A Pilot Randomized Controlled Trial Evaluating the Effectiveness of Group vs Individual Urotherapy in Decreasing Symptoms Associated with Bladder-Bowel Dysfunction

Brownrigg, Natasha; Pemberton, Julia; Jegatheeswaran, Kizanee; DeMaria, Jorge; Braga, Luis H.

doi:10.1016/j.juro.2014.10.049

Cited by 17 publications

(7 citation statements)

References 19 publications

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“…urge incontinence and frequency) and voiding symptoms. Biofeedback therapy: This is indicated for children aged ≥5 years. Devices are used to provide visual, tactile and other sensory information to help patients understand the contraction of the pelvic floor muscles, and such understanding will be used to improve lower urinary tract function. Treatment of defecation problems: Correction of fluid intake, dietary intervention and use of laxatives. Urotherapy: Comprehensive conservative therapy by specialists is necessary, including: (i) good understanding of the anatomy and physiology of the lower urinary tract; (ii) advising patients on how to alleviate lower urinary tract dysfunction (e.g. appropriate urination posture, regular urination and not holding urine); (iii) advice on lifestyle (e.g.…”

Section: Capmentioning

confidence: 99%

Guidelines for the medical management of pediatric vesicoureteral reflux

et al. 2020

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Abbreviations & Acronyms BBD = bladder and bowel dysfunction CAKUT = congenital anomalies of the kidney and urinary tract CAP = continuous antibiotic prophylaxis DMSA = dimercaptosuccinic acid fUTI = febrile urinary tract infection RN = reflux nephropathy SFU = Society for Fetal Urology UTI = urinary tract infection VCUG = voiding cystourethrography VUR = vesicoureteral reflux Correspondence: HideshiAbstract: Urinary tract infection is a bacterial infection that commonly occurs in children. Vesicoureteral reflux is a major underlying precursor condition of urinary tract infection, and an important disorder in the field of pediatric urology. Vesicoureteral reflux is sometimes diagnosed postnatally in infants with fetal hydronephrosis diagnosed antenatally. Opinions vary regarding the diagnosis and treatment of vesicoureteral reflux, and diagnostic procedures remain debatable. In terms of medical interventions, options include either follow-up observation in the hope of possible spontaneous resolution of vesicoureteral reflux with growth/development or provision of continuous antibiotic prophylaxis based on patient characteristics (age, presence/absence of febrile urinary tract infection, lower urinary tract dysfunction and constipation). Furthermore, there are various surgical procedures with different indications and rationales. These guidelines, formulated and issued by the Japanese Society of Pediatric Urology to assist medical management of pediatric vesicoureteral reflux, cover the following: epidemiology, clinical practice algorithm for vesicoureteral reflux, syndromes (dysuria with vesicoureteral reflux, and bladder and rectal dysfunction with vesicoureteral reflux), diagnosis, treatment (medical and surgical), secondary vesicoureteral reflux, long-term prognosis and reflux nephropathy. They also provide the definition of bladder and bowel dysfunction, previously unavailable despite their close association with vesicoureteral reflux, and show the usefulness of diagnostic tests, continuous antibiotic prophylaxis and surgical intervention using site markings.

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Section: Capmentioning

confidence: 99%

Guidelines for the medical management of pediatric vesicoureteral reflux

et al. 2020

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“…A recent pilot study was also published about the efficacy of group visits for urotherapy which have been proposed to improve compliance and decrease the costs of care. The study was focused on older children (>5 years of age) with BBD and showed significant improvement in LUT symptoms in children receiving either individual or group therapy sessions [44]. …”

Section: Bowel and Bladder Dysfunctionmentioning

confidence: 99%

Contemporary Management of Vesicoureteral Reflux

Johnston

Qureshi

Irvine

et al. 2016

Curr Treat Options Peds

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The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative. Careful follow-up, parental education about pathophysiology and management of VUR and UTI, and management of bowel and bladder dysfunction (BBD) when present, are the foundation of treatment. Additionally, though we recognize the limitation of continuous antibiotic prophylaxis (CAP), we believe the benefits outweigh the risks and costs for many patients. Careful observation can be considered in patients with a single medical home, parental understanding of what UTI signs and symptoms are, low grade VUR, no history of complicated UTIs and close follow-up. Surgical management remains a relevant option for select patients who fail conservative measures with breakthrough UTIs or failure to resolve. Minimally invasive surgical options are available with acceptable outcomes though open ureteroneocystostomy still carries the highest success rate.

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“…Certainly, CE trials are favoured by medical staff and parents when seeking consent [45]. Despite a number of widely accepted therapies [19] there is insufficient evidence to support such a comparative treatment for NE in children. For this reason, placebo-control is still appropriate for a non-life threatening condition such as NE [44] yet concerns about their child being randomized to ineffective treatments may outweigh the benefits for some parents [45].…”

Section: Discussionmentioning

confidence: 99%

“…The most common strategies utilised are waking the child during the night to use the bathroom and limiting the child’s water intake before going to bed [18]. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children [19] with the aim to normalise bladder emptying and storage by teaching relaxed voiding techniques [20]. Alarm interventions have demonstrated moderate effectiveness in reducing NE in approximately two thirds of children with relapse occurring in half children with ceasing the treatment [21].…”

Section: Introductionmentioning

confidence: 99%

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

et al. 2019

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BackgroundNocturnal enuresis (NE), or ‘bedwetting’, is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child’s water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE.MethodsThis study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion.DiscussionThis study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition.Trial registrationAustralian and New Zealand Clinical Trials Registration Number: 12618000288224.Protocol: 23 February 2018, version 1.1.

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A Pilot Randomized Controlled Trial Evaluating the Effectiveness of Group vs Individual Urotherapy in Decreasing Symptoms Associated with Bladder-Bowel Dysfunction

Abstract: Urotherapy, regardless of modality, effectively improved bladder-bowel dysfunction symptoms. A definitive randomized controlled trial is feasible, considering that a high recruitment rate (76%) for this population has been established.

Cited by 17 publications

References 19 publications

Guidelines for the medical management of pediatric vesicoureteral reflux

Guidelines for the medical management of pediatric vesicoureteral reflux

Contemporary Management of Vesicoureteral Reflux

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

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