J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 51(11); 2008 > Article
Han: Urotherapy for Pediatric Voiding Dysfunction

Abstract

Overactive bladder which is defined by symptoms of urinary frequency and urgency but cannot be defined by pathogenesis of this condition, can be considered as a representative of storage failure. Dysfunctional voiding which is caused by dyssynergia of the detrusor and urethral sphincter is the most common form of emptying failure. Through inadequate relaxation of urethral sphincter during contraction of detrusor muscle for voiding, intravesical pressure increases and eventually results in pathologic changes of the bladder. However, overactive bladder which is a failure of storage and dysfunctional voiding which is a failure of emptying are not completely different diseases, but are closely related and can be switched from one type to the other. Continuously increased intravesical pressure by abnormal contraction of the external urethral sphincter and primary or secondary involuntary detrusor activity are the major components in the pathophysiology, Thus thorough evaluation of the bladder and urethra and treatment of UTI and constipation which can affect the function of the bladder and urethra must be considered when establishing a treatment. If behavioral problem is accompanied or the patient shows poor compliance to urotherapy, psychological intervention by a specialist can be helpful. With increasing interest in the quality of life, active basic research in the field of voiding dysfunction and development of new drugs are in progress and shows a promising future. Meanwhile, pediatric urologist must strictly assess the significance of this disease entity during childhood through long term follow up of these children into adulthood.

References

1. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, Jorgensen TM, Rittig S, Walle JV, Yeung CK, Djurhuus JC. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006;176:314-324.

2. Kim SJ, Yang KM, Kim MJ, Jeon HJ, Han SW. The effect of biofeedback in urge syndrome and dysfunctional voiding. Korean J Urol 2003;44:1214-1219.

3. Kruse S, Hellström AL, Hjälmås K. Daytime bladder dysfunction in therapy-resistant nocturnal enuresis. A pilot study in urotherapy. Scand J Urol Nephrol 1999;33:49-52.

4. Hoekx L, Wyndaele JJ, Vermandel A. The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity. J Urol 1998;160:858-860.

5. Firlit C, Smey P, King L. Micturition urodynamic flow studies in children. J Urol 1977;119:250-253.

6. Sugar EC, Firlit CF. Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia). J Urol 1982;128:1253-1258.

7. Wennergren H, Oberg B. Pelvic floor exercises for children: a method of treating dysfunctional voiding. Br J Urol 1995;76:9-15.

8. Pfister C, Dacher JN, Gaucher S, Liard-Zmuda A, Grise P, Mitrofanoff P. The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction. BJU Int 1999;84:1054-1057.

9. Chin-Peuckert L, Pippi Salle JL. A modified biofeedback program for children with detrusor-sphincter dyssynergia: 5-year experience. J Urol 2001;166:1470-1475.

10. Bower WF, Yew SY, Sit KYF, Yeung CK. Half-day urotherapy improves voiding parameters in children with dysfunctional emptying. Eur Urol 2006;49:570-574.

11. Hoebeke P, Van Laecke V, Everraert K, Renson C, De Paepe H, Raes A, Vande Walle J. Transcuatneous neuromodulation for the urge syndrome in children: a pilot study. J Urol 2001;166:2416-2419.

12. De Gennaro M, Capitanucci ML, Mastracci P, Silveri M, Gatti C, Mosiello G. Percutaneous tibial nerve neuromodulation is well tolerated in children and effective for treating refractory vesical dysfunction. J Urol 2004;171:1911-1913.

13. Gladh G, Mattsson S, Lindstrom S. Anogenital electrical stimulation as treatment of urge incontinence in children. BJU Int 2001;87:366-371.

14. Kim JW, Kim MJ, Noh JY, Lee HY, Han SW. Extracorporeal pelvic floor magnetic stimulation in children with voiding dysfunction. BJU Int 2005;95:1310-1313.

15. Kang SH, Bae JH, Shim KS, Park HS, Cheon J, Lee JG, Yoon DK, Kim JJ, Moon du G. Extracorporeal magnetic innervation therapy in children with refractory monosymptomatic nocturnal enuresis. Urology 2007;70:576-580.

16. Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE, Reinberg YE. Preliminary results of sacral neuromodulation in 23 children. J Urol 2006;176:2227-2231.

17. Hong CH, Kim JH, Noh JY, Gil YC, Lee HY, Lee WH, Han SW. Sensory neuronal change after intravesical electrical stimulation in spinailized rat. Yonsei Med J 2002;43:652-656.

18. Hong CH, Kim YS, Kim JH, Noh JY, Koh HK, Kim CH, Han SW. Change of bladder afferent neuron after intravesical electrical stimulation. Korean J Urol 2003;44:468-472.

19. Hon CH, Kim YS, Kim JH, Noh JY, Koh HK, Kim CH, Han SW. Change of neuropeptides of bladder afferents after intravesical electrical stimulation in spinalized Rat. Korean J Urol 2003;44:363-367.

20. Han SW, Kim MJ, Kim JH, Hong CH, Kim JW, Noh JY. Intravesical electrical stimulation improves neurogenic bowel dysfunction in children with spina bifida. J Urol 2004;171:2648-2650.

21. Lee SR, Kim DS, Kim MJ, Kim CS, Jeon HJ, Han SW. Intravesical electrical stimulation in infrequent voider syndrome. Korean J Urol 2005;46:131-136.

22. Lee SH, Hong CH, Han SW. Experience of intravesical electrical stimulation therapy in children with enuresis. Korean J Urol 2002;43:748-752.

23. Hoebeke P, De Caestecker K, Vande Walle J, Dehoorne J, Raes A, Verleyen P, Van Laecke E. The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J Urol 2006;176:328-330.

24. Kuo H. Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction. J Urol 2003;170:1908-1912.

25. Mokhless I, Gaafar S, Fouda K, Shafik M, Assem A. Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder. J Urol 2006;176:1767-1770.

26. Jost WH, Müller-Lobeck H, Merkle W. Involuntary contractions of the striated anal sphincters as a cause of constipation: report of a case. Dis Colon Rectum 1998;41:258-260.

27. Miyazato M, Sugaya K, Nishijima S, Ashitomi K, Ohyama C, Ogawa Y. Rectal distention inhibits bladder activity via glycinergic and GABAergic mechanisms in rats. J Urol 2004;171:1353-1356.

28. Homsy YL, Austin PF. In: Belman AB, King LR, Kramer SA, editor. Dysfunctional voiding disorders and nocturnal enuresis. Clinical Pediatric Urology 2002;London: Martin Dunitz Ltd. 345-370.

29. De Paepe H, Renson C, Van Laecke E, Raes A, Vande Walle J, Hoebeke P. Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int 2000;85:889-893.

30. Han SW, Kim AY, Chung KM. Conservative treatment for pediatric voiding dysfunction: Chapter 2. Comprehensive aspect. Conservative Management of Female Incontinence. The Korean Society of Voiding Dysfunction and Incontinence 2007;Pentide. 215-229.

31. Chase JW, Homsy Y, Siggaard C, Sit F, Bower WF. Urotherapy and bowel dysfunction. J Urol 2004;171:2641-2643.

32. Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2006;4:1-13.

33. Nijman RJ. Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. Urology 2004;63:S1. 45-50.

34. Austin PF, Homsy YL, Masel JL, Cain MP, Casale AJ, Rink RC. Alpha-adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol 1999;162:1064-1067.

35. Husman DA. Use of sympathetic alpha antagonists in the management of pediatric urologic disorders. Curr Opin Urol 2006;16:277-282.

Figure 1
Holding techniques in girls.
(A) Vincent's Curtsey sign. (B) squatting position.
jkma-51-1040-g001-l.jpg
Figure 2
Correction of voiding posture.
jkma-51-1040-g002-l.jpg
Figure 3
Bladder diary.
jkma-51-1040-g003-l.jpg
Figure 4
Bladder training diary.
jkma-51-1040-g004-l.jpg


ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next