Clinical Study Of Diagnosis And Treatment Of Urethral Instability In Children With Overactive Bladder

BackgroundOveractive bladder(OAB)is characterized by urinary urgency accompanied by frequency,nocturia,with or without urge urinary incontinence,in the absence of a urinary tract infection(UTI)or other obvious pathology,and the pathogenesis of OAB is not completely clear.Although OAB is defined as “overactive bladder”,the lesion is not confined to the bladder,and studies has shown that urethral dysfunction can also cause symptom of OAB.The first line treatment of OAB is predominant by anticholinergic drugs for overactivity bladder in clinical practice,and lacks diagnosis and related treatment of urethral dysfunction.In recent years,synchrocystourethrometry(SCUM)has gradually increased in clinical application.SCUMis a crucial urodynamic test for simultaneous monitoring pressure variation in bladder and urethra,which is of great value in the diagnosis and treatment of bladder and urethral function in OAB patients.There are a few studies on the relationship between urethral instability(URI)and OAB in the world,and less studies on children.However,in our prior studies,the role of urethral pressure variation in the diagnosis of OAB in children has been initially found through SCUM.Further,in addition to using SCUM to diagnose the URI in children with OAB,this study will focuse on the significance of guiding pudendal nerve electrical stimulation in the treatment of OAB in children based on variation in urethral pressure.ObjectiveTo explore the correlation between URI and OAB in children throughSCUM and the application value of pudendal nerve electrical stimulation in the treatment of children with OAB.MethodsOne hundred forty eight children(boys 60,girls 88;mean 8.3±1.2 y)with OAB and fifty six children(boys 24,girls 32;mean 8.2±1.5 y)without OAB evaluated by SCUM between August 2014 and March 2017 in Pediatric Urodynamic Center.The prevalence of detrusor overactivity(DO)and URI was compared between OAB group and non-OAB group.The OAB children with URI divided randomly into stimulation group(SG)who received transcutaneous electrical pudendal nerve stimulation(TEPNS)with anisodamine and non-stimulation group(NSG)who received anisodamine alone.The criteria used to evaluate the rate of success were 1)self-reported cure,significant,or no improvement;2)percent improvement;3)average voided volume(AVV),maximum voided volume(MVV),and number of voids per day(NV)were collected and analyzed;4)visual analogue scale(VAS,level of 0 to 10).ResultsThe prevalence of DO or URI was 51.4% and 31.1%,respectively,whereas mixed OAB(both DO and URI)was 13.5% in 148 OAB children.In controls,the prevalence of URI or DO was 5.4% and 12.5%,respectively,and both none was 82.1%.The prevalence of URI in children with OAB was significantly higher than in children without OAB(P<0.01).In 66 OAB patients with URI,they were divided into SG(39/66)and NSG(22/66).Among the SG 46.2% of parents reported cure,with a ? 50% improvement rate of 38.5%.While no child was cured,with a ? 50% improvement rate of 36.4% in NSG.A significant increase in AVV and MVV together,with a decrease in NV,was seen in SG.There was a significant difference in visual analogue scale values between SG and NSG(P<0.01),18 parents showed the highest therapeutic success(10)in SG.While in NSG,the highest score indicated was 9.ConclusionsUrethral instability plays an essential role in the pathogenesis and progression of OAB in children.Synchro-cystourethrometry is a useful urodynamic technology to precisely diagnose URI.And transcutaneous electrical pudendal nerve stimulation may be an effective treatment for OAB children induced by URI.