Use of timed alarm device for pediatric daytime urinary incontinence Meta-analysis of comparative studies
Michael E Chua1,2,3, Mandy Rickard2, Jin Kyu Kim4
1Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Insights
Timed alarm devices do not improve complete response for pediatric daytime urinary incontinence (pDUI). However, these devices likely enhance treatment adherence compared to standard urotherapy alone.
Area of Science:
- Pediatric Urology
- Behavioral Therapy
- Clinical Effectiveness Research
Background:
- Pediatric daytime urinary incontinence (pDUI) is a common condition requiring effective management strategies.
- Urotherapy is a cornerstone treatment, with timed alarm devices explored as an adjunct.
- Comparative effectiveness of alarm-assisted versus standard urotherapy for pDUI remains unclear.
Purpose of the Study:
- To compare the effectiveness of timed alarm device-assisted urotherapy versus standard urotherapy alone for pediatric daytime urinary incontinence (pDUI).
- To evaluate complete response and treatment adherence rates in children with pDUI undergoing different urotherapy protocols.
Main Methods:
- Systematic literature search conducted through December 2021, with an update in July 2022.
- Included four studies (3 RCTs, 1 retrospective cohort) involving 635 children.
- Analyzed complete response and adherence rates using relative risk (RR) and random-effects modeling; assessed heterogeneity and evidence certainty (GRADE).
Main Results:
- No significant difference in complete response for pDUI between timed alarm device-assisted urotherapy and standard urotherapy (RR 1.20, 95% CI 0.81-1.76).
- Significantly higher treatment adherence observed with timed alarm devices (RR 2.97, 95% CI 1.46-6.06).
- High interstudy heterogeneity noted; evidence quality assessed as very low certainty.
Conclusions:
- Timed alarm device-assisted urotherapy does not appear to offer superior complete treatment response for pDUI compared to standard urotherapy alone.
- Timed alarm devices are likely beneficial in improving patient adherence to urotherapy regimens.
- Further high-quality research is needed due to the very low certainty of the current evidence.
Introduction:
This meta-analysis aimed to determine the comparative effectiveness of timed alarm device-assisted urotherapy vs. standard urotherapy alone in managing pediatric daytime urinary incontinence (pDUI).
Methods:
A systematic literature search was performed in December 2021, with an update search in July 2022. Comparative studies assessing the pDUI treatment effectiveness of timed alarm device-assisted urotherapy vs. urotherapy alone were identified and evaluated according to Cochrane collaboration recommendations. The assessed outcome includes pDUI complete response and adherence rates. Relative risk (RR ) with 95% confidence intervals (CI) was extrapolated. A random-effects model was used to pool effect estimates. Heterogeneity was assessed with sensitivity and subgroup analysis performed according to study design and comparative group characteristics. GRADE criteria were used to assess evidence certainty. (PROSPEROCRD 42022299173).
Results:
Four studies (three randomized controlled trials [RCTs] and one retrospective cohort) with 635 cases were included. The pooled effect estimates of pDUI complete response showed no differences between intervention groups (RR 1.20, 95% CI 0.81, 1.76). Pooled effect estimates for treatment adherence were generated from two studies, which showed significantly better adherence for the timed-alarm device group (RR 2.97, 95% CI 1.46, 6.06). Significant interstudy heterogeneity was noted; the source is likely from the study design and comparator device characteristics. The quality of evidence was assessed to be of very low certainty.
Conclusions:
Based on very low certainty evidence, timed alarm device-assisted urotherapy does not seem to have the advantage of complete treatment response over standard urotherapy alone in managing pDUI; however, a timed-alarm device is likely able to improve urotherapy treatment adherence.
