Dysfunctional voiding: exploring disease transition from childhood to adulthood

SUMMARY

Rationale & objective:
Dysfunctional voiding (DV) is a condition characterized by an impaired relaxation of the pelvic floor musculature during voiding. Both the International Continence Society (ICS) as the International Children’s Continence Society (ICCS) use equivalent definitions, wherein the existence of a staccato/intermittent urinary flow is central.
Up to date it is however still not clarified if adult cases are new-onset presentations of DV or persistent childhood complaints. It is unknown if there is a continuation of DV from childhood to adulthood. The aim of this study is therefore to explore the development of DV from childhood to adulthood, in order to improve our transitional care and to avoid repeated invasive examination in adults with childhood DV .

Study design:
This is a cohort-study with cross-sectional follow-up in female adults (>18 years) who were treated for childhood DV in the Wilhelmina Children’s Hospital. After chart study on existing data regarding DV diagnostic criteria and comorbid symptomatology at baseline and after conservative treatment in childhood, all participants will be invited for a uroflowmetry with post-void residual assessment at the outpatient clinic of the UMC Utrecht and will receive digitally a combined version of the International Consultation on Incontinence modular Questionnaire – Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and International Consultation on Incontinence modular Questionnaire – Urinary Incontinence (ICIQ-UI) questionnaires regarding lower urinary tract symptoms (LUTS) with additional questions on the presence of urinary tract infections (UTI’s).

Study population:
Female adults (>18 years) who were treated for childhood DV in the Wilhelmina children’s hospital and completed the follow-up in the RCT of Klijn et al../ UWOK 830-999-99-23.

Main study parameters/endpoints:
Persisting or relapse of DV from baseline and/or after treatment to adulthood. DV is herein defined according to the ICS and ICCS standardization paper as a bladder outlet problem, characterized by contractions of the peri-urethral striated muscles during voiding, which consequently demonstrates a staccato or intermittent uroflow pattern on uroflowmetry with or without residual urine after voiding in neurologically normal individuals
Nature and extent of the burden associated with participation, benefit and group relatedness:
Study-related risks
The risks associated with participation are negligible. Uroflowmetry with post-void residual assessment is a non-invasive procedure, without adverse events.

Study-related benefits
The outcome of the study could improve the transitional care of young-adults with DV and help to avoid repeated invasive examination in adults with childhood DV. Furthermore, outcomes of this study may improve information about future expectations for children with DV and their parents.

Having an existing cohort with a large number of neurologically normal, conservatively treated girls with DV offers herein a unique opportunity to objectively asses the transition of DV, without the occurrence of recall-bias.

The aim of our present study is therefore to explore the development of DV from childhood to adulthood in order to improve our transitional care and to avoid repeated invasive examination in adults with childhood DV

Once by a questionnaire and a visit to the outpatient clinic, UMC Utrecht.

Questionaire:
Participants will digitally receive a questionaire: a combined version of the International Consultation on Incontinence modular Questionnaire – Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and International Consultation on Incontinence modular Questionnaire – Urinary Incontinence (ICIQ-UI) questionnaires regarding LUTS, with additional questions on the current presence of UTI’s,

Flowmetry &Ultrasound:
During a 1 visit to our clinic the particitpants will undergo once a uroflowmetry with post-void residual assessment by ultrasonography. All test will be performed at the same visit.

A uroflowmetry is a simple and noninvasive test. It is the graphical recording of the urinary stream, which gives information on voided volume, flow time, velocity at start of the stream, maximal flowrate (expressed in mL/s), and flow pattern. Flow curve shape provides accurate information on voiding and are automatically assessed with Contouro to avoid inter-rater variability. DV typically comes with a staccato or interrupted flow pattern resulting in residual urine.
Therefore after uroflowmetry an transabdominal ultrasound will be done to assess the existence of residual urine in the bladder.