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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After a description of the bladder-sphincter system physiology and of the different stages in the acquisition of micturition control by children, as revealed by urodynamic explorations, the author presents the bladder immaturity syndrome. This entity includes diurnal disorders of micturition--such as urgencies, pollakiuria, more seldom retention and incontinence--which can readily be identified by questioning. It accounts for many cases of nocturnal enuresis which may benefit from treatment with anticholinergic drugs. Nocturnal enuresis without disorders of micturition in daytime is due to other physiopathological mechanisms. It is preferably treated with tricyclic antidepressants and other non-medicinal therapies. All cases should be investigated for a possible organic pathology. A practical classification of enuresis is given.
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PMID:[Enuresis: the viewpoint of the urologist]. 291 63

Most children with incontinence not associated with known neurologic impairment will have either functional immaturity of the nervous system or inflammatory conditions of the lower urinary tract as the etiology for incontinence. By using the criteria outlined in this article, one can manage selective urologic evaluation of the diurnally incontinent and enuretic child, saving most patients the cost and stress of more in-depth diagnostic evaluations.
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PMID:Incontinence and enuresis. 330 49

Acquisition of control of micturition in children involves several stages, the most critical being the bladder immaturity phase. Although the passage from bladder automatism of the neonate to coordinated conscious bladder-sphincter activity in adults is usually a problem-free period, it is nevertheless a critical and sometimes dangerous phase in certain subjects. Purely functional disorders may induce, above a certain physiological limit, a true pathologic state considered up to the present as being organic in nature and requiring urodynamic exploration to confirm their individuality. This bladder immaturity syndrome has the common denominator of diurnal or nocturnal urine leaking, sometimes with an associated lower urinary tract infection in young girls. The first part of this review discusses a clinical trial conducted in 1 097 children (840 girls, 257 boys) age 4 to 15 years, with the "urine-leaking" symptom, divided into 2 groups as a function of its diurnal or nocturnal prevalence: Group I: diurnal incontinence alone: 285 children Group II: diurnal and nocturnal incontinence: 812 children Investigations included: a clinical examination including a full past history to determine possible infectious origin, the primary or secondary nature of the disorder, possible family history and particularly any associated diurnal micturitional disorders such as pollakiuria and urgency; cytobacteriology of urine; an I.V.U. reduced to a minimum of images; cystography and micturitional study; cystometry. Results in each group were expressed analytically, and showed assimilation of the 2 groups, having in common the incontinence-urine leaking symptom, whether it occurred during the day or night, with the diurnal manifestations of pollakiuria and urgency. This clinical feature derived from simple questioning was accompanied in 9 out of 10 cases by cystographic anomalies (notched bladder outline, modified proximal urethra in young girls, sometimes vesico-renal reflux) and cystometric changes (vesical hyperactivity and hypersensitivity). These findings provide better understanding of the significance of these clinical manifestations and their place within the framework of the urinary bladder immaturity syndrome. After a summary of the physiology of the bladder-sphincter apparatus and the stages of acquisition of micturitional control, with definition successively of the automatic, immature and adult bladder, the second part of the report discusses the urinary bladder immaturity syndrome itself. Symptoms are dependent on the urodynamic factors involved.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The bladder immaturity syndrome. Apropos of 1097 cases]. 407 51

Idiopathic or "functional" urinary incontinence in children--incontinence with no known neurologic or anatomic cause--may take the form of urge incontinence, the most common type of incontinence, which is characterized by detrusor overactivity during the filling phase, or dysfunctional voiding. The latter may be classified as staccato voiding (periodic bursts of pelvic floor activity with prolonged voiding and, in some cases, residual urine), interrupted voiding (insufficient bladder emptying, infrequent voiding with several phases of micturition), or "lazy bladder" syndrome (infrequent voiding and large bladder capacity). The etiology of functional incontinence is unknown. Theories include genetic predisposition, recurrent urinary tract infections, immaturity or too-early toilet training, and sexual abuse. A severe form of urge incontinence, nonneurogenic neurogenic (Hinman) bladder, may be the end stage of dysfunctional voiding, but an occult neurologic component should also be considered. Diagnostic procedures recommended for children with urinary incontinence include careful history taking, a voiding diary, and physical examination to identify symptoms and to minimize the need for invasive procedures. Treatments include behavioral modification, biofeedback, antibiotics, anticholinergics, counseling, and neuromodulation. The antimuscarinics oxybutynin and tolterodine are, at present, the most commonly used drugs to treat incontinence. Common side effects with these agents (ie, reduced saliva production and worsening constipation) can be severe and can cause up to 10% of children using oxybutynin to discontinue treatment. Current evidence suggests that tolterodine may have a more favorable safety profile than oxybutynin. In addition, new antimuscarinics in the pipeline, eg, darifenacin and solifenacin, are expected to possess more favorable safety and tolerability profiles and may therefore help to alleviate these limitations.
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PMID:Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children. 1501 52