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Armando J Lorenzo - One of the best experts on this subject based on the ideXlab platform.

  • The role of Bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children
    Pediatric Nephrology, 2020
    Co-Authors: Armando J Lorenzo, Mandy Rickard, Joana Dos Santos
    Abstract:

    Urinary tract infections (UTIs) are a common reason for referral to pediatric specialists and the risk profile of these children is influenced by age, sex, and underlying urinary tract abnormalities. UTIs in toilet-trained children represent a different entity than confirmed, febrile UTIs that occur in infants, impacted by suboptimal Bladder habits, Bladder dysfunction, constipation, or a combination of these factors. A comprehensive literature search was conducted using PubMed and MEDLINE and search terms included recurrent UTI, VUR, Bladder and bowel dysfunction (BBD), constipation, lower urinary tract symptoms, and voiding dysfunction. Common presenting symptoms of UTI in children include fever (> 38 °C) with or without “traditional” lower urinary tract symptoms (LUTS) such as dysuria, malodorous urine, frequency, urgency, and incontinence. However, many infections in older children are afebrile episodes—consisting primarily of LUTS—which may or may not be confirmed with biochemical and/or microbiological evidence. Therefore, when evaluating toilet-trained children with recurrent UTIs, it is paramount to consider dysfunctional elimination as an underlying cause, diagnose, and treat it prior to indicating surgical options, even in the presence of VUR or other anatomical abnormalities. Although the impact of Bladder function on the risk of infections is important, so is the accurate diagnosis and initial evaluation. This review article will focus on an often overlooked yet critical factor: the impact of Bladder function, particularly for toilet-trained children, as well as the importance of implementing Bladder Training strategies, aggressive management of constipation, and pharmacological management as necessary.

  • the impact of a Bladder Training video versus standard urotherapy on quality of life of children with Bladder and bowel dysfunction a randomized controlled trial
    Journal of Pediatric Urology, 2017
    Co-Authors: Natasha Brownrigg, Luis H Braga, Mandy Rickard, Forough Farrokhyar, Kizanee Jegatheeswaran, Jorge Demaria, B Easterbrook, A Dekirmendjian, Armando J Lorenzo
    Abstract:

    Summary Introduction Bladder and bowel dysfunction (BBD) can negatively impact the quality of life (QoL) of children. Urotherapy is an accepted treatment option for BBD; however, literature that examines the impact of management options on QoL in this population is scarce. Objective To determine whether a Bladder Training video (BTV) is non-inferior to standard urotherapy (SU) in improving QoL in children with BBD. Methods Children aged 5–10 years and who scored ≥11 on the Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES) were recruited from a pediatric tertiary care center. Children were excluded with known vesicoureteral reflux; spinal dysraphism; learning disabilities; recent urotherapy; and primary nocturnal enuresis. Quality of life was evaluated using the Pediatric Incontinence Quality-of-Life questionnaire (PinQ). Questionnaires were administered at the baseline and 3-month follow-up clinic visits. Following centralized electronic blocked randomization schemes to guarantee allocation concealment, patients were assigned to receive SU or BTV during their regular clinic visits. An intention-to-treat protocol was followed. Between-group baseline and follow-up QoL scores were compared using paired and unpaired t-tests, and linear regression analysis. Results Of the 539 BBD patients who were screened, 173 (32%) were eligible, and 150 (87%) were randomized. Of these, 143 (96%) completed the study, five (3%) were lost to follow-up, and two (1%) withdrew. In total, 140/143 (97%) completed the QoL questionnaire at baseline and follow-up. Mean follow-up time was 3.5 ± 1.1 months for BTV patients and 3.7 ± 1.6 months for SU. At baseline, BTV and SU patients had a mean QoL score of 26.6 ± 13 and 23.8 ± 12, respectively (P = 0.17). Between-group mean change in PinQ scores from baseline was not statistically significant (BTV: 6.25 ± 12.5 vs SU: 3.75 ± 12.2; P = 0.23; Summary Fig.). Significant predictors of positive change in QoL were: higher symptomatology score, with a correlation coefficient of 0.5 (95% CI: 0.2–0.9; P = 0.003), and worse baseline QoL score, with a correlation coefficient of 0.5 (95% CI: 0.4–0.7; P  Conclusion Significant and similar QoL changes from baseline to follow-up were observed in both the BTV and SU groups, suggesting that BTV was non-inferior to SU in improving QoL in children with BBD. Quality of life assessment should be considered when evaluating interventions for BBD, as it appears to be an important clinical outcome with which to determine urotherapy success. Download : Download high-res image (89KB) Download : Download full-size image Summary Figure . Box plots of change in quality of life by treatment modality.

  • Bladder Training video versus standard urotherapy for Bladder and bowel dysfunction a noninferiority randomized controlled trial
    The Journal of Urology, 2017
    Co-Authors: Luis H Braga, Mandy Rickard, Forough Farrokhyar, Kizanee Jegatheeswaran, Natasha Brownrigg, Rahul K Bansal, Jorge Demaria, Armando J Lorenzo
    Abstract:

    Purpose: We evaluated whether an animated Bladder Training video was as effective as standard individual urotherapy in improving Bladder/bowel symptoms.Materials and Methods: Patients 5 to 10 years old who scored greater than 11 on the Bladder/bowel Vancouver questionnaire were included in a noninferiority randomized, controlled trial. Children with vesicoureteral reflux, neuropathic Bladder, learning disabilities, recent urotherapy or primary nocturnal enuresis were excluded from analysis. Patients were randomly assigned to receive standard urotherapy or watch a Bladder Training video in clinic using centralized blocked randomization schemes. Bladder/bowel symptoms were evaluated at baseline and 3-month followup by intent to treat analysis. A sample size of 150 patients ensured a 3.5 difference in mean symptomology scores between the groups, which was accepted as the noninferiority margin.Results: Of 539 screened patients 173 (37%) were eligible for study and 150 enrolled. A total of 143 patients (95%) c...

Steven H Woolf - One of the best experts on this subject based on the ideXlab platform.

  • pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children
    The Journal of Urology, 1997
    Co-Authors: Jack S Elder, Craig A Peters, Billy S Arant, David H Ewalt, Charles E Hawtrey, Richard S Hurwitz, Thomas S Parrott, Howard M Snyder, Robert A Weiss, Steven H Woolf
    Abstract:

    AbstractPurpose: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit.Materials and Methods: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) Bladder Training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and Bladder Training, 5) antibiotic prophylaxis, anticholinergics and Bladder Training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment.Results: Av...

  • pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children
    The Journal of Urology, 1997
    Co-Authors: Jack S Elder, Craig A Peters, Billy S Arant, David H Ewalt, Charles E Hawtrey, Richard S Hurwitz, Thomas S Parrott, Howard M Snyder, Robert A Weiss, Steven H Woolf
    Abstract:

    AbstractPurpose: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit.Materials and Methods: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) Bladder Training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and Bladder Training, 5) antibiotic prophylaxis, anticholinergics and Bladder Training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment.Results: Av...

David J Burn - One of the best experts on this subject based on the ideXlab platform.

  • Bladder Training for urinary tract symptoms in parkinson disease a randomized controlled trial
    Neurology, 2020
    Co-Authors: Claire Mcdonald, Jackie Rees, Kristian Winge, Julia L Newton, David J Burn
    Abstract:

    Objective To assess the feasibility and efficacy of Bladder Training for troublesome lower urinary tract symptoms (LUTS) in Parkinson disease (PD). Methods In this single-center, single-blinded, randomized controlled trial, participants with a history of PD and LUTS were randomized to a 12-week Bladder Training program (BT) or conservative advice (CA). Outcome measures included a 3-day volume frequency diary, International Consultation on Incontinence Questionnaire (ICIQ)–Overactive Bladder Module, and ICIQ—Quality of Life Module. Co–primary endpoints were (1) patient perception of change and (2) change in number of urgency episodes at 12 weeks. Secondary endpoints included change in ICIQ scores, number of micturitions, and volume voided. Results Thirty-eight participants were randomized (18 to CA, 20 to BT). Both CA and BT were associated with significant improvements in volume voided, number of micturitions, symptom severity scores, and measures of quality of life (all p Conclusion This controlled trial demonstrated the potential benefits of BT for LUTS in PD. Classification of evidence This study provides Class III evidence that for patients with PD and LUTS, BT significantly increased patient perception of improvement but did not significantly reduce urgency episodes.

  • lower urinary tract symptoms in parkinson s disease prevalence aetiology and management
    Parkinsonism & Related Disorders, 2017
    Co-Authors: Claire Mcdonald, Kristian Winge, David J Burn
    Abstract:

    Lower urinary tract symptoms (LUTS) are common in Parkinson's disease (PD), effecting 27-85% of patients with PD. Irritative symptoms predominate and urodynamic studies confirm high prevalence of detrusor overactivity in PD. LUTS are present early in PD and are more common in PD than in age matched controls. The assessment of LUTS in PD is complicated by coexisting bradykinesia and cognitive impairment. Although LUTS become more troublesome as PD progresses it remains unclear if LUTS severity correlates with motor symptoms and/or duration of PD. The underlying cause of LUTS in PD remains to be fully elucidated. Animal and human studies suggest the net effect of the basal ganglia is to supress micturition. Although LUTS are a common in PD, few studies have examined the assessment and management of LUTS specifically in patients with PD. Pilot studies have suggested that Bladder Training, antimuscarinic drugs and intravesical botulinum toxin maybe helpful but these trials have been small and frequently lacked a suitable control group making them vulnerable to the placebo effect. Furthermore the adverse effects of antimuscarinic drugs on cognitive and gastrointestinal function may limit the use of these drugs in PD. In this review we summarise the literature describing the prevalence of LUTS in PD, discuss the emerging data delineating the underlying pathophysiology of LUTS and examine interventions helpful in the management of LUTS in people with PD.

Jack S Elder - One of the best experts on this subject based on the ideXlab platform.

  • pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children
    The Journal of Urology, 1997
    Co-Authors: Jack S Elder, Craig A Peters, Billy S Arant, David H Ewalt, Charles E Hawtrey, Richard S Hurwitz, Thomas S Parrott, Howard M Snyder, Robert A Weiss, Steven H Woolf
    Abstract:

    AbstractPurpose: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit.Materials and Methods: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) Bladder Training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and Bladder Training, 5) antibiotic prophylaxis, anticholinergics and Bladder Training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment.Results: Av...

  • pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children
    The Journal of Urology, 1997
    Co-Authors: Jack S Elder, Craig A Peters, Billy S Arant, David H Ewalt, Charles E Hawtrey, Richard S Hurwitz, Thomas S Parrott, Howard M Snyder, Robert A Weiss, Steven H Woolf
    Abstract:

    AbstractPurpose: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit.Materials and Methods: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) Bladder Training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and Bladder Training, 5) antibiotic prophylaxis, anticholinergics and Bladder Training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment.Results: Av...

Richard C Bump - One of the best experts on this subject based on the ideXlab platform.

  • the effect of Bladder Training pelvic floor muscle Training or combination Training on urodynamic parameters in women with urinary incontinence
    Neurourology and Urodynamics, 1999
    Co-Authors: J A Fantl, Jean F Wyman, Donna K Mcclish, Richard C Bump, D M Elser, Deirdre Robinson
    Abstract:

    The purpose of this study was to compare the effect of three conservative interventions: pelvic floor muscle Training, Bladder Training, or both, on urodynamic parameters in women with urinary incontinence. Two hundred four women with genuine stress incontinence (GSI) or detrusor instability with or without GSI (DI +/- GSI) participated in a two-site trial comparing pelvic floor muscle Training, Bladder Training, or both. Patients were stratified based on severity of urinary incontinence, urodynamic diagnosis, and treatment site, then randomized to a treatment group. All women underwent a comprehensive standardized evaluation including multi-channel urodynamics at the initial assessment and at the end of 12 weeks of therapy. Analysis of covariance was used to detect differences among treatment groups on urodynamic parameters. Post-treatment evaluations were available for 181 women. No differences were found among treatments on the following measurements: maximum urethral closure pressure, mean urethral closure pressure, maximum Kegel urethral closure pressure, mean Kegel urethral closure pressure, functional urethral length, pressure transmission ratios, sTraining urethral axis, first sensation to void, maximum cystometric capacity, and the MCC minus FSV. The effect of treatment did not differ by urodynamic diagnosis. Behavioral therapy had no effect on commonly measured urodynamic parameters. The mechanism by which clinical improvement occurs remains unknown. Neurourol. Urodynam. 18:427-436, 1999.

  • Bladder Training in older women with urinary incontinence relationship between outcome and changes in urodynamic observations
    Obstetrics & Gynecology, 1991
    Co-Authors: Donna K Mcclish, J A Fantl, Jean F Wyman, Giulio Pisani, Richard C Bump
    Abstract:

    The purpose of this study was to clarify the mechanism by which Bladder Training affects urinary incontinence. Urodynamic data and specific urodynamic diagnoses of 108 women with urinary incontinence were compared before and 6 months after treatment with Bladder Training. Before treatment, 76 women