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Effective management of daytime wetting
1Nottingham City Hospital.
Insights
A structured care program for voiding dysfunction in children significantly improved outcomes for wetting and urinary tract infections. This approach, using non-invasive bladder assessment and biofeedback, proved effective for challenging cases.
Area of Science:
- Pediatric Urology
- Behavioral Pediatrics
Background:
- Voiding dysfunction is a common cause of childhood wetting and urinary tract infections (UTIs).
- Current outpatient interventions are often brief and may not achieve a complete cure.
- Significant post-voiding residual urine is a notable finding in children with these issues.
Purpose of the Study:
- To establish a planned program of care for children with voiding dysfunction.
- To assess the efficacy of a program based on physiological and psychological evaluation.
- To improve treatment outcomes for difficult-to-treat cases of childhood enuresis and UTIs.
Main Methods:
- Studied 100 children with voiding dysfunction (daytime enuresis, nocturnal enuresis, recurrent UTIs).
- Utilized non-invasive bladder assessment and biofeedback methods.
- Implemented a structured program of care focusing on physiological and psychological aspects.
Main Results:
- 79% of children achieved dryness or occasional accidents after six months of treatment.
- 48% of the studied children had a significant post-voiding residual volume.
- The program demonstrated success in managing complex cases of childhood wetting.
Conclusions:
- A planned program of care, incorporating non-invasive assessment and biofeedback, is effective for treating childhood voiding dysfunction.
- This approach can lead to significant improvements in continence and reduction in UTIs.
- Success can be achieved even in challenging cases previously considered difficult to manage.
Abstract:
Voiding dysfunction is important in the genesis of wetting and urinary tract infections but cure is not often achieved with the brief interventions possible from a busy outpatient clinic. Our aim was to establish a planned programme of care based on a physiological and psychological assessment. We studied 100 children: 70 per cent had daytime enuresis; 11 per cent nocturnal enuresis alone and 19 per cent had recurrent urinary tract infections. Following assessment we found that 48 per cent had a significant post micturition residue. After six months of treatment 79 per cent were either completely dry or had only an occasional accident. Treatment for this condition is usually considered to be very time consuming, but by using a non-invasive bladder assessment and biofeedback methods which reinforce the child's and family's understanding of bladder function, success can be achieved for some of the more difficult wetters.