Primer: diagnosis and management of uncomplicated daytime wetting in children

Long-term prospective evaluation of an inpatient voiding reeducation program for lower urinary tract conditions in children

PURPOSE

Our aim was to evaluate the efficacy of our treatment program for children with lower urinary tract conditions, developed at the Department of Pediatric Nephrology of the University Children's Hospital in Ljubljana.

METHODS

Sixty-four patients with lower urinary tract conditions were randomly allocated to two groups. Group A received treatment immediately, whereas patients of group B received no treatment for a period of 3 months-the amount of time it takes to complete our program. No child in group B experienced spontaneous regression of their symptoms in the 3-month delay period, while the patients of group A were already being treated and were achieving results. Thus, all the patients of group B then entered the program in exactly the same way as patients of group A.

RESULTS

The final success rate in both groups did not differ significantly (p = 0.706-1.000) and ranged from 86.2 % for group A and 86.7 to 90 % for group B. Long-term follow-up showed statistically identical success rates (p = 1.000).

CONCLUSION

This prospective controlled study with long-term follow-up (48 months) shows that our treatment program, applied as an inpatient voiding school program, is an effective method, with durable results.

Management of daytime urinary incontinence and lower urinary tract symptoms in children

Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagnoses include overactive bladder syndrome, dysfunctional voiding and vaginal reflux as well as less common conditions like giggle incontinence, voiding postponement, pollakiuria and diabetes insipidus. In this paper, we discuss an evidence-based approach to the management of conditions causing daytime urinary incontinence and lower urinary tract symptoms in children from a general paediatrician's perspective.

School Nurse Interventions in Managing Functional Urinary Incontinence in School-Age Children

Uncomplicated urinary incontinence (UI) in school-age children is a prevalent yet underrecognized problem that has remained in the shadow of other concerns commonly perceived as more prominent or urgent. There is good evidence that functional UI in children can be treated and managed effectively. When there is no structural or neurologic abnormality and the underlying cause of the UI is related to either the storage or voiding phase of the bladder cycle then it is considered functional. School nurses are in an ideal position to identify, manage, and help children with functional UI cope effectively while maintaining healthy psychosocial well-being and educational success.

Vaginal voiding: a common cause of daytime urinary leakage in girls

STUDY OBJECTIVE

To estimate the frequency of vaginal voiding as the cause of daytime urinary leakage in girls, and to study the effect of instructions intended to alleviate the problem.

SETTING

Girls with vaginal voiding were identified in a group of girls referred because of daytime urinary leakage. They were evaluated by a noninvasive screening protocol. Girls with vaginal voiding were instructed on how to achieve better toilet habits.

PARTICIPANTS

Twelve girls with vaginal voiding.

RESULTS

Vaginal voiding was found in 12 of 39 girls with daytime urinary leakage. Their age ranged between 8.5 and 13.9 years. They all had history of small leakage immediately after voiding. A body mass index greater than the corresponding 85th percentile was noted in 5 girls, and labial fusion was noted in 2 girls. The complaint disappeared in 10 girls and improved in the remaining 2 girls after instructions on how to achieve better toilet habits.

CONCLUSIONS

Vaginal voiding is common in girls. It occurs in girls at risk of overweight, in girls with labial fusion, and in girls adopting a hairpin posture while sitting on the toilet. The diagnosis is obtained by an adequate history. Proper voiding instructions resolve the problem.