Conservative interventions for treating functional daytime urinary incontinence in children

Area of Science:

• Pediatric Urology
• Evidence-Based Medicine
• Clinical Trials

Background:

• Functional daytime urinary incontinence in children lacks a clear neurological or anatomical cause.
• This condition presents practical challenges and can negatively impact a child's well-being and social engagement.

Purpose of the Study:

• To evaluate the effectiveness of conservative interventions for functional daytime urinary incontinence in children.
• To synthesize evidence from randomized controlled trials (RCTs) and other study designs.

Main Methods:

• Systematic search of multiple databases including Cochrane Incontinence Specialised Register, MEDLINE, and Chinese databases.
• Inclusion of RCTs, quasi-randomised, multi-arm, cross-over, and cluster-randomised studies involving children aged 5-18 years.
• Independent screening, data extraction, and risk of bias assessment; meta-analysis where feasible using random-effects models.

Main Results:

• The review included 27 RCTs with 1803 children; many studies were small and at high risk of bias.
• Transcutaneous electrical nerve stimulation (TENS) may increase continence compared to sham TENS (low-certainty evidence).
• Evidence for other conservative interventions like pelvic floor muscle training (PFMT) and urotherapy, alone or combined, versus controls or other interventions, is generally of very low to low certainty, with uncertain effects.

Conclusions:

• There is a lack of reliable evidence to support evidence-based treatment decisions for functional daytime urinary incontinence in children.
• Clinical experience and caregiver support are currently valuable resources.
• Further well-designed research with standardized interventions and outcome measures is essential.