Treatment outcomes of functional urinary incontinence in children after structured urotherapeutic training

Functional (Nonorganic) urinary incontinence (FUI) in children is a prevalent disorder and a common presenting symptom in clinical practice. Non-pharmaceutical urotherapeutic approaches are increasingly important treatment tools, but have not been studied for effectiveness. This study aims to evaluate the outcomes of children with FUI following Standardized Urinary Incontinence Training (SUIT) based on the guidelines of the German Consensus Group on Continence Training (KgKS) and to identify potential influencing factors that may hinder successful urotherapy.

A retrospective analysis on 297 children aged 5-16 who underwent SUIT between 2017 and 2022 was conducted. Patient data were gathered from institutional records and a follow-up questionnaire. Participants were categorized according to their diagnosis and symptoms, including non-monosymptomatic enuresis nocturna (Non-MEN), daytime urinary incontinence (DUI), and dysfunctional voiding (DV) without incontinence. The outcomes were evaluated at early and late follow-ups using the criteria of the International Children's Continence Society (ICCS), with statistical analyses performed to identify significant predictors of success.

214 patients were available for the evaluation of initial success rate. Partial response or better was noted in 88.3 % while 44.4 % achieved complete response. 83.0 % of the 94 patients available for long-term follow-up maintained complete success over two years. Female patients showed significantly higher initial success rates compared to males (p = 0.028). Multiple logistic regression identified voiding postponement incontinence (VPI) as a positive predictor for success, while age, psychosocial stress (PSS) and attention deficit hyperactivity disorder (ADHD) were associated with lower success rates (p = 0.0002). Patients with VPI were 2.5 times more likely to achieve treatment success than those without VPI symptoms, while ADHD patients were five times less likely to achieve treatment success compared to individuals without ADHD. Overall, in patients without PSS or ADHD, the initial success rate was 94.8 %, incorporating the partial and complete response categories, while 88.0 % of those patients exhibited complete success in the long-term category.

SUIT is an effective first-line treatment for FUI in children, with significant improvements observed in patients without comorbidities. The findings highlight the importance of tailored interventions and the potential benefits of multidisciplinary approaches that address behavioral factors in therapeutic protocols.