Daytime Urinary Incontinence Research Articles

Urodynamic effectiveness of a beta-3 adrenoreceptor agonist (vibegron) for a pediatric patient with anticholinergic-resistant neurogenic detrusor overactivity: a case report

BackgroundMyelomeningocele, which causes a neurogenic bladder, is usually treated with anticholinergics in children with neurogenic detrusor overactivity (NDO); however, anticholinergics cause side effects such as dry mouth, constipation, attention deficit, and inadequate reduction in detrusor leak point pressure. Vibegron, a novel selective beta-3 adrenoreceptor agonist, is a well-established alternative to anticholinergics in adults with an overactive bladder. It remains unknown whether this agent can be used for pediatric patients. We report the case of a girl with anticholinergic-resistant NDO due to tethered cord syndrome after myelomeningocele repair, who was treated with vibegron.Case presentationA 4-year-old Filipino girl had increased frequency of daytime urinary incontinence and foul-smelling urine since the age of 3. Clinical examination revealed constipation, and urinalysis revealed bacteriuria. Voiding cystourethrography revealed an enlarged and trabeculated bladder without vesicoureteral reflux. On the urodynamic study (UDS), she was found to have detrusor overactivity (DO) and low bladder compliance. She could not void and was diagnosed with overflow incontinence. Clean intermittent catheterization (CIC) and orally administered propiverine (0.8 mg/kg/day) were initiated, and urinary incontinence was resolved. She underwent a UDS annually; the UDS at 6 years of age still revealed DO and low bladder compliance in spite of receiving propiverine. The treatment was switched from propiverine to vibegron (1.4 mg/kg/day). On the UDS after a 5-week treatment schedule of vibegron, the DO disappeared and the bladder compliance improved. CIC and orally administered vibegron have been continued for 7 months so far, and she has had no urinary tract infection with no drug-related adverse events.Conclusions Vibegron was effective and well tolerated in the treatment of a pediatric patient with NDO. Vibegron improved the urodynamic parameters for anticholinergic-resistant neurogenic bladder. This agent can be a beneficial and preferable alternative therapeutic agent to anticholinergics in patients with anticholinergic-resistant NDO.

Evaluation of a bladder and bowel training program for therapy-resistant children with incontinence

Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common disorders in children. Although standard treatment is highly effective, subgroups of incontinence (combinations of nocturnal enuresis (NE), DUI and/or FI, or with psychological comorbidity) can relapse or take a chronic course. For these complex, therapy-resistant cases, a manualized outpatient bladder and bowel training program was developed. The aim of the study was to evaluate prospectively treatment effects of this training program, including a follow-up assessment. The training program was developed for small groups of 2-6 children (of same age and sex) aged 5-12 years with adaptations for 13-16 year-old adolescents. It consists of 7-9 weekly sessions for group training and 3 weekly sessions for individual training. The training comprises information about anatomy/physiology of the urogenital tract, pathophysiology, hygiene and balanced nutrition. Voiding and drinking diaries, stress management, relaxation and emotion regulation techniques are also included. Data of 32 children (mean age 8.6 years, range 5-13 years; 21 boys), who had received standard treatment (and did not reach complete response) are presented. 14 children received group therapy, 18 (younger children) were treated individually. Children were assessed before and after the treatment, as well as at a follow-up of 6 months later. Treatment effects were measured by incontinence frequency and treatment success according to the ICCS (complete response: 100% reduction of symptoms; partial response: 50-99% reduction of symptoms). Psychological symptoms were measured by the Child Behavior Checklist questionnaire (CBCL). Frequencies of DUI were significantly reduced from 5.7 wetting episodes/week (before training) to 4.9 (after training) to 2.0 (6 months after training). Frequencies of FI were reduced from 2.9 soiling episodes/week (before training) to 1.9 (after training), but increased to 2.6 (6 months after training). According to the ICCS classification, 11.1% of children with DUI had a complete response after training and 47.6% at follow-up after 6 months. In children with FI, 33.3% reached a complete response at the end of the training and 25% at follow-up. Additionally, psychological symptoms, especially internalizing, decreased significantly during training. Further, in 14 children with comorbid NE, nighttime wetting reduced from 5.9 before training to 1.5 episodes/week at follow-up. This bladder and bowel training program is an effective and successful treatment option for children with therapy-resistant subtypes of incontinence. Symptoms still improved 6 months after training in DUI. Additionally, the training program is helpful to decrease psychological symptoms.

Влияние функционального биологического управления в режиме электромиографии на психологическое состояние детей с нарушениями мочеиспускания и дефекации неорганического генеза

Study Objective: To identify and evaluate the impact from functional biological management (FBM) in the electromyography (EMG) mode on clinical manifestations and psychological state in children with non-organic urination and defecation impairment. Study Design: prospective controlled clinical study in parallel groups. Materials and Methods. We examined 255 children of 7 to 18 years old (mean age: 10.3 ± 3.1 years) with urinary incontinence (as the only one complaint or one of a number of complaints upon hospitalisation) and non-organic (functional) urination impairment. The study group included 153 children (66 boys and 87 girls) who had daily FBM sessions (FBM therapy) in the EMG mode (10 sessions) with the standard intensity without prior electrical stimulation. The comparison group included 102 children (43 boys and 59 girls) who were treated with oral metabolic support (MS) for 1 month. A complex examination included history, physical examination, physical development assessment, complete blood test and biochemical blood assay, urinalysis, monitoring of spontaneous urination and defecation rhythms, qualimetric tables, US examination of kidneys, urinary bladder and abdominals, urofluometry, and, if indicated, X-ray or endoscopic examinations and rectum sphincter examination. A complex psychological assessment was performed prior to and after therapy, and prevailing emotions, anxiety levels, ambitions, and self-esteem were identified. Study Results. It was found out that the children with non-organic urination impairment had mostly non-monosymptomatic enuresis (non-ME) (148 (58%)); monosymptomatic enuresis (ME) was diagnosed in 61 (24%) patients, while daytime urinary incontinence (DUI) was recorded in 46 (18%) children, with the peak detectability being at the age of 7 to 10 years. In 41.2% and 43.1%, non-organic urinary impairments (33.3% children with non-ME and 7.8% and 9.8% children with DUI) were combined with chronic constipation and faecal incontinence associated with accompanying pelvic organs impairment. FBM therapy in EMG mode was highly efficient in children both with non-organic urination impairment (84.4%) and accompanying pelvic organs impairment (74.6%); while metabolic support was efficient only in 48.3% and 40.9% of cases, respectively (р < 0.001 in both cases). Children with non-organic urination impairment and accompanying pelvic organs impairment had mostly negative emotions, increased anxiety, low ambitions and self-esteem because of the disease. Unlike metabolic support, FBM therapy in EMG mode had statistically significant impact on the shift to positive emotions, reduced anxiety, improved ambitions and self-esteem. Conclusion. When used in children with non-organic urination impairment and accompanying pelvic organs impairment, FBM therapy in EMG mode can not only arrest clinical symptoms of the disease, but also replaces negative emotions with positive ones, reduces anxiety, improves ambitions and self-esteem, resulting in higher quality of life. Keywords: impaired urination, enuresis, daytime urinary incontinence, accompanying pelvic organs impairment, functional biological management, anxiety, ambitions, self-esteem.

Evaluation of boys with daytime incontinence by combined cystourethroscopy, voiding cystourethrography and urodynamics

Objects: Approximately, 1% of school children have daytime urinary incontinence. The symptoms may be caused by an overactive bladder (OAB). In the evaluation of boys with OAB complaints, one should consider a possible urethral cause. The aim of the study was to evaluate the value of a diagnostic regime with cystourethroscopy, voiding cystourethrography (VCUG) and urodynamic pressure-flow studies in boys with OAB complaints after unsuccessful urotherapy and pharmacological therapy. Materials and Methods: Seventy-five boys (5–14 years old) were investigated with cystourethroscopy and within 24 h thereafter VCUG followed by urodynamic combined cystometry and pressure-flow study. All boys had daytime incontinence and urgency. Results: Sixty-one boys had no suspected urethral valves at cystoscopy or VCUG, and urodynamics showed no obstructed Pdet-Qmax. All 61 boys had detrusor overactivity. Two boys had late diagnosed urethral valves. In four boys, the initial cystourethroscopy was described as normal. The VCUG indicated presence of posterior urethral valves, but urodynamics showed no obstructed Pdet-Qmax. In eight boys, the initial cystourethroscopy was described as normal whereas urodynamics showed obstructed Pdet-Qmax. In four of these boys, VCUG showed abnormalities in the sphincter area but they were not described as suspected urethral valves. At repeat cystourethroscopy, urethral valves could still not be identified. Patient follow-up regarding achievement of continence after investigation guided treatment was in accordance with the literature. Conclusions: Boys can be safely evaluated by cystourethroscopy followed by urodynamics in search for a possible urethral problem. It is our suggestion, that VCUG can be restricted to those boys where urodynamics indicates obstruction or the findings by cystourethroscopy are uncertain.

PATIENT-REPORTED OUTCOME AFTER ILEAL NEOBLADDER

(Objectives) Investigation of patient-reported outcome (PRO) after ileal neobladder for bladder cancer. (Patients and methods) Forty patients who underwent radical cystectomy and ileal neobladder between July 2007 and December 2017 were asked to complete a questionnaire. PRO was evaluated using the Medical Outcomes Study Short Form-8 (SF-8) for general health-related quality of life (QOL) and the Bladder Cancer Index and the Japanese version of the Functional Assessment of Cancer Therapy-Bladder for disease specific QOL. Patients were divided into two groups according to the postoperative period (early and late), and the differences in questionnaire results between the groups were evaluated. (Results) All scores on the SF-8 were over 50 points, exceeding the Japanese national standard of 50 points for all items. The physical and mental summary scores were also favorable. For disease-specific QOL, only daytime incontinence was significantly higher in the late group, with daytime incontinence two or more times per week at 42.1%, compared to 20.0% in the early group (P=0.0403). A comparison of daytime urinary incontinence in four groups during the postoperative period showed that urinary incontinence was least frequent among patients between 64 and 101 months after surgery; patients in this group were also the youngest in age at the time of surgery. (Conclusions) Cross-sectional analysis of PRO revealed that patients with ileal neobladder had good general health-related QOL after surgery, but urinary incontinence was a significant problem.

Elimination disorders - ICD-11 classification and definitions

Elimination disorders - ICD-11 classification and definitions Abstract. Elimination disorders are common in children and are can be divided into three main groups: nocturnal enuresis, daytime urinary incontinence, and encopresis or fecal incontinence. There are also many subgroups that can be diagnosed exactly. This review critically presents the definitions and the classification suggestions of the ICD-11. It compares the definitions of enuresis according to ICD-11 with those of nocturnal enuresis and daytime urinary incontinence of the ICCS. It also contrasts encopresis according to ICD-11 with functional constipation and nonretentive fecal incontinence by the Rome-IV criteria. It becomes apparent that the ICD-11 does not reflect current research findings; that it does not render specific diagnoses, which are prerequisites for effective treatment; and that it is not exact enough for research. In conclusion, the ICCS and Rome-IV definitions are the preferred classification systems in clinical practice and research.

Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases.

Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Should we routinely assess psychological morbidities in idiopathic lower urinary tract dysfunction: ICI-RS 2019?

Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.

Validation of the effectiveness of a modified Studer orthotopic neobladder in a single center after 3 years of its application.

In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively. In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the EAU guidelines. We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4-1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease. The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.

Incontinence in persons with tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by a mutation in the TSC1 or TSC2 gene with a broad spectrum of physical and psychological manifestations. The aim of the study was to examine incontinence, psychological problems, and adaptive behavior skills in patients with TSC. Through a worldwide TSC support group, 26 children (4-17 years) and 15 adults (18-50 years) with TSC were recruited (38.1% male, mean age 16.4 years). Parents or care-givers completed the Developmental Behavior Checklist (DBC), the Parental Questionnaire: Enuresis/urinary Incontinence, and the Vineland Adaptive Behavior Scales (3rd edition). A total of 60.0% of the participants had nocturnal enuresis (NE), 51.3% daytime urinary incontinence (DUI) and 52.4% fecal incontinence (FI). 65.4% of children and 50.0% of adults had a clinically relevant DBC score. Psychological symptoms were associated with at least one subtype of incontinence. The mean adaptive behavior composite (ABC) score of the patients was 57.2 (SD = 26.1), with 38.1% in the average or below-average range (IQ >70), 26.2% with a mild, 11.9% with a moderate and 23.8% with a severe/profound intellectual disability. The incontinence rate was significantly higher in the groups with a lower ABC score. A substantial proportion of patients with TSC are affected by incontinence and psychological symptoms. Incontinence was higher in persons with lower adaptive skills and those with at least one type of incontinence showed a significantly higher DBC score. As incontinence and psychological problems affect daily functioning and well-being, assessment, and treatment are recommended.

Incontinence in persons with fetal alcohol spectrum disorders: a polish cohort

Fetal alcohol spectrum disorders(FASD) is an important preventable public health concern, associated to a number of common pediatric problems such as incontinence. Little is known about the prevalence and presentation of incontinence in FASD, which hinders effective management. The aim of the present study was to investigate incontinence among people with FASD. Parental questionnaires were sent to all eligible FASD participants. To enable comparing the observed prevalence with typically developing, non-prenatally alcohol-exposed individuals, two clinical control groups of patients undergoing immunotherapy for pollen allergy (GKA) and patients diagnosed with celiac disease (GKG) were selected. A total of 119 participants were included in the study (FAS: n=24, partial fetal alcohol syndrome [pFAS]: n=19, alcohol-related neurodevelopmental disorder [ARND]: n=28, GKA: n=34, and GKG: n=14). Overall incontinence for FASD was estimated to be 24% (confidence interval [CI] ranges from 15 to 36); nocturnal enuresis (NE) was present in 10% (CI ranges from 4 to 19), daytime urinary incontinence (DUI) in 11% (CI ranges from 5 to 21), and fecal incontinence (FI) in 13% (CI ranges from 6 to 23). Symptoms of urgency were present for 52%, voiding postponement for 10%, and straining for 2%. These data are both consistent with higher prevalence in individuals with FASD and with similar prevalence (the CIs overlap). Children and adolescents with FAS, pFAS, ARND, GKA, and GKG are affected by incontinence. Highest rates were observed in pFAS and ARND. Persons with FAS were mostly affected by DUI, those with pFAS by NE, and those with ARND by FI.

Alarm Treatment for Combined Enuresis and Daytime Urinary Incontinence in Children

Alarm Treatment for Combined Enuresis and Daytime Urinary Incontinence in Children

Complete resolution of urinary incontinence with treatment improved the health-related quality of life of children with functional daytime urinary incontinence: a prospective study

BackgroundTo assess the health-related quality of life (HRQOL) of children with daytime urinary incontinence (DUI) based on pre- and post-treatment self-reports and parent proxy-reports.MethodsThe study population comprised 117 children with at least one episode of DUI per week and their caregivers as well as 999 healthy children (control group). The Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaire was administered to assess the HRQOL of children. To assess the degree of improvement in HRQOL, we categorized children into two groups: group A achieved complete response (CR) to treatment within 12 months and group B did not achieve CR within 12 months. CR was defined as the complete resolution of symptoms or alleviation of symptoms to < 1 DUI episode/month.ResultsValid responses were collected from 84 children [53 boys and 31 girls; mean age: 7.9 ± 1.5 years (range, 6–12)]. Sixty-two patients (73.8%) were classified into group A and 22 (26.1%) into group B. Based on self-reports, significant post-treatment improvement was observed in the scores of all PedsQL items (mean total score: 82.2 ± 11.3 vs. 87.2 ± 9.8; P = 0.003). Group A showed significant improvement in the scores of all PedsQL items after achievement of CR based on child self-reports; however, this was improvement not observed in group B.ConclusionsTo the best of our knowledge, this is the first study to demonstrate the complete resolution of DUI with treatment for improving the HRQOL of these children.

Paediatric bladder dysfunction: A single centre experience of public hospital wait times.

Paediatric bladder dysfunction, including daytime urinary incontinence and enuresis, is a common and distressing condition. Unfortunately, children with these symptoms are often on waitlists for several months. This treatment delay may significantly impact upon the child and family unit. This study aimed to quantify waiting times for children who had attended hospital outpatient clinics for symptoms of wetting. A retrospective review was undertaken for patients who had been referred to The Royal Children's Hospital, Melbourne outpatient clinics for symptoms of wetting (with/without bowel symptoms). Data regarding the referral and triage pathway, up to the time of the first clinic appointment, were collected. These data were compared to a previous audit conducted in the same setting. A total of 101 clinic attendances were included in this study. The overall waiting time, from receipt of referral to the patient's first clinic attendance, was a median of 181 days (n = 94 valid responses; range 7-695). Wait times for patients with isolated symptoms of wetting were similar to patients with mixed bowel and bladder dysfunction (187 and 171.5 days, respectively). Most patients were triaged to the continence clinic (n = 68), whilst smaller proportions of patients were seen in the encopresis (n = 14), urology (n = 13), general medicine (n = 2), gastroenterology (n = 1) and nurse-led enuresis clinic (n = 3). The waiting times for patients with wetting generally exceeded 5 months. Alternative pathways for triage need to be explored to manage demand and improve wait times.

İşeme Bozukluğu Olan Çocuk Hastalarda Yaşam Kalitesi ve Etkileyen Faktörlerin Değerlendirilmesi

Objective: Health-related quality of life and its influencing factors in pediatric patients with voiding dysfunction and their parents was assessed. Method: The patients who were admitted with urinary incontinence for at least 6 months to the clinics of pediatrics and pediatric nephrology were enrolled in the study. The patients were divided into three group as daytime urinary incontinence (DUI), enuresis and both DUI and enuresis. The Pediatric Quality of Life InventoryTM (PedsQLTM) was administered to patients and mothers. Results: A total of 100 patients with voiding dysfunction aged from 5 years to 18 years (mean age: 8.8±2.6) were included in the study. The mean dysfunctional voiding symptom score was 15.5±6.6 in all groups and significantly higher in the group who experienced both DUI and NE (p&lt;0.001). No significant difference was observed in terms of mean PedsQL scores of the children and their parents between groups with urinary incontinence (65.5±16 and 58.4±13.5, respectively), but strong positive correlation was obtained (p&lt;0.001). The mean PedsQL score for the children aged from 8 years to 12 years was significantly lower than the scores for the children aged from 5 years to 7 years old (p&lt;0.05). The mean PedsQL score for the children aged from 13 years to 18 years was not different from the other age groups. Conclusions: The early diagnosis and treatment of patients aged from 8 years to 12 years who had the lowest PedsQL score is important. Additionally, the success in improvement of the quality of life of children with voiding dysfunction require cooperation with parents.

Alarm therapy or desmopressin? Insight for pediatric monosymptomatic nocturnal enuresis in meta-analysis approach

Monosymptomatic nocturnal enuresis (MNE) is a common pediatric problem. MNE is defined as involuntary urine voiding during sleep without other LUTS, such as daytime urinary frequency, urgency, or incontinence of urine. Most of nocturnal enuresis patients are MNE. Various interventions have been used for treatment and problems are emerging from desmopressin withdrawal and alarm therapy continuation issue. Study aims to compare efficacy of alarm therapy and desmopressin, also strategy to improve it. Studies searched throughout Medline, PubMed, Embase, and Cochrane since 2010 until 2019. Keywords were desmopressin, alarm therapy, pediatric, and monosymptomatic enuresis. Inclusion criteria were RCT in english language and no drop-out subject. Trials without specific number of subjects were not eligible. Studies using response rate as dependent variable. Total 12 studies were eligible for this meta-analysis with 9 studies collected for response rate and 3 studies for desmopressin withdrawal strategy. From those 9 studies comparing response rate showed alarm therapy significantly outperformed desmopressin in well-motivated parent and patients (p=0.02) with pooled Risk Ratio was 1.10, Z score was 2.31 and pooled heterogeneity (I2) was 32%. Strategy to improve desmopressin withdrawal portrayed by 3 was fully favored for structured strategy than abrupt in dose dependent matter (p=0.001; I2=0%; Z score = 3.26) but not in time dependent parameter (p=0.24; I2=0%; Z score = 1.17). This meta-analysis study showed alarm therapy is superior to desmopressin regarding response rate in well-motivated parents, but in opposite subjects, desmopressin still be the choice. In addition, it is necessary to use structured dose withdrawal strategy to optimize therapy.

Treatment of daytime urinary incontinence in children: a brief review

Treatment of daytime urinary incontinence in children: a brief review

Bladder and Bowel Dysfunction in Korean Children with Down Syndrome and Parental Quality of Life

PurposeChildren with Down syndrome (DS) are more likely to experience bladder bowel dysfunction (BBD) than typically developing children, which could in turn have a serious effect on children with DS and on their parents and other family members. This study aimed to explore the prevalence of BBD in Korean children with DS and its effect on parental quality of life (QOL). Design and methodsTo assess BBD and parental QOL, we used self-administered questionnaires (Dysfunctional Voiding Symptom Score [DVSS], Rome IV criteria, and World Health Organization Quality of Life scale [WHOQOL-BREF]) for parents of children with DS. We collected data from 86 parents between September and October 2017 through an online community website. ResultsDVSS was elevated in 26.7% of the children with DS. Specifically, 14% had daytime urinary incontinence, and 33.7% had functional constipation. Moreover, 18.6% of children had BBD according to the DVSS and Rome IV criteria. The sensitivity and specificity of DVSS to functional constipation was 55.17% and 87.72%, respectively. The BBD score and total parental QOL score were statistically correlated (r = 0.291, p = 0.007). ConclusionsAlthough children with DS are a high-risk group for BBD, their BBD symptoms are often overlooked because of their intellectual disability. Consequently, this could negatively affect children's and family's health and QOL in the long term. Practice implicationsHealth-care providers should reconsider a routine check-up of BBD in children with DS. If a child has BBD, health-care providers should consult a urologist to determine the appropriate diagnosis and intervention.

Incontinence and psychological symptoms in Phelan-McDermid syndrome.

Phelan-McDermid syndrome (PMD) is a congenital syndrome caused by a deletion on chromosome 22q13.3. About 600 cases have been identified worldwide. PMD is characterized by neonatal hypotonia, moderate/severe intellectual impairment, impaired expressive language, and typical dysmorphic features. Psychological symptoms as hyperactivity, attention problems, restlessness, and stereotyped-repetitive behavior were reported. The aim of the study was to assess incontinence and associated psychological problems in PMD. Forty-one individuals with PMD were recruited through a German support group (48.8% male; mean age 13.4 years; range, 4-55 years). Parents or caregivers completed the developmental behavior checklist (DBC), as well as the parental questionnaire: enuresis/urinary incontinence, including six questions on adaptive toileting skills. Rates of nocturnal enuresis (NE), daytime urinary incontinence, and fecal incontinence were 86%, 73%, and 79%. Rates were similar in all age groups (children, teens, adults). Constipation was present in 19%. Forty-two percent of the sample had a clinically relevant DBC score, with adults more affected than teens. Persons with NE had significantly higher "anxiety/depression" subscale scores. Toileting skills were more developed in adults than in children. Sixty-eight percent had further physical disabilities. Incontinence rates in PMD are high in all age groups. However, persons with PMD can improve their toilet skills. Therefore, the assessment and treatment of incontinence in persons with PMD is recommended. Constipation does not seem to be a major problem in PMD. Due to the high prevalence rates of somatic conditions, an assessment for organic and functional incontinence is recommended.

Current pharmacological management of idiopathic overactive bladder in children in the UK: a national survey of practice

Children with daytime urinary incontinence secondary to idiopathic overactive bladder (IOAB) commonly present to paediatric urologists following failure of standard urotherapy and/or 1st-line anticholinergics. Off-label oral medications and intravesical botulinum toxin A (BtA) are being increasingly used for treatment-refractory IOAB, despite the paucity of high-quality evidence and guidelines. Knowledge of contemporary paediatric urologists' practice allows specialists to keep up-to-date with current trends in the management of IOAB in children. 1. To present an analysis of contemporary tertiary management of IOABin children and 2. to highlight current trends in practice and identify areas of high variability in care for targeted research. Paediatric urologists (55 individuals) who attended the 2018 national British Association of Paediatric Urologists (BAPU) congress responded to a 20-question survey presented at the congress. Respondents could submit one answer per question, and one survey was taken per respondent, using secure software to disable any manipulation. Answers were analysed prospectively by a single reviewer. Of UK paediatric urologists, 98% regularly manage children with IOAB, 48% use 48-hfrequency/volume charts and others use three or seven-day bladder diaries to aid diagnosis. Oxybutynin is the 1st-line therapy for 85%, 2nd-line is tolterodine (53%), and 3rd-line is solifenacin (41%). Mirabegron is used either alone or in combination with solifenacin as 4th-line management by 55%. Those who use intravesical Botulinum toxin A (BtA) accounted for 81% and 84% of these perform invasive urodynamic assessment prior to BtA administration. Post-BtA, assessment was clinical in 18%, 24% use invasive urodynamics, whereas uroflowmetry is preferred by 58%. Of the paediatric urologists, 72% believe the most clinically significant outcome of treatment is patient-reported improvement. Treatment success is defined variably: 49% define success as completely dry, whereas 35% accept a 90% improvement as success. Off-label medications are being used widely either alone or in combination by paediatric urologists. In oral therapy-resistant IOAB, BtA is being used by the majority of specialists, usually after formal urodynamic assessment. However, post-BtA assessment and evaluation of treatment success for IOAB are variable.