Comparative, prospective, and randomized study between urotherapy and the pharmacological treatment of children with urinary incontinence

Campos, Renata Martins; Gugliotta, Antônio; Ikari, Osamu; Perissinoto, Maria Carolina; Lúcio, Adélia Correia; Miyaoka, Ricardo; D’Ancona, Carlos Arturo Levi

doi:10.1590/s1679-45082013000200012

Cited by 8 publications

(12 citation statements)

References 13 publications

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“…However, the evidence level is low as most studies of urotherapy programs are retrospective and non-controlled. Some recent controlled studies show the efficiency of urotherapy over pharmacologic treatment and suggest its use as the initial treatment [40].…”

Section: Managementmentioning

confidence: 99%

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children

et al. 2020

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The objective is to review the literature related to lower urinary tract (LUT) conditions in children to conceptualize general practice guidelines for the general practitioner, pediatrician, pediatric urologist, and urologist. PubMed was searched for the last 15-year literature by the committee. All articles in peer-review journal-related LUT conditions (343) have been retrieved and 76 have been reviewed extensively. Prospective trials were few and the level of evidence was low. Most of the recommendations have been done by committee consensus after extensive discussion of literature reports. History taking is an integral part of evaluation assessing day-and nighttime urine and bowel control, urgency, and frequency symptoms. Exclusion of any neurogenic and organic cause is essential. Uroflowmetry and residual urine determination are recommended in all patients to evaluate bladder emptying. Urodynamic studies are reserved for refractory or complicated cases. Urotherapy that aims to educate the child and family about bladder and bowel function and guides them to achieve normal voiding and bowel habits should initially be employed in all cases except those who have urinary tract infections (UTI) and constipation. Specific medical treatment is added in the case of refractory overactive bladder symptoms and recurrent UTIs.Conclusion: Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases. What is Known:• Symptoms of the lower urinary tract may have significant social consequences and sometimes clinical morbidities like urinary tract infections and vesicoureteral reflux. In many children, however, there is no such obvious cause for the incontinence, and they are referred to as having functional bladder problems. What is New: • This review aims to construct a practical recommendation strategy for the general practitioner, pediatrician, pediatric urologist, and urologist for LUTS in children. Producing recommendations for managing LUTS in children based on high-quality studies is not possible. LUTS in children should be evaluated in a multimodal way by minimal invasive diagnostic procedures. Urotherapy is the mainstay of treatment and specific medical treatment is added in refractory cases.

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Section: Managementmentioning

confidence: 99%

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children

et al. 2020

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“…Antimuscarinic drugs are employed in the treatment of LUTS with encouraging results, (3) as reported by Campos et al, (6) in a study comparing PFMT with the use of oxybutynin in children with NMNE. The PFMT group showed better results in the reduction of incontinence episodes.…”

Section: Introductionmentioning

confidence: 78%

“…The child was instructed to color the figures alone, but the assistance of parents was allowed in case of doubts. (6)…”

Section: Methodsmentioning

confidence: 99%

Pelvic floor muscle training alone or in combination with oxybutynin in treatment of nonmonosymptomatic enuresis. A randomized controlled trial with 2-year follow up

Campos¹,

Lúcio²,

Lopes³

et al. 2019

Einstein (São Paulo)

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Objective To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis. Methods A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire. Results The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them. Conclusion All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups.

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“…However, in the present study, the location of bladder neck in the pelvic area was assessed only at rest, and the bladder neck was found to be located closer to symphysis pubis (forward and downward) in the incontinent group. In a study by Campos et al comparing the effectiveness of pelvic floor muscle training and pharmacological (antimuscarinic) treatment (both in combination with behavioral modifications) in children diagnosed with non‐monosymptomatic enuresis, pelvic floor exercises were more effective than antimuscarinic therapy in improving enuresis 12 . Considering the BNP difference revealed in our study in the context of that study's findings, this higher effectiveness can be explained by the ability of pelvic floor muscle strengthening to improve bladder neck support.…”

Section: Discussionmentioning

confidence: 99%

Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting

Oktay

Isik

2022

J of Ultrasound Medicine

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Objectives Urinary incontinence (UI) is a frequent cause of admission to pediatric nephrology outpatient clinics. The aim of this study was to determine whether anatomical changes in lower urinary tract structures (retrovesical angulation [RVA] and bladder neck position [BNP]) are associated with UI in pediatric patients with daytime‐wetting in comparison to healthy children. Methods In this prospective study, patients with daytime UI diagnosed using the Dysfunctional Voiding Symptom Score of the International Children's Continence Society and 3‐day‐voiding/bowel diary were compared with an age‐ and sex‐matched control group without incontinence. In addition to routine clinical evaluation, RVA and BNP were measured at rest using transabdominal ultrasound (TA‐US). Intra‐rater agreement was estimated. Results A total of 88 children were included in the study, with 44 children (22 boys, 22 girls) each in patient and control groups. RVA was significantly greater and BNP was significantly lower in the patient group versus control group (RVA: 134.30 ± 10.05 vs 127.94 ± 13.15, P = .013; BNP: 11.88 ± 4.53 vs 17.20 ± 5.55, P < .001, respectively). Irrespective of the presence of incontinence, girls had a significantly greater RVA than boys (P < .001). However, there was no difference between sexes in BNP values (P = .630). Intra‐rater agreement was very strong for RVA (P < .001, r = .897), and strong for BNP (P < .001, r = .774). Conclusions TA‐US imaging is a non‐invasive and practical procedure routinely performed in pediatric patients presenting with UI complaints. Our study demonstrated anatomical changes in lower urinary tract structures in pediatric patients with UI. These changes should be considered in the diagnosis, follow‐up, and treatment of patients with UI.

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Comparative, prospective, and randomized study between urotherapy and the pharmacological treatment of children with urinary incontinence

Cited by 8 publications

References 13 publications

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children

EAU-ESPU guidelines recommendations for daytime lower urinary tract conditions in children

Pelvic floor muscle training alone or in combination with oxybutynin in treatment of nonmonosymptomatic enuresis. A randomized controlled trial with 2-year follow up

Role of Transabdominal Ultrasonography in the Evaluation of Pediatric Patients With Daytime Wetting

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