Department of Pediatric and Adolescent Medicine, NIDO Denmark, Gødstrup Hospital, Gl. Landevej 61, 7400, Herning, Denmark.
Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark.
J Pediatr Urol. 2022 Feb;18(1):24.e1-24.e9. doi: 10.1016/j.jpurol.2021.11.013. Epub 2021 Nov 29.
Daytime urinary incontinence (DUI) is defined as an involuntary leakage of urine during daytime in children 5 years or older. It is a common disorder in the pediatric population most often caused by an overactive bladder (OAB). A stepwise approach is recommended in the treatment of DUI, with standard urotherapy (SU) being first line treatment followed by pharmacological treatment when SU is unsuccessful. To our knowledge few studies have compared patients achieving continence solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment in the pediatric population.
The aim of the study was to characterize and compare children suffering from OAB and DUI who became continent solely on urotherapy with patients achieving continence on a combination of urotherapy and pharmacological treatment.
All children successfully treated for DUI from 2015 to 2020 were retrospectively analyzed and compared using data from patient's records, 48-h flow-volume charts, and uroflowmetry analysis.
180 children were successfully treated for DUI. Of these 23 (13%) had bowel dysfunction, 94 (52%) were successfully treated with standard urotherapy (SU) and 64 (35%) needed pharmacological treatment. Children who achieved continence on a combination of SU and pharmacological treatment had a significantly higher baseline voiding frequency (7.6 and 6.5 respectively, p=0.007) and more baseline incontinence episodes during daytime when compared to children who became dry solely on urotherapy (2.2 and 1.1 respectively, p < 0.001). Both groups had a similar baseline age (p=0.96) and received a similar duration of standard urotherapy prior to the eventual pharmacological treatment (p = 0.73).
Most children achieved daytime continence solely on standard urotherapy. We found that children requiring additional pharmacological treatment to achieve continence suffer from a more severe overactive bladder. As such it could be speculated that children with high voiding frequencies and multiple daily incontinence episodes may benefit from adding anticholinergics to SU earlier during the course of treatment, than what is recommended by the International Children's Continence Society (ICCS) today. However prospective interventional studies are needed for safe conclusions.
Our comparison showed that children requiring a combination of SU and pharmacological treatment to achieve continence, had a significantly higher baseline voiding frequency and more baseline incontinence episodes when compared to children requiring only SU to achieve continence.
日间尿失禁（DUI）定义为 5 岁及以上儿童日间无意识漏尿。它是儿科人群中一种常见的疾病，通常是由膀胱过度活动（OAB）引起的。对于 DUI 的治疗，推荐采用逐步治疗方法，标准尿路治疗（SU）是一线治疗，当 SU 治疗不成功时，再采用药物治疗。据我们所知，很少有研究比较过仅接受尿路治疗而达到控尿的患者与同时接受尿路治疗和药物治疗而达到控尿的患者在儿科人群中的差异。
本研究的目的是描述和比较仅接受尿路治疗而达到控尿的 OAB 和 DUI 患儿与同时接受尿路治疗和药物治疗而达到控尿的患儿。
回顾性分析了 2015 年至 2020 年期间成功治疗 DUI 的所有患儿的资料，分析数据来自患儿病历、48 小时流量-容积图和尿流率分析。
180 例患儿成功治疗 DUI。其中 23 例（13%）存在肠道功能障碍，94 例（52%）接受标准尿路治疗（SU）成功，64 例（35%）需要药物治疗。同时接受 SU 和药物治疗达到控尿的患儿基础排尿频率明显高于仅接受 SU 治疗达到控尿的患儿（分别为 7.6 和 6.5，p=0.007），日间基础失禁发作次数也明显高于仅接受 SU 治疗达到控尿的患儿（分别为 2.2 和 1.1，p<0.001）。两组患儿的基础年龄无明显差异（p=0.96），且在接受最终药物治疗前接受的标准尿路治疗持续时间也无明显差异（p=0.73）。
大多数患儿仅接受标准尿路治疗就能达到日间控尿。我们发现，需要额外药物治疗才能达到控尿的患儿存在更严重的膀胱过度活动。因此，可以推测，那些排尿频率高、日间失禁发作次数多的患儿可能会受益于更早地在治疗过程中加入抗胆碱能药物，而这早于国际儿童尿控协会（ICCS）目前的建议。然而，需要前瞻性干预研究来得出安全的结论。
我们的比较显示，需要同时接受 SU 和药物治疗才能达到控尿的患儿的基础排尿频率和基础失禁发作次数明显高于仅需接受 SU 治疗即可达到控尿的患儿。
