Bladder Dysfunction In Children Research Articles

Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research.

Neurogenic bladder dysfunction (NB) represents a challenge in pediatric urology. Intravesical botulin toxin-A (BTX-A) bladder injection is part of the armamentarium for the treatment of this condition, usually after failed first-line medical strategies and before the escalation to more invasive options such as neuromodulation or augmented cystoplasty in severe cases. However, there is still a lack of consensus about the appropriate treatment modality for the pediatric population. A review of the last 10 years' research was performed on the PubMed database by two authors. Articles doubly selected and meeting the inclusion criteria were collected and analyzed for their study type, demographics, neurological disease(s) at diagnosis, BTX-A treatment modality and duration, previous treatment, clinical and urodynamic parameters, adverse events, outcomes, and follow-ups. A total of 285 studies were initially selected, 16 of which matched the inclusion criteria. A cohort of 630 patients was treated with BTX-A at a median age of 9.7 years, 40% of which had a diagnosis of myelomeningocele. The results of the selected publications show the overall efficacy and safety of BTX-A injections in children and confirmed BTX-A as a valuable strategy for NB treatment in pediatric population. Nevertheless, up to now, the literature on this topic offers scarce uniformity among the published series and poor protocol standardization.

Can targeted, non-invasive, EMG-uroflowmetry led assessments help characterisation of non-neurogenic bladder dysfunction in children?

Can targeted, non-invasive, EMG-uroflowmetry led assessments help characterisation of non-neurogenic bladder dysfunction in children?

Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction

Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45±4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p=0.049, r=-0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58±0.68mm in the NC group and 2.18±1.35mm in the LC group (p=0.044). Left lateral wall thickness was 1.45±0.44mm in the NC group and 2.02±1.4mm in the LC group (p=0.033). Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.

Analysis of complications of neurogenic bladder dysfunction in children

Dysfunction of the lower urinary tract is a fairly common consequence of perinatal lesions of the nervous system. Dysfunction of the bladder and muscles of the urogenital diaphragm in this group of children can be accompanied by severe urodynamic disorders and, in some cases, can lead to complications such as chronic recurrent urinary tract infection, vesicoureteral reflux, nephrosclerosis, kidney atrophy, chronic renal failure. Purpose. To study uronephrological complications in children with various forms of neurogenic bladder dysfunction and suggest methods for their prevention and pathogenetic treatment. Material and methods. 67 children with neurogenic bladder dysfunction were examined. All children underwent comprehensive uronephrological and neurological diagnostics using objective neuroimaging, electrophysiological and functional research methods. Results. Complications leading to somatic health disorders in patients were diagnosed. These included chronic cystitis — in 13 (19.4%) patients, chronic pyelonephritis — in 57 (85.1%), vesicoureteral reflux — in 25 (37.3%), chronic renal failure — in 8 (11.9%) children. Therapy for neurogenic bladder dysfunction consisted of basic therapy of the central nervous system lesion, as well as symptomatic therapy aimed at normalizing the functional state of the bladder. In the vast majority of cases of neurogenic bladder dysfunction complications, their relief occurred within a year in the process of curing the underlying disease. In some cases, in children with severe neurological disorders (myelodysplasia, meningoradiculocele), along with medication and physiotherapy, surgical manipulations (periodic bladder catheterization) and surgical interventions (epicystostomy) were performed. Conclusion. In children with detrusor hyperreflexia and mild «high» lesions of the nervous system, clinical symptoms of neurogenic bladder dysfunction were usually noted, worsening only their quality of life. In children with a significant neurological deficit and a rather severe lesion of the lumbosacral spinal cord, complications developed that worsened the somatic health of this group of patients.

Longitudinal follow-up of bladder function in children who participated in the Swedish Reflux Trial

Several publications have reported the coexistence of vesicoureteral reflux (VUR) and bladder dysfunction in children. Whether this dysfunction remains in the longer term is not yet known. This study revisited children who participated in the Swedish Reflux Trial (SRT) with the primary aim of evaluating whether bladder and bowel dysfunction (BBD) in these patients persisted until adolescence. The secondary aim was to evaluate two BBD subgroups, and relations to recurrent urinary tract infections (UTI). Of the 161 eligible children at SRT study-end, 73 children participated. Their bladder function was evaluated longitudinally using a validated BBD questionnaire with symptom score (cut-off ≥7) and uroflowmetry, at five (T2) and ten years (T3) after study-end. T1 was the SRT study-end. Besides BBD, the sub-diagnoses overactive bladder (OAB) and dysfunctional voiding symptoms (DVS) were calculated from symptom scores. BBD was diagnosed in 37% of children at mean age 3.7 years, which decreased with age to 23% of adolescents (mean age 15.7). DVS and OAB subgroups were equally common at T1, but only DVS was identified at the last follow-up (T3) (p=0.0008). Recurrent UTIs were seen in 17% at T3 and were more common in patients with BBD (p=0.038). The gender distribution of BBD also changed, from being equally common at the end of the SRT to affecting mainly adolescent girls at the last follow-up (p=0.022). Information was available regarding VUR status after repeat VCUGs during follow-up in 22 patients, 12 of them after endoscopic treatment. An improvement in VUR grade was found in the 22, but during follow-up numbers with BBD or UTI did not differ between treated and non-treated groups. The prevalence of BBD decreased from 37% at 3-4 years of age to 23% in adolescence, when it was almost exclusively seen in girls. BBD and the subgroup DVS were associated with UTI. Even if epidemiological studies have established a predisposition to bladder symptoms and UTI in girls, little is known about bladder function in adolescents with a history of VUR during the first years of life. One limitation of the study was the number of patients participating. Also, the number of patients with kidney damage was more common in the cohort. In this longitudinal follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both BBD and recurrent UTIs mainly affected girls.

Personalized Pre-clinic Nursing Telemedicine Visit: An Efficient and Efficacious Approach for Bowel and Bladder Dysfunction in Children

To evaluate the effectiveness and efficacy of a Registered Nurse (RN) led educational pre-clinic telephone call on compliance and outcomes in children with bowel and bladder dysfunction (BBD). A retrospective chart review of a prospectively applied protocol in a single academic institution was performed for children aged 4-17 presenting with BBD. All children underwent a pre-clinic RN telemedicine visit where they were educated on pathophysiology of BBD, provided personalized urotherapy and bowel recommendations and instructed to complete pre-clinic questionnaires and voiding diaries. Patients were evaluated by a provider 4weeks following RN call. Data collected included compliance with forms, bowel management and need for imaging/testing, medications, and biofeedback. Patients were considered to improve with urotherapy alone if they were discharged from urology without the need for medications and/or biofeedback. In total, 277 patients completed an RN call and 224 patients attended a provider visit between December 2020 and June 2022. Mean age was 9.4years (3:1 Female to Male ratio). During the RN call, 154 (56%) patients had bowel management initiated. Of the 224 patients seen by a provider, 69% (n=154) had symptom improvement or resolution with urotherapy alone. Thirty-eight patients (17%) enrolled in biofeedback with 7 (3%) completing all 8 sessions. Thirty-two patients (14%) required medication for daytime bladder symptoms. Our novel RN-led pre-clinic telemedicine visit demonstrates excellent compliance and patient outcomes for children with BBD and can reduce the use of unnecessary imaging, medications, and time-consuming treatments such as biofeedback.

Evaluation of bladder dysfunction in children and adolescents with type 1 diabetes mellitus by uroflowmetry.

Diabetic cystopathy is a condition characterized by decreased bladder sensitivity, increased bladder capacity, decreased bladder contractility and increased residual urine volume. It can also be considered as an early indicator of autonomic dysfunction. In this study, it was aimed to evaluate bladder functions by uroflowmetry in children and adolescents with the diagnosis of type 1 diabetes mellitus. Type 1 diabetes mellitus children and adolescents were applied uroflowmetry and post-void residual urine volumes were evaluated. The physical examination findings of the patients and the laboratory data of diabetes control were obtained from the clinic files. A total of 51 cases aged 72-216 (155.6±35.4) months were enrolled into the study. Diabetes age of the cases was 66.5±46.2(13-180) months. The last one year average of HbA1c of the patients was found to be 9.7±1.9%. A total of 9.8% had good, 39.2% moderate and 51% poor metabolic control, respectively. While urodynamic evaluation was normal in 36 (70.6%) of 51 participants, voiding dysfunction was found in 15. There was no statistically significant difference between groups with and without voiding dysfunction in terms of age, gender, duration of diabetes, metabolic control and HbA1c values. It is very important to follow up patients with type 1 diabetes mellitus in terms of autonomic dysfunction. Diabetic bladder clinic, which can be observed independently of diabetes duration and metabolic control, is also included in this status. Urodynamic evaluation will be helpful both in demonstrating bladder dysfunction and in preventing possible complications.

Frequency of Voiding and Defecation Dysfunction in Primary School Children in Zahedan, Southeast Iran

Background: Childhood voiding and defecation dysfunction are common problems in children of all ages worldwide. The prevalence of bowel and bladder dysfunction in children is reported to be approximately 47%. Objectives: Due to the different ethnic and socio-cultural characteristics, this study was conducted to investigate the frequency of voiding and defecation dysfunction in primary school children. In this study, we examined the urinary and defecation problems of patients and their relationship with each other. Methods: This cross-sectional descriptive-analytical study was performed on 400 children aged 7 to 13 years in Zahedan in 2016. Data were collected through a questionnaire. Finally, data were analyzed using SPSS 16 version. Statistical analysis was performed using descriptive and analytical statistics of the chi-square test. P-values less than 0.05 were considered statistically significant. Results: In this study, 400 students with a mean age of 9.96 ± 2.07 were studied, of whom 188 (47.1%) were girls and 212 (52.9%) were boys. The prevalence of urinary incontinence was 56.9%, 63.7% of whom were girls, and 36.3% were boys. The difference in the prevalence of urinary incontinence between girls and boys was large and statistically significant (P = 0.04). The prevalence of fecal incontinence was 61.7% among girls and 62.4% among boys (the total prevalence was 62.4% [239 cases]), but the difference in prevalence between girls and boys was small and statistically insignificant (P = 0.83). Conclusions: The prevalence of defecation dysfunction in school-age children was much higher than in previous studies. This may be due to differences in cultural and geographical environments. Due to the high prevalence of defecation dysfunction in children, it is recommended to have more focus on public education on various types of urinary and fecal dysfunction in urban and rural communities.

Approach to the choice of methods for correction of neurogenic bladder dysfunction in children

Currently, parents of various specialties are turning to doctors with complaints of urination disorders in children, which is manifested by urinary incontinence during the daytime, imperative urges and enuresis. These disorders are associated with functional disorders, if there are no malformations of the spinal cord resulting from the immaturity of the growing organism or may be the cause of the detrimental effect of the benefits of civilization on the emerging organism. The function of the lower urinary tract consists of the friendly but opposite activity of the detrusor and sphincter. We have a wide range of medicines, treatment methods, biofeedback and physiotherapy, but the so-called golden standard of treatment does not yet exist. Each of these methods should be prescribed according to clearly identified diagnostic criteria.

Optimising the management of children with concomitant bladder dysfunction and behavioural disorders

Bladder dysfunction and behavioural disorders in children are commonly concomitant; hence, it is difficult to treat each in isolation. Pharmacotherapy is common treatment for behavioural disorders, and these medications may have intended or unintended positive or negative bladder sequelae. This review identifies the literature regarding the effects of behavioural pharmacotherapy on bladder functioning and possible bladder management strategies in children with concomitant behaviour and bladder disorders to enable clinicians to better manage both conditions. A PROSPERO registered PRISMA-guided review of three major databases was performed. After an initial scoping study revealed significant heterogeneity, a narrative approach was undertaken to discuss the results of all relevant cases relating to children being treated with pharmacotherapy for behaviour disorders and outcomes related to bladder function. Studies were screened to identify those that described effects of commonly prescribed medications in children with behavioural disorders such as stimulants, alpha 2 agonists, tricyclic antidepressants (TCA), serotonin and noradrenergic reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI) and antipsychotics, and the findings and implications were summarised. The review identified 46 studies relevant to behavioural pharmacotherapy and bladder function (stimulants (n = 9), alpha 2 agonists (n = 2), TCAs (n = 7), SNRIs (n = 8), SSRIs (n = 8) and antipsychotics (n = 6). Six studies focused specifically on bladder management in children with behavioural disorders with concurrent behavioural pharmacotherapy. This review identifies useful factors that may assist clinicians with predicting unintended bladder effects following initiation of behavioural pharmacotherapy to facilitate the best approach to the treatment of bladder dysfunction in children with behavioural disorders. With this evidence, we have provided a useful decision-making algorithm to aide clinicians in the management of these dual pathologies.

PD02-05 EFFICACY AND SAFETY OF VIBEGRON AS ADJUVANT TREATMENT ON REFRACTORY NEUROGENIC BLADDER DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA

You have accessJournal of UrologyCME1 May 2022PD02-05 EFFICACY AND SAFETY OF VIBEGRON AS ADJUVANT TREATMENT ON REFRACTORY NEUROGENIC BLADDER DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA Kazuyuki Nishinaka, and Naoya Masumori Kazuyuki NishinakaKazuyuki Nishinaka More articles by this author , and Naoya MasumoriNaoya Masumori More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002517.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of vibegron with improved selectivity and metabolic stability in comparison with previously disclosed β3-adrenoceptor agonists for treating antimuscarinic-resistant neurogenic bladder dysfunction in children with spina bifida. METHODS: In this retrospective study, 19 patients below 15 years of age, with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida, underwent a video-urodynamic study before and during the prescription of vibegron. The dosage was 12.5, 25 or 50 mg once daily, based on age and body weight, for at least 12 weeks from January 2020 to July 2021, in addition to antimuscarinic therapy. The video-urodynamic study was conducted to evaluate bladder compliance, maximum cystometric bladder capacity, detrusor overactivity, detrusor leak point pressure, and vesicoureteral reflux. This was done subsequently prior to the beginning and after three months of vibegron administration. Patient-reported efficacy and adverse events were measured. RESULTS: Treatment with vibegron add-on therapy drastically improved bladder compliance and maximum cystometric bladder capacity compared to treatment with antimuscarinic agents alone (6.2; IQR: 5.2–10.4 vs. 28.3; IQR: 22.7–50.7 mL/cmH2O, P < 0.0001; and 178; IQR: 135–235 vs. 450; IQR: 358–502 mL, P<0.0001, respectively). Bladder deformity in 12 patients improved after taking the drug (image 1: before taking vibegron and image 2: after taking vibegron, obtained from the same case). Moreover, vesicoureteral reflux, confirmed in four patients, disappeared post administration. All the 18 patients who were incontinent before remained dry after initiating therapy with vibegron during the daytime. None of the patients showed side effects or discontinued treatment owing to intolerance to vibegron. CONCLUSIONS: Vibegron as adjuvant treatment in children with antimuscarinic-resistant neurogenic bladder dysfunction due to spina bifida showed favorable video-urodynamic efficacy with no apparent adverse events. Vibegron helped to achieve urinary continence in the entire sample population. Vibegron is a favorable treatment option for the treatment of refractory neurogenic bladder dysfunction in children with spina bifida. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e37 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuyuki Nishinaka More articles by this author Naoya Masumori More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ultrasound-Estimated Bladder Weight Correlates With Videourodynamic Studies in Neurogenic Bladder Dysfunction.

This retrospective study was designed to evaluate which lower urinary tract ultrasound parameter(s) could predict the results of invasive urodynamic testing which are the current reference standard in the evaluation of bladder dysfunction in children with spina bifida. Fifty eight children with spina bifida undergoing video urodynamic evaluation and a renal bladder ultrasound as their standard of care were evaluated. Quantitative and qualitative ultrasound parameters were then correlated with the videourodynamic study results which served as the reference standard. For bladders with ending storage pressures above 15 cm H2 O, there were increases in these ultrasound measured parameters: 1) bladder mass (P=.00019), 2) bladder/body mass ratio (P=.0059), and 3) wall thickness (P=.01). We defined the storage cost as the final storage pressure divided by the percentage of expected bladder capacity attained. These data were analyzed to compute receiver operating curves with assuming end storage pressures cutoff points of 15, 20, 30, and 40 cm H2 O. The optimal area under the curve was found for a bladder weight of 65 g and a pressure cutoff of 30 cm H2 O with a sensitivity of 75% with a specificity of 84%. Bladder weight is independent of luminal volume, can be normalized to body weight, and may serve as a clinically valuable tool for noninvasive screening to define a subset of patients with neurogenic bladder with a higher likelihood of having abnormal videourodynamic results.

A0651 - Beta-3 adrenoceptor agonist for the treatment of bladder dysfunction in children: A systematic review and meta-analysis

A0651 - Beta-3 adrenoceptor agonist for the treatment of bladder dysfunction in children: A systematic review and meta-analysis

Treatment of various forms of neurogenic bladder dysfunction in children

Treatment of various forms of neurogenic bladder dysfunction in children

β3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis.

ß3-adrenergic receptor agonists (ß3 agonists) have been used in treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO) in adults. However, their use in children has only recently been approved by the U.S. Food and Drug Administration for patients with NDO. As in adults, the role of ß3 agonists in children may include conditions such as OAB. This systematic review and meta-analysis aims to understand the intended use, efficacy and safety of ß3 agonists in the pediatric population. A literature search was performed in February 2021 across MEDLINE®, Embase®, Scopus®, the Cochrane Library and ClinicalTrials.gov. No language restrictions were placed. All records describing the clinical use of ß3 agonists in pediatric patients (<18 years of age) were included, regardless of the methodological design or outcomes assessed. The identified records were screened by 2 independent authors. The reporting was compliant with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Data extraction was performed by 2 independent reviewers, blinded to each other's extractions. The data were pooled using the fixed effects model. Of 367 records identified, 8 studies were included in the review (3 prospective and 5 retrospective). ß3 agonists led to improvements in both urodynamics parameters and self-reported outcomes such as incontinence. Commonly reported side effects were headaches (3%‒5.9%), constipation (3.5%‒5.7%), rhinitis/nasopharyngitis (1.7%‒5.8%) and blurred vision (1.7%‒2.9%). Clinically meaningful changes in safety outcomes (blood pressure, heart rate, electrocardiogram-related changes, liver function) were rare. Before and after ß3 agonist use, pooled effect estimates for maximum cystometric capacity for 171 patients were mean difference of +98.84 ml (95% CI 74.72, 122.96); for complete dryness, assessment of 235 patients showed a Peto odds ratio of 8.68 (95% CI 5.22, 14.45). ß3 agonists appear to be a promising, effective and safe alternative/adjunctive therapy in management of pediatric NDO or OAB, with improvements in both objective urodynamics parameters and subjective patient-reported outcomes following their use.

Parental perceptions of bladder dysfunction in children with symptomatic joint hypermobility.

Children with symptomatic joint hypermobility (SJH) report chronic pain, fatigue, and joint instability as their main symptoms. Symptoms can extend beyond musculoskeletal and include lower urinary tract dysfunction (LUTD). There are no studies exploring parent-perceived quality of life (QoL) in children with LUTD, or strategies used to manage symptoms in this population. Our online cross-sectional survey assessed parents of 6-18-year-olds via two UK charitable organizations. It included the Pediatric Incontinence Questionnaire (PinQ), the Dysfunctional Voiding Symptom Score, and questions exploring treatments and efficacy. Sixty-seven parental questionnaires were analyzed. The majority of children were white females (95%, n= 64). Urgency (97%, n= 65) and enuresis (41.7%, n= 28) were the most frequently reported symptoms. The PinQ questionnaire showed that children were emotionally distressed by LUTD. Twenty-nine parents (43%, n= 29) reported pharmacotherapy as the most effective treatment. Few had accessed other treatments such as physiotherapy (16%, n= 18). Most parents reported that overall treatment did not meet their expectations. This study highlights that parents perceive LUTD as having a great impact on their child's QoL. There is need for education among clinicians about LUTD and hypermobility-related disorders, and for development and evaluation of treatments.

Outcome of Urinary Bladder Dysfunction in Children.

Bladder dysfunction in children is common, the most frequent underlying causes are neurologic bladder (NB), dysfunctional voiding syndrome (DVS), and the valve bladder syndrome (VBS). The aim of this study was to determine the 10-y survival rate and the associated morbidities in children with bladder dysfunction. One hundred ninety-nine children were included in the study; 60 with VBS, 75 DVS, and 64 NB. The mean age was 44 mo (CI: 37-50.9) and mean GFR 50.1 (CI 44.6-55.6) mL/min/1.73m2. The 10-y survival rate was 89%. Compared with patients with VBS, the mortality was 11 times higher among patients with NB (p = 0.02) but not significantly higher than patients with DVS (p = 0.2). GFR < 15mL/min/1.73 m2 increases mortality rate by 6 times compared with normal GFR (p = 0.007). Late age at presentation (> 5 y) increases mortality risk and/or the need for renal replacement therapy (RRT) by almost 5 times (p = 0.013). It was concluded that the etiology of bladder dysfunction, baseline GFR, and the age at presentation significantly influence the survival rate and morbidities.

Власний досвід реконструктивно-пластичних операцій на сечовому міхурі в дітей

In our country, complex surgical reconstruction of the distal urinary tract in severe bladder dysfunction in children is performed infrequently, given the number of children who need these operations. These operations were carried out in our country by specialists invited from abroad. Therefore, we want to share our first experience of performing a complex surgical reconstruction of the distal urinary tract in children. Purpose – to іmprove the quality of life of children with severe bladder dysfunction. Materials and methods. The results of reconstructive and plastic operations on the bladder in 7 children with severe bladder dysfunction were analyzed. Four patients had a neurogenic bladder 3 of them had a spinal bladder), and two patients had a microcyst after surgical correction of bladder exstrophy and total epispadias. Augmentation ileocystoplasty was performed in 3 children, two of them also underwent appendicocystostomy, 3 patients underwent only appendicocystostomy. An assessment of the urinary tract condition, the degree of urinary retention, postoperative complications and quality of life of operated children. Results. All operated children recovered. The bladders in three patients after augmentation have sufficient volume and fully provide reservoir function. We did not observe metabolic acidosis or other serious metabolic disorders described by other authors in the children we operated on. Urolithiasis was also not observed after surgery. In 5 patients who underwent appendicocystostomy, the latter is well catheterized, has a good cosmetic effect. In 4 out of 5 patients there is no leakage of urine through the stoma. All operated children were recovered for vesicoureteral reflux and chronic pyelonephritis. According to the results of the survey, the improvement of most parameters of quality of life of operated patients (cessation of urinary tract infection, complete urinary retention with more infrequent and controlled urination, the ability to visit children’s groups and social adaptation of these children in society). Conclusions. Based on the first own experience of augmentation ileocystoplasty and appendicocystostomy according to Mitrofanoff, the good efficiency of these reconstructive-plastic operations is noted. In all operated patients the quality of life significantly improved – controlled urination was achieved, the progression of kidney damage was stopped. All postoperative complications are successfully corrected. Of great importance for achieving a good effect of treatment is the correct choice of the the urinary tract surgical reconstruction type in each case. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: augmentation ileocystoplasty, appendicocystostomy, children.

Onabotulinumtoxin A (Botox): A reasonable alternative for refractory neurogenic bladder dysfunction in children and young adults.

We aimed to describe the effectiveness of Onabotulinumtoxin A (Botox) in children with neurogenic bladder (NGB) unresponsive to medical therapy to determine urodynamic parameters predictive of success. Children receiving Botox for refractory NGB, between 2008 and 2019, from a single academic center, were included in this study. Botox success was defined as improvement of incontinence and/or urodynamic parameters. Of 34 patients who received Botox, 13 (38.2%) had a positive response from their first injection, with improvement in capacity by a median of 35% of expected capacity for age compared to only a 9% increase in those who did not respond clinically. When patients were divided into groups by baseline urodynamic parameters, high-pressure (Pdetmax > 20 cm H2 O) patients had significantly greater improvement in compliance compared with low-pressure patients (p = 0.017). Low compliance patients (<10 ml/cm H2 O) had a dramatic improvement of 3.08 ml/cm H2 O in their compliance compared with minimal change in the high compliance group (p = 0.003). Finally, low-capacity (<50% of expected CC) patients had significant improvement in capacity and compliance when compared with high-capacity patients (p = 0.004 and p = 0.036, respectively). Improvement in detrusor overactivity (DO) was noted in both the clinical responders and non-responders. In our series, 38% had clinical success with intradetrusor Botox injections for refractory neurogenic bladder. When successful, improvement in capacity and compliance, DO, and/or incontinence was consistent with prior literature. While we could not determine which parameters predicted success, subdividing patients into categories based on baseline urodynamic parameters identified who would benefit from Botox treatment based on differential improvements in capacity and compliance. At least 1 injection of Botox should be considered for a subset of children with refractory NGB, before undertaking more invasive treatments.

Effectiveness of standard urotherapy (basic bladder advice) and combination therapies in managing bladder dysfunction in children with treated behavioral disorders: Results of a prospective cohort (DABBED) study

We evaluated the efficacy of standard urotherapy and combination therapies in treatment of bladder dysfunction in children with treated behavioral disorders. Prospective study of children (6-16 years) with bladder dysfunction and behavioral disorders was conducted between March 2018-2020. Eligible children were initially offered standard urotherapy and those with no response at 3months were offered combination therapies. Symptomatic response, changes in Akbal score and PinQ score were reported at 6months and outcomes were correlated to behavioral diagnoses and medications. Thirty-nine consecutive children (male=27, mean age [SD] 10.3 [±2.0] years) were recruited, of whom 29 completed the study (five lost to follow-up, three non-compliant to treatment, two excluded). Thirty-four (87%) children had attention deficit/hyperactivity disorder. Monosymptomatic nocturnal enuresis (n=11) and non-monosymptomatic enuresis (n=17) were the commonest diagnoses. Following 3-month review, 14 (38%) children continued to receive standard urotherapy, while 15 (41%) children were transitioned to combination therapy. At 6-month review, complete/partial response was seen in 62% (23/37) and no response in 16% (6/37); with 32% (12/37) responding to standard urotherapy alone. Akbal symptom scores (15.9-11.5; P< 0.01) and PinQ scores (26.0-19.5; P= 0.008) improved significantly at 6-month follow-up. Type of underlying behavioral disorder(s) or medications for behavioral disorder did not influence the outcomes. This study confirms that children with underlying behavioral disorders are able to have a good response to the appropriate therapy for their bladder dysfunction with a third of children responding to standard urotherapy alone.