Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review

Abstract

BackgroundUrinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques.MethodsMEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders.ResultsThree randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress.DiscussionThe results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.

Urine collection methods in precontinent children treated at the paediatric emergency department

“…It is, nevertheless, an invasive and painful technique that can be associated with complications in up to 20% of infants, including haematuria, urethral trauma and iatrogenic infection 3 . CCUC is a non‐invasive and relatively new stimulation technique, which permits the collection of urine from infants quickly, safely and effectively 8 . Contamination rates for CCUC in our study were low and were similar to those described in many studies for UC 2 …”

“…CCUC was the most widely used collection method in children under 3 months and was used significantly more often than in older infants. This could be justified by the use of a standardised urination stimulation technique implemented in our centre, the effectiveness of which has been demonstrated in previous studies 8,10–13 …”

“…2 Midstream urine sampling is the universally accepted method of urine collection in continent children, but it is rarely used in infants due to the time investment required and the frequent failure. [4][5][6] Recent studies have shown that various bladder stimulation techniques can facilitate direct micturition collection in this age group; 7,8 for instance, the 'Quick-wee' method by Kaufman et al 9 In 2013, our group described a standardised technique based on liquid intake and suprapubic and lumbar stimulation manoeuvres. The efficacy and validity of this technique has been confirmed in children under 3 months of age, [10][11][12][13][14][15] and in 2016, this technique was implemented in our centre (Hospital Universitario Infanta Sofía, HUIS) following coordinated training of nursing staff.…”

“…This could be justified by the use of a standardised urination stimulation technique implemented in our centre, the effectiveness of which has been demonstrated in previous studies. 8,[10][11][12][13] Urine culture is considered positive or negative based on the CFU/mL of a specific pathogenic organism. However, there is controversy in the literature regarding the cut-off value that defines a significant count of microorganisms for the different available collection methods.…”

Chlorhexidine skin cleaning to reduce clean‐catch urine contamination in infants: A pilot study

“…Clean-catch urine (CCU) is the recommended collection method for pre-continent children in many guidelines, 1 but has a contamination rate of 15-46%. [2][3][4] Contamination corrupts test results, delays appropriate treatment and often necessitates recollection with invasive methods.…”