Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence.

OBJECTIVE: To assess the effectiveness of a 10-day inpatient treatment programme for persistent urge incontinence based on behavior modification via biofeedback of micturition behavior. METHODS: 95 patients aged 6-17 (86 girls, 9 boys) with documented and persistent urge incontinence, with or without dysfunctional voiding, mostly based on recurrent urinary tract infections, and at least a 1 year lasting failure of standard regimen and pharmacological therapy, were 'cognitively' treated. After 6 months the patients were evaluated for flow pattern, number of wet incidents, micturition frequency and urge compliants. RESULTS: 65 patients (68.4%) obtained good results, 12 (12.6%) showed average improvement, 18 patients (19%) did not improve. CONCLUSIONS: This cognitive noninvasive treatment programme seems promising in its effectiveness and compares favorably with existing biofeedback methods based on urodynamic procedures, although expensive by its inpatient status. Further study towards an outpatient implementation is needed.

Treatment of enuresis risoria in children by self-administered electric and imaginary shock.

OBJECTIVE: To treat enuresis risoria (giggle micturition) by a self-administered electric and imaginary shock and to evaluate the outcome after behavioural therapy. PATIENTS AND METHODS: Six boys and three girls with enuresis risoria were evaluated and treated. The mean age at referral was 10.4 years (range 5.7-14.2). All children had episodes of involuntary complete bladder emptying triggered by hearty laughter or giggling. The frequency ranged from four times per day to twice a week. No other voiding problems were noted. Five patients (four boys and one girl, mean age 10.2 years, range 5.7-14.2) received conditioning training which consisted largely of the self-administration of a harmless, painless electric shock to the back of one hand, at the moment when micturition was induced by laughter, leading to inhibition of the voiding reflex. Later, the electric shock was replaced by an imaginary shock. Training was undertaken on an outpatient basis. A mean of eight sessions, each of 45 min duration, was necessary to train the children. The mean follow-up was 26 months (range 12-51). RESULTS: The frequency of wetting was reduced by a mean of 89% in all children 1 year after the successful completion of the training. In three children, followed for 2 years, this result stabilized at that proportion. One of these children, followed for > 3 years, gradually reverted to the original pattern of daily wetting and another patient, with a follow-up of > 4 years, maintained an 86% reduction of wetting incidents. CONCLUSION: Until now, there was no specific treatment for enuresis risoria and not all patients outgrow the problem; this experimental conditioning programme shows promise in diminishing wetting incidents. However, the programme needs further testing in a prospective study.

Functional daytime incontinence: non-pharmacological treatment.

In children with 'functional incontinence', defined as any form of (daytime) wetting caused by non-neuropathic bladder/sphincter dysfunction, most signs and symptoms are rooted in habitual non-physiological responses to signals from bladder and urethra. These responses develop at toddler age, when children learn how to remain dry. Once they have become a habit, incomplete bladder emptying and recurrent urinary tract infections come into play, reiterating the non-physiological responses into fixed patterns of bladder/sphincter dysfunction with functional incontinence as the leading symptom. Non-pharmacological treatment of functional incontinence implies relearning and training the normal responses to signals from bladder and urethra: a cognitive process, with perception of the signals reinforced by biofeedback. This type of treatment is best combined with long-term chemoprophylaxis. Severe cases will benefit from anticholinergic drugs, as adjuvants to the training programme. Urodynamics play a crucial role in documenting the specific patterns of incontinence and in providing biofeedback. For a successful programme, psychological screening of the children is indispensable.

[Obese children and their treatment]. / Obese kinderen en hun behandeling.

Retrospectively the data were analyzed of 188 children treated for obesity. The mean age at which obesity begins is 5,5 years, but the mean age at which medical help is sought is 9,5 years. In 78% of these children one or both parents were obese. The mean caloric value of the pretreatment feeding pattern was 924 kJ (220 kCal) less than the reference quantities for age. Thirty-nine percent of cases stopped visiting the clinic themselves. Mean weight loss is 10% of the median weight-for-height. No differences were found between the results of various therapeutical regimens.