Gunilla Gladh

Quality of life in neurologically healthy children with urinary incontinence

Aim: To bring forward the arguments for active treatment of urine incontinence in otherwise healthy children, a quality‐of‐life (QoL) study was performed. Subjects and methods: A self‐rating QoL questionnaire, child‐adjusted and validated, was completed by 120 neurologically healthy children, aged 6–16 y, with urinary incontinence. Another 239 age‐matched children made up a control group. The two groups were compared both totally and in age‐related subgroups (6–8, 9–12, >12 y) concerning the index for all questions, for universal parts (without questions dealing with incontinence) as well as for specific key domains. Results: The patient group had a significantly lower index than the control group both with and without items related to incontinence (p <0.0001). Social situation, self‐esteem and self‐confidence were most influenced, particularly in the youngest children. Thirty‐one children (13%) of the control group reported incontinence and did not score their QoL as good as their continent peers but better than the study patients.

Voiding pattern in healthy newborns

A 4‐hour observation period has been used in infants to investigate suspected bladder dysfunction. The aim of the present study was to extend the usefulness of this protocol by establishing reference values for voiding frequency, intervals, volumes, and residual urine in healthy newborns. The study included 51 healthy newborns, 26 girls and 25 boys, aged 3 to 14 days. During a 4‐hour period, all micturitions and residuals were recorded as well as feeding, sleeping, crying, and defecations. The observation was completed with the child undressed to observe the urinary stream during one void. Different provocation tests were tried to induce urinary leakage. All newborns voided with a stream, about once per hour, with a median volume of 23 mL. For each voiding parameter, there was a large inter‐ and intra‐individual variability. Double voidings were common as well as sizable residual volumes. The diuresis was about six times higher than in healthy school children. The healthy newborns did not leak during provocation tests such as manual compression of the bladder. Neurourol. Urodynam. 19:177–184, 2000.

Tap-water enema for children with myelomeningocele and neurogenic bowel dysfunction.

Aim: To evaluate the outcome of transrectal irrigation (TRI) using clean tap water without salt in children with myelomeningocele and neurogenic bowel problems. Methods: 40 children (21 boys and 19 girls; aged 10 mo to 11 y) with myelomeningocele and neurogenic bowel dysfunction were treated with TRI given by a stoma cone irrigation set daily or every second day. A questionnaire on the effects on faecal incontinence, constipation and self‐management was completed by the parents, 4 mo–8 y (median 1.5 y) after start. Effects on rectal volume, anal sphincter pressure and plasma sodium were evaluated before and after the start of irrigation. Results: At follow‐up, 35 children remained on TRI, four had received appendicostomy, while one defecated normally. For all children but five (35/40; 85%) the procedure worked satisfactorily, but a majority found the procedure very time consuming and only one child was able to perform it independently. All children were free of constipation; most (35/40) were also anal continent. Rectal volume and anal sphincter pressure improved, while plasma sodium values remained within the normal range.

Anogenital electrical stimulation as treatment of urge incontinence in children: TREATMENT OF URGE INCONTINENCE IN CHILDREN

Objectives To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy‐resistant urge incontinence.

OUTCOME OF THE BLADDER COOLING TEST IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTION

PURPOSE We evaluated the diagnostic use of the bladder cooling test in children with neurogenic bladder dysfunction. MATERIALS AND METHODS We performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningocele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapidly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was considered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion. RESULTS The bladder cooling test was positive in 37 children younger than 4 years, at which age it is normally positive. The test was negative in only 2 patients, indicating a complete lower motor neuron lesion. It was positive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic bladder dysfunction. Four of the 20 children with a negative test voided normally, while the remainder had no voiding contractions, suggesting a nonfunctional spinal sacral reflex arch to the bladder. CONCLUSIONS The bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron lesion. It may be used longitudinally to demonstrate changes in bladder function with growth.

How to reach independence in the toilet situation – an update

Background At SRHSB in Heidelberg (2007) was shown that for children with myelomeningocele (MMC) the awareness of ability and degree of independence in the toilet activity was too unrealistic. The study is now extended to a larger group of children with observation of the toilet activity in the childs own environment at home or at school. The aim was to evaluate if independence in the toilet situation was different in a well-known home environment compared to a hospital setting.

Outcome on renal function in children with neurogenic bladder dysfunction of a standardised follow-up programme

Background Renal damage still constitutes a major reason for morbidity and mortality in persons with Spina Bifida [1]. Clean intermittent catheterisation is the cornerstone in treatment of neurogenic bladder dysfunction often combined with anticholinergics [2]. Multiple techniques of renal protective surgery have been developed but have also significant risks of both shortand long-term side effects. In Sweden national guidelines for follow-up of children with Spina Bifida have been developed [3], now under revision.

Independence in the toilet activity in children with myelomeningocele

Background Most children with myelomeningocele (MMC) have neurogenic bladder dysfunction, with often lifelong needs of treatment making many of them dependent into adulthood. The aim of the present study was to identify and describe deficits in motor respectively executive functions, and time-concept perception hindering independence in the toilet situation for children with MMC treated with clean intermittent catheterisation (CIC) and secondarily to describe their own opinions on how their toilet activity works.