytime (0.8 ± 0.22 vs 0.05 ± 1.20p=0.0002), frequency (45% vs 5%), mean average voided volume (126.54 ± 56.05 mL vs 84.34 ±34.26 mL p=0.0001), mean daytime average voided volume (121.33 ± 59.59 mL vs 87.90 ± 36.41mL p =0.0033), mean maximum voided volume (232.25 ± 113.99 mL vs 130.85 ± 49.99 mLp<0.0001), mean bladder thickness (3.83 ± 0.68 mm vs 3.38 ± 0.62 mm p = 0.0030), mean PVR(12.96 ± 10.54 mL vs 5.21 ± 5.68 mL p=0.0001). PVR was significant in 45% of cases compared to3% significant PVR (when 4-6 years old defined as >10ml or >10%of EBC, and if >7 years old >20mlor >15% of EBC). When mean PVR was computed as percentage of EBC, R-UTI group had astatistically higher percentage compared to the no-UTI group (6.27 ± 2.52 % vs 2.52 ± 2.75 %p=0.0001). Mean observed bladder capacity (OBC) was found to be more than the EBC in 35% ofcases in the R-UTI group compared to 12% of No-UTI group (p=0.018). Uroflow-EMG in the R-UTI group were, 85% synergic, 12% dyssynergic and 3% interrupted pattern. EMG in the No-UTIgroup were, 38% synergic, 55% dyssynergic, 2% delayed relaxation, 5% interrupted. The EMGpatterns were statistically significant between the groups (p<0.0001). Uroflow patterns werecomparable between the two groups (p=1.000).@*CONCLUSION@#Constipation was more frequent in the R-UTI group. R-UTI group had a higher meanfrequency of EBC > 125% during daytime, frequency, mean average voided volume, mean averagevoided volume during daytime, mean maximum voided volume, mean bladder thickness, mean PVRcompared to the without UTI group. Mean observed bladder capacity was observed to be greater thanthe EBC in the R-UTI group compared to the No-UTI group. R-UTI group was synergic compared toNo-UTI group which were dyssynergic.

Add-on Therapy With the α-Blockers Tamsulosin and Naftopidil Improves Voiding Function by Enhancing Neuronal Activity in Prostatic Hyperplasia Rats / 대한배뇨장애요실금학회지

PURPOSE: Benign prostatic hyperplasia (BPH) impacts quality of life in men by causing lower urinary tract symptoms. α1-Adrenoceptor (α1-AR) blockers improve lower urinary tract symptoms. We investigated the efficacy of add-on therapy with α1-AR blockers on BPH rats. METHODS: Rats in the drug-treated groups were orally administered each drug once a day for 30 days after orchiectomy. To induce BPH, rats were castrated and testosterone (20 mg/kg) was injected subcutaneously once per day for 30 days. Cystometry was conducted to measure voiding contraction pressure and the interval contraction time, immunohistochemistry was performed to measure c-Fos and nerve growth factor (NGF) expression in the neuronal voiding centers, and nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry was used to measure nitric oxide synthase (NOS) expression. RESULTS: Orchiectomy and testosterone injection decreased voiding contraction pressure and the interval contraction time, suggesting BPH symptoms. Voiding contraction pressure and the interval contraction time were greater in the group that received the combination treatment (tamsulosin with naftopidil) than in the tamsulosin monotherapy or naftopidil monotherapy groups. c-Fos, NGF, and NOS expression in the neuronal voiding centers was enhanced by BPH induction. c-Fos, NGF, and NOS expression was suppressed by the combination treatment (tamsulosin with naftopidil) to a greater extent than was the case for tamsulosin monotherapy or naftopidil monotherapy. CONCLUSIONS: Combination therapy of tamsulosin and naftopidil showed greater efficacy for the treatment of BPH than tamsulosin monotherapy or naftopidil monotherapy; therefore, combination therapy can be considered as a novel therapeutic method for BPH.