Bieke Samijn

Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review.

To systematically review the scientific literature addressing lower urinary tract symptoms (LUTS) and urodynamic findings in adults and children with Cerebral Palsy (CP). Prognostic factors were also investigated.

Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.

INTRODUCTION Although the short-term effects of urotherapy as a treatment strategy for lower urinary tract (LUT) conditions have been well documented, the long-term effects remain largely unknown. A better insight into the long-term effects of urotherapy could improve the clinical guidelines for children with incontinence. OBJECTIVE This study aimed to investigate the long-term effects (i.e., from 6 months to 2 years) from a clinical voiding reeducation program among children with LUT conditions. STUDY DESIGN This study was a prospective continuation of the follow-up study of Hoebeke et al. (2011). Thirty-eight children (mean age 9 years) with LUT conditions completed an extensive clinical voiding reeducation program (VS). Data on medication, voiding, drinking, pelvic floor tone, uroflowmetry, and incontinence were recorded 2 years after the VS. These data were compared with the outcomes at 6 months follow-up and at intake before voiding school. RESULTS Six months after voiding school, 22 children continued having daytime incontinence (ID) and/or enuresis (EN). Six of them became dry at 2 years. Conversely, 16 children were dry at 6 months, of which eight relapsed at 2 years. Whereas all parameters significantly improved 6 months after VS, further improvements from 6 months to 2 years could only be noticed for the proportion of children suffering from overactive bladder (92% at intake, 55% at 6-month follow-up and 18% at 2-year follow-up) (Figure). Fluid intake and pelvic floor tone improved after 6 months, but showed a significant relapse after 2 years (P = 0.013, P = 0.031, respectively). DISCUSSION Hoebeke et al. (2011) concluded that results continued to improve after VS. No further improvements could be noticed 2 years after VS, although individual shifts were present. The results of the present study underline the value of long-term follow-up to detect those needing ongoing treatment to prevent relapse. Fluid intake and pelvic floor tone deteriorated from 6 months to 2 years. It could be hypothesized that inadequate fluid intake, possibly leading to decreased voided volumes, may be seen as an indicator for upcoming incontinence relapse. It could be stated that adequate fluid intake and pelvic floor tone may play a role in remaining continent for the long term. Study limitations should be considered. The study population was heterogeneous and rather small. Together with other missing values, this could have influenced the results. CONCLUSION Close individual, long-term follow-up after clinical voiding reeducation in children is recommended in order to timely detect and prevent potential relapse.

Risk factors for daytime or combined incontinence in children with cerebral palsy

Purpose: We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy. Materials and Methods: A cross‐sectional case‐control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP‐Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were performed for variables and clusters, respectively. A final associative logistic model including all clusters was developed. Results: The study included 34 incontinent children and 45 continent children. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), Gross Motor Function Classification System level IV (OR 10.63) and V (OR 34.00), and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced daytime or combined urinary incontinence negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for daytime or combined urinary incontinence. Conclusions: Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy.

Uroflow measurement combined with electromyography testing of the pelvic floor in healthy children

To investigate if the standard protocol for uroflowmetry, recommended by the International Childrens Continence Society, remains accurate when integrating EMG measurement by means of superficial electrodes.