Summary
Introduction
Urinary incontinence is the most frequently observed lower urinary tract symptom in
children with cerebral palsy (CP). Being continent can positively influence quality
of life of the child and the social environment.
Objective
To investigate the effectiveness of incontinence training with urotherapy in children
with CP.
Study design
A population-based case-control study was conducted including 21 children with CP
and 24 typically developing children between 5 and 12 years old, both with daytime
incontinence or combined daytime incontinence and enuresis.
Children received treatment for one year with three-monthly examination by means of
uroflowmetry, a structured questionnaire and bladder diaries. Children started with
three months of standard urotherapy. After three, six and nine months of training,
specific urotherapy interventions (pelvic floor muscle training with biofeedback,
alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial
treatment. Therapy was individualized to probable underlying conditions.
Effectiveness was controlled for spontaneous improvement due to maturation and analysed
by means of longitudinal linear models, generalized estimating equations and multilevel
cumulative odds models. Comparison with typically developing children was assessed
by means of Kaplan–Meier survival analysis.
Results
Results suggest effectivity rate of incontinence training is lower and changes occur
more slowly in time in children with CP compared to typically developing children
(Figure).
Within the group of children with CP, significant changes during one year of training
were found for daytime incontinence (p < 0.001), frequency of daytime incontinence
(p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct
toilet posture (p = 0.034) and fecal incontinence (p = 0.026).
Discussion
Maximum voided volume and fluid intake at the start of training were significantly
lower in children with CP and could explain a delayed effectiveness of urotherapy.
Treatment of constipation demonstrated a positive effect on maximum voided volume
and should be initiated together with standard urotherapy when constipation is still
present after implementation of a correct fluid intake schedule. Future research with
a larger sample size is recommended.
Conclusions
Graphical AbstractPercentage of patients with 50 % improvement daytime incontinence. Legend: –Children
with cerebral palsy; ····Typically developing children; + Lost to follow-up.
Keywords
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Article info
Publication history
Published online: May 24, 2022
Accepted:
May 17,
2022
Received in revised form:
February 4,
2022
Received:
December 22,
2020
Footnotes
☆This research was supported by La Fondation Paralysie Cérébrale/La Fondation Motrice. The manuscript was corrected for spelling and grammar errors by Cambridge proofreading LCC.
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
