Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic...

Area of Science:

• Pediatric Urology
• Behavioral Medicine
• Clinical Trials

Background:

• Functional urinary incontinence affects 8.4% of school-aged children, predominantly girls, causing significant morbidity.
• Overactive bladder (OAB) and dysfunctional voiding (DV) are common diagnoses associated with childhood incontinence.

Purpose of the Study:

• To compare the efficacy of oxybutynin, placebo, and bladder training for OAB.
• To evaluate cognitive treatment versus pelvic floor training for DV in children.
• To investigate the role of urodynamic studies in diagnosing and managing childhood incontinence.

Main Methods:

• A multi-center controlled trial randomized children with OAB or DV to different treatment arms.
• Interventions included oxybutynin, bladder training, cognitive treatment, and pelvic floor training, with all children receiving standardized cognitive treatment.
• Urodynamic studies were conducted pre- and post-treatment to assess bladder and pelvic floor activity.

Main Results:

• For OAB, cure rates were similar across placebo (39%), oxybutynin (43%), and bladder training (44%).
• For DV, cure rates were 52% for controls and 49% for pelvic floor training.
• Pre-treatment urodynamic patterns did not correlate with clinical diagnoses, and new patterns emerged post-treatment in at least 20% of cases.

Conclusions:

• Cognitive treatment emerged as the primary driver of success, highlighting a mismatch between clinical symptoms and urodynamic findings.
• The unpredictable nature of urodynamic changes and treatment response suggests underlying factors beyond simple bladder or pelvic floor dysfunction.
• Gender-specific prevalence and the impact of cognitive treatment point towards social stress, potentially mediated by corticotropin-releasing factor pathways, as a significant contributing factor to childhood incontinence.