Comparison and characteristics of children successfully treated for daytime urinary incontinence

Published:November 29, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.11.013

      Summary

      Introduction

      Daytime urinary incontinence (DUI) is defined as an involuntary leakage of urine during daytime in children 5 years or older. It is a common disorder in the pediatric population most often caused by an overactive bladder (OAB). A stepwise approach is recommended in the treatment of DUI, with standard urotherapy (SU) being first line treatment followed by pharmacological treatment when SU is unsuccessful. To our knowledge few studies have compared patients achieving continence solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment in the pediatric population.

      Objective

      The aim of the study was to characterize and compare children suffering from OAB and DUI who became continent solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment.

      Methods

      All children successfully treated for DUI from 2015 to 2020 were retrospectively analyzed and compared using data from patient's records, 48-h flow-volume charts, and uroflowmetry analysis.

      Results

      180 children were successfully treated for DUI. Of these 23 (13%) had bowel dysfunction, 94 (52%) were successfully treated with standard urotherapy (SU) and 64 (35%) needed pharmacological treatment. Children who achieved continence on a combination of SU and pharmacological treatment had a significantly higher baseline voiding frequency (7.6 and 6.5 respectively, p=0.007) and more baseline incontinence episodes during daytime when compared to children who became dry solely on urotherapy (2.2 and 1.1 respectively, p < 0.001). Both groups had a similar baseline age (p=0.96) and received a similar duration of standard urotherapy prior to the eventual pharmacological treatment (p = 0.73).

      Discussion

      Most children achieved daytime continence solely on standard urotherapy. We found that children requiring additional pharmacological treatment to achieve continence suffer from a more severe overactive bladder. As such it could be speculated that children with high voiding frequencies and multiple daily incontinence episodes may benefit from adding anticholinergics to SU earlier during the course of treatment, than what is recommended by the International Children's Continence Society (ICCS) today. However prospective interventional studies are needed for safe conclusions.

      Conclusion

      Our comparison showed that children requiring a combination of SU and pharmacological treatment to achieve continence, had a significantly higher baseline voiding frequency and more baseline incontinence episodes when compared to children requiring only SU to achieve continence.

      Abbreviations:

      BMI-SDS WHO (Standard deviation for BMI distribution of 5–19-year-old children), DUI (Daytime Urinary Incontinence), EBC (Expected Bladder Capacity), ICCS (International Children's Continence Society), MVV (Maximum Voided Volume), OAB (Overactive Bladder), SU (Standard Urotherapy)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-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 Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Austin P.F.
        • Bauer S.B.
        • Bower W.
        • Chase J.
        • Franco I.
        • Hoebeke P.
        • et al.
        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: 471-481https://doi.org/10.1002/nau.22751
        • Chang S.J.
        • Van Laecke E.
        • Bauer S.B.
        • von Gontard A.
        • Bagli D.
        • Bower W.F.
        • et al.
        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
        • Warner T.C.
        • Baandrup U.
        • Jacobsen R.
        • Bøggild H.
        • Aunsholt Østergaard P.S.
        • Hagstrøm S.
        Prevalence of nocturia and fecal and urinary incontinence and the association to childhood obesity: a study of 6803 Danish school children.
        J Pediatr Urol. 2019; 15 (225.e1-.e8)https://doi.org/10.1016/j.jpurol.2019.02.004
        • Gontard A.V.
        • Kuwertz-Broking E.
        The diagnosis and treatment of enuresis and functional daytime urinary incontinence.
        Dtsch Arztebl Int. 2019; 116: 279-285https://doi.org/10.3238/arztebl.2019.0279
        • Gür E.
        • Turhan P.
        • Can G.
        • Akkus S.
        • Sever L.
        • Güzelöz S.
        • et al.
        Enuresis: prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey.
        Pediatr Int. 2004; 46: 58-63https://doi.org/10.1111/j.1442-200X.2004.01824.x
        • Swithinbank L.V.
        • Heron J.
        • von Gontard A.
        • Abrams P.
        The natural history of daytime urinary incontinence in children: a large British cohort.
        Acta Paediatr. 2010; 99: 1031-1036https://doi.org/10.1111/j.1651-2227.2010.01739.x
        • Stone J.J.
        • Rozzelle C.J.
        • Greenfield S.P.
        Intractable voiding dysfunction in children with normal spinal imaging: predictors of failed conservative management.
        Urology. 2010; 75: 161-165https://doi.org/10.1016/j.urology.2009.06.100
        • Fitzgerald M.P.
        • Thom D.H.
        • Wassel-Fyr C.
        • Subak L.
        • Brubaker L.
        • Van Den Eeden S.K.
        • et al.
        Childhood urinary symptoms predict adult overactive bladder symptoms.
        J Urol. 2006; 175: 989-993https://doi.org/10.1016/s0022-5347(05)00416-7
        • Nieuwhof-Leppink A.J.
        • Schroeder R.P.J.
        • van de Putte E.M.
        • de Jong T.
        • Schappin R.
        Daytime urinary incontinence in children and adolescents.
        Lancet Child Adolesc Health. 2019; 3: 492-501https://doi.org/10.1016/s2352-4642(19)30113-0
        • van Gool J.D.
        • de Jong T.P.
        • Winkler-Seinstra P.
        • Tamminen-Möbius T.
        • Lax H.
        • Hirche H.
        • et al.
        Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence.
        Neurourol Urodyn. 2014; 33: 482-487https://doi.org/10.1002/nau.22446
        • Allen H.A.
        • Austin J.C.
        • Boyt M.A.
        • Hawtrey C.E.
        • Cooper C.S.
        Initial trial of timed voiding is warranted for all children with daytime incontinence.
        Urology. 2007; 69: 962-965https://doi.org/10.1016/j.urology.2007.01.049
        • Schäfer S.K.
        • Niemczyk J.
        • von Gontard A.
        • Pospeschill M.
        • Becker N.
        • Equit M.
        Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis.
        Eur Child Adolesc Psychiatr. 2018; 27: 949-964https://doi.org/10.1007/s00787-017-1051-6
        • Hagstroem S.
        • Rittig S.
        • Kamperis K.
        • Djurhuus J.C.
        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
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • Elliott V.
        • Fernandez M.
        • O'Neal L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inf. 2019; 95: 103208https://doi.org/10.1016/j.jbi.2019.103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inf. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
        • Hagstroem S.
        • Rittig N.
        • Kamperis K.
        • Mikkelsen M.M.
        • Rittig S.
        • Djurhuus J.C.
        Treatment outcome of day-time urinary incontinence in children.
        Scand J Urol Nephrol. 2008; 42: 528-533https://doi.org/10.1080/00365590802098367
        • Van Arendonk K.J.
        • Austin J.C.
        • Boyt M.A.
        • Cooper C.S.
        Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder.
        Urology. 2006; 67 (discussion 53-4): 1049-1053https://doi.org/10.1016/j.urology.2005.11.060
        • Borch L.
        • Hagstroem S.
        • Bower W.F.
        • Siggaard Rittig C.
        • Rittig S.
        Bladder and bowel dysfunction and the resolution of urinary incontinence with successful management of bowel symptoms in children.
        Acta Paediatr Int J Paediatr. 2013; 102: e215-e220https://doi.org/10.1111/apa.12158
        • Sureshkumar P.
        • Jones M.
        • Cumming R.
        • Craig J.
        A population based study of 2,856 school-age children with urinary incontinence.
        J Urol. 2009; 181 (discussion 15-6): 808-815https://doi.org/10.1016/j.juro.2008.10.044
        • Yüksel S.
        • Yurdakul A.
        • Zencir M.
        • Çördük N.
        Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study.
        J Pediatr Urol. 2014; 10: 1181-1186https://doi.org/10.1016/j.jpurol.2014.05.008
        • Rittig N.
        • Hagstroem S.
        • Mahler B.
        • Kamperis K.
        • Siggaard C.
        • Mikkelsen M.M.
        • et al.
        Outcome of a standardized approach to childhood urinary symptoms - long-term follow-up of 720 patients.
        Neurourol Urodyn. 2014; 33: 475-481https://doi.org/10.1002/nau.22447
        • Amicarelli A.R.
        • Kotelnikova Y.
        • Smith H.J.
        • Kryski K.R.
        • Hayden E.P.
        Parenting differentially influences the development of boys' and girls' inhibitory control.
        Br J Dev Psychol. 2018; 36: 371-383https://doi.org/10.1111/bjdp.12220
        • Chaplin T.M.
        • Aldao A.
        Gender differences in emotion expression in children: a meta-analytic review.
        Psychol Bull. 2013; 139: 735-765https://doi.org/10.1037/a0030737
        • Else-Quest N.M.
        • Hyde J.S.
        • Goldsmith H.H.
        • Van Hulle C.A.
        Gender differences in temperament: a meta-analysis.
        Psychol Bull. 2006; 132: 33-72https://doi.org/10.1037/0033-2909.132.1.33
        • Melling C.V.
        • Goyal A.
        Current pharmacological management of idiopathic overactive bladder in children in the UK: a national survey of practice.
        J Pediatr Urol. 2020; 16 (37.e1-.e8 https://doi.org/10.1016/j.jpurol.2019.10.013)