Annual Scientific Meeting

16 October 2004 (Saturday), 2:00pm íV 5:30pm
Ballroom, Basement, Holiday Inn Golden Mile Hotel, Nathan Road, TST,

2:00 pm < Registration >
2:15 pm Keynote speech
  Childhood Elimination Symptoms are Carried into Adulthood
  > Prof. Wendy Bower
> Department of Surgery, Chinese University of Hong Kong
3:15 pm Annual General Meeting and Tea Break
3:45 pm Paper Presentations
  Recent Advances in Management of Overactive Bladder
  > Dr. Francis Lee
> Tung Wah Hospital
  Acupuncture as a Mode of Neuromodulation for Overactive Bladder
  > Dr. BWM Que, B Leung
> United Christian Hospital
  Prevalence of Incomplete Bladder Emptying in Elderly Wards
  > Dr. C K Tam
> TWGHs Wong Tai Sin Hospital
Registration Fee: Members: Free
  Non-Member: $100
For Registration: please fill in the registration form & send to attached address ASAP (In case of urgency, please fax [2354-2854] or e-mail [tamckstep@yahoo.com.hk] the registration form first and pay the registration fee on site)
(Please note that you can assume your registration is confirmed once registered unless you are informed that it is not the case. No confirmation letter will be sent.)

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Childhood Elimination Symptoms are Carried into Adulthood


WF Bower1, SK Yip2, CK Yeung1
1 Department of Surgery, The Chinese University of Hong Kong
2 Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong

The Elimination Syndrome (ES) is little known in adulthood and the natural history of symptoms from childhood indefinite. This study aimed to evaluate the natural history of Elimination Syndrome (ES) and to identify aspects of the disorder that do not remit.

Materials and methods:
A 42 item questionnaire was self-administered to 223 consecutive women attending a urogynaecological clinic and to the same number of normative women. Data sets from the normative cohort reporting current bladder problems were excluded. Descriptive statistics, chi squared and Kruskal-Wallis tests were used to compare variables.

Urogynaecological patients (UG) had significantly higher ES scores than the cohort of normative adults (UG: mean 3.44, median 2, IQR 0-5; Normative: mean 1.36, median 1, IQR 0-2; p< 0.001). An ES score of < 4 was seen in 25% of urogynae women versus 84% of normative subjects. Chi-squared analysis showed the following symptoms to be significantly more often reported in childhood by urogynaecology patients: UTI, VUR, urgency, frequency, urge incontinence, both slow and intermittent urine flow, small volume high urge voids, needing bowel medication, frequent faecal soiling and nocturnal enuresis. Higher ES scores correlated significantly with current adult urgency, urge leak, recent UTI, incomplete emptying, post-void leak, hesitancy, nocturia and nocturnal enuresis. Constipation and faecal incontinence in adulthood showed a significant association with high ES scores (each p< 0.001). Urogynaecological patients reported significantly more current bowel problems than the normative cohort (p< 0.001). Table 1 describes the significant associations identified by univariate analysis.

Table 1: Significant associations between key ES symptoms and adult dysfunctions. (Blank cells indicate non significant association).

+/- urge
Adult faecal
urge leak
P< 0.006       P< 0.014 P< 0.026
  P< 0.001 P< 0.006 P< 0.034    
  P< 0.027        
Slow /
urine flow
  P< 0.026     P< 0.036  
Constipation P< 0.002 P< 0.013 P< 0.007 P<0.001 P<0.003 P< 0.001
  P< 0.008 P< 0.05     P< 0.001

This is the first report of the negative impact and unrelenting effect of ES in later life. It appears that primary childhood symptoms do not resolve spontaneously and that early tailored paediatric intervention for ES is clearly warranted.

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Recent Advances in Management of Overactive Bladder
Recent Advances in Management of Overactive Bladder

Dr. Francis Lee, Tung Wah Hospital

Overactive bladder (OAB) is a chronic condition in which the bladder contracts too early during filling phase. The International Continence Society defined it as a symptom complex consists of urinary frequency, nocturia, urgency and/or urge incontinence. Use of antimuscarinic drugs, such as oxybutynin, has been the mainstay of treatment of OAB for many years. However, these drugs have high incidence of side effects and long term compliance is poor. The use of the more bladder-selective antimuscarinic drug tolteradine and changing the bioavailability of oxybutynin has significantly decreased the incidence of side effects. Recent reports on the use of extravesical neuromodulation and intravesical therapies blocking the afferent and efferent pathways of bladder contraction have opened up new horizons for the management of OAB.

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Acupuncture as a Mode of Neuromodulation for Overactive Bladder

BACKGROUND: Neuromodulation(NM) in the form of sacral nerve stimulation(SNS) has been widely accepted. Incidentally, the S3 foramina used in SNS were also acupoints used in Traditional Chinese Medicine (TCM) for various pelvic pathology.We conducted a pilot study to assess the usefulness of electroacupuncture as a form of neuromodulation. METHOD: From August 2001 to August 2003, 40 male patients (mean age 62.8, range 38-79) who suffered from overactive symptoms but were either shown to have normal maximum flow rate or have been treated with TURP were studied. Electroacupuncture on S3 bilaterally and on RN 4 were performed for a consecutive period of 8 days. Uroflometry, Voiding diary, mid-stream urine culture, IIEF-5, NIH-CPSI and SF-36 questionaires were completed before treatment, 6 weeks, 12 weeks, 18 weeks and 24 weeks post-treatment.Subjective assessment of results of the treatment were also recorded. RESULTS: At the end of acupuncture course,50% of all patients found the treatment beneficial and would recommend to friends with similar symptoms. At 6-week, 55% found this treatment useful. This ratio dropped to 42.5% at 12-week, and further down to 30% at 18-week. At 24-week, only 20% still recommend the treatment.

CONCLUSION: Electroacupuncture may be beneficial in patients with overactive bladder symptom, but the effects were not sustained after 12 weeks.It may have a role as intermittent therapy, or as temporary nerve testing before SNS.

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Prevalence of Incomplete Bladder Emptying in Elderly Wards

Prevalence of Incomplete Bladder Emptying in Elderly Wards

Dr. C.K. Tam
SMO, Dept. Of Rehabilitation & Extended Care, TWGHs Wong Tai Sin Hospital

Introduction: Recurrent urinary retention and urinary tract infections (UTI) are commonly encountered problems in elderly patients admitted into hospitals.Incomplete bladder emptying (IBE) is a closely related problem and in fact post-voided residual volume (PVR) >150ml or 200ml has also been defined as chronic urinary retention.

Purpose of the Project: To determine the prevalence of various degrees of IBE in elderly patients admitted into a convalescent hospital and to determine a reasonable cut-off value of PVR required for further investigations & interventions based on the relationship between PVR and the risk of UTI.

 Methods: 119 consecutive patients admitted into 2 convalescent wards from August 1 to 31, 2004 were included in the study. Patients without urinary catheter were screened within 48 hours of admission with an ultrasonic bladder scanner to measure PVR immediately after micturition. A urine sample was sent for routine microscopy & culture within 48 hours of admission.Medical records were traced to determine any documented UTI before admission and up to 4 weeks after admission.

 Results: 12.6% patients were already on urinary catheter on admission and another 21.8% patients were found to have PVR >100ml.9.2% patients had PVR >400ml requiring immediate catheterization. There was increased risk of UTI when PVR was above 100ml.

 Conclusion: There was a high prevalence of IBE in elderly patients and screening of all patients on admission for raised PVR is advisable to identify the problems early and to prevent subsequent complications.PVR of 100ml appeared to be a reasonable and practical cut-off value for elderly patients indicated for further investigations and interventions and also be the minimum goal of any interventions.

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