ABSTRACT
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.
Subject(s)
Humans , Male , Female , Child , Adolescent , Urination Disorders/therapy , Urinary Bladder Diseases/therapy , Gastrointestinal Diseases/therapy , Constipation/therapy , Encopresis/therapyABSTRACT
Behavioral therapy refers to a broad range of treatment modalities that regulate the child's behavior to induce a therapeutic effect on nocturnal enuresis. Simple behavioral therapies include fluid restriction, lifting, waking, introducing reward systems, and bladder training. Simple behavioral therapy is significantly less effective than an enuresis alarm or desmopressin. If a child needs treatment, an enuresis alarm or desmopressin should not be delayed. Enuresis alarms are an effective form of treatment, although they require active involvement of the health care provider to reduce the likelihood of dropout and to motivate the child and parents.
Subject(s)
Child , Humans , Behavior Therapy , Deamino Arginine Vasopressin , Enuresis , Health Personnel , Lifting , Nocturnal Enuresis , Parents , Reward , Urinary BladderABSTRACT
Non-neurogenic pediatric voiding dysfunction is defined as a problem during bladder filling or emptying without any neurogenic abnormality in children. The appropriate treatment of non-neurogenic pediatric voiding dysfunction is important because the disorder is frequently seen in clinical practice and might result in damages of the child's bladder or kidney. Urotherapy can be defined as nonsurgical nonpharmacological treatment for voiding dysfunction, categorized into standard urotherapy or specific intervention. Understanding of the underlying pathophysiology of non-neurogenic pediatric voiding dysfunction will lead to a change in management, from expensive and potentially harmful medications and invasive procedures to effective, noninvasive treatment of urotherapy.
Subject(s)
Child , Humans , Kidney , Urinary BladderABSTRACT
Overactive bladder which is defined by symptoms of urinary frequency and urgency but cannot be defined by pathogenesis of this condition, can be considered as a representative of storage failure. Dysfunctional voiding which is caused by dyssynergia of the detrusor and urethral sphincter is the most common form of emptying failure. Through inadequate relaxation of urethral sphincter during contraction of detrusor muscle for voiding, intravesical pressure increases and eventually results in pathologic changes of the bladder. However, overactive bladder which is a failure of storage and dysfunctional voiding which is a failure of emptying are not completely different diseases, but are closely related and can be switched from one type to the other. Continuously increased intravesical pressure by abnormal contraction of the external urethral sphincter and primary or secondary involuntary detrusor activity are the major components in the pathophysiology, Thus thorough evaluation of the bladder and urethra and treatment of UTI and constipation which can affect the function of the bladder and urethra must be considered when establishing a treatment. If behavioral problem is accompanied or the patient shows poor compliance to urotherapy, psychological intervention by a specialist can be helpful. With increasing interest in the quality of life, active basic research in the field of voiding dysfunction and development of new drugs are in progress and shows a promising future. Meanwhile, pediatric urologist must strictly assess the significance of this disease entity during childhood through long term follow up of these children into adulthood.
Subject(s)
Child , Humans , Ataxia , Compliance , Constipation , Contracts , Muscles , Quality of Life , Relaxation , Specialization , Urethra , Urinary Bladder , Urinary Bladder, OveractiveABSTRACT
A group of 112 patients suffering from urticaria of varied etiology was treated with auto-urotherapy. The technic and preparation of the urine for injection is describedOf this group, 106 patients had a follow-up ranging from three months to three and a half years. There was no recurrence of the urticaria during this period of observation. One case failed to respond to this form of treatment (45 injections)There were no untoward reactions to the treatment save local pain on the site of injection, and abscess formation, observed in 4 cases. (Summary)