Sven Mattsson

A new fast-melting oral formulation of desmopressin: a pharmacodynamic study in children with primary nocturnal enuresis

To determine the pharmacodynamic properties of a new oral lyophilisate formulation of desmopressin (in single doses of 30, 60, 120, 240, 360 or 480 µg) in children with known primary nocturnal enuresis (PNE) and thus identify those dosages that could provide a duration of action corresponding to a typical length of night‐time sleep in children with PNE; additional objectives were to determine the safety and tolerability of desmopressin in this population.

Urinary flow in healthy schoolchildren

The urinary tree flow in 180 healthy schoolchildren aged 7‐16 years was examined with a new kind of uroflowmeter. The examinations were performed at ordinary school toilets and each child presented at least two registrations. Besides the shape of the flow curve, the urinary flow was evaluated by the parameters voided volume, maximum flow rate, average flow rate. How at 1 second and at 0.5 seconds, time to maximum How. and voiding time. All parameters were related to sex. age. and body parameters.

Medical problems in adolescents with myelomeningocele (MMC) : an inventory of the Swedish MMC population born during 1986-1989.

Aim: To describe the prevalence of myelomeningocele (MMC) and the medical needs of adolescents, 15–18 years, with MMC in Sweden, at a time when they are on the threshold of adulthood, leaving paediatrics.

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.

Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program.

PURPOSE Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines. MATERIALS AND METHODS Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth. RESULTS Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up. CONCLUSION High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage.

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.

Flow rate nomograms in 7- to 16-year-old healthy children.

To construct flow rate nomograms for children, 180 healthy boys and girls aged 7–16 years were examined with a new kind of flowmeter. Each child presented at least two registrations. The flow rate was significantly higher at the second examination and these micturitions were used to construct the nomograms. The relation between flow rate and volume may be described by the function flow = b volumec, where b and c describe the slope and curvature, respectively. The advantages of using this relation are that non‐parametric statistics can be employed, the variation around the median increases with increasing volume, and it is easy to calculate volume corrected flow rates. The exponent 0.5, often used earlier, was found to overestimate flow rates obtained at low volumes. In the constructed nomograms, the exponent varied between 0.29 and 0.42.

Children and youth with myelomeningocele's independence in managing clean intermittent catheterization in familiar settings

Aim:  To examine the ability of children and youth with myelomeningocele to independently manage clean intermittent catheterization.