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To assess the association between self-reported sleep quality and nocturia in nursing home residents.The association between self-reported poor sleep quality and nocturia was examined in eighty nursing home residents from two nursing facilities using logistic regression analysis.Poor sleep quality was reported by 29% of the eighty participants (median age 89±7 years, 77% of women). Nocturia was more frequent in patients with versus without self-reported poor sleep quality (78% vs 47%, p=0.01). Nocturia was independently associated with self-reported poor sleep quality after controlling for age, gender, self-rated health status, cognitive frailty score, antidepressant and hypnosedative use (OR[95%CI] of 6.1[1.8-25.4]).Nocturia severely impaired sleep quality in nursing home residents. Nocturia should be investigated in nursing home residents to optimize sleep quality.

Objective Post-menopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. Design, setting, population and methods Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. Results Overall, 91.5 % reported nocturia, 55% ≥2 /night. There was a difference of 167.5 mL (p1.3 was significantly predicted by age (OR 1.07, p

Objective Nocturnal lower urinary tract symptoms (nLUTS) increase with age, frailty and comorbid systemic illness and affect many older people. The aim of this study was to describe the prevalence of nLUTS in a hospital aged-care sub-acute environment. Methods Prospective clinical audit based on semi-structured bedside interviews of older adult patients admitted to a tertiary hospital aged rehabilitation ward over a 7-month period. Results A total of 147 eligible patients were included in this clinical audit. The prevalence of nLUTS was 80% (76% nocturia; 54% nocturnal urgency; 32% nocturnal enuresis; 51% nocturnal incontinence). The incidence of any nLUTs was 37%. Half the sample reported daytime incontinence, which always co-existed with at least one nLUTS. Conclusion Nocturnal lower urinary tract symptoms are a problem for four out of five older hospitalised patients. This highlights the need to screen for nLUTS early in the hospital admission and for implementation of a multidisciplinary team intervention to decrease morbidity and improve quality of life in this vulnerable population.

Objective:The objective of this study is to identify variables that describe nocturia-related bother in a sample of community-dwelling individuals.Materials and methods:Community-dwelling individuals age 40 years and older who woke to pass urine at night completed an online questionnaire. Participants were asked (i) their top three concerns in relation to nocturia, (ii) to agree or disagree with a list of statements related to bother, and (iii) to complete the Nocturia Impact Diary items. Fisher exact test and the Mann–Whitney U test were used to assess whether differences in nocturia-related bother existed when comparing participants stratified by nocturia severity.Results:Moderate to extreme nocturia-related bother was described by 56% of the 202 respondents and by 68% of individuals with nocturia two or more times per night. Effects of nocturia, specifically sleep disruption and impact on daytime function, were the most cited concerns. Low nocturia-related health literacy was evident. The sample was younger (83% age Conclusion:The study highlights the potential to evaluate patient care based on change in sleep and daytime function rather than solely on nocturia frequency. A suite of patient-reported outcome measures adjunctive to clinical data may have utility in quantifying meaningful change to patients after treatment for nocturia.Level of evidence:Not applicable for this multicentre audit.

OBJECTIVE To investigate whether treatment of overactive bladder (OAB), one comorbidity of nocturia, could reduce waking to void and improve other co-existing symptoms. METHODS A prospective cohort study was conducted at Royal Melbourne Hospital. Participants received 12 weeks of standard treatment, including lifestyle interventions and pharmacotherapy. Outcome measures were nocturia episodes, severity of urinary urgency/incontinence, sleep quality, daytime somnolence, anxiety and depression scores, quality of life and change in blood pressure. RESULTS Twenty participants completed the study. Nocturia frequency improved by one void per night. Overactive Bladder Symptom Score, sleep quality, first uninterrupted sleep time and systolic blood pressures improved. There were no significant changes in daytime somnolence, mood or quality of life. CONCLUSIONS In this pilot study, nocturia and other co-morbid dysfunctions appeared to improve when the severity of OAB was reduced. Treatment of OAB co-morbid with nocturia reduces urinary symptoms and may improve sleep parameters and positively impact return to health.

OBJECTIVE: This study aimed to describe the characteristics of nocturia in older hospitalised patients and to explore knowledge, beliefs, and experiences associated with night toileting while in hospital in order to identify unmet care needs. METHODS: A multisite mixed methods cross-sectional study of older hospitalised adults who were admitted for ≥ 2 days was conducted using a standardized researcher-administered questionnaire. An additional cohort 16 older hospitalised adults with nocturia > twice per night were interviewed to understand the experience and impact of nocturia during hospitalisation. RESULTS: Nocturia was experienced by 260 out of 308 participants. In-hospital nocturia was significantly correlated with nocturia in the month preceding admission, high diurnal voiding frequency and nocturnal urinary urgency. Bother was attributed to multiple nocturia episodes. Participants had poor knowledge and understanding of nocturia and believed the symptom to be a normal occurrence; only 20% had discussed management with staff. Disrupted sleep and fear of falling were common in older immobile participants with nocturia. CONCLUSION: Nocturia is highly prevalent in hospitalised older people. Toileting multiple times at night bothers patients, disrupts sleep, heightens a fear of falling yet is rarely addressed in ward management plans. A screening process to identify, assess, provide education and intervene for nocturia has the potential to improve wellbeing, safety at night and to address risk factors.

To observe the impact of different hormonal treatment options on nocturia, its causative factors and bother in postmenopausal women.This prospective study recruited 245 postmenopausal women and divided them into four treatment groups based on patient's choice: Estrogen + Progesterone (E+P), Estrogen-only in patients with a prior hysterectomy, tissue-selective estrogen complex (TSEC) and no treatment. Nocturia and its causative factors were observed using two standardized questionnaires before and after treatment: the International Consultation on Incontinence Questionnaire Nocturia Module and the Targeting the individual's Aetiology of Nocturia to Guide Outcomes (TANGO). The results of the Targeting the individual's Aetiology of Nocturia to Guide Outcomes were divided in four influencing topics of which the sum score was calculated.A significant reduction in prevalence of nocturia ≥ twice per night was seen after treatment, as the prevalence decreased from 27.7% (59/213) to 16.4% (35/213). Specified per therapy, a significant reduction in nocturnal voiding frequency was observed in patients treated with E+P and TSEC (P = 0.018 and P = 0.018, respectively). This improvement could be explained by a significant reduction in SLEEP sum score in patients treated with E+P and TSEC (P 0.001, P = 0.013, respectively). Estrogen-only led to a significant change in URINARY TRACT sum score, which is the result of a reduction in urgency prevalence (P = 0.039).E+P and TSEC treatment led to a significant reduction in nocturia prevalence and bother in women with ≥ 2 nocturnal voids. This effect is mainly the result of improvement in sleep disorders, however an improvement in bladder disorders can be suggested as well. More research is necessary to confirm these findings.Video Summary:http://links.lww.com/MENO/A710.

Limited literature concerning nocturia in early postmenopausal women is available. However, due to the lack of endogenous estrogen in these women, an increased prevalence of nocturia is expected.This prospective observational trial recruited 210 'early' postmenopausal women consulting the Ghent University menopause clinic. Postmenopausal status was biochemically confirmed. Women completed 3 questionnaires: the ICI questionnaire on nocturia (ICIQ-N); 'Targeting the individual's Aetiology of Nocturia to Guide Outcomes' (TANGO) and the Perceived Stress Scale (PSS). Moreover, information concerning women's age, anthropometrics and lifestyle was collected. Nocturia was defined as two or more nocturnal voids.Nocturia was reported in 24.8% (52/210) of the postmenopausal women. Bother increased with every nocturnal void. Women with two or more nighttime voids were found to have significantly increased prevalence of urgency compared with women with only one (p 0.001; 38.5% versus 22.7%). Trouble initiating sleep at the start of the night and insomnia during the night were significantly different in women with a different nocturnal frequency (initiating sleep p = 0.09, no voids 34.4 %, 1 void 39.2 %, ≥ 2 voids 53.8 %; insomnia p 0.001; no voids 1.6%, 1 void 22.7 %, ≥ 2 voids 53.8 %). In addition to bladder and sleep dysfunctions, waist circumference was a risk factor for nocturia (OR 1.04; 95 % CI: 1.01-1.08).Nocturia is an important problem in early postmenopausal women, affecting a quarter of the questioned women. Etiology of nocturia in this population is multifactorial as estrogen withdrawal is accompanied by bladder and sleep dysfunctions.

Context The impact of food and drinks on body fluid metabolism is of direct clinical relevance but current evidence remains fragmented. Aim Synthesise current evidence on the role of food and drinks in urine production. Methods Systematic review as per PRISMA guidelines using MEDLINE and EMBASE databases (completed October 2019). Studies reporting on the effect of food, food constituents, and drinks on urine production were included. Two authors performed an independent extraction of relevant articles using predetermined data sets and completed quality-of-study indicators. Results A total of 49 studies were included, of which 21 enroled human subjects, and 28 were clinically relevant animal studies (all of which utilised rodent models). The included studies were determined to be of variable quality. High dietary sodium, as well as wine, spirits, high-caffeine coffee, and caffeinated energy drinks, increased urine production in human studies. Decreased urine production was associated with low dietary sodium and consumption of milk, orange juice, and high-salt/high-sugar drinks. In animal models, a variety of fruits, vegetables, herbs, spices, and honey were associated with increased urine production. Conclusion Current evidence suggests that although several types of food and drinks may impact body fluid metabolism, the quality of the data is variable. Urine production appears to be influenced by multiple factors including composition (ie, moisture, macronutrients, and electrolytes), metabolite load, and the presence of specific diuresis-promoting substances (eg, caffeine, alcohol) and other bioactive phytochemicals. Future research is needed to support current evidence and the physiologic mechanisms underlying these findings.

Background The aim of this study is to evaluate the validity and reliability of the Targeting the Individual's Aetiology of Nocturia to Guide Outcomes (TANGO) screening tool, which is used to determine nocturia etiology. Methods Patients hospitalized in urology, orthopedics, and general surgery clinics between September 2019 and January 2020 were included in the study. Demographic characteristics of the participants such as age, gender, drug use, and nocturia severity were assessed by the researchers. The Turkish version of the TANGO questionnaire consisting of 22 questions was filled in by the patients. The patients were asked to repeat the same test 4 weeks later. Results A total of 124 patients were included in the study. The mean age of the patients participating in the study was 51.20 ± 18.50 (38-82). The result of the reliability assessment showed that the total score intraclass correlation coefficient was 0.715 (individual item score weighted kappa coefficients, 0.696-0.731) and the Cronbach's alpha coefficient was 0.727. A total of 112 patients filled in the TANGO screening tool again after 4 weeks. The test-retest reliability analysis kappa value was 0.75 (0.68-0.83). In the validity analysis, a moderately positive correlation was observed between the TANGO-Urinary Incontinence Score and the number of nocturia (r = 0.452, P = .003). Conclusion According to the validation study, the TANGO screening tool is valid and reliable to determine the nocturia etiology for the Turkish population.

Purpose: The authors investigated the reliability of myotonometry-measured muscle tone in the thenar and perineal muscles. Methods: Participants were women aged 18–50 years who were asymptomatic for thumb and pelvic floor dysfunction (interrater study n=20; intrarater study n=43) or who were symptomatic for vulvodynia (interrater study n=14; intrarater study n=32). Mechanical properties (stiffness, frequency, decrement, relaxation time, and creep) of the muscles were measured using a myotonometer (MyotonPRO) while the muscles were in a relaxed state. Measures were performed twice by two assessors. Intra- and interrater reliability were determined using intra-class correlation coefficients (ICCs) and absolute reliability using the standard error of measurement and a minimum detectable change. Results: The primary property of interest, muscle stiffness, showed very good interrater (ICC 0.85–0.86) and intrarater (ICC 0.82–0.88) reliability in the thenar eminence. In the perineal muscles, reliability results ranged from good to very good for interrater (ICC 0.70–0.86) and intrarater (ICC 0.80–0.91) reliability for muscle stiffness. Absolute reliability was confirmed, with all measures showing minimal variance. Conclusions: Muscle stiffness of the smaller muscles of the body can be reliably measured using the MyotonPRO. The device could be used as a reference standard in the development of a digital palpation scale that would facilitate accurate diagnosis of muscle tone.

A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.

Aims: Nocturia or waking at night, to urinate is a common cause of awakenings and may lead to sleep disturbance, impaired somatic health, impaired quality of life, and increased mortality. The aim of this report is to point out and discuss the aspects and issues that need to be addressed to improve the care of nocturia. Methods: This paper is a report of the presentations and subsequent discussion of a Think Tank session at the annual International Consultation on Incontinence-Research Society (ICI-RS) in June 2018 in Bristol. Results and conclusion: Nocturia is a known risk factor for in-hospital falls. Unfortunately, its assessment in acutely hospitalized (older) people is not the current practice and ward-based care plans are not tailored to this symptom. A new care pathway for hospitalized patients who have nocturia should be considered. More research into the relation of cardiovascular disorders and nocturnal polyuria (NP) is warranted and management of NP patients may be improved by involving a cardiologist in their management. There is definitely a need for phenotyping nocturia in relation to bladder capacity, filling phase, and emptying phase symptoms and how to treat the different phenotypes. In the near future, smart automated monitoring devices and applications might help us to diagnose and treat nocturia with less efforts.

Objectives: Although nocturia is a risk factor for incident falls in the community, studies are required to gain an understanding of incident falls related to nocturnal toileting in hospitals. The aim of this study is to describe the prevalence and characteristics of incident falls in adult hospitalized patients related to nocturnal toileting.Methods: A retrospective review of the electronic incident reporting and learning system and medical records of inpatients that had an incident fall.Results: The prevalence of toileting-related incident falls was 53% (73/137) and 28% of all incident falls were related to nocturnal toileting.Intravenous fluid infusion was associated with falls related to toileting, whereby median perfusion volume during night-time was 375 ml [IQR: 225-578 ml].Conclusions: The prevalence of nocturnal toileting-related incident falls in hospitals is high. Nocturia could be a leading cause of these incident falls. Intravenous fluid infusion might be part of the aetiology of (iatrogenic) nocturia.

Introduction Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. Methods Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. Results The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract—thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing. Conclusions Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.

Introduction Nocturnal enuresis is a common clinical condition in the pediatric population. The aim of this study was to assess the effectiveness of acupuncture treatment on pediatric nocturnal enuresis. Methods The search of publications using “acupuncture” and “enuresis” or “bedwetting” as keywords was performed in 6 databases. To be included studies had to (1) compare acupuncture with conventional treatment or placebo; (2) investigate a pediatric sample; and (3) provide results at the end of treatment or follow-up. Languages included were English; Italian; and Chinese. Analysis was performed according to PRISMA guidelines. Primary outcome was reduction in wet nights. Side effects and dropouts were secondary outcomes. Results We included 10 studies (7 randomized controlled trials and 3 non-randomized controlled trials) covering a total of 888 patients. A favorable, but non significant, effect of acupuncture compared with conventional care and placebo emerged. The type of acupuncture was the main source of heterogeneity. No statistically significant differences emerged across non-randomized and randomized studies. No difference was found in dropouts. Side effects in the acupuncture group were minor but rarely reported. Conclusions Acupuncture seems to be an effective option for the treatment of nocturnal enuresis, though further large randomized trials are needed because no statistically significance emerged and low quality of the included studies might have overestimated results. Acupuncture treatment seems feasible and with minor side effects.

Children with complex health problems require multi-disciplinary care. Using the case of congenital urological disorders as an example, children and adolescents with urinary tract involvement require care by multidisciplinary teams. At some point as adolescents or young adults they are moved to an adult service. This is a transfer from a multiple intervention health model to a single clinician environment during a time coinciding with other major life changing events.

Aim Nocturia frequency has been used as a measure of treatment efficacy for nocturia even though fluctuation of the symptom over time has been well described in the literature. Additionally, given the multifactorial causal pathway and clinically relevant comorbidities, frequency alone may be an insufficient marker of treatment direction. The aim of this study was to investigate factors associated with nocturia-related bother to identify additional variables that may capture the impact of nocturia, direct clinical care and have potential to quantify treatment outcome. Methods Prospective data from tertiary hospital Urology and Continence cohorts were matched for identical variables to generate a sample of 204 datasets. Descriptive statistics were obtained to describe the two cohorts. Characteristics of patients were evaluated across levels of nocturia frequency and nocturia-related bother using nonparametric methods; statistically significant differences between groups in each cohort were established. Results Nocturia frequency alone does not comprehensively reflect attributable bother. Five sleep variables (poor quality sleep, short time to first awakening to void, less than 7 hours of total sleep, primary sleep latency, and daytime sleepiness) and daily urinary urgency were significantly associated with high nocturia-related bother. Attributable bother, despite high-frequency nocturia, was minimized by male gender, lack of daily urinary urgency and good sleep quality. Poor health status, urinary urgency and sleep latency were associated with nocturia frequency. Conclusions Items of importance to individuals with nocturia have been identified from patient data. These variables have the potential to sit alongside change in nocturia frequency as potential markers of treatment response.

AIMS To explore and objectify the impact of diuresis on the presence of daytime and nighttime LUTS, and associated bother. METHODS Participants (healthy volunteers and patients referred to our hospital for a urologic consultation) were asked to complete a 72-hour bladder diary and also had to fill in a Likert scale (0: no bother; 10: maximal bother) to evaluate the LUTS-associated bother during daytime and nighttime. Three groups were defined: no/mild bother (Bother ≤2), moderate bother (3 ≤ Bother ≤ 6), and strong bother (Bother ≥7). Questionnaires in order to assess LUTS (ICIQ MLUTS and ICIQ FLUTS), quality of life (SF-36, NqOL), and quality of sleep (PSQI) were completed. RESULTS During daytime and nighttime, the study of participants with a strong bother associated with LUTS revealed a statistically significant higher fluid intake than those without bother (1640 mL vs 1800 mL during daytime, P = 0.007). Also, those with higher diuresis rate had more bother related to LUTS than the others (71.3 mL/h in group 1 vs 87.3 mL/h in group 3 (P

Purpose: We updated the terminology in the field of pediatric lower urinary tract function. Materials and Methods: Discussions were held in the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society, the urology section of the American Academy of Pediatrics, the European Society of Pediatric Urology, as well as other experts in the field. Results and Conclusions: New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results.

Aims: Nocturia, or waking up at night to void, is a highly prevalent and bothersome symptom. Currently, there is a lack of clear and consistent recommendations regarding evaluation and management of nocturia. The aim of this report is to discuss how to fill the gaps in our knowledge in order to develop a practical patient-oriented diagnostic and therapeutic algorithm for nocturia. Methods: This paper is a report of the presentations and subsequent discussion of a Think Tank session at the annual International Consultation on Incontinence Research Society (ICI-RS) in June 2017 in Bristol. Results and Conclusion: Further investigations are needed to better understand the pathophysiology of nocturia, to allow improvement in diagnosis, and to optimize treatment by increasing efficacy and reducing adverse events. Patient-oriented practical guidelines on nocturia are needed to help clinicians from different disciplines diagnose and treat nocturia.

Summary Purpose We reviewed and collated information concerning the available tools for the measurement of symptoms and outcomes in pediatric continence. Materials and methods MEDLINE, EMBASE, and CINHAL databases were searched for relevant articles published prior to December 2016 and independently screened by two researchers. Expert opinion was also widely sought through consultation with the ICCS Board membership and their professional networks and the multidisciplinary authorship group. The most relevant materials were then selected for analysis and inclusion and resulted in a document available on the ICCS website for all members to review. Insights and feedback were considered with consensus and agreement reached to modify the document. Results and conclusions A variety of useful tools for the assessment and measurement of bladder and bowel dysfunction and quality of life and behavioral comorbidities are presented together with their indications and potential pitfalls. ICCS cannot recommend one over another as the most useful for each clinician will vary depending on the clinical setting, available time, and patient population. We provide a framework for choosing those that are most appropriate based on our findings.

Objectives To develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia. Methods Variables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the Short-Form (SF) screening tool. The tool was administered to 252 individuals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected were subjected to descriptive analysis; criteria were applied to reduce the number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the individual's Aetiology of Nocturia to Guide Outcomes. Results The demographic characteristics of the sample are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long-Form to the SF is presented. The resultant TANGO-SF patient-completed nocturia screening tool is reported. Conclusions A novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.

Resumen Objetivos Adaptar al espanol la terminologia del tracto urinario inferior en el ambito pediatrico con motivo del informe de la ICCS de 2006 Material y metodologia se han mantenido discusiones en la Reunion de Consenso en conceptos y terminologia en la que han participado miembros de Grupos Espanol de Urodinamica y de la Sociedad Iberoamericana de Neurourologia y Uroginecologia (SINUG) Resultados y conclusiones Se ofrecen las nuevas definiciones y terminologia estandarizada en espanol, que tiene en cuenta los cambios realizados en el ambito de los adultos y los nuevos resultados en la investigacion. Se presentan los terminos ingleses (frecuentemente entre parentesis). Se discuten algunas propuestas (usualmente en las notas al pie)

OBJECTIVE: Since the prevalence of obesity in children is increasing, the frequency of pediatric non-alcoholic fatty liver disease (NAFLD) is growing. A reliable non-invasive biomarker for monitoring progression of liver fibrosis would be useful. In cirrhotic persons serum bile acid (BA) levels are significantly elevated. We hypothesized that BA levels and composition in pediatric NAFLD vary depending on the stage of fibrosis.METHODS: Children with NAFLD were compared with controls and classified by stages of fibrosis (NAFLD-F0, n = 27; NAFLD-F≥1, n = 65) based on liver-biopsy findings. Fasted metabolic and cholestasis status was assessed by several blood tests. BA profiles were measured by tandem mass spectrometry and compared with healthy controls (n = 105).RESULTS: Compared with controls, all NAFLD patients were overweight and showed significantly elevated glucose, insulin, AST, and ALT levels. Total serum BA were lower in non-fibrotic NAFLD children than in a control cohort (1.73 vs 3.6 μmol/l) due to low glycine-conjugated BA levels incompletely compensated by increases in taurine-conjugated or unconjugated BA. In fibrotic NAFLD patients BA levels were lower than in controls (2.45 vs 3.6 μmol/l) but higher than in non-fibrotic patients (2.45 vs 1.73 μmol/l) and the BA pattern resembled that of healthy controls. Fibroblast growth factor 19 levels were significantly lower in both NAFLD groups than in controls (p≤0.001) and were positively correlated with ursodeoxycholic acid levels.CONCLUSION: Our data indicate that serum BA levels decrease in early NAFLD and increase during progression to fibrosis. Given that BA are increased in cirrhotic adults, we postulate a continuous rise as NAFLD advances. BA may have a value as a non-invasive biomarker in pediatric NAFLD progression.

Objectives: To quantify the prevalence of urinary and faecal incontinence in the Australian population by deriving age and gender-specific rates of urinary and faecal incontinence from the literature. Methods: Systematic review and meta-analysis. A search of MEDLINE and EMBASE from 1995 to 2001 was performed in duplicate. The following a priori inclusion criteria were applied to studies: community based sampling frame, response rate > 65%, > 125 participants per gender group, and age and gender separation of results (stratification). Results: There were significant differences in the definitions used, the time frames of interest, and the populations surveyed. There was significant heterogeneity across studies. Overall prevalence of urinary incontinence for Australian adults was estimated to be 19.3% and 2.2% in Australian women and men, respectively. Overall prevalence of faecal incontinence was estimated to be 5.3% and 5.5% in Australian women and men, respectively. Conclusions: It is disappointing that with so many studies published in this area, there is still a lack of high quality, basic descriptive epidemiology of this important health problem. These estimates of the prevalences of urinary and faecal incontinence should assist policy making in this area.

PURPOSE: The impact of the original International Children's Continence Society terminology document on lower urinary tract function resulted in the global establishment of uniformity and clarity in the characterization of lower urinary tract function and dysfunction in children across multiple health care disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric lower urinary tract function.MATERIALS AND METHODS: A variety of worldwide experts from multiple disciplines in the ICCS leadership who care for children with lower urinary tract dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. In addition, contributions and feedback from the multidisciplinary ICCS membership were solicited.RESULTS: Following a review of the literature during the last 7 years the ICCS experts assembled a new terminology document reflecting the current understanding of bladder function and lower urinary tract dysfunction in children using resources from the literature review, expert opinion and ICCS member feedback.CONCLUSIONS: The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of lower urinary tract function in children. For the complete document visit http://jurology.com/.

K. HJALMAS,*† SWEDEN; T. ARNOLD, NEW ZEALAND; W. BOWER, AUSTRALIA/HONG KONG; P. CAIONE, ITALY; L. M. CHIOZZA, ITALY; A. VON GONTARD, GERMANY; S. W. HAN, S. KOREA; D. A. HUSMAN, USA; A. KAWAUCHI, JAPAN; G. LACKGREN, SWEDEN; H. LOTTMANN, FRANCE; S. MARK, NEW ZEALAND; S. RITTIG, DENMARK; L. ROBSON, USA; J. VANDE WALLE, BELGIUM AND C. K. YEUNG, HONG KONG ON BEHALF OF THE INTERNATIONAL CHILDREN’S CONTINENCE SOCIETY (ICCS)