4.1 Neuromodulation and LUTS
Neuromodulation is a treatment option for children who have not responded to standard urotherapy, particularly those with overactive bladder (OAB). It includes techniques such as transcutaneous electrical nerve stimulation (TENS) and peripheral tibial nerve stimulation (PTNS), Sacral nerve stimulation, both of which offer minimally invasive solutions. PTNS targets specific peripheral nerves or their dermatomes to alter the afferent and efferent neurological pathways between the brain, brainstem and pelvic organs involved in the micturition cycle, thereby normalizing abnormal bladder function. Neuromodulation helps patients gain better control of their bladder. This session will explain the clinically applied neurostimulation techniques and the current evidence supporting these therapies.
Learning objectives
The participant:
- Gain a comprehensive understanding of neuromodulation techniques, including transcutaneous electrical nerve stimulation (TENS) and peripheral tibial nerve stimulation (PTNS).
- Understand how neuromodulation works to alter the afferent and efferent neurological pathways between the brain, brain stem, and pelvic organs to normalize bladder function.
- Understand the benefits and considerations of minimally invasive neuromodulation techniques
- Learn practical steps for implementing neuromodulation techniques in clinical practice, including patient selection and treatment protocols.
Literature
Book: Pediatric incontinence evaluation and clinical management: evaluation of bowel and bladder dysfunction. Section 4
a. Chapter 17 Peripheral tibial nerve stimulation therapy of functional voiding problems, Mario de Gennaro
b. Chapter 18 Sacral nerve stimulation therapy for the treatment of functional voiding problems, Alonso Carrasco jr.
c. Chapter 19 Superficial sitmulation therapy for the treatment of functional voiding problems, Ubirajara Barroso jr.
4.2 Further details of urotherapy and CIC
As a urotherapist, you will use behavioural techniques and explain their rationale to the child and their family. You will help the child to recognise and change their micturition and defecation behaviors, helping them to understand these behaviours and their consequences. Key elements of CBT such as psychoeducation, behaviour modification, reinforcement and exposure are central to this process.
For children with persistent post-void residuals and/or incontinence, self-intermittent catheterization may be a viable solution. This session will cover how to introduce and teach this technique effectively
Learning objectives
The participant
- Learn to incorporate key elements of CBT, such as psychoeducation, behavior modification, reinforcement, and exposure, into urotherapy
- Understand when self-intermittent catheterization is a viable solution and learn how to introduce and teach this technique to children and their families.
Literature
Senior J. Clean intermittent self-catheterisation and children. Br J Community Nurs. 2001 Aug;6(8):381-6. doi: 10.12968/bjcn.2001.6.8.7054. PMID: 11865205
4.3 case presentations of and by the student
For part gather a practice situation(s) of your own in which you provide a structured description of the child in his/her situation using a case(s) and the thinking steps you go through as a urotherapist to analyze the child's micturition and/or defecation problems, and describe and justify the care given in the form of interventions. You present thet case to the group and we discuss the case or situation together. The intention is that you have provided care to the child yourself in this situation/case. Name the reason why you want to discuss this situation/case. Form a question you are asking yourself,
for example;
- have I made the correct diagnosis?
- Have I collected all the important data, is any information missing?
- is additional research still needed?
- did I choose the best intervention?
- what went well what are the pitfalls for the child/parents or yourself as caregiver
These topics will be discussed in more detail in class.
Put this question(s) and the case or situation in a powerpoint file.
