Clinical Urodynamics in Childhood and Adolescence

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The aim of the book series is to highlight new knowledge on physiopathology,
diagnosis and treatment in the fields of pelvic floor dysfunctions, incontinence and
neurourology for specialists (urologists, gynecologists, neurologists, pediatricians,
physiatrists), nurses, physiotherapists and institutions such as universities and
hospitals.

More information about this series at http://www.springer.com/series/13503

Giovanni Mosiello • Giulio Del Popolo
Jian Guo Wen • Mario De Gennaro
Editors

Clinical Urodynamics
in Childhood and
Adolescence
Editors
Giovanni Mosiello Giulio Del Popolo
Pediatric NeuroUrology Research and Clinic Neurourology Department
Bambino Gesù Pediatric Hospital Careggi Hospital
Rome, Italy Florence, Italy

Jian Guo Wen Mario De Gennaro

Pediatric Urodynamic Center Urology Unit
First Affiliated Hospital of Zhengzhou Bambino Gesù Pediatric Hospital
University Rome, Italy
Zhengzhou, China

Pediatric Surgery and Urology

First Affiliated Hospital of Xinxiang
Medical University
Xinxiang, China

ISSN 2510-4047     ISSN 2510-4055 (electronic)

Urodynamics, Neurourology and Pelvic Floor Dysfunctions
ISBN 978-3-319-42191-9    ISBN 978-3-319-42193-3 (eBook)
https://doi.org/10.1007/978-3-319-42193-3

Library of Congress Control Number: 2018935128

© Springer International Publishing AG, part of Springer Nature 2018

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Series Editor’s Preface

As President of the Italian Society of Urodynamics, I am very proud to present this

new book in our series: Clinical Urodynamics in Childhood and Adolescence.
When our Society defined this project with Springer, we had exactly the idea to
offer to clinicians, and all health care providers, some practical books to use in their
daily clinical practice.
The readers will be able to find three different parts: diagnostic tests, patholo-
gies, and management, stressing the value of urodynamics that is sometimes con-
fused with a minor part of urological practice, not considering the value to represent
the functional part of urology.
All the authors are recognized experts of bladder and bowel, or in pediatric or in
adult people, in some cases in both, because involved in transitional care project. All
of them are valuable and active in different scientific societies. Furthermore, the
majority of them are members of the International Continence Society and the
International Children Continence Society.
I would like to thank all of them for their valuable contribution. A special thanks
to the editors Giulio, Jian, Mario, and last but not least to Giovanni Mosiello for
involving all of us in this book and for his perseverance and his efforts to publish it.

Enrico Finazzi Agrò

Rome, Italy

v
Foreword

Pediatric urodynamics has always been a challenging field, for both the referring
doctors and those who are performing the studies. This special population of chil-
dren and adolescent patients usually suffers from complex or complicated lower
urinary tract dysfunction. Other pathologies such as congenital anomalies, high-
grade vesico-ureteral reflux, and outlet obstructions can add to the difficulty of uro-
dynamic studies.
The International Continence Society (ICS) is very pleased with this textbook,
which discusses clinical urodynamics in this patient population to shed light on the
typical indications and critical technical aspects relevant to this age group. I am
proud of Giovanni Mosiello, who is Chairman of the ICS Children and Young
Adults Committee, for authoring this valuable book. I expect that it will serve as a
valuable reference for those who are interested in urodynamics performance and
knowledge.

Sherif Mourad
ICS General Secretary
Cairo, Egypt

vii
Preface

Pediatric urology often involves reconstruction of congenital malformations, which

requires specialized surgical skills. Many patients with these congenital malforma-
tions commonly experience continence dysfunction. For this reason, reconstructive
surgery must be performed while keeping function in mind. Thus, a pediatric urolo-
gist must be a functional urologist, with knowledge of the long-term effects of
pathologies and the treatment performed. A pediatric urologist must be able to dis-
tinguish between functional incontinence (which is very common in childhood) and
incontinence related to neurogenic or anatomic causes.
Many pathologies that are surgically treated in childhood may still have lifelong
effects, such as incontinence. In all of these situations, it is important to understand
the possible future effects of any treatments performed in childhood. For this rea-
son, we decided to publish the first book on clinical urodynamics in children and
young adults.
We offer a special thanks to all friends who agreed to participate in the writing of
this book by sharing their great experiences.
On behalf of the other editors—Giulio De Popolo, Mario De Gennaro and Jian
Guo Wen—we hope you enjoy.

Giovanni Mosiello
Rome, Italy

ix
Contents

Part I Diagnostic Evaluation

1 Anatomy and Neurophysiology of the Lower Urinary
Tract and Pelvic Floor ������������������������������������������������������������������������������   3
Lotte Kaasgaard Jakobsen, Jens Christian Djurhuus,
and L. Henning Olsen
2 Clinical Evaluation: History Taking and Urological,
Gynaecological and Neurological Evaluation������������������������������������������ 11
Cevdet Kaya and Christian Radmayr
3 Diagnostic Scores, Questionnaires and Quality-of-Life Measures
in Paediatric Continence �������������������������������������������������������������������������� 21
Wendy F. Bower
4 Diaries �������������������������������������������������������������������������������������������������������� 29
Ana Ludy Lopes Mendes, Ilaria Jansen, and Giovanni Mosiello
5 Ultrasound and MRI����������������������������������������������������������������������������������� 37
J.M. Nijman
6 Endoscopy�������������������������������������������������������������������������������������������������� 45
Murat Ucar, Selcuk Keskin, and Selcuk Yucel
7 Noninvasive Urodynamics and Flowmetry in Children,
Adolescents, and Young Adults���������������������������������������������������������������� 63
Mario Patricolo
8 Cystometry, Pressure Flow Study and Urethral
Pressure Measurement����������������������������������������������������������������������������   73
Jian Guo Wen
9 Videourodynamic in Children������������������������������������������������������������������ 95
Valerio Iacovelli, Giuseppe Farullo, Andrea Turbanti,
and Enrico Finazzi Agrò
10 The Neurophysiological Testing���������������������������������������������������������������� 101
Giorgio Selvaggio and Roberto Cordella

xi
xii Contents

11 Diagnostic Tests for Defecation Disorders ���������������������������������������������� 109

Peter Christensen

Part II Pathological Conditions

12 Lower Urinary Tract Dysfunction in Children and Young Adults:
An Introduction������������������������������������������������������������������������������������������ 117
Tryggve Nevéus
13 Neurogenic Bladder: Myelomeningocele, Occult Spina Bifida,
and Tethered Cord ������������������������������������������������������������������������������������ 127
Pieter Dik, Laetitia M.O. de Kort, and Paul W. Veenboer
14 Spinal Cord Injury and Iatrogenic Lesions������������������������������������������ 143
Giulio Del Popolo and Elena Tur
15 Cerebral Palsy and Other Encephalopathies������������������������������������������ 153
Stuart Bauer
16 Urinary Incontinence in Children and Adolescents with Mental
and Physical Disabilities: Comorbidities and Barriers�������������������������� 165
Mario Patricolo and June Rogers
17 Monosymptomatic Enuresis���������������������������������������������������������������������� 175
Eliane Garcez da Fonseca
18 Nonmonosymptomatic Nocturnal Enuresis�������������������������������������������� 189
Kwang Myung Kim
19 Overactive Bladder������������������������������������������������������������������������������������ 193
Lorenzo Masieri, Chiara Cini, and Maria Taverna
20 Daytime Lower Urinary Tract Conditions���������������������������������������������� 205
Marleen van den Heijkant
21 Congenital and Iatrogenic Incontinence: Ectopic Ureter,
Ureterocele, and Urogenital Sinus������������������������������������������������������������ 213
Keara N. DeCotiis, Liza M. Aguiar, and Anthony A. Caldamone
22 Bladder Exstrophy ������������������������������������������������������������������������������������ 225
Alan Dickson
23 Posterior Urethral Valves�������������������������������������������������������������������������� 237
Mario De Gennaro, Maria Luisa Capitanucci, Giovanni Mosiello,
and Antonio Zaccara
24 Hypospadia and Urethral Stricture���������������������������������������������������������� 251
Carlos Arturo Levi D’Ancona, Juliano Cesar Moro,
and Caio Cesar Citatini de Campos
Contents xiii

Part III Therapies

25 Cognitive Behavioral Therapy on the Basis of Urotherapy ������������������ 261
Anka J. Nieuwhof-Leppink and M.A.W. Vijverberg
26 Pelvic Floor Rehabilitation and Biofeedback������������������������������������������ 277
Sandro Danilo Sandri
27 Pharmacological Therapy ������������������������������������������������������������������������ 297
John Weaver and Paul Austin
28 Sacral Neuromodulation in Children������������������������������������������������������ 303
Ilaria Jansen, Ana Ludy Lopes Mendes, Francesco Cappellano,
Mario De Gennaro, and Giovanni Mosiello
29 Bowel Dysfunction Management�������������������������������������������������������������� 313
Giuseppe Masnata, Valeria Manca, Laura Chia, and Francesca Esu
30 Percutaneous Tibial Nerve Stimulation (PTNS)
and Transcutaneous Electrical Nerve Stimulation (TENS) ������������������ 319
Maria Luisa Capitanucci, Giovanni Mosiello,
and Mario De Gennaro
31 Botulinum Toxin, Endoscopy, and Mini-­Invasive Treatment���������������� 327
Giovanni Palleschi, Antonio Luigi Pastore, Davide Moschese,
and Antonio Carbone
32 Laparoscopic Procedures�������������������������������������������������������������������������� 337
Rafał Chrzan
33 Open Surgery for Incontinence���������������������������������������������������������������� 349
Tom P.V.M. de Jong and Aart J. Klijn

Index�������������������������������������������������������������������������������������������������������������������� 371
Contributors

Enrico Finazzi Agrò Department of Experimental Medicine and Surgery, Urology

Division, Tor Vergata University of Rome, Rome, Italy
Liza M. Aguiar, M.D. Division of Pediatric Urology, Hasbro Children’s Hospital,
Warren Alpert School of Medicine, Brown University, Providence, RI, USA
Paul Austin, M.D. Division of Urologic Surgery, St. Louis Children’s Hospital,
Washington University School, St. Louis, USA
Stuart Bauer, M.D. Department of Urology, Boston Children’s Hospital, Boston, MA,
USA
Wendy F. Bower, FACP,PhD,Dip EpiBio,BAppSc(PT) Division of Medicine and
Community Care, Melbourne Health, Melbourne, VIC, Australia
Anthony A. Caldamone, M.D. Division of Pediatric Urology, Hasbro Children’s
Hospital, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
Caio Cesar Citatini de Campos Division of Urology, Universidade Estadual de
Campinas—UNICAMP, Campinas, São Paulo, Brazil
Maria Luisa Capitanucci, M.D. Division of Urology, Surgery for Continence and
Urodynamics, Bambino Gesù Children Hospital, Rome, Italy
Francesco Cappellano Department of Urologist, Nation Hospital, Abu Dhabi, UAE
Department of Neuro-Urology, Verona University, Verona, Italy
Antonio Carbone Faculty of Pharmacy and Medicine, Department of Medico-
Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
ICOT Hospital—Uroresearch Association, Latina, Italy
Laura Chia Pediatric Urology Unit and Spina Bifida Center, Brotzu Hospital,
Cagliari, Italy
Peter Christensen Pelvic Floor Unit, Department of Surgery, Aarhus University
Hospital, Aarhus, Denmark
Rafał Chrzan Department of Pediatric Urology, Children’s University Hospital,
Jagiellonian University Medical College, Krakow, Poland

xv
xvi Contributors

Chiara Cini Division of Pediatric Urology, Meyer Pediatric Hospital, Florence, Italy
Roberto Cordella, M.Sc., Ph.D. Department of Neurosurgery, Fondazione IRCCS
Istituto Neurologico “Carlo Besta”, Milan, Italy
Carlos Arturo Levi D’Ancona Division of Urology, Universidade Estadual de
Campinas—UNICAMP, Campinas, São Paulo, Brazil
Keara N. DeCotiis, M.D. Division of Pediatric Urology, Hasbro Children’s Hospital,
Warren Alpert School of Medicine, Brown University, Providence, RI, USA
Alan Dickson Consultant Paediatric Urologist, Royal Manchester Childrens
Hospital, Stony Littleton, Bath, UK
Pieter Dik Department of Pediatric Urology, Wilhelmina Children’s Hospital,
Utrecht, The Netherlands
Jens Christian Djurhuus Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
Giuseppe Farullo Department of Experimental Medicine and Surgery, Urology
Division, Tor Vergata University of Rome, Rome, Italy
Francesca Esu Pediatric Urology Unit and Spina Bifida Center, Brotzu Hospital,
Cagliari, Italy
Eliane Garcez da Fonseca The University of the State of Rio de Janeiro, Souza
Marques Medical School, Rio de Janeiro, RJ, Brazil
Mario De Gennaro Urology, Robotic Surgery and Urodynamic Unit—Department
of Surgery, Children’s Hospital Bambino Gesù, Rome, Italy
Marleen van den Heijkant, F.E.B.U., F.E.A.P.U. Department of Urology,
UZ Leuven, Gasthuisberg, Leuven, Belgium
L. Henning Olsen Department of Clinical Medicine, Department of Urology,
Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
Valerio Iacovelli Department of Experimental Medicine and Surgery, Urology
Division, Tor Vergata University of Rome, Rome, Italy
Lotte Kaasgaard Jakobsen Department of Clinical Medicine, Department of
Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus,
Denmark
Ilaria Jansen Department of Urology, AMC, Amsterdam, Netherlands
Department of Biomedical Engineering and Physics, AMC, Amsterdam, Netherlands
Tom P.V.M. de Jong Department of Pediatric Urology, University Children’s
Hospitals UMC Utrecht and AMC Amsterdam, Utrecht, The Netherlands
Cevdet Kaya, M.D. Department of Urology, School of Medicine, Marmara
University, Istanbul, Turkey
Contributors xvii

Selcuk Keskin, M.D. Department of Urology, Acıbadem University School of

Medicine, İstanbul, Turkey
Kwang Myung Kim, M.D. Department of Pediatric Urology, Seoul National
University Children’s Hospital, Seoul, Republic of Korea
Aart J. Klijn Department of Pediatric Urology, University Children’s Hospitals
UMC Utrecht and AMC Amsterdam, Utrecht, The Netherlands
Laetitia M.O. de Kort Department of Urology, University Medical Center Utrecht,
Utrecht, The Netherlands
Ana Ludy Lopes Mendes Division of Urology, Surgery for Continence and
Neuro-Urology, Bambino Gesù Pediatric Hospital, Rome, Italy
Valeria Manca Pediatric Urology Unit and Spina Bifida Center, Brotzu Hospital,
Cagliari, Italy
Lorenzo Masieri Division of Pediatric Urology, Meyer Pediatric Hospital,
Florence, Italy
Giuseppe Masnata Pediatric Urology Unit and Spina Bifida Center, Brotzu Hospital,
Cagliari, Italy
Juliano Cesar Moro Division of Urology, Universidade Estadual de Campinas—
UNICAMP, Campinas, São Paulo, Brazil
Davide Moschese Faculty of Pharmacy and Medicine, Department of Medico-
Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
Giovanni Mosiello, M.D. Pediatric NeuroUrology Research and Clinic, Bambino
Gesù Pediatric Hospital, Rome, Italy
Tryggve Nevéus, M.D., Ph.D. Uppsala University Children’s Hospital, Uppsala,
Sweden
Anka J. Nieuwhof-Leppink Pediatric Psychology and Social Work, Wilhelmina’s
Children Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
J.M. Nijman Department of Urology and Pediatric Urology, University Medical
Center, Groningen, The Netherlands
Giovanni Palleschi Faculty of Pharmacy and Medicine, Department of Medico-
Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
ICOT Hospital—Uroresearch Association, Latina, Italy
Antonio Luigi Pastore Faculty of Pharmacy and Medicine, Department of
Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome,
Latina, Italy
ICOT Hospital—Uroresearch Association, Latina, Italy
Mario Patricolo Al Noor Hospital, Abu Dhabi, UAE
xviii Contributors

Giulio Del Popolo Neuro-Urology and Spinal Unit, Careggi University Hospital,
Florence, Italy
Christian Radmayr, M.D. Department of Urology, School of Medicine, Innsbruck
University, Innsbruck, Austria
June Rogers Manchester Disabled Living, Manchester, UK
Sandro Danilo Sandri Department of Urology and Spinal Unit, Hospital of
Legnano, Legnano, Italy
Department of Urology and Spinal Unit, Hospital of Magenta, Milan, Italy
Giorgio Selvaggio, M.D. Department of Pediatric Surgery, Children’s Hospital
“V.Buzzi”, Milan, Italy
Maria Taverna Division of Pediatric Urology, Meyer Pediatric Hospital,
Florence, Italy
Elena Tur Neuro-Urology and Spinal Unit, Careggi University Hospital,
Florence, Italy
Andrea Turbanti Department of Experimental Medicine and Surgery,
Urology Division, Tor Vergata University of Rome, Rome, Italy
Murat Ucar, M.D. Department of Urology Section of Pediatric Urology,
Saglik Bilimleri University Tepecik Training and Research Hospital, İzmir, Turkey
Paul W. Veenboer Department of Urology, University Medical Center Utrecht,
Utrecht, The Netherlands
M.A.W. Vijverberg Pediatric Psychology and Social Work, Wilhelmina’s Children
Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
John Weaver, M.D. Division of Urologic Surgery, St. Louis Children Hospital,
Washington University School, St. Louis, MO, USA
Jian Guo Wen Pediatric Urodynamic Center, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, China
Pediatric Surgery and Urology, First Affiliated Hospital of Xinxiang Medical
University, Xinxiang, China
Selcuk Yucel, M.D. Department of Urology, Acıbadem University School of
Medicine, İstanbul, Turkey
Antonio Zaccara Division of Urology, Surgery for Continence and Urodynamics,
Bambino Gesù Children Hospital, Rome, Italy
 Part I
Diagnostic Evaluation
Anatomy and Neurophysiology
of the Lower Urinary Tract and Pelvic 1
Floor

Lotte Kaasgaard Jakobsen, Jens Christian Djurhuus,

and L. Henning Olsen

1.1 Bladder

The urinary tract undergoes a very dynamic development during foetal life. Emerging
from the metanephros, the human kidney begins to produce urine at 10–12 weeks of
gestation [1, 2]. At this time the bladder is a cylindrical tube of cuboidal cells in a
single layer. During the second trimester, 4–5 cell layers develop, forming a low com-
pliant ‘bladder’ at the 21st week of gestation [3–5]. The foetal bladder handles a rela-
tively large amount of fluid, draining to the amniotic cavity with a subsequent oral
reuptake by the foetus. The salt and water homeostasis, however, is cleared by the
placenta and eventually by the mother’s kidneys [6]. Any deviation from this cycle
may lead to a more or less pathological consequence for the foetus. In the beginning
the lower urinary tract is a conduit with coordinated peristalsis propulsing the urine
through the urethra, as is the case with the upper urinary tract. After the formation of
the external sphincter, the lower urinary tract develops graduate filling and emptying,
and the bladder wall properties change. From being a coordinated peristaltic conduit,
the bladder becomes an organ with chaotic micromotions in the bladder wall.

L.K. Jakobsen (*) • L. Henning Olsen

Department of Clinical Medicine, Department of Urology, Section of Pediatric Urology,
Aarhus University Hospital, Aarhus, Denmark
e-mail: [email protected]
J.C. Djurhuus
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

© Springer International Publishing AG, part of Springer Nature 2018 3

G. Mosiello et al. (eds.), Clinical Urodynamics in Childhood and Adolescence,
Urodynamics, Neurourology and Pelvic Floor Dysfunctions,
https://doi.org/10.1007/978-3-319-42193-3_1