Initial Trial of Timed Voiding Is Warranted for All Children with Daytime Incontinence

• Published in: Urology (Ridgewood, N.J.) N.J.), 2007-05, Vol.69 (5), p.962-965
• Main Authors: Allen, Heidi A, Austin, J. Christopher, Boyt, Margaret A, Hawtrey, Charles E, Cooper, Christopher S
• Format: Article
• Language: English
• Subjects: Biofeedback, Psychology; Biological and medical sciences; Child; Child, Preschool; Cholinergic Antagonists - therapeutic use; Diurnal Enuresis - diagnosis; Diurnal Enuresis - drug therapy; Diurnal Enuresis - rehabilitation; Female; Follow-Up Studies; Humans; Male; Medical sciences; Nephrology. Urinary tract diseases; Predictive Value of Tests; Probability; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Time Factors; Treatment Outcome; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urination - physiology; Urodynamics; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2007.01.049

Objectives To analyze the relationship between potential prognostic factors and early success after treatment of childhood daytime urinary incontinence without anticholinergic medication. Methods A total of 63 patients with daytime urinary incontinence met the inclusion criteria for a retrospective review of the effect of a timed voiding regimen. The severity, duration, and frequency of wetting, along with age, sex, and uroflow parameters, were recorded. Statistical analysis was used to determine the factors predictive of improvement in wetting without anticholinergic treatment. Results Of 315 children evaluated with daytime incontinence, only 24% were treated with nonanticholinergic methods. At the first follow-up visit, 6.3% of patients treated without anticholinergics became dry, 38.1% showed significant improvement, 36.5% were slightly improved, and 19.0% were unchanged. Age, sex, duration or severity of wetting, constipation, bladder capacity, and uroflow pattern and parameters were not predictive of early improvement with timed voiding. Patients with good compliance with timed voiding were significantly more likely to improve than those with poor compliance ( P = 0.014). Conclusions The results of our study have indicated that anticholinergic therapy appears to be overused as a first-line treatment for children with daytime urinary incontinence in our clinic population. The lack of reliable predictive factors regarding the response to nonanticholinergic treatment suggests a trial of timed voiding should be used as an initial treatment for all children with daytime urinary incontinence. Almost 45% of our patients had significant improvement in the frequency of wetting within 4 months without anticholinergics.