Does the addition of hyaluronidase to betamethasone in topical treatment of phimosis improves results? - A randomized double-blind clinical trial.

INTRODUCTION: Phimosis is defined as the inability to retract the foreskin, preventing partial or complete exposure of the glans. OBJECTIVES: To compare the efficacy of topical treatment with betamethasone alone and in combination with hyaluronidase, evaluate systemic absorption of cortisol, and identify factors that predispose the success of topical treatment of phimosis in children aged 3-10 years. METHODS: This randomized double-blinded clinical trial involved 152 participants (3-10 years old) with phimosis. The children were divided into two groups: betamethasone associated with hyaluronidase (betamethasone valerate 2.5 mg + hyaluronidase 150 UTR; Group A) and betamethasone (betamethasone valerate 2.5 mg; Group B). Parents were instructed on how to use the ointment (twice a day, after hygiene, for 60 days) and on collecting salivary cortisol measurements at 11pm and 9am, before and after treatment. Participants were evaluated after 30 and 60 days. Fisher's exact test and paired t-test were used to analyze the data. RESULTS: Ninety children (69.77%) were successfully treated with the proposed treatment, with the success rate for Group A being 75.38% versus 64.06% for Group B, p = 0.18). Systemic absorption evaluated by salivary cortisol did not show differences after the intervention (p > 0.05), indicating that there was no systemic absorption when using ointments with or without hyaluronidase. The factors of age (OR = 0.98 - CI: 0.97-1.00), adherence (OR = 1.49 - CI: 0.53-4.16), balanoposthitis (OR = 1.85 - CI: 0.47-7.19), and previous use of corticosteroids (OR = 1.21 - CI: 0.53-2.72) also did not show influenced results CONCLUSION: Topical therapy for true phimosis with betamethasone 0.2% + hyaluronidase, despite showing no differences when compared with betamethasone 0.2% alone, for a period of up to 60 days, proved to be safe, effective, and with good results. The variables analyzed could not predict the expected clinical response. REBEC: RBR-76bhgyb.

Ureteral obstruction may activate kidney latent tuberculosis. A qualitative study.

Objectives: To analyze the hypothesis that ureteral obstruction may activate kidney latent tuberculous though qualitative study of Urogenital Tuberculosis patients. Methods: A qualitative study was conducted using semistructured interviews in eight patients with Urogenital Tuberculosis. The progression of the disease from the initial symptoms was characterized through the analysis of the clinical and radiological data. The presence of ureteral obstruction prior to the onset of renal tuberculosis was observed in three patients. Results: Patient 1: A 58-year-old female had five episodes of acute left ureteral lithiasis in two years prior to left kidney tuberculosis. Patient 2: A 55-year-old male patient had a 1.2 cm proximal left ureteral stone and in the following six months, the diagnosis of tuberculosis was made in a nonfunctioning left kidney with ureteral thickening and stenosis. Patient 3: A 47-year-old male patient had a 1.2 cm stone in the proximal right ureter and developed urinary tuberculosis with a nonfunctioning right kidney and a contracted bladder. Conclusion: Kidney tuberculosis may appear in the same kidney that had previously suffered stone ureteral obstruction, which may have created local conditions for the activation of latent foci of renal tuberculosis.

Treating asthma in patients with enuresis: repercussions on urinary symptoms

ABSTRACT Background: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. Objective: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. Materials and Methods: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. Results: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. Discussion: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. Conclusion: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.

Treating asthma in patients with enuresis: repercussions on urinary symptoms.

BACKGROUND: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.

One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children

ABSTRACT Introduction: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days. We hypothesized that one day voiding diary would be enough for guiding treatment. Materials and Methods: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. Results: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. Conclusion: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.

One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children.

INTRODUCTION: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days.We hypothesized that one day voiding diary would be enough for guiding treatment. MATERIALS AND METHODS: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. RESULTS: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. CONCLUSION: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

ABSTRACT Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p<0.01). Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery.

INTRODUCTION: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. METHODS: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. RESULTS: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p˂0.01). CONCLUSION: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Heart rate variability in men with lower urinary tract symptoms: a case-control study.

PURPOSE: Measurement of heart rate variability (HRV) allows evaluation of autonomic nervous system activity. Decreased HRV is associated with autonomic disbalance, poor health and higher mortality. Our objective is to evaluate the HRV in men with lower urinary tract symptoms (LUTS) through a case-control study. METHODS: LUTS were considered as the outcome and HRV variables were considered as exposure. The protocol included anamnesis, LUTS assessment, anthropometry, blood pressure and HRV measurement by analyzing the variation in the time interval between consecutive heartbeats or RR intervals. The mathematical study of HRV indicators allowed the assessment of the cardiac autonomic modulation of the volunteers. RESULTS: Eighty nine patients were included in the study, with 34 allocated to the case group (with LUTS) and 55 to the control group (without LUTS). The patients were similar in terms of age and systolic and diastolic blood pressure. Among the HRV variables, the mean VLF index for the very low frequency of the spectrum associated with the frequency domain was significantly higher in volunteers without LUTS. Control group patients presented a mean of 113.18 ± 166.74 ms2, while patients with LUTS presented a mean of 69.21 ± 61.98 ms2 (p = 0.032). CONCLUSIONS: Men 50-59 years of age without chronic diseases and with LUTS have an unfavorable cardiac autonomic profile indicated by significantly lower levels of the VLF component of HRV compared to men without LUTS.

Evaluation of pedometer use in men with lower urinary tract symptoms: a randomized clinical trial.

PURPOSE: To assess the effect of a pedometer use in men aged between 50 and 59 years presenting lower urinary tract symptoms (LUTS). METHODS: A single-center, not blind clinical trial with two parallel groups and equal randomization was performed with 38 men aged 50-59 years with LUTS. All patients received guidance and encouragement to physical activity practice. Only the intervention group received a Pedometer with a goal of 10,000 steps/day. After a period of 12 weeks, the groups were compared through the following variables: number of steps/day, IPSS score, flexibility, anthropometric values and Maximum Oxygen Consumption (VO2max). RESULTS: The number of steps per day in the intervention group was 9753 ± 1549 compared to 6212 ± 1152 in the control group (p = 0.004). Pedometer use efficacy was a 50% risk reduction of not achieve the goal of 10,000 steps per day. Regarding IPSS score, the intervention group achieved lower scores (6.95 ± 2.85 vs. 10.16 ± 3.23, p = 0.007). Pedometer use efficacy was a 94% risk reduction of not achieve more than 30% reduction in IPSS score. In VO2max, the intervention group performed better than the control group (34.84 ± 3.25 vs. 32.58 ± 6.89; p = 0.011). There was no difference in flexibility and anthropometric values between the groups. CONCLUSIONS: The use of pedometer in LUTS patients provided an increase in the number of steps/day, a decrease in LUTS score and an improvement in VO2max measure. CLINICAL TRIAL REGISTRATION: Trial url: www.ensaiosclinicos.gov.br/rg/RBR-4vynk5/ . Register Number: RBR-4vynk5 .

Quality of life in enuretic children

ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The "AUQEI" questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

Quality of life in enuretic children.

INTRODUCTION: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. PATIENTS AND METHODS: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The "AUQEI" questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. RESULTS: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. CONCLUSIONS: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial.

PURPOSE: This study aims to evaluate the impact of psychological intervention with parents of children with enuresis on treatment outcome. MATERIALS AND METHODS: A total of 66 children with enuresis were randomized into 2 groups. All children received urotherapy orientation and psychological counseling. Psychological intervention was performed with parents in the experimental group and not in the control group. All parents answered a questionnaire to evaluate violence against their children (Parent-Child Conflict Tactics Scale) and the Tolerance Scale. The Child Behavior Checklist was applied to evaluate behavior problems. Children responded to the Impact Scale and the Children and Youth Self-Concept Scale. Treatment results were assessed with a 14-day wet night diary. RESULTS: Mean age and gender were similar in both groups. Parent-Child Conflict Tactics Scale showed less violence after the treatment in the experimental group (p=0.007). The Tolerance Scale indicated that parents of children with enuresis were intolerant and that, after treatment, intolerance had a greater decrease in the experimental group (p <0.001). The Impact Scale showed that children suffer some impact from enuresis, and that in those in the experimental group this impact was smaller after treatment (p=0.008). No differences were seen in the Child Behavior Checklist or Children and Youth Self-Concept Scale after intervention. After treatment the percentage of dry nights had a greater improvement in the experimental group (52%, range 30% to 91%) than in the control group (10%, range 3% to 22.5%; p <0.001). Children in the experimental group had a 6.75 times greater chance of having a complete response to treatment. CONCLUSIONS: Psychological intervention with parents of children with enuresis during their treatment improved the percentage of dry nights and the impact of enuresis, while their parents started coping better with the problem and became more tolerant, reducing punishment toward their children.