Outcome of a standardized approach to childhood urinary symptoms-long-term follow-up of 720 patients.

AIMS: To investigate the relevance of enuresis subtyping for selection of treatment modality and for long-term outcome in a large consecutive patient cohort. MATERIALS AND METHODS: We included all patients referred for urinary incontinence during a 5-year period but excluding recurrent urinary tract infections (UTI). Type and severity of incontinence, prior history, results of examinations performed, number of visits, and effect of all treatments provided, were included in a clinical database. RESULTS: Seven hundred twenty children aged 4-16 years (mean 8.5 ± 2.2 years, 239 girls) were included in the analysis (42% with monosymptomatic (MNE), 55% with non-MNE, and 3% with isolated daytime incontinence). Initial evaluation revealed only few underlying causes (one neurological and eight anatomical). Investigations showed significant differences between MNE and non-MNE patients as both maximal voided volume and nocturnal urine volume was lower in non-MNE patients (P < 0.001). Follow-up for average 1,587 days (3.4 years) was performed in 660 (92%) patients. A higher number of visits and a longer treatment period were needed for non-MNE patients (on average 4.7 ± 2.8 visits) than MNE patients (3.1 ± 1.6 visits, P < 0.001). The most common treatment regimen that resulted in dryness in both MNE (40%) and non-MNE (36%) was the alarm system. Interestingly, of the 539 patients who initially were referred due to desmopressin resistance 177 (33%) of these were dry on desmopressin monotherapy. CONCLUSIONS: The study indicated that MNE and non-MNE are two distinct disease entities with different optimal treatments and showed that the latter patients are more difficult and time-consuming to manage.

Direct mail improves knowledge of basic life support guidelines in general practice: a randomised study.

BACKGROUND: Implementation of new guidelines into clinical practice is often incomplete. Direct mail is a simple way of providing information to physicians and may improve implementation of new guidelines on basic life support (BLS). The aim of this study was to describe knowledge of the most recent European Resuscitation Council (ERC) Guidelines for BLS among general practitioners (GPs) and investigate whether direct mail improves theoretical knowledge of these guidelines. METHODS: All general practice clinics (n=351) in Central Denmark Region were randomised to receive either direct mail (intervention) or no direct mail (control). The direct mail consisted of the official ERC BLS/AED poster and a cover letter outlining changes in compression depth and frequency in the new guidelines. In general practice clinics randomised to intervention, every GP received a direct mail addressed personally to him/her. Two weeks later, a multiple-choice questionnaire on demographics and BLS guidelines were mailed to GPs in both groups. RESULTS: In total, 830 GPs were included in this study (direct mail, n=408; control, n=422). The response rate was 58%. The majority (91%) of GPs receiving direct mail were familiar with BLS Guidelines 2010 compared to 72% in the control group (P<0.001). Direct mail improved knowledge of the new recommended chest compression depth (67% vs. 40%, P<0.001) and chest compression frequency (62% vs. 40%, P<0.001). CONCLUSION: Direct mail improved knowledge of changes in BLS guidelines and thus facilitated the implementation of this knowledge into clinical practice. Resuscitation councils and medical societies may consider using direct mail as a simple strategy to facilitate implementation of changes in clinical guidelines.

[Urine samples from children collected in their homes]. / Børneurinprøver indsamlet i hjemmet.

INTRODUCTION: Children at high risk of urinary tract infection (UTI) enter a programme for domestic urine sampling at the Paediatric Department in Aarhus. Parents collect urine, describe symptoms and post the samples. We wanted to determine the value of domestic urine sampling and to evaluate the programme. MATERIAL AND METHODS: All samples received in 2004 were studied. RESULTS: A total of 706 urine samples from children in the programme were cultivated. In all 76 children fulfilled the criteria for UTI when culture and symptoms were compared. Dip-slide analysis had a sensitivity of 72% and a negative predictive value of 96%. A total of 329 urine samples with negative dip-slide analyses were collected from children with no urinary tract symptoms. Only 27 of these samples were culture-positive and none of these children developed signs of UTI. CONCLUSION: The results from this study suggest that home urine sampling from children at high risk of UTI with no symptoms does not contribute towards avoiding the development of pyelonephritis. A home urine sample analysis programme for children with symptoms is, however, a valuable instrument for early and efficient treatment of UTI in children with high risk of UTI. Urine samples should only be cultivated if the child has symptoms or the dip-slide test is positive.

Treatment outcome of day-time urinary incontinence in children.

OBJECTIVE: To analyse retrospectively the efficacy of day-time incontinence treatment in a secondary referral centre and consider characteristics of responders to the different therapeutic interventions. MATERIAL AND METHODS: All children treated for day-time urinary incontinence at the authors' clinics from 2000 to 2004 were included. Children with ongoing urinary tract infections were excluded. Before treatment, children filled out registrations of incontinence episodes and 48h frequency-volume charts. Faecal disorders were treated before urinary incontinence. All children were subjected to standard urotherapy and were secondarily recommended a timer-watch. If standard urotherapy had no effect, anticholinergics were added. RESULTS: The study included 240 children with day-time urinary incontinence. Of these, 45 had faecal problems and 17% obtained urinary continence when these were successfully treated. In total, 126 (55%) became dry on standard urotherapy. Of the 60 children who had a timer-watch in addition to standard urotherapy, 70% became dry. Of the 62 children who had anticholinergics in addition to standard urotherapy, 81% became continent. Fifteen (6%) did not achieve continence and another 11 patients were lost to follow-up. Children who became dry solely on standard urotherapy had a significantly lower voiding frequency (p<0.05), larger voided volumes as a percentage of those expected for age (p<0.01) and fewer incontinence episodes per week (p<0.05) than children needing anticholinergics. CONCLUSIONS: Most children achieve day-time continence solely on standard urotherapy. Children who need anticholinergics to achieve dryness seem to be those with more severe bladder reservoir function abnormalities and symptoms.

Normal differential renal function does not indicate a normal kidney after partial ureteropelvic obstruction and subsequent relief in 2-week-old piglets.

PURPOSE: We investigated the functional consequences of relieving ureteric obstruction in young pigs with experimental hydronephrosis (HN) induced by partial unilateral ureteropelvic obstruction. MATERIALS AND METHODS: Three groups of animals were followed from the age of 2 weeks to the age of 14 weeks: Eight animals had severe or grades 3-4 HN throughout the study. Six animals had relief of the obstruction after 4 weeks. Six animals received sham operations at both ages. Morphological and functional examinations were performed at age 6 weeks and again at age 14 weeks and consisted of magnetic resonance imaging (MRI), technetium-diethylenetriaminepentaaceticacid ((99m)Tc-DTPA) renography, renal technetium-dimercaptosuccinicacid ((99m)Tc-DMSA) scintigraphy, and glomerular filtration rate (GFR) measurement. RESULTS: After relief of the partial obstruction, there was reduction of the pelvic diameter and improvement of urinary drainage. Global and relative kidney function was not significantly affected by either obstruction or its relief. Renal (99m)Tc-DMSA scintigraphy showed a change in both the appearance of the kidney and a change in the distribution within kidneys even after relief of obstruction. CONCLUSION: This study shows that partial ureteric obstruction in young pigs may be associated with little effect on global and differential kidney function. However, even after relief of HN, the distribution of (99m)Tc-DMSA in the kidney remains abnormal suggesting that a normal differential renal function may not represent a normal kidney.

The impact of daytime diuresis on voiding frequency and incontinence classification in children.

PURPOSE: Daytime voiding frequency is an important criterion in the classification of childhood incontinence. The aim of this study was to assess the relative impact of diuresis and bladder capacity on voiding frequency. MATERIALS AND METHODS: We analyzed data from 570 children 4 to 15 years old (median age 8.3 +/- 2.0 years) treated for urinary incontinence at a secondary referral center, and 87 healthy controls. Based on frequency-volume charts, daytime voiding frequency, age adjusted maximum voided volume, daytime diuresis and fluid intake were calculated. Children were classified according to voiding frequency into 3 groups-decreased (fewer than 3 voids daily), normal (3 to 7) and increased voiding frequency (more than 7). RESULTS: A total of 219 children had monosymptomatic enuresis, while 351 children presented with daytime symptoms. In children with daytime symptoms we found a significant difference between voiding frequency groups regarding daytime diuresis (decreased voiding frequency 12.3 +/- 4.1 ml/kg, normal 18.7 +/- 6.0 ml/kg, increased 31.1 +/- 9.8 ml/kg, p <0.001). In contrast, maximum voided volume observed/expected bladder capacity for age did not differ significantly between normal and increased frequency groups (72% +/- 25% vs 74% +/- 23%), compared to patients with decreased voiding frequency (89% +/- 30%, p <0.01). Also, in healthy children we found a positive correlation between voiding frequency and daytime diuresis, whereas maximum voided volume observed/expected bladder capacity for age did not correlate with voiding frequency. Furthermore, we observed a significant positive correlation between fluid intake and diuresis (r = 0.53, p <0.001). CONCLUSIONS: In healthy controls and children with incontinence daytime voiding frequency depends mainly on diuresis, and seems less influenced by bladder capacity. Diuresis should be taken into consideration when evaluating voiding frequency from frequency-volume charts in children.