Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra

Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries

بررسی اثرات تحريک الکتريکی در بهبودعملکرد ادراری در کودکان مبتلا به اختلالات غیرعصبی ادراری

چکیده هدف مطالعه: در این مطالعه اثر تحریک الکتریکی interferential روی اختلالات عملکردی و غیر عصبی ادراری کودکان بررسی شد. مواد و روش ها: 80 کودک با اختلالات عملکردی و غیر عصبی ادراری شامل 9 پسر و 71 دختر در رده ی سنی 5 تا 13 سال وارد این مطالعه شدند و به طور تصادفی به دو گروه مساوی case و کنترل تقسیم شدند. گروه کنترل تحت درمان دارویی آنتی کولینرژیک و یوروتراپی اولیه شامل آموزش رژیم غذایی صحیح و مصرف درست مایعات، آموزش روش صحیح ادرار کردن، داشتن دفعات ادرار منظم و آموزش نحوه ریلکس کردن عضلات کف لگن و اسفنکتر ادراری در حین ادرار کردن قرار گرفتند. گروه case علاوه بر موارد ذکر شده برای گروه کنترل، تحت درمان با تحریک الکتریکی interferential نیز قرار گرفتند که شامل 15 جلسه درمانی، هفته ای دومرتبه، هر بار به مدت 20 دقیقه بود. چارت ادراری کامل کودک توسط والدین قبل، بعد از اتمام دوره درمان و یکسال بعد برای تمام کودکان حاضر در مطالعه پر شد. تمامی کودکان قبل، بعد از اتمام دوره درمان و یکسال بعد تحت سونوگرافی کلیه ها و مجاری ادراری و یوروفلومتری- الکترومیوگرافی (EMG) قرار گرفتند. یافته ها: 40 درصد کودکان در گروه case و 41 درصد کودکان در گروه کنترل بی اختیاری ادراری در طول روز داشتند که بعد از اتمام دوره درمان و یکسال بعد به طور معنی داری در گروه case در مقایسه با کنترل کاهش پیدا کرد (P < 0.05). بی اختیاری ادراری طی شب (شب ادراری) نیز به طور معنی داری در گروه case در مقایسه با کنترل کاهش یافت (P < 0.05). در رابطه با پارامترهای یوروفلومتری، بعد از اتمام دوره درمان و یکسال بعد maximum urine flow به طور معنی داری در گروه case در مقایسه با گروه کنترل افزایش یافته و voiding time به طور معنی داری کاهش یافت (P < 0.05). در ابتدای مطالعه تمامی کودکان فرم ادرار (flow pattern) غیرنرمال داشتند که بعد از اتمام دوره ی درمان در 80 درصد از گروه case و 55 درصد از گروه کنترل اصلاح شد. بعد از یکسال اصلاح flow pattern غیرنرمال به نرمال در گروه case در مقایسه با کنترل بیشتر بود (P < 0.015). تغییر معنی داری در بهبود عفونت ادراری، بازگشت ادرار از مثانه به حالب و یبوست بین دو گروه case و کنترل وجود نداشت. نتیجه گیری: ترکیب روش درمانی تحریک الکتریکی interferential با درمان دارویی و یوروتراپی در درمان کودکان مبتلا به اختلالات عملکردی و غیرعصبی ادراری روشی موثر، ارزان و بدون عارضه جانبی است

Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease study 2019

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors). Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population. Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)). Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.publishedVersio

Management of Urinary Incontinence in Complete Bladder Duplication by Injection of Bulking Agent at Bladder Neck Level into the Proximal Urethra

Bladder duplication is a rare entity in children. The term encompasses a wide spectrum of anomalies from isolated bladder duplication in coronal or sagittal planes to duplicated bladder exstrophy and associated musculoskeletal and visceral anomalies. Given this wide variability, the treatment of these patients is not standardized. We hereby present a female patient with chief complaint of long-standing urinary incontinence who had complete bladder and urethral duplication and pubic diastasis. The patient was treated with bulking agent injection at the incompetent bladder neck and proximal urethra with resolution of incontinence, obviating the need for extensive surgeries

Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms

ABSTRACT Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients. Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children's Continence Society guidelines. Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients. Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR