Ten-year retrospective evaluation of therapeutic choices and related satisfaction in patients with auricular deformities.

To adequately counsel future patients with auricular abnormalities, this study aimed to analyze the therapeutic choices patients make after consultation concerning their auricle and/or hearing. All patients who visited the auricle consultation between January 2010 and January 2020 were included. This comprises patients with all types of auricular anomalies of both congenital and acquired etiology. Follow-up was performed by telephone to obtain informed consent and to take a short nonvalidated questionnaire regarding their therapeutic choices and satisfaction with these choices. Patient characteristics and information regarding therapeutic choices after consultation were subsequently obtained from the patients' medical files. The main outcome parameters were the patients' therapeutic choices regarding the auricle and hearing. A total of 134 patients (61.2%) were included with a mean follow-up of 3.85 years. For congenital and acquired etiologies, 72.8% and 18.2% declined reconstruction, 14.0% and 18.2% chose autologous, 5.3% and 0% chose alloplastic, 6.1% and 45.4% chose prosthetic, and 1.8% and 18.2% chose another type of reconstruction, respectively. A total of 54.9% declined hearing rehabilitation, while 38.2% chose percutaneous bone conduction device (BCD), 2.0% transcutaneous BCD, and 4.9% BCD on a softband. The overall satisfaction score was 8.7/10 concerning the auricle and 8.3/10 regarding hearing. In conclusion, most patients with a congenital etiology chose to wait or decided against auricular reconstruction, while patients with acquired etiologies mostly opted for reconstruction by a prosthesis. Patients or their caregivers were very satisfied with their choice, regardless of whether this implies reconstruction or no reconstruction, which emphasizes the importance of shared decision-making and thorough counseling.

Autologous versus prosthetic nasal and auricular reconstruction - patient, professional and layperson perceptions.

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face.

The relationship between children with voiding problems and their parents.

PURPOSE: We determined whether parents of children with overactive bladder and dysfunctional voiding had had similar symptoms in childhood. MATERIALS AND METHODS: A case-control study was done in parents with and without children with overactive bladder or dysfunctional voiding. All were recruited from an outpatient clinic. Diagnoses in children were made according to the International Children's Continence Society standardization report. Childhood symptoms in parents were assessed by a 19-item questionnaire and current urogenital symptoms were assessed by the Urogenital Distress Inventory. Comparisons between groups were made with categorical and interval statistics. RESULTS: A total of 173 cases and 98 controls were entered in the study. Statistically significantly more mothers of children with overactive bladder or dysfunctional voiding reported having had similar symptoms in childhood than mothers of children without lower urinary tract symptoms. Overactive bladder symptoms of childhood persisted into adulthood. No association between childhood dysfunctional voiding symptoms and adult emptying disorders was noted. Fathers of children with overactive bladder reported to have stopped bed-wetting at a significantly later age than control fathers. CONCLUSIONS: Results reveal an association between overactive bladder symptoms in children and their parents. To a lesser extent this finding also holds true for dysfunctional voiding symptoms.

[Further development of 'Enuresis nocturna' guidelines for children with persistent problems]. / Uitwerking Richtsnoer 'Enuresis nocturna' voor kinderen met hardnekkige klachten.

To achieve dryness in children who suffer from persistent bedwetting, it is important to find out which factors play a role in their bedwetting and why previous treatment has failed. The use of a micturition diary is essential. The child's problems and needs have to be identified and treated individually. The enuresis alarm, with the proper guidance, is the preferred form of initial treatment. Desmopressin is particularly suitable in cases of nocturnal polyuria or if the use of the alarm is unfeasible. If the alarm does not have any effect within two weeks or if a rapid result is important, a combination of desmopressin and the alarm is advisable. Bedwetting combined with daytime micturition problems is often indicative of a small bladder capacity and/or detrusor instability. In these children bladder training and/or treatment with an anticholinergic drug (possibly combined with desmopressin) may be effective.

The treatment of post-urethrotomy incontinence in pediatric and adolescent females.

PURPOSE: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. MATERIALS AND METHODS: Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5. RESULTS: Conservative treatment has been completely successful in 7 patients. Primary open or needle colposuspension was unsuccessful in 6 of 9 cases, including several requiring further surgery to achieve dryness. The results of excising urethral scars with bladder neck and urethral reconstruction were good in 4 of 5 patients at a followup of at least 4 years. CONCLUSIONS: When previous internal urethrotomy appears to be an important factor in the evaluation of incontinence, conservative therapy is the treatment of choice. Conservative therapy should consist of biofeedback reeducation of the voiding pattern and physical therapy. When surgery is needed, excision of the urethral scars with reconstruction of the bladder neck and urethra plus colposuspension is superior to colposuspension only.

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: clinical and urodynamic assessment.

Assessment of children with daytime wetting starts with the distinction between 'enuresis diurna' and 'functional incontinence', incontinence being defined as any form of wetting caused by bladder/sphincter dysfunction. Standard history-taking does not allow for a sharp enough distinction: pertinent questions have to be asked about daytime wetting, night-time wetting, micturition, and about urge and reactions to urge. By using urodynamics to expose the pathophysiology behind the patterns of bladder/sphincter dysfunction, these questions were formulated and validated in a series of 156 children, referred with persistent daytime wetting to a programme for cognitive bladder training. With history-taking organized into a simple questionnaire, complemented by urodynamics, four patterns of bladder/sphincter dysfunction emerged: urge syndrome, staccato voiding, fractionated and incomplete voiding, and lazy bladder syndrome. A strong correlation was found between recurrent urinary tract infections and non-neuropathic bladder/sphincter dysfunction, implying that detection and treatment of bladder/sphincter dysfunction is essential in every child with recurrent urinary tract infections, especially in the presence of vesico-ureteral reflux.

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.