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Comparison and characteristics of children successfully treated for daytime urinary incontinence
Alexander Slot Jessen1, Soeren Hagstroem2, Luise Borch1
1Department of Pediatric and Adolescent Medicine, NIDO Denmark, Gødstrup Hospital, Gl. Landevej 61, 7400, Herning, Denmark.
Insights
Children with daytime urinary incontinence (DUI) needing medication often have more severe overactive bladder (OAB) symptoms. Early intervention with medication may benefit those with frequent daytime wetting and high voiding frequency.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Child Health
Background:
- Daytime urinary incontinence (DUI) is a common pediatric condition, often linked to overactive bladder (OAB).
- Treatment typically follows a stepwise approach, starting with standard urotherapy (SU) and progressing to pharmacological treatment if SU is insufficient.
Purpose of the Study:
- To compare the characteristics of children with DUI and OAB who achieved continence with SU alone versus those who required a combination of SU and pharmacological treatment.
Main Methods:
- Retrospective analysis of 180 children successfully treated for DUI between 2015 and 2020.
- Data included patient records, 48-hour flow-volume charts, and uroflowmetry analysis.
Main Results:
- 52% of children achieved continence with SU alone, while 35% required pharmacological treatment.
- Children needing pharmacological treatment had significantly higher baseline voiding frequencies and more daily incontinence episodes compared to those treated with SU only.
Conclusions:
- Children requiring combined SU and pharmacological treatment exhibit more severe OAB symptoms.
- Consideration of earlier introduction of anticholinergics for children with high voiding frequencies and multiple daily incontinence episodes may be beneficial, warranting further prospective studies.
Introduction:
Daytime urinary incontinence (DUI) is defined as an involuntary leakage of urine during daytime in children 5 years or older. It is a common disorder in the pediatric population most often caused by an overactive bladder (OAB). A stepwise approach is recommended in the treatment of DUI, with standard urotherapy (SU) being first line treatment followed by pharmacological treatment when SU is unsuccessful. To our knowledge few studies have compared patients achieving continence solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment in the pediatric population.
Objective:
The aim of the study was to characterize and compare children suffering from OAB and DUI who became continent solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment.
Methods:
All children successfully treated for DUI from 2015 to 2020 were retrospectively analyzed and compared using data from patient's records, 48-h flow-volume charts, and uroflowmetry analysis.
Results:
180 children were successfully treated for DUI. Of these 23 (13%) had bowel dysfunction, 94 (52%) were successfully treated with standard urotherapy (SU) and 64 (35%) needed pharmacological treatment. Children who achieved continence on a combination of SU and pharmacological treatment had a significantly higher baseline voiding frequency (7.6 and 6.5 respectively, p=0.007) and more baseline incontinence episodes during daytime when compared to children who became dry solely on urotherapy (2.2 and 1.1 respectively, p < 0.001). Both groups had a similar baseline age (p=0.96) and received a similar duration of standard urotherapy prior to the eventual pharmacological treatment (p = 0.73).
Discussion:
Most children achieved daytime continence solely on standard urotherapy. We found that children requiring additional pharmacological treatment to achieve continence suffer from a more severe overactive bladder. As such it could be speculated that children with high voiding frequencies and multiple daily incontinence episodes may benefit from adding anticholinergics to SU earlier during the course of treatment, than what is recommended by the International Children's Continence Society (ICCS) today. However prospective interventional studies are needed for safe conclusions.
Conclusion:
Our comparison showed that children requiring a combination of SU and pharmacological treatment to achieve continence, had a significantly higher baseline voiding frequency and more baseline incontinence episodes when compared to children requiring only SU to achieve continence.
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