1 / 33

Paediatric Urotherapy Training in Hong Kong: Bladder Rehabilitation for Children

Explore paediatric urotherapy for children with urinary incontinence, nocturnal enuresis, and bladder dysfunction. Learn about assessment, training programs, and advantages of enuresis alarm and biofeedback therapy. Discover the benefits of neuromodulation techniques. Ideal for kids over 5 years old.

kim-spears
Download Presentation

Paediatric Urotherapy Training in Hong Kong: Bladder Rehabilitation for Children

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Paediatric Urotherapy Training Frances Shit NS, MSc (Hons), ET, Dept. of Surgery, PWH, CUHK HKSAR

  2. Urinary Incontinence in Children • Urine leakage in a child from 5 years of age • Leakage occurs on a regular basis (> once / week ) and sufficient to cause social inconvenience

  3. Urinary Incontinence in Children Night (Nocturnal Enuresis) Day Functional Organic Structural / anatomical Anomalies Neurogenic bladder dysfunction

  4. Urotherapy • Treatment / training aimed at normalizing the bladder function by active cooperation ( learning & practice ) of the child, based on evaluation of the function ( Anna-Lena Hellstrom, 1990)

  5. The design of a Paediatric Urotherapy Nurse Clinic in Hong Kong

  6. Paediatric Urotherapy Nurse Clinic • Aims: To provide bladder rehabilitation training for children who present with daytime and / or night time enuresis • Services started since June, 2001 in Li Ka Shing Surgical OPD, PWH • HA nurse clinic accreditation - 2009 • Session: every Wednesday a.m. • Training: includes out-patients & in-patients programme

  7. Referrals from different clinics General Paed. Surgery Nocturnal Enuresis Paediatric Urology Private clinic Screening Paed. Urotherapy Nurse Clinic

  8. Ideal candidates • > 5 years old children • Children with day time urinary symptoms +/- nocturnal enuresis • No neurological / structural / urological problems

  9. Assessment • Medical & surgical history, UTI episodes • Medications, urinalysis • Physical examination of abdomen, genital areas, spine Bladder diary Bed wetting chart Bowel function diary

  10. Radiological investigations • Ultrasonography of urinary tract • Spine X-ray • Magnetic Resonance Imaging • Micturition Cystometric Urethrogram ( MCU ) • Renal Scans • Uroflowmetry, bladder scan for PVR • Urodynamic studies

  11. Urotherapy training program • Individualized program based on assessment information, signs & symptoms of voiding disorders • Aim: to help the child to get control over its voiding

  12. Urotherapy training program • Standard urotherapy training • Bowel management program • Enuretic alarm training • Biofeedback therapy • Neuromodulations

  13. Standard urotherapy training • Cognitive and behavioral training • Scheduled drinking, time voiding • Optimal toilet posture • Active relaxation exercise • Uroflow biofeedback with bladder scanner measurement • Double voiding strategies if large PVR

  14. Bladder man • Cognitive and behavioral training • anatomy & physiology of urinary system • behavioral modification of voiding style

  15. Optimal toilet posture

  16. Snoopy chart Bladder volume training • Encourage drinking • Random urine output once daily / alt. day • Set target

  17. Dry Pie • Enuresis record for children • 5 weeks in a pie chart

  18. Reward chart • Color 1 bar for a dry day or dry night • Reward for achieve a pre-set target

  19. Uroflow biofeedback with bladder scanner measurement

  20. Uroflow biofeedback • Visualize uroflowmetry curve during voiding • Learn to correct flow curve • Check PVR

  21. Urotherapy training program • Standard urotherapy training • Bowel management program • Enuretic alarm training • Biofeedback therapy • Neuromodulations

  22. Urotherapy training program • Standard urotherapy training • Bowel management program • Enuretic alarm training • Biofeedback therapy • Neuromodulations

  23. Nocturnal Enuresis • The failure to achieve bladder control by a given age, usually defined as 5 years ,with wetting occur during sleep without organic disease

  24. Nocturnal Enuresis Primary • The child has never been dry for a significant length of time Secondary • Loss of control after a significant period ( 12 months or more ) of being dry, beyond the age of 3 years

  25. Enuresis Alarm • Offer a choice of type ( body worn vs bed pad ) • Regular follow up and feedback FAILURE • Review reason why e.g. alarm breakdown, failure to wake, turning off alarm, parental intolerance

  26. Advantages: high initial and long term response rate safety of equipment Dis-advantages: fail to awake disrupted sleep for the rest of family possible technical failure Enuresis Alarm

  27. Urotherapy training program • Standard urotherapy training • Biofeedback therapy • neuromodulations

  28. Biofeedback training • Aim: to help develop greater awareness & voluntary control over the pelvic floor muscles during voiding • Out-patient or in-patient individualized training

  29. Urotherapy training program • Standard urotherapy training • Biofeedback therapy • Neuromodulations

  30. Neuromodulation • Transcutaneous electrical nerve stimulation ( TENS) • Electrodes bilaterally put over S3 level • Stimulation of the pudendal nerve to activate the pelvic floor and modulates innervation of the bladder, sphincter and pelvic floor • Clinical changes: • Decrease number of wet episodes • Decrease urge intensity

  31. Urotherapy Protocol • Urotherapy protocol for detrusor overactivity ( DO) • Urotherapy protocol for dysfunctional voiding ( DV) • Urotherapy protocol for DO & DV

  32. Conclusions • The development of the Urotherapy Clinic can improve children’s micturition parameter by intensive voiding re-education • Great support can be provided to child & families during the training process

  33. Thank You

More Related