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Biomedical subjects

G Gladh

Publications and source records attributed to G Gladh.

5 recordsLinked to original sources

Relative filling of the bladder at daytime voids in healthy school children.

PURPOSE: We analyzed how healthy children use their bladder storage capacity during everyday life, and how transient changes in diuresis affect bladder filling and voiding intervals. MATERIALS AND METHODS: Voided volumes and times were recorded during 1 or 2 24-hour periods by 206 healthy school children 7 to 15 years old. For each individual voided volumes were expressed as percentage of maximum voided volume (MVV). Mean diuresis preceding each void was estimated by dividing voided volume by voiding interval. A total of 1,098 voids were analyzed. RESULTS: The first void in the morning was the largest for a majority of the children (73%). Most daytime voids were considerably smaller than the individual MVV. Single voids less than half MVV occurred in 80% of the children, and more than one-third had voids smaller than 20% of their storage capacity. MVV was the same for children with different voiding frequency but the relative filling decreased with the number of voids per 24 hours. At high diuresis voids tended to occur at shorter intervals with somewhat larger relative filling of the bladder. Nighttime voids that occurred in 23 children were in most cases (19) much smaller than the individual MVV. CONCLUSIONS: Healthy children typically void when they want to, not necessarily when they need to, and only exceptionally with a full bladder. The voiding pattern is more dependent on social activities and convenience than on physiological factors such as bladder capacity, filling and diuresis.

Adolescent↗

Anogenital electrical stimulation as treatment of urge incontinence in children.

OBJECTIVES: To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy-resistant urge incontinence. PATIENTS AND METHODS: The study included 48 children (24 girls and 24 boys, 5-14 years old) with a diagnosis of bladder instability verified by cystometry in all. Anogenital afferent stimulations were applied using a battery-powered dual constant-current stimulator. The children were stimulated continuously at 10 Hz for 20 min once or twice daily and if required the children and/or the parents continued to apply the treatment at home. For home stimulation a single (anal) channel stimulator was used. The patients were instructed to stimulate for 20 min at maximum intensity two to three times a week until the effects were optimal. The outcome was evaluated retrospectively by comparing voiding/incontinence diaries obtained before and at the follow-up 6-12 months after the end of treatment. RESULTS: AGAS was applied at the clinic for a median (range) of 9 (4-20) times. Thirty-one children continued with home stimulation for another 25 (5-96) sessions. At the follow-up, 18 children were cured and another seven improved, with a leakage score of less than half that before treatment. The treatment was well tolerated by most children. CONCLUSIONS: Anogenital afferent stimulation is an effective, potentially curative treatment in children with severe urge incontinence. Home stimulation is a well accepted adjuvant to treatment at the clinic and improves the outcome.

Adolescent↗

Voiding pattern in healthy newborns.

A 4-hour observation period has been used in infants to investigate suspected bladder dysfunction. The aim of the present study was to extend the usefulness of this protocol by establishing reference values for voiding frequency, intervals, volumes, and residual urine in healthy newborns. The study included 51 healthy newborns, 26 girls and 25 boys, aged 3 to 14 days. During a 4-hour period, all micturitions and residuals were recorded as well as feeding, sleeping, crying, and defecations. The observation was completed with the child undressed to observe the urinary stream during one void. Different provocation tests were tried to induce urinary leakage. All newborns voided with a stream, about once per hour, with a median volume of 23 mL. For each voiding parameter, there was a large inter- and intra-individual variability. Double voidings were common as well as sizable residual volumes. The diuresis was about six times higher than in healthy school children. The healthy newborns did not leak during provocation tests such as manual compression of the bladder. Neurourol. Urodynam. 19:177-184, 2000.

Defecation↗

Outcome of the bladder cooling test in children with neurogenic bladder dysfunction.

PURPOSE: We evaluated the diagnostic use of the bladder cooling test in children with neurogenic bladder dysfunction. MATERIALS AND METHODS: We performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningocele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapidly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was considered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion. RESULTS: The bladder cooling test was positive in 37 children younger than 4 years, at which age it is normally positive. The test was negative in only 2 patients, indicating a complete lower motor neuron lesion. It was positive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic bladder dysfunction. Four of the 20 children with a negative test voided normally, while the remainder had no voiding contractions, suggesting a nonfunctional spinal sacral reflex arch to the bladder. CONCLUSIONS: The bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron lesion. It may be used longitudinally to demonstrate changes in bladder function with growth.

Adolescent↗

Positive bladder cooling test in neurologically normal young children.

The bladder cooling test, which consists of rapid infusion of 0 to 8C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children 6 months to 13 years old. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test was positive during the first 4 years of life but typically negative in children older than 5 years. These findings indicate that a positive bladder cooling test is an infant reflex response that, with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.

Adolescent↗