Comparison and characteristics of children successfully treated for daytime urinary incontinence

Characteristics of Children Successfully Treated for Daytime Urinary Incontinence

OBJECTIVE

A stepwise approach is recommended for the treatment of daytime urinary incontinence, with standard urotherapy as the first-line treatment, followed by pharmacological treatment when standard urotherapy is unsuccessful. This study was aimed at characterizing and comparing children with an overactive bladder and daytime urinary incontinence who became continent solely on standard urotherapy and those who achieved continence on a combination of standard urotherapy and pharmacological treatment.

METHODS

This retrospective study included 221 patients with complete continence during the day.

RESULTS

Of these patients, 104 (47%) were successfully treated with standard urotherapy, and 117 (53%) required pharmacological treatment. Children who achieved continence on a combination of standard urotherapy and pharmacological treatment had significantly more baseline incontinence episodes during the daytime (p = 0.001) and lower voided volumes (voided volume/estimated bladder capacity: 37 and 42 mL respectively, p = 0.0085) compared with children who were treated with standard urotherapy only. Half the patients underwent an initial screening, including the use of a bladder diary, without the need for time-consuming and complex urotherapy.

CONCLUSIONS

Most children achieved daytime continence solely through standard urotherapy. Additionally, half of the patients achieved continence at the initial screening, including the use of the bladder diary. Children requiring additional pharmacological treatment to achieve continence have more severely overactive bladders.

SunCloud: A mobile application for children with urinary incontinence

BACKGROUND AND AIM

Urinary incontinence is an important problem with potentially adverse effects on the psychological, social and personality development of children. Today, with the developing technology, the use of information and communication technologies such as wearable technology, message services and mobile applications has become widespread in solving health problems. In this study, it was aimed to develop a mobile application that facilitates the follow-up of children, increases their compliance with treatment and ensures the continuity of communication between them and the health worker. The methodology, design and preliminary evaluation results of the mobile application are presented in this article.

METHODS

During the development process of the mobile application, the content was first created in line with the literature review. After the content was determined, the interface design was made on MS Word and Photoshop software. At this stage, six experts were consulted for content and design. The mobile application, finalised in design, was implemented on Android and IOS platforms. After the mobile application was created, 10 children and their families were interviewed.

RESULTS

Nine of the families (90%) found the developed mobile application useful and easy to use. Families' suggestions to improve the mobile application were to make it more interesting for children and to enrich its content.

CONCLUSION

In line with the feedback, the mobile application was updated and finalised. Preliminary results are promising that the developed mobile application can be used as an aid to treatment in children with urinary incontinence. With the mobile application developed, urotherapy training was not limited to the time they visited the hospital. This suggests that the mobile application can eliminate the problem of partial or omitted treatment. This research has shown that leveraging technology can be a good option to increase treatment success.

CLINICAL TRIAL NUMBER

NCT05815940.

Effect of standard urotherapy to children with overactive bladder on quality of life

PURPOSE

Overactive bladder (OAB) is a common syndrome in children, which may affect the patient's quality of life (QoL). This study aimed to evaluate the effect of standard urotherapy (SU) given on the quality of life for children diagnosed with OAB.

METHODS

The study was conducted on 107 children aged 2 to 13 years who applied to the urology clinic of a hospital in China and were diagnosed with OAB. The QoL was assessed using the Pediatric Incontinence Questionnaire (PINQ). The QoL was evaluated before and 1 month later SU given.

RESULTS

Of the 107 children, at baseline, the children with OAB revealed a total mean PINQ score of 27.40 ± 13.19, and the total mean PINQ score was 13.72 ± 9.63 at 1 month later. PINQ score showed a statistically significant difference between before and after 1 month treatment (P < 0.001).

CONCLUSIONS

The QoL of children with OAB increased may due to SU provided outpatient clinics. And it is important for children and their parents to investigate and monitor to what extent the QoL of children diagnosed with OAB is affected.

Personal hygiene, environmental conditions, and toilet use of children in primary schools: A cohort study

BACKGROUND

Many primary school children withhold urine and stool whilst at school for various reasons. Limited toilet access and the failure to provide safe, sanitary toilets are putting children at risk for toilet avoidance behavior.

OBJECTIVE

We aimed to examine personal hygiene, environmental conditions, the perception of these on children, and their toilet use in primary schools.

STUDY DESIGN

Children aged 6-12 and their parents were asked to complete a self-report questionnaire regarding toilet behavior and the perception of school toilet standards.

RESULTS

The main findings are listed below using the data from the questionnaire.

DISCUSSION

We found that 9% and 63% of the children avoided urination and defecating at school, respectively. Similar results were reported previously. The participants' perceptions regarding the environmental conditions of school toilets and conditions revealed that 34% of the children felt that the toilets were dirty or very dirty. Around one-third of them reported a lack of toilet paper sometimes or most of the time. These unsatisfying hygienic conditions of school toilets can be easily solved. Unfortunately, 46% of the children in our study experienced bullying in school toilets. These worrisome data are seldom reported in other studies. The urination habits of the girls, who mostly preferred to partially squat or stand may lead to dysfunctional voiding and incomplete bladder emptying. Our study was limited by the relatively small population, the subjectiveness of the self-reporting questionnaire, and the voiding and defecation habits of the investigated children during school hours. These hours do not necessarily reflect the children's habits after school hours and during the weekends. Despite these limitations, the discussed issues regarding personal hygiene and the environmental conditions in the sampled primary schools are extremely important.

CONCLUSION

Nearly half of the school children had negative perceptions of school toilets. This should raise awareness and concern for school staff to consider and investigate potential facilities improvement in light of the impact observed here. Implementation of appropriate education and a better environment of toilet facilities and security is important for the children's well-being.

Long-Term Follow-Up of Lower Urinary Tract Outcome in Children with Dysfunctional Voiding

Objective: To investigate the long-term clinical and urodynamic outcomes of a small cohort of children who received short-term urotherapy for confirmed dysfunctional voiding (DV) and lower urinary tract symptoms (LUTS). Materials and Methods: This study included 26 children with confirmed LUTS and DV via video urodynamic study (VUDS) and received standard urological therapy, pelvic floor muscle training, or surgical intervention in childhood. Their current lower urinary tract conditions were assessed by chart review and direct and telephone interviews. Charts of 14 patients who underwent follow-up VUDS were reviewed to investigate their bladder and voiding dysfunction or follow-up on previous treatment results. The satisfaction of lower urinary tract status was assessed using the global response assessment (GRA) scale. Results: At initial enrolment, the mean age was 9.54 ± 3.88 years, and urological treatment was performed during the first 1−5 years thereafter. Most patients were not regularly followed in the urology clinic. Among the 14 children available for follow-up, a GRA score of 3 was reported by 10 (71.4%) after a mean follow-up period of 10.3 ± 6.74 (range, 2−20) years, indicating satisfactory bladder and voiding conditions. Four children with less favorable outcomes (GRA score of <3) had significantly more post-void residual urine volume at baseline, and 75% of these patients had central nervous system diseases. Daytime incontinence and enuresis rates were significantly decreased at follow-up compared with the baseline. Significantly increased bladder capacity and sensation and significantly decreased voiding detrusor pressure were found on follow-up VUDS. Conclusions: Children with DV who received standard urotherapy upon diagnosis exhibited improved LUTS at a 10-year follow-up. Of the 14 children available for follow-up, 10 (71.4%) reported satisfactory bladder and voiding status without further medication or urotherapy, with significantly decreased voiding detrusor pressure.