Rehabilitation strategies for low anterior resection syndrome. A systematic review.

OBJECTIVE: To summarize the evidence in the literature about rehabilitative treatments that reduce low anterior resection syndrome (LARS) symptoms in patients who underwent surgery for colorectal cancer. METHODS: We have search in PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health and Scopus databases. Studies selected were limited to those including only patient undergone low rectal resection with sphincter preservation and with pre-post assessment with a LARS score. Five articles fit the criteria. RESULTS: The percutaneous tibial nerve stimulation demonstrated moderate results and sacral nerve stimulation was found to be the best treatment with greater symptom improvement. Only one study considered sexual and urinary problems in the outcomes assessment. CONCLUSIONS: In clinical practice patients should evaluate with the LARS and other score for evaluation of urinary and sexual problems. Future research must be implemented with higher quality studies to identify the least invasive and most effective treatment/s.

A Review of Functional Electrical Stimulation Treatment in Spinal Cord Injury.

Functional electrical stimulation (FES) has been widely adopted to elicit muscle contraction in rehabilitation training after spinal cord injury (SCI). Conventional FES modalities include stimulations coupled with rowing, cycling, assisted walking and other derivatives. In this review, we studied thirteen clinical reports from the past 5 years and evaluated the effects of various FES aided rehabilitation plans on the functional recovery after SCI, highlighting upper and lower extremity strength, cardiopulmonary function, and balder control. We further explored potential mechanisms of FES using the Hebbian theory and lumbar locomotor central pattern generators. Overall, FES can be used to improve respiration, circulation, hand strength, mobility, and metabolism after SCI.

Closed-loop stimulation of the pelvic nerve for optimal micturition.

OBJECTIVE: Neural stimulation to restore bladder function has traditionally relied on open-loop approaches that used pre-set parameters, which do not adapt to suboptimal outcomes. The goal of this study was to examine the effectiveness of a novel closed-loop stimulation paradigm for improving micturition or bladder voiding. APPROACH: We compared the voiding efficiency obtained with this closed-loop framework against open-loop stimulation paradigms in anesthetized rats. The bladder pressures that preceded voiding, and the minimum current amplitudes for stimulating the pelvic nerves to evoke bladder contractions, were first calibrated for each animal. An automated closed-loop system was used to initiate voiding upon bladder fullness, adapt the stimulation current by using real-time bladder pressure changes to classify voiding outcomes, and halt stimulation when the bladder had been emptied or when the safe stimulation limit was reached. MAIN RESULTS: In vivo testing demonstrated that the closed-loop system achieved high voiding efficiency or VE (75.7% ± 3.07%, mean ± standard error of the mean) and outperformed open-loop systems with either conserved number of stimulation epochs (63.2% ± 4.90% VE) or conserved charge injected (32.0% ± 1.70% VE). Post-hoc analyses suggest that the classification algorithm can be further improved with data from additional closed-loop experiments. SIGNIFICANCE: This novel approach may be applied to an implantable device for treating underactive bladder (<60% VE), especially in cases where under- or over-stimulation of the nerve is a concern.

Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury.

STUDY DESIGN: Exploratory qualitative. OBJECTIVES: The aim of this study was to describe the experiences of bowel and bladder dysfunction on social activities and relationships in people with spinal cord injury living in the community. SETTING: People living with spinal cord injury experiencing bowel and bladder dysfunction. METHODS: Participants were recruited through the Australian Quadriplegic Association Victoria. Semi-structured in-depth interviews were undertaken with purposively selected participants to ensure representation of age, gender, spinal cord injury level and compensation status. A thematic analysis was performed to interpret patient experiences. RESULTS: Twenty-two participants took part in the study. Bladder and bowel dysfunction altered relationships because of issues with intimacy, strained partner relationships and role changes for family and friends. A lack of understanding from friends about bladder and bowel dysfunction caused frustration, as this impairment was often responsible for variable attendance at social activities. Issues with the number, location, access and cleanliness of bathrooms in public areas and in private residences negatively affected social engagement. Social activities were moderated by illness, such as urinary tract infections, rigid and unreliable bowel routines, stress and anxiety about incontinence and managing the public environment, and due to continuous changes in plans related to bowel and bladder issues. Social support and adaptation fostered participation in social activities. CONCLUSION: Tension exists between managing bowel and bladder dysfunction and the desire to participate in social activities. Multiple intersecting factors negatively affected the social relationships and activities of people with spinal cord injury and bowel and bladder dysfunction.

Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.

INTRODUCTION: Although the short-term effects of urotherapy as a treatment strategy for lower urinary tract (LUT) conditions have been well documented, the long-term effects remain largely unknown. A better insight into the long-term effects of urotherapy could improve the clinical guidelines for children with incontinence. OBJECTIVE: This study aimed to investigate the long-term effects (i.e., from 6 months to 2 years) from a clinical voiding reeducation program among children with LUT conditions. STUDY DESIGN: This study was a prospective continuation of the follow-up study of Hoebeke et al. (2011). Thirty-eight children (mean age 9 years) with LUT conditions completed an extensive clinical voiding reeducation program (VS). Data on medication, voiding, drinking, pelvic floor tone, uroflowmetry, and incontinence were recorded 2 years after the VS. These data were compared with the outcomes at 6 months follow-up and at intake before voiding school. RESULTS: Six months after voiding school, 22 children continued having daytime incontinence (ID) and/or enuresis (EN). Six of them became dry at 2 years. Conversely, 16 children were dry at 6 months, of which eight relapsed at 2 years. Whereas all parameters significantly improved 6 months after VS, further improvements from 6 months to 2 years could only be noticed for the proportion of children suffering from overactive bladder (92% at intake, 55% at 6-month follow-up and 18% at 2-year follow-up) (Figure). Fluid intake and pelvic floor tone improved after 6 months, but showed a significant relapse after 2 years (P = 0.013, P = 0.031, respectively). DISCUSSION: Hoebeke et al. (2011) concluded that results continued to improve after VS. No further improvements could be noticed 2 years after VS, although individual shifts were present. The results of the present study underline the value of long-term follow-up to detect those needing ongoing treatment to prevent relapse. Fluid intake and pelvic floor tone deteriorated from 6 months to 2 years. It could be hypothesized that inadequate fluid intake, possibly leading to decreased voided volumes, may be seen as an indicator for upcoming incontinence relapse. It could be stated that adequate fluid intake and pelvic floor tone may play a role in remaining continent for the long term. Study limitations should be considered. The study population was heterogeneous and rather small. Together with other missing values, this could have influenced the results. CONCLUSION: Close individual, long-term follow-up after clinical voiding reeducation in children is recommended in order to timely detect and prevent potential relapse.

Pelvic Floor Physical Therapy as Primary Treatment of Pelvic Floor Disorders With Urinary Urgency and Frequency-Predominant Symptoms.

OBJECTIVE: To assess the efficacy of pelvic floor physical therapy (PFPT) as primary treatment of urinary urgency and frequency symptoms METHODS: We conducted a prospective cohort study of women with urinary urgency and frequency symptoms. Participants underwent PFPT once or twice per week for 10 weeks. Symptom improvement was assessed by validated questionnaires (Pelvic Floor Distress Inventory-Short Form 20 and Patient Global Impression of Improvement), voiding diaries, and subjective measures. RESULTS: Fifty-seven participants enrolled; 21 (36.8%) withdrew or completed less than 5 weeks of PFPT. Thirty-one (54.4%) of the remaining 36 participants completed 10 weeks of PFPT. The mean age of the study group (n = 36) was 48.9 ± 15.0 years. The primary diagnoses were overactive bladder syndrome (n = 24, 66.7%) and painful bladder syndrome (n = 12, 33.3%). Women attended a median of 14.0 (interquartile range [IQR], 8.0-16.0) PFPT visits over a median of 11.9 weeks (IQR, 10.0-18.1). At baseline, the median Pelvic Floor Distress Inventory-Short Form 20 score was 79.2 (IQR, 53.1-122.9), and decreased to 50.0 (IQR, 25.0-88.5; P < 0.001) after PFPT; the urinary and prolapse symptom subscales both decreased significantly. Participants reported a decrease from a median of 10.0 voids per day to 8.0 (P < 0.001). On the Patient Global Impression of Improvement, 62.5% of women reported that they were "much better" or "very much better." CONCLUSIONS: The PFPT with myofasical release techniques improves urinary symptoms while avoiding medications and more invasive therapies. The high dropout rates suggest that motivation or logistic factors may play a significant role in the utilization and success of this treatment option.

Functional electrical stimulation cycling has no clear effect on urine output, lower limb swelling, and spasticity in people with spinal cord injury: a randomised cross-over trial.

QUESTION: Does functional electrical stimulation (FES) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury? DESIGN: Randomised cross-over trial. PARTICIPANTS: Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney. INTERVENTION: Participants were randomised to an experimental phase followed by a control phase or vice versa, with a 1-week washout period in between. The experimental phase involved FES cycling four times a week for two weeks and the control phase involved standard rehabilitation for two weeks. Assessments by a blinded assessor occurred at the beginning and end of each phase. Allocation was concealed and an intention-to-treat analysis was performed. OUTCOME MEASURES: The primary outcome was urine output (mL/hr) and the secondary outcomes were lower limb circumference, and spasticity using the Ashworth Scale, and the Patient Reported Impact of Spasticity Measure (PRISM). In addition, participants were asked open-ended questions to explore their perceptions about treatment effectiveness. RESULTS: All participants completed the study. The mean between-group difference (95% CI) for urine output was 82mL/hr (-35 to 199). The mean between-group differences (95% CI) for lower limb swelling, spasticity (Ashworth), and PRISM were -0.1cm (-1.5 to 1.2), -1.9 points (-4.9 to 1.2) and -5 points (-13 to 2), respectively. All point estimates of treatment effects favoured FES cycling. Participants reported many benefits from FES cycling. CONCLUSION: There were no clear effects of FES cycling on urine output, swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects. TRIAL REGISTRATION: ACTRN12611000923965.

Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding.

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.

[Ketamine-induced vesicopathy]. / Ketamininduzierte Vesikopathie.

We report about a 25-year-old patient with transnasal ketamine abuse over years presenting with severe irritative urinary dysfunction (imperative urinary urgency, pollakisuria, dysuria) and severe alguria. Cystoscopia showed ketamine-induced vesicopathy with errosive cystitis; other etiologies could be excluded. Despite serious effort the patient was not motivated for abstinence from ketamine. After two ineffecient therapies with botulinum toxin A (200 and 400 I. E.) injected into the bladder, a prostate preserving cystectomia and ileum neobladder were mandatory.

Risk factors for persistent low bladder compliance after radical hysterectomy.

INTRODUCTION: Bladder compliance deteriorates immediately after radical hysterectomy (RH), and low bladder compliance causes upper urinary tract dysfunctions such as progressive hydronephrosis. The aims of this study were to clarify risk factors for persistent low bladder compliance after RH and to propose a postsurgical management protocol for improved recovery of bladder function. METHODS: A total of 113 consecutive patients who underwent RH with the intention to preserve the pelvic autonomic nerve system were included in this prospective study. Urodynamic studies were performed according to a planned schedule: presurgery and 1, 3, 6, and 12 months after surgery. Autonomic nerves were preserved at least unilaterally in 95 (84.1%) of the 113 patients, but this was not possible in the remaining 18 patients (15.9%). Postoperative adjuvant radiation therapy (RT) was performed in 14 patients. The relationships between bladder compliance and various clinical factors were investigated using logistic regression analysis. Covariates included age, nerve-sparing procedure, adjuvant RT, and maximum abdominal pressure during the voiding phase. Bladder compliance at 12 months after surgery was used as the dependent variable. RESULTS: Radical hysterectomy with a non-nerve-sparing procedure (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-11.0), adjuvant RT (OR, 10.3; 95% CI, 2.5-43.5), and voiding with abdominal pressure at 3 months after surgery (OR, 2.9; 95% CI, 1.1-7.2) were risk factors for persistent low bladder compliance. CONCLUSIONS: A nerve-sparing procedure and prohibition of voiding with abdominal strain during the acute and subacute phases after RH resulted in improved recovery of bladder compliance. Adjuvant RT should be avoided in patients who undergo nerve-sparing RH if an alternative postoperative strategy is possible.

Regeneration and functional recovery of intrapelvic nerves removed during extensive surgery by a new artificial nerve conduit: a breakthrough to radical operation for locally advanced and recurrent rectal cancers.

PURPOSE: In the current strategy against locally advanced and recurrent rectal cancers possibly involving intrapelvic nerves, there has been a serious dilemma between extensive surgery and limited surgery. The former can attain high tumor curability by sacrificing the nerve functions while the latter prioritizes the patient quality of life by preserving the nerve functions but with a compromised curability. Here we present a new surgical strategy for locally advanced and recurrent rectal cancers, which realize both high tumor curability and good quality of life. METHODS: A new artificial nerve conduit (polyglycolic acid collagen tube) developed by in site tissue engineering technology was applied to recovery the disturbed functions after removing the nerves from 11 patients undergoing extensive surgery for intrapelvic advanced or recurrent colorectal cancers. The reconstructed nerves included eight autonomic nerves which are essential for the genitourinary function and three somatic nerves which control the sensation and mobility of the legs. RESULTS: Out of ten cases followed up more than 2 years and evaluated fully, eight including two report cases showed a functional recovery of the disturbed autonomic and somatic nerves clinically. The nerve function started to recover from 3 to 6 months after the operation and continued to improve with times. No specific complications associated with the nerve repair have been noted. CONCLUSIONS: The new strategy utilizing the nerve conduit can be a breakthrough in radical operations for locally advanced and recurrent rectal cancers to resolve the problems between tumor curability and the patient quality of life.

Duloxetine treatment of long-term ketamine abuse-related lower urinary tract symptoms: a case report.

OBJECTIVE: To report a case of ketamine abuse-related lower urinary tract symptoms (LUTS) in a depressed patient, who was successfully treated with duloxetine. CASE REPORT: A 19-year-old woman with long-term (3 years) daily ketamine abuse had developed moderate depressive symptoms after forced cessation of ketamine use, together with severe LUTS of 3 months' duration. Urinary analysis and culture revealed negative results, and treatment with antibiotics was unsuccessful. Ketamine abuse-related LUTS were suspected and duloxetine was prescribed at 60 mg daily. After 2 weeks, the symptoms of depression and LUTS had been relieved. CONCLUSIONS: Duloxetine can be considered as one of the therapeutic drugs of choice for depressive patients with significant LUTS.

Fisioterapia na cistite intersticial / Physical therapy on interstitial cystitis

Cistite intersticial (CI) é uma síndrome de etiologia desconhecida, multifatorial, que provoca sintomas no trato urinário inferior como aumento na frequência urinária, urgência miccional, noctúria, acompanhada de dor vesical que frequentemente é aliviada após a micção. A prevalência é maior nas mulheres, que podem apresentar dor em região suprapúbica, perineal, vaginal e, não raramente, dispareunia. A conduta terapêutica é difícil, pela baixa eficácia nos tratamentos oferecidos e pelo alto impacto da doença na qualidade de vida dos pacientes. A fisioterapia surge como um tratamento promissor e de papel fundamental na melhora sintomatológica e redução da disfunção do assoalho pélvico, que comumente acometem os portadores dessa síndrome. Apesar da escassez de trabalhos científicos, principalmente no Brasil, utilizando apenas técnicas fisioterapêuticas, esta revisão discutiu o papel da fisioterapia na CI, enfatizando a terapia manual para o assoalho pélvico (massagem de Thiele) e a terapia comportamental como técnicas mais empregadas para alívio dos sintomas e melhoria na qualidade de vida dos pacientes

Interstitial cystitis (IC) is a mulfactorial syndrome with unknown etiology, which causes symptoms on the lower urinary tract characterized by urinary frequency, urgency, nocturia and bladder pain that diminishes with bladder emptying. The prevalence is significantly higher in women who may have suprapubic, vaginal, perineal pains and dyspareunia. The therapeutic is difficult due to the lower efficiency of the treatments offered and the higher impact in the quality of patients' life. The physical therapy appears tobe a promising treatment and has a fundamental part on the symptoms improvement and reduction of pelvic floor dysfunction. In spite of the shortage of scientific articles using only physiotherapeutic techniques, mainly in Brazil, this review discussed the role of physical therapy on the IC, mainly manual therapy of pelvic floor (Thiele massage) and behavior therapy to relieve the symptoms and improve the quality of life

The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study.

OBJECTIVES: To evaluate the efficacy of a training program with uroflowmetry biofeedback and pelvic floor relaxation biofeedback on urodynamic and voiding parameters in women with dysfunctional voiding. METHODS: Eighty-six women with recurrent urinary tract infections (UTIs) and dysfunctional voiding were randomly assigned to receive a treatment schedule as follows: uroflowmetry biofeedback (group 1), biofeedback training of the pelvic floor muscles (group 2), uroflowmetry biofeedback combined to biofeedback training of the pelvic floor muscles (group 3), no treatment (group 4). Patients were regularly evaluated by American Urological Association Symptom Index and urodynamics during the study period. All the patients were followed up for 1 year with monthly urine cultures. A further evaluation was done at month 24 by American Urological Association Symptom Index and free uroflowmetry with measurement of residual urine. RESULTS: The prevalence of storage and emptying symptoms decreased significantly at 3, 6, and 12 months in the groups 1, 2, and 3, and remained stable during the study period. Mean flow rate, flow time, voiding volume increased significantly, whereas postvoid residual urine decreased. The prevalence of UTI decreased significantly in groups 1, 2, and 3. At month 24, storage and emptying symptoms and voiding patterns were similar to the baseline values in all the patients. The incidence of UTIs was similar to baseline values in groups 1, 2, and 3. CONCLUSIONS: Training the voluntary control of the pelvic floor seems essential in obtaining control over the bladder function. These results reinforce the importance of pelvic floor therapy in the resolution of UTIs.

Sintomas urinários pós-histerectomia radical: revisão de literatura e análise de dados / Urinary symptons after radical hysterectomy: bibliographic review and analysis of data

O carcinoma do colo uterino representa um importante problema de saúde pública. Mundialmente é a quarta maior causa de mortes por câncer, e no Brasil é a neoplasia mais frequente do trato genital feminino, sendo a segunda maior causa de morte por câncer em mulheres e a primeira de morte em mulheres em idade reprodutiva. Uma das formas de tratamento é a histerectomia radical, sendo que neste tratamento 70 por cento das mulheres apresentam disfunção vesical após o procedimento. O objetivo do estudo foi analisar a relação de sintomas urinários pós-cirurgia. Foi realizado levantamento bibliográfico com publicações entre os anos de 1997 a 2007. Percebeu-se que sintomas urinários são cada vez mais frequentes após histerectomia radical e entre as causas a mais provável é a lesão nervosa durante o procedimento, prejudicando ainda mais a qualidade de vida destas pacientes. Sabendo-se disto, é de fundamental importância o acompanhamento multidisciplinar destas doentes, incluindo-se nesta equipe o fisioterapeuta, o qual poderá contribuir significantemente no tratamento proposto.

The carcinoma of the uterine cervix is a great public health problem. In the world, it is the fourth leading cause of cancer deaths and in Brazil, it is the most common cancer of the female genital tract, and the second cause of cancer deaths in women and the first of death in women at reproductive age. One of the treatment methods is the radical hysterectomy. In this treatment, 70 percent of women present bladder dysfunction after surgery. The objective of the study was to examine the relation of urinary symptoms after radical hysterectomy for cancer of the cervix, and to examine the causes of the presence of urinary symptoms after surgery. The bibliographic survey was done on publications between the years of 1997 and 2007. It is possible to emphasize that urinary symptoms are increasingly frequent after radical hysterectomy. The disease itself undermines the physical, psychological and social well-being of the patient, and after the withdrawal of the uterus other consequences may appear, further damaging the quality of life of these patients. Bearing this in mind, it is a fundamental importance multidisciplinary monitoring of these patients, including in this team the physical therapist, who could contribute significantly in the proposed treatment.

Urodynamic responses to anal stretch in patients with detrusor sphincter dyssynergia.

OBJECTIVE: To evaluate the urodynamic responses to anal stretch in patients with detrusor sphincter dyssynergia (DSD). DESIGN: Descriptive study. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Patients (N=36) with suprasacral spinal cord injury who had DSD confirmed on cystometrography. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Detrusor pressure, urethral pressure, and summated electromyogram of external urethral sphincter on cystometrography. RESULTS: The urodynamic responses to anal stretch were evaluated in the first half (time 1, 1-15s) and the second half (time 2, 16-30s) of the evaluation time period. The activity of external urethral sphincter was reduced significantly in both times 1 and 2 (P<0.5). The medians of reduction percentages were 33% and 35% for times 1 and 2, respectively. The change of detrusor pressure was not significant in either time 1 or time 2. CONCLUSIONS: Anal stretch can reduce the activity of external urethral sphincter without significant change in detrusor pressure.

Internet education for spinal cord injury patients: focus on urinary management.

The goal of this project was to develop a Web site with articles that focus on urinary self-care management for those with spinal cord injuries. The investigator wrote 18 articles on topics that were selected by two review panels--one whose members have long-term spinal cord injuries and another consisting of rehabilitation nurses. The panel members critically reviewed the articles for content and topic. After revisions, nine of the 18 articles were translated from English into Spanish and then translated back into English to ensure accuracy. Consumers were asked to rate their satisfaction with the articles on a scale of 1-10, with 10 being the highest. There were a total of 1,162 hits on the Web site during a period of 13 months; 811 were for the Spanish articles, and 351 were for the English articles. The mean rating score for the articles was 8.02, with a standard deviation of 1.38. These findings are consistent with reports that the Internet can provide both user-friendly education for those living with disabilities and culturally sensitive health information for those who have limited access to other sources of information.

[The comparative study on selective alpha1-blocker and behavioural therapy in the treatment of discoordinated voiding in children]. / Porównawcza ocena skutecznosci stosowania selektywnych alfa-blokerów i terapii behawioralnej w leczeniu nieprawidlowej koordynacji wypieraczowo-zwieraczowej.

PURPOSE: To compare the efficiency of selective alpha1-blocker and behavioural therapy in the treatment of detrusor-sphincter discoordination in children. MATERIALS: Prospective, randomized study, approval of Ethics Committee, group of 60 children, age: 5 to 17, detrusor-sphincter discoordination. All children had a history of: recurrent UTI, irregular mictions with or without incontinence in "voiding diary". All have normal upper urinary tract in USG. Dicoordination was diagnosed by pathologic uroflowmetry curve and results with significant postvoiding residual urine in USG. Treatment group 1 (n=30): treatment with selective alpha1-blocker (doxazosin) in age related dosage. Group 2 (n=30): behavioral therapy and rehabilitation with conducting "voiding diary" with timed voiding. All children were also instructed on proper toilet posture, relaxation of the pelvic-floor muscles. After 6 weeks: changes in voiding patterns: No. of micturitions/day, average voided volume were estimated. Uroflowmetry was performed and voided volume, Av. flow rate, shape of the curve (1=normal, 2=flatened, irregular, 3=portions), residual urine (10% of Void.vol.) were calculated. Urinalysis and urin culture were obtained. RESULTS: Of 60 children 57 completed the study: Group 1 (n=30), Group2 (n=27). In Group 1 (alpha1-blocker): improvement in voiding patterns n=21, improvement in UF parameters n=20. In Group 2 (rehabilitation): improvement was estimated in 17 patients. Side effects were noted in 6 children from Group 1 (alpha1-blockers) (headache, hypotonia, vertigo, epistaxis), and non from the Group 2 (rehabilitation). CONCLUSIONS: Both treatment methods seemes to be effective in detrusor-sphincter discoordination. Selective alpha1-blockers alone are more effective than training and rehabilitation exercises.

Half-day urotherapy improves voiding parameters in children with dysfunctional emptying.

OBJECTIVES: Children with voiding dysfunction benefit from intensive bladder emptying re-education; however, hospitalization for such training is not always financially viable or realistic. The aim of this study was to evaluate whether half-day voiding re-education in pairs improved immediate and mid-term voiding parameters. METHODS: 48 children (mean age, 8.9 years; 54% male) identified in the urotherapy clinic as having either (1) abnormal uroflow curves, (2) a postvoid residual urine (PVRU)>10% of voided volume, or (3) proven dysfunctional voiding, were recruited and age- and gender-matched. Training over a half day included postural instruction, abdominal wall muscle pattern recognition, pelvic floor muscle relaxation training, and supervised voiding. Data from the initial clinic visit was compared to that after training, and at 1 and 3 mo follow-up. Families completed a questionnaire after the session. RESULTS: Urine flow curves were abnormal in 76.2% of initial clinic visit voids, 14% of patients after the half-day training session, and 11.7% of children at the 3-mo follow-up. Initial emptying efficiency (voided volume as a percentage of total bladder volume for that void) and mean PVR significantly improved following half-day training with gains maintained at both follow-up visits. CONCLUSION: Training children in pairs over a half day resulted in significantly improved bladder emptying that was sustained at the 3-mo follow-up.