Search

Objective Functional urinary incontinence causes considerable morbidity in 8.4% of school-age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi-center controlled trial was designed, the European Bladder Dysfunction Study. Methods Seventy girls and 27 boys with clinically diagnosed OAB and urge incontinence were randomly allocated to placebo, oxybutynin, or bladder training (branch I), and 89 girls and 16 boys with clinically diagnosed DV to either cognitive treatment or pelvic floor training (branch II). All children received standardized cognitive treatment, to which these interventions were added. The main outcome variable was daytime incontinence with/without urinary tract infections. Urodynamic studies were performed before and after treatment. Results In branch I, the 15% full response evolved to cure rates of 39% for placebo, 43% for oxybutynin, and 44% for bladder training. In branch II, the 25% full response evolved to cure rates of 52% for controls and 49% for pelvic floor training. Before treatment, detrusor overactivity (OAB) or pelvic floor overactivity (DV) did not correlate with the clinical diagnosis. After treatment these urodynamic patterns occurred de novo in at least 20%. Conclusion The mismatch between urodynamic patterns and clinical symptoms explains why cognitive treatment was the key to success, not the added interventions. Unpredictable changes in urodynamic patterns over time, the response to cognitive treatment, and the gender-specific prevalence suggest social stress might be a cause for the symptoms, mediated by corticotropin-releasing factor signaling pathways. Neurourol. Urodynam. 33:482-487, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (bedwetting, enuresis) is the commonest urinary symptom in children and adolescents and can lead to major distress for the affected children and their parents. Physiological and non-physiological types of urinary incontinence are sometimes hard to tell apart in this age group. Methods: This article is based on selected literature retrieved by a PubMed search and on an interdisciplinary expert consensus. Results and conclusion: Nocturnal enuresis has a variety of causes. The main causative factors in monosymptomatic enuresis nocturna (MEN) are an impaired ability to wake up when the bladder is full, due to impaired or absent perception of fullness during sleep, and an imbalance between bladder capacity and nocturnal urine production. On the other hand, non-monosymptomatic enuresis nocturna (non-MEN) is usually traceable to bladder dysfunction, which is also the main cause of diurnal incontinence. A basic battery of non-invasive diagnostic tests usually suffices to determine which type of incontinence is present. Further and more specific testing is indicated if an organic cause is suspected or if the treatment fails. The mainstay of treatment is urotherapy (all non-surgical and non-pharmacological therapeutic modalities). Some patients, however, will need supportive medication in addition. Urinary incontinence has different causes in children and adults and must therefore be diagnosed and treated differently as well. All physicians who treat the affected children (not just pediatri cians and family doctors, but also pediatric nephrologists, urologists, pediatric surgeons, and child psychiatrists) must be aware of the specific features of urinary incontinence in childhood. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to determine the psychometric properties of the German version of the Pediatric Enuresis Module to assess Quality of Life, Short Form (PEMQOL-SF) in a sample of parents of children with urinary incontinence. Methods The parents of 88 children (63 male, 25 female, mean age: 9.3 [SD ± 2.5, range 6-18] years) with urinary incontinence were asked to complete the PEMQOL-SF. For evaluation of convergence validity, parents and children completed the respective versions of the DCGM-10 and the PinQ questionnaire. Results Mean PEMQOL-SF scores were 72.2 [SD ± 14.1] (child impact scale) and 73.7 [SD ± 16.5] (family impact scale). The PEMQOL-SF had a Cronbach's alpha of 0.68 (child impact scale) and 0.80 (family impact scale), respectively. PEMQOL-SF child [family] impact scale scores correlated with the DCGM-10 with scores of r = 0.34 (r = 0.13; self-report version) and r = 0.63 (r = 0.48; proxy version) and with the PinQ with scores of r = −0.31 (r = −0.16; self-report version) and r = −0.63 (r = −0.54; proxy version), respectively. Conclusions The psychometric properties of the PEMQOL-SF were good for the family impact scale, but poor for the child impact scale. In its present form, the PEMQOL-SF cannot be recommended for routine clinical use. Nevertheless, a reduction of questionnaire items could lead to better psychometric properties. Neurourol. Urodynam. 29:1397-1402, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the long-term effectiveness of a urotherapy training program implemented at our institution. Day- and/or night-time wetting as a consequence of functional urinary incontinence is a common problem in childhood. A number of treatment methods are available, among them urotherapy. Material and methods. Forty-eight patients (age range 10-14 years) with urge incontinence or dysfunctional voiding were evaluated with a questionnaire 2 years after completion of a urotherapy training program. Results. Two years after completion of training, 86.7% of the inpatient and 93.8% of the outpatient groups with day-time wetting and 79.2% of the inpatient and 41.6% of the outpatient groups with night-time wetting were cured or had improved. Conclusions. Compared with the published data on the natural course of incontinence, the urotherapy program evaluated in this study resulted in higher success rates. Compared with 6-month follow-up, improvement rates proved to be stable, and cure rates (with the exception of patients with night-time wetting in the outpatient training group) even increased significantly during the 2-year follow-up. [ABSTRACT FROM AUTHOR]