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European Journal of Physical and... Sep 2012Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter, or the pelvic floor during voiding. Urinary incontinence, pelvic holding maneuvers, voiding difficulties, urinary tract infections (UTIs), constipation and vesicoureteral reflux are highly associated with DV.
AIM
To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with DV.
DESIGN
Prospective clinical controlled study
SETTING
Outpatient clinical facility
POPULATION
Forty-three children, 5-13 years of age, with dysfunctional voiding
METHODS
In addition to standard urotherapy (education, timed voiding, adequate fluid intake, voiding posture and pattern, constipation management and hygiene issues), children were assigned abdominal and PFM retraining. Diaphragmatic breathing exercises were done in lying and sitting positions, for the purpose of achieving abdominal muscle relaxation. PFM retraining consisted of low-level three-second contractions followed by thirty-second relaxation periods. Selected children received pharmacotherapy (anticholinergics or desmopressin). Recurrent symptomatic UTIs were treated with antibiotic prophylaxis. Uroflowmetry with PFM electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. Clinical manifestations and uroflowmetry parameters were analysed before and after the therapy.
RESULTS
After one year of therapy, urinary incontinence was cured in 20 out of 24 patients (83%), nocturnal enuresis in 12 out of 19 children (63%), while 13 out of 19 children (68%) were UTI free. All 15 patients recovered from constipation. Post-treatment uroflowmetry parameters showed significant improvements and a bell-shaped curve was observed in 36 out of 43 children.
CONCLUSION
In combination with standard urotherapy, abdominal and pelvic floor muscle retraining is beneficial for curing urinary incontinence, nocturnal enuresis and UTIs in children with DV, as well as for normalizing urinary function. Further trials are needed to define the most effective treatment program which would result in the best treatment outcome.
CLINICAL REHABILITATION IMPACT
To improve clinical and objective treatment outcome in dysfunctional voiders. Diaphragmatic breathing and pelvic floor muscle exercises are simple and easy to learn and could be assigned to children aged 5 or older. As they do not require special equipment, they can be performed at all health care levels.
Topics: Adolescent; Biofeedback, Psychology; Breathing Exercises; Child; Child, Preschool; Diaphragm; Electromyography; Female; Follow-Up Studies; Humans; Male; Nocturnal Enuresis; Pelvic Floor; Prospective Studies; Relaxation Therapy; Treatment Outcome; Urination Disorders; Urodynamics
PubMed: 22669134
DOI: No ID Found -
Folia Medica Cracoviensia 2021The combination of the functional disorders of urination and defecation constitutes the Dysfunctional Elimination Syndrome (DES). DES refers to an abnormal pattern of... (Review)
Review
The combination of the functional disorders of urination and defecation constitutes the Dysfunctional Elimination Syndrome (DES). DES refers to an abnormal pattern of elimination of unknown etiology characterized by bowel and bladder incontinence and withholding, with no underlying anatomic or neurologic abnormalities. Essential precondition for a child to be subsumed under this entity is the exclusion of either anatomical or neurological causative factors. In the present review study the individual entities of dysfunctional filling, such as the unstable or lazy bladder, or dysfunctional urination, such as the detrusor sphincter dyssynergia and the functional constipation are being described comprehensively. Subsequently, the analysis of the pathophysiological effects of the dysfunctional elimination syndrome such as incontinence, urinary tract infections and the conservation or the deterioration of vesicoureteric reflux, is being accentuated. With the documentation of DES, the therapeutic strategy should aim at treating both the functional disorder of the vesicourethral unit and the functional constipation. The first part does not specify depending on the type of this disorder. Rarely, surgical treatment of functional urinary disorders may be required.
Topics: Child; Constipation; Humans; Urinary Tract Infections; Urination Disorders; Vesico-Ureteral Reflux
PubMed: 34510166
DOI: 10.24425/fmc.2021.137225 -
Journal of the Formosan Medical... Mar 2018In clinical practice, many patients cannot empty their bladders within an acceptable duration. Common complaints include weak urinary stream and incomplete emptying,... (Review)
Review
In clinical practice, many patients cannot empty their bladders within an acceptable duration. Common complaints include weak urinary stream and incomplete emptying, which may affect quality of life. Bladder emptying requires sufficient detrusor contractile power, velocity, and durability. The urodynamic term for inadequate detrusor contraction is detrusor underactivity (DU). Although this definition was provided by the ICS, it may not be clinically practical. Analogous to the relationship between overactive bladder (OAB) and detrusor overactivity (DO), the symptom complex caused by DU is termed underactive bladder (UAB). Many conditions lead to UAB, such as advanced age, neurogenic bladder and BOO, but the definite pathophysiology directly leading to UAB is still being widely studied without a widely-accepted consensus. The preferred mainstream treatment for increased residual urine volume caused by UAB is intermittent catheterization, while pharmacotherapy is still disappointing after decades of development. There are no studies on surgical treatment for UAB with an acceptable level of evidence. We reviewed the recent literature on UAB and DU to provide a comprehensive discussion of the related presentation, etiology, diagnosis and management.
Topics: Humans; Urinary Bladder Diseases; Urinary Bladder, Neurogenic; Urination Disorders
PubMed: 28969876
DOI: 10.1016/j.jfma.2017.09.006 -
Sleep Medicine Reviews Apr 2011Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits... (Review)
Review
Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.
Topics: Adolescent; Adult; Comorbidity; Endpoint Determination; Humans; Nocturia; Quality of Life; Sleep Deprivation; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Urination Disorders; Young Adult
PubMed: 20965130
DOI: 10.1016/j.smrv.2010.03.002 -
International Journal of Clinical and... 2014The Urofacial (Ochoa) Syndrome (UFS) is a rare autosomal recessive disorder and over 100 patients have been reported thus far. UFS is characterized by the abnormal... (Review)
Review
The Urofacial (Ochoa) Syndrome (UFS) is a rare autosomal recessive disorder and over 100 patients have been reported thus far. UFS is characterized by the abnormal facial expression and dysfunctional voiding. The patients show a peculiar distortion of the facial expression (grimacing as if in pain or sadness when they tried to smile or laugh) along with urinary tract infection, enuresis, vesicoureteral reflux and hydronephrosis without any underlying neurological lesion and previous urinary obstruction. Some patients are also noted with nocturnal lagophthalmos. Until 2010, HPSE2, the gene encodes Heparanse 2 on chromosome 10, was thought to be the only culprit gene for this syndrome. However, another criminal gene, LRIG2, which encodes leucine-rich repeats and immunoglobulin-like domains 2, was also come into the light in 2012. Studies for dissecting the biological functions of HPSE2 and LRIG2 in urinary abnormalities are ongoing. In this minireview, we will update the discovery of novel clinical manifestations relevant to this syndrome and discuss with focus for the impact of HPSE2 on voiding dysfunction.
Topics: Animals; Facial Expression; Facies; Genetic Predisposition to Disease; Glucuronidase; Humans; Membrane Glycoproteins; Mutation; Phenotype; Risk Factors; Urinary Bladder; Urination Disorders; Urologic Diseases
PubMed: 24966895
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Jan 2005
Topics: Autonomic Nervous System; Female; Fibromyalgia; Humans; Urination; Urination Disorders
PubMed: 15643453
DOI: No ID Found -
BMJ (Clinical Research Ed.) May 2004
Review
Topics: Algorithms; Electric Stimulation Therapy; Female; Humans; Male; Medical History Taking; Physical Examination; Urinary Bladder Diseases; Urination Disorders
PubMed: 15117794
DOI: 10.1136/bmj.328.7447.1063 -
British Medical Journal Feb 1956
Topics: Diabetes Complications; Diabetes Mellitus; Humans; Urination Disorders; Urologic Diseases
PubMed: 13284347
DOI: 10.1136/bmj.1.4964.433 -
British Medical Journal Sep 1971
Topics: Flatulence; Humans; Inflammation; Urination Disorders
PubMed: 5097982
DOI: 10.1136/bmj.3.5777.769 -
Anesthesiology Jul 2013
Topics: Analgesia, Epidural; Female; Humans; Kidney; Male; Urinary Bladder; Urination Disorders
PubMed: 23856669
DOI: 10.1097/ALN.0b013e3182977002