Treatment of Daytime Urinary Incontinence in Children: A Systematic Review of Randomized Controlled Trials

Centre for Kidney Research, Children's Hospital at Westmead, University of Sydney, Westmead, NSW 2145, Australia.
The Journal of Urology (Impact Factor: 4.47). 08/2003; 170(1):196-200; discussion 200. DOI: 10.1097/01.ju.0000072341.34333.43
Source: PubMed


We sought to determine the benefits and harms of interventions for children with daytime urinary incontinence.
Trials of any interventions for children with primary daytime incontinence (the urge syndrome and/or dysfunctional voiding) were identified from the Cochrane Controlled Trials Register, MEDLINE, EMBASE, reference lists of articles, abstracts from conference proceedings and contact with known experts in the field. Once identified, trial quality was assessed, data were extracted and results were expressed in terms of relative risks (RR) with 95% confidence intervals (CI) for individual trials, and summary estimates were obtained using a random effects model. All steps were done by 2 independent reviewers.
Randomized trials of terodiline (2 studies), daytime alarms (1), imipramine (1) and biofeedback/oxybutynin (1) involving 383 children were reviewed. No intervention was demonstrated to be effective. In the latter trial, which was the only one to evaluate a currently used intervention, after 9 months of treatment there was no difference in the proportions of children with unimproved daytime wetting with oxybutynin (RR 0.74, CI 0.26 to 2.13) and biofeedback (0.92, 0.59 to 1.43) compared with placebo.
No intervention tested in a trial to date has been proved to be of benefit to children with daytime urinary incontinence.

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Available from: JF Knight, Apr 24, 2014
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    • "Patients who progress despite treatment or who present in renal insufficiency will require renal replacement therapy including dialysis and transplantation. Conclusions regarding treatment are hampered by the lack of quality data.[47] "
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    ABSTRACT: Dysfunctional voiding (DV) is a voiding disorder characterized by dyssynergic striated sphincteric activity in the absence of a proven neurological etiology. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. There is a striking lack of clarity regarding what this entity represents, the diagnostic methodology and treatment. The limitations of existing guideline documents are analyzed. Specifically, use of the term "habitual", the assumption that bladder changes are secondary to the outlet, the emphasis on "staccato" voiding and the implication of striated urethral sphincter are discussed. Literature shows that DV may also present with continuous slow flow or normal flow. Dyssynergia may be at the level of the striated urethral sphincter, the pelvic floor or both, better termed "striated urethral sphincter-pelvic floor complex" (SUS-PFC).A diagnostic algorithm is provided so that patients are evaluated on merit rather than on the basis of different philosophies of individual centers. High-risk markers such as hydronephrosis, vesicoureteral reflux, renal failure or marked voiding difficulty should prompt a formal urodynamics evaluation and imaging for neurological etiology. Patients with predominantly storage symptoms with incidental staccato voiding can be managed initially, on the basis of non-invasive evaluation. Conservative urotherapy including biofeedback is appropriate initial management for patients without high risk factors. Treatment and evaluation should be escalated based on response. Patients with severe DV will need treatment similar to neurogenic bladder including clean intermittent catheterization and measures to control storage pressures.
    Indian Journal of Urology 10/2011; 27(4):437-47. DOI:10.4103/0970-1591.91429
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    • "To the best of our knowledge, publications of confirmatory clinical trials in children suffering from nonneurogenic overactive bladder (OAB) and urinary incontinence demonstrating superiority of antimuscarinics over placebo are still missing. On the other hand, antimuscarinics—for example, propiverine hydrochloride (in the following referred to as propiverine)—are very well-established in these children as well as in children suffering from neurogenic detrusor overactivity [1] [2] [3] [4] [5] [6]. Reflecting this fact, the International Consultation on Incontinence (ICI) recommends antimuscarinic treatment for this indication in children so far with a lower level of evidence (level 3, grade B/C) [7]. "
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    ABSTRACT: Until now no confirmatory clinical trial in children suffering from nonneurogenic overactive bladder (OAB) and urinary incontinence could demonstrate superiority for antimuscarinics over placebo. The following study was conducted to prove efficacy and tolerability of propiverine compared to placebo. A randomized, double-blind, placebo-controlled phase 3 trial with parallel-group design in children aged 5-10 yr was performed. Prior to the 8-wk medical therapy urologic baseline diagnostics, a 3-wk lifestyle advice (urotherapy) was established. After re-evaluation of in- and exclusion criteria and uroflowmetry, only children fulfilling the requested criteria were allocated to a body-weight-adjusted therapy (10 or 15 mg propiverine twice daily or corresponding placebo). Efficacy parameters derived from bladder diary and a micturition volume protocol. Decrease in voiding frequency per day was chosen as primary efficacy parameter; secondary endpoints included voided volume and incontinence episodes. A safety assessment was conducted. Of 171 randomized children, 87 were treated with propiverine and 84 with placebo. The primary efficacy parameter showed a decrease in voiding frequency (-2.0 episodes for propiverine versus -1.2 for placebo; p=0.0007). Superiority could also be demonstrated for voided volume (31.4 vs. 5.1 ml; p<0.0001) and incontinence episodes (-0.5 vs. -0.2 episodes per d; p=0.0005). The trial design did not allow for separate evaluation of the effect of urotherapy prior to medical treatment. Propiverine was well-tolerated in children. Altogether 23% of side-effects were reported for propiverine and 20% for placebo. This clinical trial showed superior efficacy of propiverine over placebo and good tolerability for the treatment of children suffering from OAB and urinary incontinence. An important additional factor for the success of the trial was a modified trial design with previous urotherapy. Identifier: NCT00603343.
    European Urology 05/2008; 55(3):729-36. DOI:10.1016/j.eururo.2008.04.062 · 13.94 Impact Factor
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