Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials
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Premala Sureshkumar1, Wendy Bower, Jonathan C Craig
1Centre for Kidney Research, Children's Hospital at Westmead, University of Sydney, Westmead, NSW 2145, Australia.
Insights
This study found no proven benefits for interventions treating childhood daytime urinary incontinence. Current treatments like oxybutynin and biofeedback showed no significant improvement over placebo in trials.
Area of Science:
- Pediatric Urology
- Clinical Trials
- Evidence-Based Medicine
Background:
- Daytime urinary incontinence is a common condition in children.
- Various interventions exist, but their efficacy requires rigorous evaluation.
Purpose of the Study:
- To systematically review the benefits and harms of interventions for children with primary daytime urinary incontinence.
- To assess the effectiveness of treatments for urge syndrome and dysfunctional voiding.
Main Methods:
- Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE) and other sources.
- Quality assessment of identified randomized trials and data extraction by two independent reviewers.
- Meta-analysis using random effects models to derive summary estimates of treatment effects.
Main Results:
- Reviewed randomized trials included terodiline, daytime alarms, imipramine, and biofeedback/oxybutynin, involving 383 children.
- No intervention demonstrated statistically significant effectiveness in treating daytime urinary incontinence.
- A trial comparing oxybutynin and biofeedback to placebo showed no difference in treatment outcomes after nine months.
Conclusions:
- Current evidence does not support the effectiveness of any intervention for childhood daytime urinary incontinence.
- Further high-quality research is needed to identify beneficial treatments for this condition.
Purpose:
We sought to determine the benefits and harms of interventions for children with daytime urinary incontinence.
Materials And Methods:
Trials of any interventions for children with primary daytime incontinence (the urge syndrome and/or dysfunctional voiding) were identified from the Cochrane Controlled Trials Register, MEDLINE, EMBASE, reference lists of articles, abstracts from conference proceedings and contact with known experts in the field. Once identified, trial quality was assessed, data were extracted and results were expressed in terms of relative risks (RR) with 95% confidence intervals (CI) for individual trials, and summary estimates were obtained using a random effects model. All steps were done by 2 independent reviewers.
Results:
Randomized trials of terodiline (2 studies), daytime alarms (1), imipramine (1) and biofeedback/oxybutynin (1) involving 383 children were reviewed. No intervention was demonstrated to be effective. In the latter trial, which was the only one to evaluate a currently used intervention, after 9 months of treatment there was no difference in the proportions of children with unimproved daytime wetting with oxybutynin (RR 0.74, CI 0.26 to 2.13) and biofeedback (0.92, 0.59 to 1.43) compared with placebo.
Conclusions:
No intervention tested in a trial to date has been proved to be of benefit to children with daytime urinary incontinence.
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