Kourosh Afshar

Associate Professor

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Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - Mar 2019)
Bladder and bowel dysfunction in children : an investigation of cardiac autonomic nervous system activity and related therapies (2017)

Bladder and bowel dysfunction (BBD) consists of a prevalent group of conditions presenting mainly with lower urinary tract symptoms. The autonomic nervous system (ANS), comprising mainly of the sympathetic (SNS) and parasympathetic nervous systems (PNS), regulates lower urinary tract function. ANS role in the pathogenesis of BBD in not known. BBD management initiates with education and life-style modification (standard urotherapy or SU). Additionally, adjunctive treatments may be administered. Current treatments are often partially effective, costly, and sometimes associated with side-effects.The overall goal of this dissertation was to describe cardiac ANS activity in children with BBD before receiving any treatments and subsequently after current and proposed adjunctive therapies.Study 1: Forty children with BBD were compared with nineteen healthy controls for the activity of ANS measured via spectral analysis of heart rate variability (HRV). Results demonstrated a significantly lower overall ANS and PNS activity at baseline in BBD group.Study 2: The efficacy of pelvic floor biofeedback in children with BBD was assessed via a systematic literature review and meta-analysis of randomized controlled trials (RCT) which showed no improvement in resolution of urinary incontinence after 6 months of biofeedback compared to other adjunctive treatments.Study 3: Ten children from Study 1 with overactive bladder (OAB) were followed receiving antimuscarinics for approximately 3 months. Results showed a significant reduction in the PNS activity after treatment accompanied by a failure to achieve complete symptom resolution.Study 4: Twenty-three children with BBD were randomized to SU plus diaphragmatic breathing (DB) or SU only in a pilot trial. Results showed a low overall feasibility for proposing DB in controlling symptoms mainly due to low adherence during an approximately 3 months of follow-up. Positive correlations were found between number of DB practices and change from baseline in overall ANS and PNS activity.In summary, BBD was associated with a significantly low overall ANS and PNS activity. There is lack of evidence supporting relative treatment efficacy of biofeedback. Use of antimuscarinics in OAB was associated with further reduction in cardiac PNS activity and the pilot study showed low overall feasibility for proposing DB for three months.

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