Li Xing, Wen Jian Guo, Xie Hui, Wu Xing Dong, Shen Tong, Yang Xiao Qing, Wang Xi Zheng, Chen Gui Xia, Yang Mei Feng, Du Yu Kai
Department of Maternal and Childi Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China.
Pediatric Urodynamic Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450002, China.
J Pediatr Urol. 2020 Jun;16(3):352.e1-352.e8. doi: 10.1016/j.jpurol.2020.02.016. Epub 2020 Mar 10.
Globally, attitudes and practices towards toilet training have changed several decades ago and children are completing toilet training at a later age compared to previous generations. Concurrently, there has been an increase in the incidence of pediatric bladder bowel dysfunction (BBD), including lower urinary tract dysfunction (LUTD). Whether the fact of delayed toilet training may negatively impact the ability of children to obtain bladder and bowel control and cause LUT dysfunction remains controversial.
To investigate the association between age at initiation of toilet training or approach to toilet training and the risks of lower urinary tract (LUT) dysfunction.
A comprehensive search of the CENTRAL, EMBASE and MEDLINE via Ovid SP, and CINAHL via EBSCO databases was conducted to identify RCTs, cohort or case-control studies investigating the association between age at initiation of toilet training, approach used for toilet training, and pediatric LUT dysfunction.
A total of 10 studies with 24,121 participants (aged 5-17) were included for pooled analysis. Overall, the odds ratio (OR) with 95% confidence interval (95%CI) of LUT dysfunction in children who initiated toilet training at a younger age when compared to those who initiated toilet training at an older age, was 0.71 (0.63-0.81), P < 0.001), irrespective of the approach used for toilet training (Table). Subgroup analysis for day-time incontinence (persistent daytime wetting) was 0.77 (0.62-0.95), P = 0.014; although the outcomes for enuresis fluctuated, favorable results were still observed in the earlier training group (OR:0.63, 95%CI:0.43-0.94, P = 0.023). Subgroup analysis for age at initiating toilet training vs LUT dysfunction also showed favorable results in children who were trained earlier, i.e., before 24 months (OR:0.77, 95% CI 0.63-0.94, P = 0.009). Sensitivity analysis confirmed that the results were robust.
Although the definition about the age of initial toilet training varied greatly in studies, findings from the current study suggested that the optimal time for initiating toilet training may be prior to the age of 24 months; if toilet training was initiated after 24 months or later, it may result in increased prevalence of LUT dysfunction. Since no RCTs studies were included in the current meta-analysis, well-designed longitudinal studies with larger sample size and from different cultural background are needed to confirm these results.
This meta-analysis presents preliminary findings that show the incidence of LUTD may be decreased by initiating toilet training in children at a younger age.
在全球范围内，几十年前人们对如厕训练的态度和做法已经发生了变化，与前几代人相比，儿童完成如厕训练的年龄更大。与此同时，小儿膀胱肠道功能障碍（BBD）的发病率有所上升，包括下尿路功能障碍（LUTD）。延迟如厕训练是否会对儿童获得膀胱和肠道控制能力产生负面影响并导致下尿路功能障碍仍存在争议。
研究开始如厕训练的年龄或如厕训练方法与下尿路（LUT）功能障碍风险之间的关联。
通过Ovid SP全面检索CENTRAL、EMBASE和MEDLINE，并通过EBSCO数据库检索CINAHL，以识别研究开始如厕训练的年龄、如厕训练方法与小儿LUT功能障碍之间关联的随机对照试验、队列研究或病例对照研究。
共纳入10项研究，24121名参与者（年龄5 - 17岁）进行汇总分析。总体而言，与开始如厕训练较晚的儿童相比，开始如厕训练较早的儿童发生LUT功能障碍的比值比（OR）及95%置信区间（95%CI）为0.71（0.63 - 0.81），P < 0.001），无论采用何种如厕训练方法（表）。白天尿失禁（持续白天尿床）的亚组分析为0.77（0.62 - 0.95），P = 0.014；尽管遗尿的结果有所波动，但在较早训练组仍观察到有利结果（OR：0.63，95%CI：0.43 - 0.94，P = 0.023）。开始如厕训练的年龄与LUT功能障碍的亚组分析也显示，在24个月之前接受训练的儿童有较好结果，即（OR：0.77，95%CI 0.63 - 0.94，P = 0.根据当前的荟萃分析，虽然研究中关于开始如厕训练年龄的定义差异很大，但研究结果表明，开始如厕训练的最佳时间可能在24个月之前；如果在24个月或更晚开始如厕训练，可能会导致LUT功能障碍的患病率增加。由于当前的荟萃分析未纳入随机对照试验研究，因此需要设计良好、样本量更大且来自不同文化背景的纵向研究来证实这些结果。
这项荟萃分析提出的初步研究结果表明，在儿童较小时开始如厕训练可能会降低LUTD的发病率。
