Management of lower urinary tract dysfunction: A stepwise approach

Thom, Matthew; Campigotto, Mary; Vemulakonda, Vijaya M.; Coplen, D.E.; Austin, Paul F.

doi:10.1016/j.jpurol.2011.01.004

Cited by 32 publications

(28 citation statements)

References 27 publications

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“…İGD tanısı koyduğu-muz 3 hastamızın tamamında semptomlar %90'dan fazla iyileşmiştir. Thom işeme, dışkılama ve diyet alışkanlıklarının değiştirilmesi ile AEM veya İGD olan 50 hastanın %68'inde iyileşme sağlandığını gös-termiştir (26) . Çalışmamızda bu oran %64,3'tür.…”

Section: Discussionunclassified

Role of the treatment of functional constipation for improving voiding dysfunctions

Can¹,

Sayan²

2016

Buch

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ÖZAmaç: KFK (Kronik Fonksiyonel Kabızlık) ile kliniğe başvuran hastalarda tabloya işeme bozukluklarının da eşlik ediyor olması sık görülen bir durumdur. AEM (Aşırı Etkin MesaneOveractive Bladder) ve İGD (İşemeyi Geciktirme Davranışı-Voiding Postponement) ve İİB (İşeme İşlev Bozukluğu-Dysfunctional Voiding) KFK'a en sık eşlik eden işeme bozukluğu türle-ridir. Çalışmamızda amaç, hem KFK ile en sık görülen işeme bozukluğu tipini hem de KFK tedavisine en iyi yanıt veren işeme bozukluğu tipini göstermektir. Böylece hangi işeme bozukluğu türlerinde standart işeme rejimi ve KFK tedavisinin yeterli olabileceğini, hangi tip işeme bozukluklarında ise ilaç tedavisi, biofeedback tedavi, nöromodülasyon gibi ileri tedavi seçeneklerinin düşünülmesi gerektiği açıklığa kavuşmaktadır. Yöntemler: Tepecik Eğitim ve Araştırma Hastanesi Çocuk Cerrahisi Kliniğinde 2007-2013 yılları arasında kabızlık ve işeme bozukluğunun birlikte görüldüğü 73 hasta incelenmiş ve KFK tedavisinde başarı sağlanan ve düzenli bağırsak alışkanlığı kazanmış olan 44 hasta öykü, muayene ve laboratuvar verileri ışığında değerlendirilmiştir. Bulgular: KFK tedavisinde başarı sağlanan ve düzenli bağırsak alışkanlığı kazanmış olan 44 hastanın yaşları 5-13 yaş arasında değişmekteydi. Çalışma kapsamındaki hastaların 19'u erkek (%43,2), 25'i kızdır (%56,8). KFK ve işeme bozukluğunun birlikte bulunduğu 44 hastamızda işeme bozukluklarının dağılımı şöyledir: 31 hastada aşırı etkin mesane AEM (%70,4), 10'unda işeme işlev bozukluğu (İİB) (%22,7), 3'ünde (%6,8) işemeyi geciktirme davranışı (İGD) saptanmıştır. Buna göre KFK'nın tedavisi ile düzenli bağırsak alışkanlığı kazanan hastalarımızda işeme bozukluklarının düzelmesinde başarı oranları şöyleydi: Tam iyileşme 18 hastada (% 40,9), iyileşme 9 hastada (%20,4) ve kısmi iyileşme 8 hastada (%18,2) sağlanabilmiş, 9 hastada (%20,4) iyileşme olmamıştır. Sonuç: KFK'da içi gaita ile dolu, genişlemiş rektum mesaneye bası yaparak hem dolma hem de boşalma fonksiyonlarını bozar ve üriner inkontinans, idrar yolu enfeksiyonu gibi tablolara yol açar. KFK işeme bozukluğu tipleri içinde en sık AEM ile birlikte izlenir. Kabızlığın tedavisi ile en yüksek iyileşme AEM ve İGD olan çocuklarda görülür. İİB ise kabızlık tedavisine en az yanıt veren işeme bozukluğu tipidir.Anahtar kelimeler: İşeme bozukluğu, kronik fonksiyonel kabızlık, ürodinami ABSTRACT Objective: Accompaniment of voiding dysfunctions in patients who suffer from CFC (Chronic Functional Constipation) is a frequent condition. OAB (Overactive Bladder), VP (Voiding Postponement) and DV (Dysfunctional Voiding) are the most frequently accompanying types of voiding disorders to CFC. We aimed to demonstrate both the most accompanying type of voiding dyfunction to CFC and the most treatment -responsive type of voiding dysfunction to CFC treatment. So it will be clear that which types of voiding dysfunctions can be treated by only standart therapy of CFC or need further treatment methods like medication, biofeedback therapy or neuromodilation. Methods: Seventy-three patients who suffered ...

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Section: Discussionunclassified

Role of the treatment of functional constipation for improving voiding dysfunctions

Can¹,

Sayan²

2016

Buch

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“…10 Thom et al suggested a stepwise approach with other modalities to assist cases refractory to medical treatment. 11 Sacral neuromodulation is FDA approved in adults and more than 400 related articles have been published. Off-label use in children has increased in the last few years with favorable results.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Sacral Nerve Modulation in Children with Validated Questionnaires

et al. 2013

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“…Treatment of children with BBD usually starts with a behavioral-modification program that consists of: timed voiding (5–7 times a day); improvement of pelvic floor relaxation by adjusted posture and breathing exercises; double voiding before bedtime; reduction in caffeine, colorants and carbonation from the diet; and treatment of constipation with increased fiber [16]. With behavioral modification alone, >55% of children had a significant symptom improvement, confirming the functional link between the bladder and bowel [16].…”

Section: Treatment Options For Co-morbid Lower Urinary Tract Dysfunctmentioning

confidence: 99%

“…With behavioral modification alone, >55% of children had a significant symptom improvement, confirming the functional link between the bladder and bowel [16]. Behavioral therapy in children with bladder-sphincter dysfunction also decreased the prevalence of functional fecal incontinence by 21–30%; however, no direct correlation was found between improved functional fecal incontinence and bladder-sphincter dysfunction [17].…”

Section: Treatment Options For Co-morbid Lower Urinary Tract Dysfunctmentioning

confidence: 99%

Genitourinary and gastrointestinal co-morbidities in children: The role of neural circuits in regulation of visceral function

Malykhina

Brodie

Wilcox

2016

Journal of Pediatric Urology

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Summary Objective Pediatric lower urinary tract dysfunction (LUTD) is a common problem in childhood. Lower urinary tract symptoms in children include overactive bladder, voiding postponement, stress incontinence, giggle incontinence, and dysfunctional voiding. Gastrointestinal co-morbidities, including constipation or fecal incontinence, are commonly associated with lower urinary tract (LUT) symptoms in children, often reaching 22–34%. This review summarized the potential mechanisms underlying functional lower urinary and gastrointestinal co-morbidities in children. It also covered the current understanding of clinical pathophysiology in the pediatric population, anatomy and embryological development of the pelvic organs, role of developing neural circuits in regulation of functional co-morbidities, and relevant translational animal models. Materials and methods This was a non-systematic review of the published literature, which summarized the available clinical and translational studies on functional urologic and gastrointestinal co-morbidities in children, as well as neural mechanisms underlying pelvic organ ‘crosstalk’ and ‘cross-sensitization’. Results Co-morbidity of pediatric lower urinary and gastrointestinal dysfunctions could be explained by multiple factors, including a shared developmental origin, close anatomical proximity, and pelvic organ ‘cross-talk’. Daily physiological activity and viscero-visceral reflexes between the lower gastrointestinal and urinary tracts are controlled by both autonomic and central nervous systems, suggesting the dominant modulatory role of the neural pathways. Recent studies have provided evidence that altered sensation in the bladder and dysfunctional voiding can be triggered by pathological changes in neighboring pelvic organs due to a phenomenon known as pelvic organ ‘cross-sensitization’. Cross-sensitization between pelvic organs is thought to be mainly coordinated by convergent neurons that receive dual afferent inputs from discrete pelvic organs. Investigation of functional changes in nerve fibers and neurons sets certain limits in conducting appropriate research in humans, making the use of animal models necessary to uncover the underlying mechanisms and for the development of novel therapeutic approaches for long-term symptomatic treatment of LUTD in the pediatric population. Conclusion Pediatric LUTD is often complicated by gastrointestinal co-morbidities; however, the mechanisms linking bladder and bowel dysfunctions are not well understood. Clinical studies have suggested that therapeutic modulation of one system may improve the other system's function. To better manage children with LUTD, the interplay between the two systems, and how co-morbid GI and voiding dysfunctions can be more specifically targeted in pediatric clinics need to be understood.

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Management of lower urinary tract dysfunction: A stepwise approach

Cited by 32 publications

References 27 publications

Role of the treatment of functional constipation for improving voiding dysfunctions

Role of the treatment of functional constipation for improving voiding dysfunctions

Prospective Evaluation of Sacral Nerve Modulation in Children with Validated Questionnaires

Genitourinary and gastrointestinal co-morbidities in children: The role of neural circuits in regulation of visceral function

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