Summary
Background
Urotherapy is an umbrella term for all non-surgical, non-pharmacological interventions
for lower urinary tract disorders (LUTD) in children and adolescents. Urotherapy is
a specialized practice, which has become mainstay therapy not only for daytime urinary
incontinence, but also for nocturnal enuresis, functional constipation and fecal incontinence.
The aim of urotherapy is to achieve the normalization of the micturition and bowel
pattern and to prevent further functional disturbances by repeated training. It is
well known that in the treatment of adult and childhood incontinence a team approach
is best, where there are shared areas of expertise and also discipline-specific expertise
available.
Aim
We present a consensus view from a cross-professional team of experts affiliated with
the International Children's Continence Society on definitions, indications and practice
of urotherapy. This is a selective, non-systematic review with practical recommendations
for the implementation and research on urotherapy.
Methods
The document uses the globally accepted ICCS terminology. Evidence-based literature
serves as the basis, but in areas lacking in primary evidence, expert consensus is
used. Before submission, a full draft was made available to all ICCS members for additional
comments.
Results

Graphical AbstractDaytime urinary incontinence and enuresis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of daytime urinary incontinence : a standardization document from the International Children’s Continence Society.Neurourol Urodyn. 2017; 36: 43-50https://doi.org/10.1002/nau.22911
- The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children's Continence Society.Neurourol Urodyn. 2016; 35: 471-481
- Treatment of daytime urinary incontinence: a standardization document from the International Children's Continence Society.Neurourol Urodyn. 2017 Jan; 36 ([Internet]) ([cited 2018 Jan 26];Available from:): 43-50https://doi.org/10.1002/nau.22911
- Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society.Pediatr Nephrol. 2018; 33: 2207-2219https://doi.org/10.1007/s00467-017-3799-9
- Urinary and fecal incontinence – a training program for children and adolescents.Hogrefe Publishing, Boston/Göttingen2015: 209
- Management of functional constipation in children with lower urinary tract symptoms: report from the standardization committee of the international children's continence society.J Urol. 2013; 190 ([Internet]) (Available from:): 29-36https://doi.org/10.1016/j.juro.2013.01.001
- Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society.J Pediatr Urol. 2020; 16: 10-19
- Simple behavioural interventions for nocturnal enuresis in children.Cochrane Database Syst Rev. 2004; 2https://doi.org/10.1002/14651858.CD003637
- Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children’s Continence Society.J Pediatr Urol. 2013; 9 ([Internet]) (Available from:): 234-243https://doi.org/10.1016/j.jpurol.2012.10.026
- Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis.Eur Child Adolesc Psychiatr. 2017; : 1-16
- Conservative treatment for functional daytime urinary incontinence in children.Cochrane Database Syst Rev. 2016; 2016
- Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction : a systematic review ଝ.J Pediatr. 2019; ([Internet]) (xx). Available from:https://doi.org/10.1016/j.jped.2019.02.007
- Domestic water quantity, service level and health.World Health Organization, 2003 (Vol. WHO/SDE/WS)
- Urinary incontinence and nocturia in healthy schoolchildren.Acta Paediatr. 1994; 83: 950-954
- Timer watch assisted urotherapy in children: a randomized controlled trial.J Urol. 2010; 184: 1482-1488https://doi.org/10.1016/j.juro.2010.06.024
- Enuresis and spontaneous cure rate Study of 1129 enuretics.Arch Dis Childh. 1974; 49 (Table II): 259-263https://doi.org/10.1136/adc.49.4.259
- Functional nonretentive fecal incontinence in Children : a frustrating and long-lasting clinical entity.2009: 98-100
- Management of functional nonretentive fecal incontinence in children: recommendations from the International Children’s Continence Society.J Pediatr Urol. 2016; 12: 56-64https://doi.org/10.1016/j.jpurol.2015.09.008
- The diagnosis and treatment of enuresis and functional daytime urinary incontinence. vol. 116. Dtsch Arztebl Int., 2019: 279-285 16th ed.
- Alarm interventions for nocturnal enuresis in children.Cochrane Database Syst Rev. 2005; 18 (Review) (CD002911(2))https://doi.org/10.1002/14651858.CD002911.pub2
- Relapse rate and subsequent parental reaction after successful treatment of children suffering from nocturnal enuresis: a 2½ year follow-up of bibliotherapy.Behav Res Ther. 1995; 33: 309-311https://doi.org/10.1016/0005-7967(94)00041-h
- Predictors for a positive outcome of adapted clinical dry bed training in adolescents and adults with enuresis.Neurourol Urodyn. 2016; 35: 1006-1010https://doi.org/10.1002/nau.22869
- Voiding postponement in children—a systematic review.Eur Child Adolesc Psychiatr. 2016; 25: 809-820
- Central inhibition of refractory overactive bladder complaints, results of an inpatient training program.J Pediatr Urol. 2015; 11: 21-e1-5https://doi.org/10.1016/j.jpurol.2014.06.024
- Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence.Eur Urol. 1997; 31 ([Internet]) (Available from:): 68-72
- Prospective evaluation of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.J Urol. 2011 Aug; 186 ([Internet]) ([cited 2018 Jan 26] Available from:): 648-654
- The management of dysfunctional voiding in children: a report from the standardisation committee of the international children's continence society.J Urol. 2010; 183 ([Internet]) (Available from:): 1296-1302https://doi.org/10.1016/j.juro.2009.12.059
- Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review.J Pediatr Urol. 2011; 7 ([Internet]) (Available from:): 342-348https://doi.org/10.1016/j.jpurol.2011.02.019
- Bladder rehabilitation, the effect of a cognitive training programme on urge incontinence.Eur Urol. 1997; 31: 68-72
- Prospective evaluation of inpatient and outpatient bladder training in children with functional urinary incontinence.Urology. 2006; 67: 176-180
- Electrical stimulation for lower urinary tract dysfunction in children : a systematic review of the literature.Neurourol Urodyn. 2011; 30: 1429-1436https://doi.org/10.1002/nau.21140
- Review article Electroneurostimulation for the management of bladder bowel dysfunction in childhood.Eur J Paediatr Neurol. 2016; 21 ([Internet]) (Available from:): 67-74https://doi.org/10.1016/j.ejpn.2016.05.012
- Do the definitions of the underactive bladder and detrusor underactivity help in managing patients: International Consultation on Incontinence Research Society ( ICI-RS ) Think Tank 2017?.2018: 60-68 (February)
- Dysfunctional voiding: the importance of non-invasive urodynamics in diagnosis and treatment.Pediatr Nephrol. 2018; 33
- Use of urine alarms in toilet training children with intellectual and developmental disabilities: a review.Res Dev Disabil. 2016; 53–54: 232-241
- The daytime alarm: a useful device for the treatment of children with daytime incontinence.J Urol. 2006; 176: 325-327https://doi.org/10.1016/S0022-5347(06)00303-X
- Alarm interventions for nocturnal enuresis in children.Nurs Times. 2005; 97: 37
- Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.J Pediatr Urol. 2016; 12 ([Internet]) (Available from:): 37.e1-37.e6https://doi.org/10.1016/j.jpurol.2015.04.045
- Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction.J Pediatr Urol. 2010; 6: 490-495
- Therapieresistente harninkontinenz und enuresis: Gruppenblasenschulung.Monatsschr Kinderheilkd. 2011; 159: 565-571
- Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence.J Urol. 2009; 182 ([Internet]) (Available from:): 2072-2078https://doi.org/10.1016/j.juro.2009.05.101
- Parasacral transcutaneous electrical nerve stimulation for overactive bladder in constipated children: the role of constipation.J Pediatr Urol. 2016; 12 ([Internet]) (Available from:): 396.e1-396.e6https://doi.org/10.1016/j.jpurol.2016.04.047
- Review of intermittent catheterization and current best practices.Urol Nurs. 2011; 31 ([Internet]) (Available from:): 12-29
- Impact of the route of clean intermittent catheterization on quality of life in children with lower urinary tract dysfunction.Neurourol Urodyn. 2018; 37: 2833-2840
- Long-term bladder management by intermittent catheterisation in adults and children.Cochrane Database Syst Rev. 2007; 4 (Review)https://doi.org/10.1002/14651858.CD006008.pub2
Article info
Publication history
Published online: November 05, 2020
Accepted:
November 4,
2020
Received in revised form:
September 9,
2020
Received:
June 11,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.