Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children

Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid–induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid–induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate ( P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child’s ability to awaken to the sense of bladder fullness or contractions. Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863

Proposal of a Lab Bench for the Unobtrusive Monitoring of the Bladder Fullness with Bioimpedance Measurements

(1) Background: millions of people, from children to the elderly, suffer from bladder dysfunctions all over the world. Monitoring bladder fullness with appropriate miniaturized textile devices can improve, significantly, their daily life quality, or even cure them. Amongst the existing bladder sensing technologies, bioimpedance spectroscopy seems to be the most appropriate one to be integrated into textiles. (2) Methods: to assess the feasibility of monitoring the bladder fullness with textile-based bioimpedance spectroscopy; an innovative lab-bench has been designed and fabricated. As a step towards obtaining a more realistic pelvic phantom, ex vivo pig’s bladder and skin were used. The electrical properties of the fabricated pelvic phantom have been compared to those of two individuals with tetrapolar impedance measurements. The measurements’ reproducibility on the lab bench has been evaluated and discussed. Moreover, its suitability for the continuous monitoring of the bladder filling has been investigated. (3) Results: although the pelvic phantom failed in reproducing the frequency-dependent electrical properties of human tissues, it was found to be suitable at 5 kHz to record bladder volume change. The resistance variations recorded are proportional to the conductivity of the liquid filling the bladder. A 350 mL filling with artificial urine corresponds to a decrease in resistance of 7.2%, which was found to be in the same range as in humans. (4) Conclusions: based on that resistance variation; the instantaneous bladder fullness can be extrapolated. The presented lab-bench will be used to evaluate the ability of textiles electrodes to unobtrusively monitor the bladder volume.

Post-operative Recovery Assessment of Urinary Tract Dysfunction Following Radical Hysterectomy for Cervical Cancer Patients

Objectives: To assess the length of recovery phase in urinary tract dysfunction following radical hysterectomy for cervical cancer patients in Ciptomangunkusumo Hospital. Methods: This survey study was conducted in Cipto Mangunkusumo Hospital from September 2016 to May 2017. Subjects were cervical cancer patients from stage IA2 to IIA2 underwent radical hysterectomy. Suprapubic catheter (SPC) was inserted to observe the urine production after procedure. Patients were then directed for bladder training protocol involving clamping and opening SPC. Sensation of bladder fullness followed by spontaneous micturition were recorded. Measurement of post voiding residual (PVR) urine volume after spontaneous micturition until less than 100 mL was considered as resolution of urinary tract dysfunction. The average days of every achieved phase were then calculated. Results: Twenty-nine subjects underwent radical hysterectomy during observation period. But only 21 subjects continued the bladder training protocol and recorded for the recovery phases. The average time needed to obtain sensation of bladder fullness and spontaneous micturition were 7.57 ± 4.78 days (median 5 days, minimum 3 days, maximum 22 days)and 8 ± 5.21 days (median 6 days, minimum 3 days, maximum 23 days). The objective PVR urine became less than 100mL was obtained after 21.42 ± 18 days (median 18 days, minimum 7 days, maximum 74 days). Conslusion: Following radical hysterectomy, recording the recovery phase of urinary tract dysfuction is essential to ensure complete resolution. Complete resolution of the urinary dysfunction is achieved after 21.42±18 days in average (median 18 days, minimum 7 days, maximum 74 days). Keywords: cervical cancer, radical hysterectomy, urinary tract dysfunction, post voiding residual volume. Abstrak Tujuan: Menilai masa pemulihan disfungsi saluran kemih setelah histerektomi radikal pada pasien kanker serviks di RSUPN Ciptomangunkusumo. Metode: Studi survei dilakukan di RSUPN Cipto Mangunkusumo dari September 2016 hingga Mei 2017. Subjek penelitian terdiri dari pasien kanker serviks stadium IA2 hingga IIA2 yang menjalani histerektomi radikal. Kateter suprapubik (SPC) digunakan sebagai alat untuk memantau produksi urin pasca operasi. Pasien diinstruksikan untuk mengikuti protokol bladder training yaitu melalui prosedur menutup dan membuka kateter. Rasa sensasi ingin berkemih dan berkemih spontan. Pengukuran residu volume urin pasca berkemih dibawah 100mL dianggap merupakan indikator pemulihan disfungsi saluran kemih. Rata-rata hari dari setiap fase kemudian dihitung. Hasil: Dua puluh sembilan subjek didapatkan selama penelitian. Namun, hanya 21 subjek yang dapat mengikuti protocol bladder traning dan dicatat perkembangan pemulihannya. Rata-rata hari yang diperlukan untuk merasakan sensasi berkemih dan berkemih spontan adalah 7,57 ± 4.78 hari (median 5 hari, minimum 3 hari, dan maksimum 22 hari) dan 8 ± 5.21 hari. (median 6 hari, minimum 3 hari dan maksimum 23 hari) Rata-rata hari untuk mencapai residu urin di bawah 100 mL adalah 21.42 ± 18 (median 18 hari, minimum 7 hari, dan maksimum 74 hari). Kesimpulan: Setelah prosedur histerektomi radikal, pencatatan masa pemulihan penting untuk dipantau untuk memastikan pemulihan lengkap. Rata-rata hari yang diperlukan untuk pemulihan adalah 21.42 ± 18 hari (median 18 hari, minimum 7 hari, dan maksimum 74 hari). Kata kunci: kanker serviks, histerektomi radikal, disfungsi saluran kemih, volume residu paska berkemih.

Influence of bladder fullness on the detection of urinary tract obstruction by dynamic renal scintigraphy

Objective: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. Materials and methods: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. Results: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. Conclusion: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

The Sensation Meter: An Unprompted Method to Characterize Patient-Reported Bladder Sensation in Real-Time

Overactive bladder (OAB) syndrome is characterized by symptoms of urgency, with or without incontinence, usually with increased voiding frequency and nocturia [1], and is prevalent throughout the world [2]. Chronic OAB symptoms are studied with validated surveys, while acute symptoms can be assessed using bladder diaries. These methods may be subject to recall bias, since diaries are typically completed after voiding. The accepted standard for clinical assessment of bladder function and sensation is a urodynamics (UD) study which involves filling the bladder with a catheter. During a UD study, three verbal sensory thresholds (VSTs) are recorded [3]. These thresholds, First Sensation, First Desire to void, and Strong Desire to void, only provide limited, episodic information about acute sensation during filling. Thus, there is a clear need for a tool to evaluate the development of real-time bladder sensation during bladder filling. The objective of this study was to develop a novel Sensation Meter, a patient interface implemented on a touchscreen device that continuously records the patient’s real-time, unprompted sensation of bladder fullness.