3.1 LUTS Treatment and medication/lecture online
Introduction
Urotherapy is defined as a non-medical or non-surgical treatment, which means that the urotherapy treatment may be sufficient without the support of medication or, on the contrary, it aims to ensure that the child no longer needs medication.
In your practice you will encounter children who are on or need medication. Think of children who have regular urinary tract infections, constipation or overactive bladder to the extent that they need (temporary) medication to help. Medication is also a form of treatment for bedwetting.
The doctor (general practitioner, paediatrician or urologist) is always responsible for prescribing medication. Some urologists are also trained as nurse specialists and may prescribe certain medications in this function.
Knowledge about medication is important to be able to give advice, answer questions but also refer or refer to the physician in a timely manner.
Learning objectives
The participant;
- Can explain and name when medication treatment is initiated.
- Knows the pharmacological effects of bladder relaxants (anticholinergics)
- Can make consideration and recommendation regarding which type of anticholirgics is preferred.
- Can name the pharmacological effects of laxatives
- Can give consideration and recommendations regarding use of laxatives in defecation training and/or urotherapy treatment
- Can name the pharmacological effects of antibiotics in urinary tract infections and is familiar with what determines the choice of antibiotics
Literature
Book: Pediatric incontinence - evaluation and clinical management: evaluation of bowel and bladder dysfunction Section 4
a. chapter 15 Pharmacotherapy of the child with functional incontinence and retention, Paul F. Austin and Israel Franco
b.chapter 16 Treatment of functional constipation and fecal incontinence, Vera Loening-Baucke and Alexander Swidsinski c.
Recommended literature
Tekgul S, Stein R, Bogaert G, Undre S, Nijman RJM, Quaedackers J, 't Hoen L, Kocvara R, Silay MS, Radmayr C, Dogan HS. EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children. Eur J Pediatr. 2020 Jul;179(7):1069-1077. doi: 10.1007/s00431-020-03681-w. PMID: 32472266.
3.2 Treating young children ( 1.5-5 yrs)/ lecture online
Introduction
Four percent of all children entering elementary school for the first time are found to be not toilet trained. The age that toddlers become diaper-free has increased from 1.5-2 years of age to 3.5 years of age currently worldwide. Not being toilet trained at school is seen as a problem by teacher, and often causes a lot of stress to parents, has a negative impact on the environment due to the amount from disposable diapers and may correlate with greater risk to bladder bowel dysfunctions in the child.
Many health care professionals see children between the ages of 3 and 5 who are urine/ stool incontinent. These children are still in the toilet training phase. Becoming toilet-trained is a gradual process. While one child may become dry almost by itself, toilet training for another takes a lot of effort. It is important to identify toilet-training problems early and apply the most effective intervention. It is also important to identify early signs of LUTS
During this block of lessons, we reflect on;
- difference potty training problems and LUTS
- How do you assess the cognitive maturity of the child in relation to his or her age?
- What advice do you give to facilitate the toilet training process ?
- How to guide parents in this.
- What is a proper treatment strategy?
Learning objectives
The participant;
- Can explain and name the difference between not toilet-trained and incontinence
- Can name the stages and different facilitation techniques of toilet training
- Can name difference between calendar age and cognitive maturity of child
- Can explain different methods of toilet training
- Can give consideration and recommendation for starting toilet training
Literature
Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol. 2020 Jun;16(3):342-349. doi: 10.1016/j.jpurol.2020.03.003. Epub 2020 Mar 14. PMID: 32253149.
Kaerts N, Van Hal G, Vermandel A, Wyndaele JJ. Readiness signs used to define the proper moment to start toilet training: a review of the literature. Neurourol Urodyn. 2012 Apr;31(4):437-40. doi: 10.1002/nau.21211. Epub 2012 Mar 6. PMID: 22396334.
3.3 Urotherapy; the treatment cases/ online Lecture
Introduction
Urotherapy is a complex and challenging process in which cooperation between the child, parents and therapist is essential.
Case studies are used to cover the entire urotherapy process, from referral and admission to additional investigations and training progress. This includes detailed considerations such as what to look for, how to guide a child and explain bladder function and dysfunction, and how to motivate the child to make the necessary effort to achieve success.
Learning objectives
The participant:
- Gain a comprehensive knowledge of the urotherapy process, including referral, intake, additional investigations and training progress.
- Develop effective strategies for explaining bladder function and dysfunction in a clear and understandable way to guide a child through urotherapy.
- Discover techniques to motivate the child and encourage them to make the effort necessary to succeed in their urotherapy training.
Literature
Article:
Nieuwhof-Leppink AJ, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P, Yang S, von Gontard A. Definitions, indications and practice of urotherapy in children and adolescents: - A standardization document of the International Children's Continence Society (ICCS). J Pediatr Urol. 2021 Apr;17(2):172-181. doi: 10.1016/j.jpurol.2020.11.006. Epub 2020 Nov 5. PMID: 33478902.
Book: pediatric incontinence evaluation and clinical management: evaluation of bowel and bladder dysfunction. Section 4
a. Chapter 12 Implementation of urotherapy, Wendy F. Bower
b. Chapter 14 Biofeedback for the treatment of functional voiding problems, Ann Raes
c. Chapter 21 Psychological management of BBD, 201 Monika Equit and Alexander von Gontard
3.4 Q&A Discussion/ Live session online
During this online session you will have the opportunity to ask questions based on the lectures you have attended.
