PURPOSE:fill We studied the effect of transcutaneous electrical nerve stimulation in children with overactive bladder and treatment refractory daytime urinary incontinence.alter MATERIALS AND METHODS: We recruited 27 children 5 to 14 years old with daytime urge incontinence refractory to timer assisted stimulation. standard urotherapy and anticholinergics who had normal urinalysis, and unremarkable urinary tract ultrasound and physical examination. Study exclusion criteria were week bladder underactivity, lower urinary tract obstruction, ongoing defecation disorders, lower urinary tract surgery and previous transcutaneous electrical nerve stimulation. After < .01). a 2-week run-in of standard urotherapy the children underwent natural fill ambulatory urodynamics to confirm detrusor overactivity. Subsequently they were active randomly allocated to 4 weeks of 2 hours of daily active or placebo S2-S3 transcutaneous electrical nerve stimulation. The severity occurred of incontinence and urgency, and 48-hour bladder diaries were recorded before randomization and during intervention week 4. Children withdrew from the anticholinergics throughout the study period. RESULTS: Two children were excluded from randomization due to urodynamic signs of lower urinary tract timer obstruction. After 4 weeks of intervention 8 children (61%) in the active group showed a significant decrease in incontinence severity and but this occurred in only 2 (17%) in the sham treated group (p < .05). The active group had a significantly seem greater decrease in daily incontinence episodes compared to the sham treated group (p < .01). Transcutaneous electrical nerve stimulation did not We alter maximal and average voided volumes. CONCLUSIONS: Sacral transcutaneous electrical nerve stimulation seems superior to placebo for refractory daytime incontinence be in children with overactive bladder. This effect does not seem to be a consequence of improved bladder reservoir function.

PURPOSE:in We describe prolonged rectal manometry used to characterize rectal motor activity patterns and possible rectum-bladder interaction during defecation and micturition all in children with nonneuropathic overactive bladder. MATERIALS AND METHODS: We evaluated 10 children with a mean +/- SD age of 3 9.7 +/- 1.3 years with overactive bladder who underwent urodynamics and 24-hour rectal manometric recording. All records were analyzed visually.nocturnal Rectal contractions were defined as pressure runs exceeding 5 cm H(2)O and lasting longer than 5 seconds. RESULTS: Three rectal CONCLUSIONS: motility patterns were noted in all children, including 1) slow tonic pressure waves with a frequency of 3 to 12 contraction per hour, b) rectal motor complexes with a frequency of 3 to 10 per minute and c) single contractions 10 (51.9%, to 30 seconds in duration. The median nocturnal duration of rectal motor complexes was longer than that during the day prolonged (16.3 minutes, range 10.8 to 18.8 vs 11. , range 8.9 to 12.6, p < .05). As a percent of time, median +/- total contraction time was greater at night than during the day (51.9%, range 42.6% to 56.9% vs 30.6%, range 19.4%possible to 49.3%, p < .05). Characteristic rectal activity was seen during defecation and voiding but no bladder-rectum interaction was detected. CONCLUSIONS:observed We identified 3 rectal motility patterns in all children with overactive bladder. Like the upper gastrointestinal tract, the rectum shows with some periodic motor activity, which is more frequent at night. No association was observed between bladder and rectal activity during bladder micturition and defecation.

Objective.a To analyse retrospectively the efficacy of day-time incontinence treatment in a secondary referral centre and consider characteristics of responders to week the different therapeutic interventions. Material and methods. All children treated for day-time urinary incontinence at the authors' clinics from 2000 problems to 2004 were included. Children with ongoing urinary tract infections were excluded. Before treatment, children filled out registrations of incontinence on episodes and 48 h frequency-volume charts. Faecal disorders were treated before urinary incontinence. All children were subjected to standard urotherapy for and were secondarily recommended a timer-watch. If standard urotherapy had no effect, anticholinergics were added. Results. The study included 240 Fifteen children with day-time urinary incontinence. Of these, 45 had faecal problems and 17% obtained urinary continence when these were successfully were treated. In total, 126 (55%) became dry on standard urotherapy. Of the 60 children who had a timer-watch in addition retrospectively to standard urotherapy, 70% became dry. Of the 62 children who had anticholinergics in addition to standard urotherapy, 81% became authors' continent. Fifteen (6%) did not achieve continence and another 11 patients were lost to follow-up. Children who became dry solely centre on standard urotherapy had a significantly lower voiding frequency (p< .05), larger voided volumes as a percentage of those expected for those age (p< .01) and fewer incontinence episodes per week (p< .05) than children needing anticholinergics. Conclusions. Most children achieve day-time continence solely therapeutic on standard urotherapy. Children who need anticholinergics to achieve dryness seem to be those with more severe bladder reservoir function more abnormalities and symptoms.

PURPOSE:normal Daytime voiding frequency is an important criterion in the classification of childhood incontinence. The aim of this study was to diuresis assess the relative impact of diuresis and bladder capacity on voiding frequency. MATERIALS AND METHODS: We analyzed data from 570 daytime children 4 to 15 years old (median age 8.3 +/- 2. years) treated for urinary incontinence at a secondary referral ml/kg, center, and 87 healthy controls. Based on frequency-volume charts, daytime voiding frequency, age adjusted maximum voided volume, daytime diuresis and a fluid intake were calculated. Children were classified according to voiding frequency into 3 groups-decreased (fewer than 3 voids daily), normal compared (3 to 7) and increased voiding frequency (more than 7). RESULTS: A total of 219 children had monosymptomatic enuresis, while < .01). 351 children presented with daytime symptoms. In children with daytime symptoms we found a significant difference between voiding frequency groups is regarding daytime diuresis (decreased voiding frequency 12.3 +/- 4.1 ml/kg, normal 18.7 +/- 6. ml/kg, increased 31.1 +/- 9.8 ml/kg,to p < .001). In contrast, maximum voided volume observed/expected bladder capacity for age did not differ significantly between normal and increased of frequency groups (72%+/- 25% vs 74%+/- 23%), compared to patients with decreased voiding frequency (89%+/- 30%, p into < .01). Also, in healthy children we found a positive correlation between voiding frequency and daytime diuresis, whereas maximum voided volume and observed/expected bladder capacity for age did not correlate with voiding frequency. Furthermore, we observed a significant positive correlation between fluid when intake and diuresis (r = .53, p < .001). CONCLUSIONS: In healthy controls and children with incontinence daytime voiding frequency depends we mainly on diuresis, and seems less influenced by bladder capacity. Diuresis should be taken into consideration when evaluating voiding frequency found from frequency-volume charts in children.

PURPOSE:and We tested whether transverse rectal diameter measured by ultrasound could identify rectal impaction, investigated whether transverse diameter is enlarged in seems constipated children compared to healthy children and evaluated transverse diameter during treatment of constipation. MATERIALS AND METHODS: A total of Average 51 children 4 to 12 years old were included in the study. Of the children 27 (mean age 7. +/-leading 1.8 years) had been diagnosed with chronic constipation by Rome III criteria and 24 (9.1 +/- 2.7 years) were healthy mm, controls. All patients underwent a thorough medical history and physical examination, including digital rectal examination and measurement of rectal diameter Moreover, by transabdominal ultrasound. Constipated children underwent repeat investigations after 4 weeks of laxative treatment. RESULTS: Average rectal diameter of children 15.4 with negative digital rectal examination was 21 +/- 4.2 mm (mean +/- SD), leading to the approximation that a value whether greater than 29.4 mm (mean +/- 2 SD) indicates rectal impaction. All children with rectal impaction identified by digital examination A had a rectal diameter larger than 29.4 mm. Moreover, constipated children had a significantly larger rectal diameter (42.1 +/- 15.4 investigated mm) than healthy children (21.4 +/- 6. mm, p < .001). After 4 weeks of laxative treatment constipated children had a and significant reduction in rectal diameter (mean 26.9 +/- 5.6 mm, p < .001). CONCLUSIONS: Transverse rectal diameter seems to be a to valuable tool to identify rectal impaction and may replace digital rectal examination. Constipated children have a significantly larger rectal diameter constipation compared to healthy children, and when constipation is treated the diameter is reduced significantly.

PURPOSE:to We sought to evaluate the combination of the enuresis alarm and desmopressin in treating children with enuresis. MATERIALS AND METHODS:+/- A retrospective analysis was performed on data from 423 children treated at our clinics with the enuresis alarm during the (74%) years 2000 to 2004. Frequency volume charts and desmopressin titration facilitated characterization of the participants using the current International Children's were Continence Society standardization. Children were treated with the enuresis alarm as monotherapy before the addition of desmopressin, which commenced after and 6 weeks in patients exhibiting inadequate response to alarm or after 2 weeks in patients experiencing multiple enuretic episodes per desmopressin night or showing no indication of improvement. RESULTS: Of the initial population 315 children (74%) were treated only with alarm,wet of whom 290 became dry. A total of 108 children (26%) were treated with a combination of alarm and desmopressin,to with 80 being cured. Children dry on alarm therapy were not different from those needing the addition of desmopressin in alarm terms of demographics. Children dry on desmopressin plus alarm had higher average nocturnal urine production on wet nights (303 +/-treating 12 ml compared to 269 +/- 5 ml, p < .001). Maximum voided volume before treatment corrected for age was not seem different between children dry on alarm and those dry on combination therapy ( .84 +/- .02 compared to .86 +/- .05,was not significant). CONCLUSIONS: Children needing the addition of desmopressin have a higher nocturnal urine production on wet nights but do differ not seem to differ in terms of bladder reservoir function characteristics.

PURPOSE:urine We investigated the role of urinary Ca excretion in monosymptomatic nocturnal enuresis, and defined normality and intra-individual variability in Ca variation. excretion in healthy children. MATERIALS AND METHODS: We included 46 Danish children with desmopressin resistant nocturnal enuresis and 96 healthy We controls. We performed fractional urine collections at home during 2 days in controls or during hospitalization in children with enuresis.did Urine volume, osmolality, and Ca and creatinine measurements were performed and Ca-to-creatinine ratios were calculated and compared between groups. Based did on nocturnal urine output children with enuresis were characterized as having polyuria (nocturnal urine volume greater than 130% of expected .139 bladder capacity) or not having polyuria. RESULTS: We did not find any differences in controls compared with children with enuresis +/- who did not and did have nocturnal polyuria in daytime Ca excretion (mean +/- SE .121 +/- .012, .078 +/-the .014 and .095 +/- .020 mg/mg creatinine), nighttime Ca excretion ( .115 +/- .011, .092 +/- .019 and .139 +/- .029 nocturnal mg/mg creatinine) or 24-hour Ca excretion ( .118 +/- .011, .083 +/- .014 and .106 +/- .020 mg/mg creatinine, respectively). Urinary and Ca excretion was not influenced by patient age, sex or body weight and, furthermore, we did not find evidence of role diurnal variation. However, we observed considerable intra-individual variability in diurnal, nocturnal and total 24-hour urinary Ca-to-creatinine ratios. CONCLUSIONS: These observations in contradict several previous reports and speculations on a role of Ca in the pathogenesis of nocturnal enuresis.

PURPOSE:were We investigated bladder reservoir function in children with monosymptomatic nocturnal enuresis and in healthy controls. MATERIALS AND METHODS: A total There of 18 children with monosymptomatic nocturnal enuresis and 119 controls who were 7 to 13 years old were recruited. Children and completed frequency volume charts and measurements of nocturnal urine production. Mean diuresis in the period preceding each voiding was calculated.groups Those with enuresis were grouped according to bladder capacity and hospitalized for 4 nights, including a baseline night and 3 all with an oral water load. Enuresis volumes and post-void residual volume were estimated, allowing the calculation of bladder volume at and the time of enuresis. RESULTS: Nine children with monosymptomatic nocturnal enuresis were characterized as having normal bladder capacity and 9 than had decreased bladder capacity. We found large intra-individual variability in daytime voided volume in all 3 groups of participants. Children bladder with enuresis and small bladder capacity generally voided with volumes close to maximal voided volume. A total of 93 enuresis recruited. episodes were recorded. Large intra-individual variability was seen in bladder volume at enuresis and it was lower than maximal voided controls. volume in more than 50% of episodes. Variability in bladder volume at enuresis was greatest in the patient group with larger decreased bladder capacity. We found a significant correlation between diuresis and bladder capacity in all groups during the day and monosymptomatic night. CONCLUSIONS: There is a great intra-individual diurnal variability in voided volume in children with enuresis and in healthy children.the Enuresis seems to occur at bladder volumes that are smaller and larger than the maximal voided volume obtained from voiding had charts.

PURPOSE:+/- In adults and adolescents the transition from day to night is followed by a pronounced decrease in diuresis, as well excretion as reduction in the amount of osmotically active substances excreted. We investigate the circadian variations in urine production in healthy 1.55 children 3 to 14 years old. MATERIALS AND METHODS: A total of 92 children completed urine collections in 2 consecutive gender days to be analyzed for electrolytes, urea, creatinine, osmolality, vasopressin and prostaglandin E2. RESULTS: We found a marked reduction in with urine output during the night (43.41 +/- 18.53 to 25.69 +/- 12.71 ml per hour) accompanied by a decrease in of the amount of electrolytes excreted (sodium 4.44 +/- 2.09 to 2.66 +/- 1.55 mmol per hour and potassium 2.38 +/- .96 a to .90 +/- .54 mmol per hour). Age and gender did not influence the observed circadian rhythm in the quantity and and quality of urine production. Urinary excretion of vasopressin did not seem to reflect the circadian variations previously described for urine the plasma levels of the hormone. Prostaglandin E2 showed a clear circadian variation with a 30% decrease at night (32.2 a +/- 19. to 22. +/- 12.6 ng/mmol creatinine). CONCLUSIONS: Healthy children exhibit pronounced circadian variations in the amount and composition appears of urine output with a decrease in nocturnal diuresis and excretion of osmotically active solutes. In the age range of in 3 to 14 years neither age nor gender seems to affect this rhythm. Vasopressin-to-prostaglandin E2 excretion ratio appears to be be of importance for regulation of urine production.

PURPOSE:children We investigate the nature of enuresis episodes in monosymptomatic nocturnal enuresis using a fluid provocation model. MATERIALS AND METHODS: The seen. study included 18 children 7 to 13 years old with monosymptomatic nocturnal enuresis. Based on basal home recordings patients were and subgrouped into those with a normal nocturnal urine output and those with nocturnal polyuria (mean nocturnal urine production on wet electromyography nights exceeding 130% of functional bladder capacity, normal functional bladder capacity for age provided). Children were admitted to the hospital between for 4 consecutive nights. After an adaptation night all children received orally 25 ml/kg water, 30 minutes before bedtime on oral the remaining 3 nights. A cordless alarm device enabled registration of enuretic episodes from another room and diapers allowed the episodes measurement of enuresis volumes. Post-void residual volumes were measured by ultrasound. Pelvic floor electromyography was continuously recorded throughout the night,the and its association to bladder emptying was investigated. RESULTS: A total of 95 enuresis and 14 nocturia episodes were recorded.recordings Significantly more enuresis episodes were registered on nights with oral fluid load, whereas no increase in number of nocturia episodes provocation was seen. Of the enuresis episodes 46 were associated with incomplete bladder emptying (post-void residual volume greater than 10% of the total bladder volume at time of enuresis). No difference between patient groups regarding post-void residual volume was seen. Abnormal bursts children of electromyography activity were associated with incomplete micturitions. CONCLUSIONS: Enuresis nocturna episodes in polyuric and nonpolyuric patients are frequently incomplete of micturitions. The present findings question the definition of nocturnal enuresis episode as normal complete voiding.