Hildegard Lax

Clinical results of anti-inflammatory therapy in Graves’ ophthalmopathy and association with thyroidal autoantibodies*

objective  Graves’ ophthalmopathy (GO) is clinically associated with autoimmune thyroid disease, and autoantibodies to thyroidal antigens, especially to the TSH‐receptor (TRAb), might be involved in the disease process. While there is mounting evidence that TRAb are associated with GO at the onset of the disease, so far no studies have looked at the association between thyroidal autoantibodies and the clinical outcome of GO therapy. The aim of this retrospective study was to evaluate whether TSH binding inhibitory immunoglobulins (TBII) and thyroid stimulating antibodies (TSAb) are still associated with the clinical activity and severity of GO after the completion of anti‐inflammatory therapy. In addition, we wanted to elucidate whether thyroid peroxidase (TPO) or thyroglobulin (TG) autoantibodies (TPOAb and TGAb) are in any way related to GO.

The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: A multicenter controlled trial in children

PURPOSE The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. MATERIALS AND METHODS In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment. RESULTS In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome. CONCLUSIONS Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission

Objective  To evaluate the relationship between severity of Graves’ ophthalmopathy (GO) and relapse/remission rate of associated thyroid disease.

Pediatric UrologyThe Relevance of Urodynamic Studies for Urge Syndrome and Dysfunctional Voiding: A Multicenter Controlled Trial in Children

PURPOSE The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. MATERIALS AND METHODS In the European Bladder Dysfunction Study 97 children with clinically diagnosed urge syndrome received standard treatment, to which was randomly added placebo, oxybutynin or bladder training with online feedback. In a separate branch 105 children with clinically diagnosed dysfunctional voiding were randomly allocated to standard treatment or standard treatment plus pelvic floor training with online feedback. In all children urodynamic studies were performed before and immediately after treatment. RESULTS In urge syndrome detrusor overactivity was present in 33% of cases before and 27% after treatment (of which 65% were de novo). Detrusor overactivity did not correlate with treatment outcome. In dysfunctional voiding increased pelvic floor activity during voiding, which was present in 67% of cases before and 56% after treatment (of which 45% were de novo), did not correlate with treatment outcome. In urge syndrome as well as in dysfunctional voiding neither maximum detrusor pressure during voiding, cystometric bladder capacity, bladder compliance nor free flow patterns correlated with treatment outcome. CONCLUSIONS Neither detrusor overactivity nor increased pelvic floor activity during voiding correlated with treatment outcome. Standard treatment could be the first choice in urge syndrome as well as in dysfunctional voiding, reserving urodynamic studies for patients in whom this first approach fails.

Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence

Functional urinary incontinence causes considerable morbidity in 8.4% of school‐age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi‐center controlled trial was designed, the European Bladder Dysfunction Study.

Functional urinary and fecal incontinence in neurologically normal children: symptoms of one ‘functional elimination disorder’?

Authors from Belgium, the Netherlands and Germany tried to clarify the relationship between disordered defecation and non‐neuropathic bladder‐sphincter dysfunction; they found few arguments for a casual relationship between these conditions.

Improving the Cure Rate of Alarm Treatment for Monosymptomatic Nocturnal Enuresis by Increasing Bladder Capacity—A Randomized Controlled Trial in Children

PURPOSE We prospectively assessed response and cure rates of alarm treatment, following pretreatment with antimuscarinics and/or holding exercises aimed at increasing maximum volume voided in 149 children with monosymptomatic nocturnal enuresis. MATERIALS AND METHODS In a prior trial the same 149 children had been randomized into 5 groups to assess interventions for increasing maximum volume voided, namely placebo or antimuscarinics with (groups A and B, respectively) and without (C and D, respectively) holding exercises, and a control group (E) receiving just alarm treatment. Following pretreatment groups A to D received alarm treatment. Full response and cure rates were assessed, as well as the influence on these rates of baseline maximum volume voided, increase in maximum volume voided after pretreatment, gender, age and previous treatment. RESULTS Neither full response nor cure was influenced significantly by the increase in maximum volume voided achieved in groups A and B with holding exercises. Overall full response ranged from 50% to 73%, and overall cure ranged from 50% to 67%. Possible predictors for full response and cure were prior treatment (p <0.02) and age younger than 8 years (p <0.05). CONCLUSIONS In monosymptomatic nocturnal enuresis increasing maximum volume voided does not affect response or cure rate of subsequent alarm treatment. Previous treatment and age younger than 8 years are possible predictors for response and cure.

Self-reported urinary incontinence, voiding frequency, voided volume and pad-test results: variables in a prospective study in children

To determine the congruence between self‐reported and objective data on incontinence, voided volume (VV) and voiding frequency (VF), in a prospective study of treatment of functional urinary incontinence (UI) due to urge syndrome or dysfunctional voiding in children.

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

OBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS. A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbachs Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems. RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant. CONCLUSION.More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding.

Long-term effects of a urotherapy training program in children with functional urinary incontinence: A 2-year follow-up

Objective. To evaluate the long-term effectiveness of a urotherapy training program implemented at our institution. Day- and/or night-time wetting as a consequence of functional urinary incontinence is a common problem in childhood. A number of treatment methods are available, among them urotherapy. Material and methods. Forty-eight patients (age range 10–14 years) with urge incontinence or dysfunctional voiding were evaluated with a questionnaire 2 years after completion of a urotherapy training program. Results. Two years after completion of training, 86.7% of the inpatient and 93.8% of the outpatient groups with day-time wetting and 79.2% of the inpatient and 41.6% of the outpatient groups with night-time wetting were cured or had improved. Conclusions. Compared with the published data on the natural course of incontinence, the urotherapy program evaluated in this study resulted in higher success rates. Compared with 6-month follow-up, improvement rates proved to be stable, and cure rates (with the exception of patients with night-time wetting in the outpatient training group) even increased significantly during the 2-year follow-up.