Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: JF Knight, Apr 24, 2014
    • "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] "
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2011 · Indian Journal of Urology
    • "Although the use of standard urotherapy is generally accepted, documentation of the efficacy of this therapeutic intervention is vague, with few experimental data available. Hellstrom et al. reported a 1 year cure rate of 51% in a group of 70 children suffering from diverse day-time micturition disturbances [12], whereas van Gool et al. found an incontinence cure rate of 40% 9 months after the initiation of standard urotherapy [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To analyse retrospectively the efficacy of day-time incontinence treatment in a secondary referral centre and consider characteristics of responders to the different therapeutic interventions. All children treated for day-time urinary incontinence at the authors' clinics from 2000 to 2004 were included. Children with ongoing urinary tract infections were excluded. Before treatment, children filled out registrations of incontinence episodes and 48h frequency-volume charts. Faecal disorders were treated before urinary incontinence. All children were subjected to standard urotherapy and were secondarily recommended a timer-watch. If standard urotherapy had no effect, anticholinergics were added. The study included 240 children with day-time urinary incontinence. Of these, 45 had faecal problems and 17% obtained urinary continence when these were successfully treated. In total, 126 (55%) became dry on standard urotherapy. Of the 60 children who had a timer-watch in addition to standard urotherapy, 70% became dry. Of the 62 children who had anticholinergics in addition to standard urotherapy, 81% became continent. Fifteen (6%) did not achieve continence and another 11 patients were lost to follow-up. Children who became dry solely on standard urotherapy had a significantly lower voiding frequency (p<0.05), larger voided volumes as a percentage of those expected for age (p<0.01) and fewer incontinence episodes per week (p<0.05) than children needing anticholinergics. Most children achieve day-time continence solely on standard urotherapy. Children who need anticholinergics to achieve dryness seem to be those with more severe bladder reservoir function abnormalities and symptoms.
    No preview · Article · May 2008 · Scandinavian Journal of Urology and Nephrology
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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. ClinicalTrials.gov Identifier: NCT00603343.
    Full-text · Article · May 2008 · European Urology
Show more