case Prof. Dr.J.Vande Walle Feb Universitair Ziekenhuis Gent 1
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1 case Prof. Dr.J.Vande Walle Feb
2 A boy, 10 years old! Bedwetting 5/7days! nocturia! wet pants! Frequency 5 x/day! constipation! adhd! URI/ uropathie 2
3 Urological symptoms* /ALARMSYMPTOMS Yes Leakages of urine during the day Frequency of urination >8x/day? Frequency of urination <3x/day? Sudden and urgent need to urinate? Need to push in order to urinate (straining)? Fractionated voiding? Illness./malformation of kidneys and/or urinary tract? Previous history* Urinary tract infections? Yes Stools** Yes Constipation? Traces of stools in underpants (NOT due to inadequate wiping of bottom)? Drinking habits*** Does the child drink a lot in the evening and/or at night? Psychology** Yes Yes 3
4 A boy, 10 years old! Bedwetting 5/7days! Sometimes only drops! nocturia.. But parents are waking him up! wet pants! Sometimes a few drops! When he is nerveous, when it is cold, when he drinks to much, after sport, giggling! Frequency 5 x/day! But has to pee during lessons! 12 times/day when he drinks more! Is postponing 4
5 A boy, 10 years old! Frequency 5 x/day! But has to pee during lessons! 12 times/day when he drinks more! STANDAARDISED FLUID INTAKE INCREASES SENSITIVITY 5
6 Urological symptoms* /ALARMSYMPTOMS Yes Leakages of urine during the day Yes Frequency of urination >8x/day? Yes Frequency of urination <3x/day? Sudden and urgent need to urinate? Yes Need to push in order to urinate (straining)? Fractionated voiding? Illness./malformation of kidneys and/or urinary tract? Previous history* Urinary tract infections? Yes Stools** Yes Constipation? Traces of stools in underpants (NOT due to inadequate wiping of bottom)? Drinking habits*** Does the child drink a lot in the evening and/or at night? Psychology** Awareness of behavioural problems or other Yes Yes 6
7 A boy, 10 years old! cturnal diuresis ml! Morning void ml! Diaper ml! nocturia! 2 times /day wet pants! But only after school at home 7
8 A boy, 10 years old Hjalmas formula (10 +1)*30 = 300ml! cturnal diuresis ml! Morning void ml! Diaper ml! nocturia! 2 times /day wet pants! But only after school at home 8
9 Further diagnostics! Uroflow = Optional / obligatory?! Ultrasound for residue Optional / obligatory?! US bladder wall Optional / obligatory?! US kidney Optional / obligatory?! Cystomanometry Optional / obligatory?! Videocystomanometry Optional / obligatory? 9
10 25 ml/s Flow Rate urinary flow curves of healthy children S 25 ml/s Flow Rate S 10
11 25 ml/s Flow Rate urinary flow curves of healthy children INTERPRETATION S 25 ml/s Flow Rate S 11
12 MEANING OF THICK BLADDER WALL 12
13 13
14 A boy, 10 years old! Bedwetting 5/7days! Sometimes only drops! nocturia.. But parents are waking him up! Wet pants! Sometimes a few drops! When he is nerveous, when it is cold, when he drinks to much, after sport, giggling! Frequency 5 x/day! But has to pee during lessons! 12 times/day when he drinks more! Is postponing 14
15 15
16 16
17 - 17
18 EBM = treatment? 18
19 EBM = treatment? ne First treat daytime symptoms before tackling nighttime 19
20 EBM = treatment?! Urotherapy! Bladder volume training! Anticholinergics! Oxybutinine! Solfenacine / tolterodine! propiverinehcl! Imipramine! Pelvic floor relaxation therapy! Neuromodulation?! Alarm 20
21 A boy, 10 years old and what.. if! cturnal diuresis ml! Morning void ml ml! Diaper ml. only drops! nocturia! 0 times /day wet pants 21
22 A boy, 10 years old and what if! cturnal diuresis ml! Morning void ml! cturia 180 ml! nocturia! 0 times /day wet pants 22
23 choice! If no ADHD / therapy compliant! Oxybutinine 3 x/day! + urotherapy! If ADHD / poor compliance! Solifenacin / tolterodine / propiverinehcl! If daytime problems resolved! Treat nocturnal enuresis if present 23
24 A boy, 10 years old and what if! cturnal diuresis ml! Morning void ml! cturia ml! 3times /day wet pants 24
25 A boy, 10 years old and what if! cturnal diuresis ml! Morning void ml! cturnal enuresis ml! 3 times /day wet pants 25
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