Urotherapy In Children: Quantitative Measurements Of Daytime Urinary Incontinence Pre- And Post Treatment
PURPOSE To quantitatively assess the effectiveness of urotherapy for children with daytime urinary incontinence, according to the definitions of the International Children's Continence Society. MATERIAL AND METHODS We performed a retrospective review of 122 children (age: mean 9, range 5-14 yrs) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria were neurologic abnormalities. Therapy is based on cure of daytime incontinence, regulate fluid intake and voiding frequency, and increase maximum voided volume once a normal voiding pattern was obtained. In 98/122 children (80%) daytime urinary incontinence was present as a predominant symptom and in 42/98 cases (43%) combined with a history of recurrent UTI's. Therapy was given by an experienced nurse practitioner and consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regular defecation were made. All patients received a personal and monitoring booklet. Before and at the end of the training patients were evaluated for number and severity of daytime wet accidents per week. We used a scoring system to grade the severity of incontinence. RESULTS Using the ICCS definitions of treatment outcome, success rate was determined: of all children with daytime urinary incontinence 78% responded to the urotherapy: 38 children (42%) had a full response: they all became dry during daytime, 8 (9%) showed good response, 24 (27%) showed partial response, 20 (22%) had no response and in 8 cases objective data were missing after training. Additional benefit was evident in improvement of accompanying voiding symptoms, such as voiding frequency and flow pattern. CONCLUSIONS Urotherapy is successful for the treatment of daytime urinary incontinence in children, with a response of 78% of our cases with an intensive outpatient training protocol. Further study towards long-term efficacy will be performed.