Refractory enuresis in children and adolescents: How can urodynamics affect management and what is the optimum test?

Elmissiry, Mostafa; Abdel-Karim, Ali M.; Badawy, Haitham; Élsalmy, Salah; Ali, Gaber

doi:10.1016/j.jpurol.2012.04.015

Cited by 12 publications

(14 citation statements)

References 18 publications

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“…After exstrophy repair, bladder capacity and compliance increase (3); it is important to determine if this is accompanied by decreased CT content as well as specific changes that lower bladder compliance, e.g., increase of the collagen type III-to-type I ratio (5,16) or elastin content (29). Many children refractory to anticholinergic therapy show dysfunction on urodynamic investigation (8). The altered phenotype described above in children is recapitulated in adults with detrusor overactivity (DO) and bladder outflow obstruction and mirrored in normal very young animals and those with DO induced by outflow obstruction (14).…”

Section: Discussionmentioning

confidence: 99%

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Functional properties and connective tissue content of pediatric human detrusor muscle

Johal

Wood

Wagg

et al. 2014

American Journal of Physiology-Renal Physiology

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The functional properties of human pediatric detrusor smooth muscle are poorly described, in contrast to those of adult tissue. Characterization is necessary for more informed management options of bladder dysfunction in children. We therefore compared the histological, contractile, intracellular Ca2+ concentration responses and biomechanical properties of detrusor biopsy samples from pediatric (3-48 mo) and adults (40-60 yr) patients who had functionally normal bladders and were undergoing open surgery. The smooth muscle fraction of biopsies was isolated to measure proportions of smooth muscle and connective tissue (van Gieson stain); in muscle strips, isometric tension to contractile agonists or electrical field stimulation and their passive biomechanical properties; in isolated myocytes, intracellular Ca2+ concentration responses to agonists. Pediatric detrusor tissue compared with adult tissue showed several differences: a smaller smooth muscle-to-connective tissue ratio, similar contractures to carbachol or α,β-methylene ATP when corrected for smooth muscle content, and similar intracellular Ca2+ transients to carbachol, α,β-methylene ATP, raised K+ concentration or caffeine, but smaller nerve-mediated contractions and greater passive stiffness with slower stress relaxation. In particular, there were significant atropine-resistant nerve-mediated contractions in pediatric samples. Detrusor smooth muscle from functionally normal pediatric human bladders is less contractile than that from adult bladders and exhibits greater passive stiffness. Reduced bladder contractile function is not due to reduced smooth muscle contractility but to greater connective tissue deposition and to functional denervation. Significant atropine resistance in pediatric detrusor, unlike in adult tissue, demonstrates a different profile of functional neurotransmitter activation. These data have implications for the management of pediatric bladder function by therapeutic approaches.

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Section: Discussionmentioning

confidence: 99%

“…CHILDHOOD ENURESIS may be refractory to conventional treatment, and those with continued symptoms may need treatments, including intravesical botulinum toxin (2,8). Urodynamic observations include poor compliance, detrusor overactivity, and outflow abnormalities.…”

mentioning

confidence: 99%

Functional properties and connective tissue content of pediatric human detrusor muscle

Johal

Wood

Wagg

et al. 2014

American Journal of Physiology-Renal Physiology

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“…Several authorshave felt that diagnoses based on UF pattern appearance without simultaneous electromyography (EMG) to support them can be misleading and that reliance on UF pattern alone can lead to over diagnoses of dysfunctional voiding (DV) and detrusor underactivity. [ 6 7 8 ] When assessing patients with lower urinary tract dysfunction, UF with EMG (UFEMG) can be superior to UF alone or a conventional UDS for improving diagnostic accuracy and selecting the most appropriate therapy. In the present study, we evaluated the role of UFEMG in evaluation of children with non-neurogenic lower urinary tract dysfunction as compared with a conventional urodynamic study.…”

Section: Introductionmentioning

confidence: 99%

Role of uroflowmetry with electromyography in the evaluation of children with lower urinary tract dysfunction

Babu¹,

Gopinath²

2015

Indian J Urol

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Introduction:A conventional urodynamic study (UDS) is considered invasive while uroflowmetry is considered inadequate in the evaluation of children with lower urinary tract dysfunction. The aims of this study were to identify the role of uroflowmetry with electromyography (UFEMG) in this group.Methods:A cohort of 121 children (age 5–12 years; M:F = 2:3) with symptoms of lower urinary tract dysfunction underwent a detailed voiding history and clinical assessment. Those with evidence of neurological abnormality, obstructive uropathy or active urinary tract infection were not included. They were prospectively studied using UFEMGfirst, followed by UDS on the same day.Results:A total of 76 (63%) children had abnormality on UFEMG while only 12 (10%) had abnormality on UDS. UFEMG was significantly superior in picking up abnormality (P = 0.03). Three types of UFEMG abnormalities were identified: (1) dysfunctional voiding (prolonged staccato trace with active pelvic floor and normal voided volume: n = 42), (2) idiopathic detrusor overactivity (shortened trace with quiet pelvic floor and reduced voided volume: n = 16) and (3) detrusor underutilization disorder (prolonged flat trace with quiet pelvic floor and large voided volume: n = 18).Conclusions:UFEMG is ideal non-invasive test in children with lower urinary tract dysfunction. It helps in identifying the different patterns and the appropriate treatment modality.

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“…Enuresis is defined by the International Children's Continence Society (ICCS) as loss of discrete amounts of urine during sleep in children older than 5 years [1]. Enuresis in children is generally benign but can cause emotional stress to children and their parents [2].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Salvage Interferential Electrical Stimulation Therapy in Patients With Medication-Refractory Enuresis: A Pilot Study

Lee

Park

2013

Int Neurourol J

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PurposeIn pediatric patients with enuresis, the protocol for salvage therapy in patients in whom first-line therapy was not successful has not yet been established. Interferential electrical stimulation (IF-ES) therapy is advantageous because it is noninvasive and shows high compliance. We aimed to investigate the efficacy and safety of IF-ES therapy on pediatric enuresis in a pilot study.MethodsWe investigated 10 patients who underwent IF-ES therapy between August 2012 and March 2013 at our clinic. Patients with a history of previous treatment with desmopressin and anticholinergic agents for at least 3 months and those in whom alarm treatment previously failed or was refused by parents were eligible. Electrical current was given starting at approximately 20 mA and was increased until the patient complained of discomfort. Treatment was performed once a week, 20 minutes per treatment, 6 times per cycle. After each cycle, an interview was performed and voiding diaries were filled. The physician in charge evaluated improvement according to the International Children's Continence Society criteria.ResultsA final analysis was performed in 10 patients (5 male and 5 female patients) in whom therapy for nocturnal enuresis had failed. Eight patients had nonmonosymptomatic enuresis and 2 had monosymptomatic enuresis. The mean age of the patients was 8.5±2.4 years, and the mean number of treatments was 10.6±3.6 times. A full response was observed in 1 patient (10%); a good response, in 1 patient (10%); a partial response, in 7 patients (70%); and no response, in 1 patient (10%).ConclusionsOur study demonstrated that IF-ES therapy can be a promising treatment for the future, is safe, and can benefit from appropriate clinical trials in carefully selected groups. IF-ES therapy is expected to be a safe and effective treatment modality for children with enuresis.

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Refractory enuresis in children and adolescents: How can urodynamics affect management and what is the optimum test?

Cited by 12 publications

References 18 publications

Functional properties and connective tissue content of pediatric human detrusor muscle

Functional properties and connective tissue content of pediatric human detrusor muscle

Role of uroflowmetry with electromyography in the evaluation of children with lower urinary tract dysfunction

Efficacy of Salvage Interferential Electrical Stimulation Therapy in Patients With Medication-Refractory Enuresis: A Pilot Study

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