Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
J Pediatr Urol. 2022 Aug;18(4):447.e1-447.e9. doi: 10.1016/j.jpurol.2022.05.014. Epub 2022 May 25.
Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment.
To investigate the effectiveness of incontinence training with urotherapy in children with CP.
A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis.
Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p < 0.001), frequency of daytime incontinence (p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct toilet posture (p = 0.034) and fecal incontinence (p = 0.026).
Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended.
Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.
尿失禁是脑瘫（CP）儿童中最常见的下尿路症状。能够控制排尿可以积极影响儿童的生活质量和社会环境。
研究尿失禁训练结合尿路治疗对 CP 儿童的疗效。
本研究为基于人群的病例对照研究，纳入 21 例 CP 儿童和 24 例年龄在 5 至 12 岁之间的典型发育儿童，均有日间尿失禁或日间尿失禁合并遗尿。儿童接受为期一年的治疗，每三个月通过尿流率、结构化问卷和膀胱日记进行检查。儿童首先接受三个月的标准尿路治疗。在训练三个月、六个月和九个月后，可以在初始治疗中添加特定的尿路治疗干预（盆底肌训练结合生物反馈、警报治疗或神经调节）和/或药物治疗。治疗针对可能的潜在疾病进行个体化。由于成熟的自发改善而进行的有效性控制，并通过纵向线性模型、广义估计方程和多级累积优势模型进行分析。与典型发育儿童的比较通过 Kaplan-Meier 生存分析进行评估。
结果表明，与典型发育儿童相比，CP 儿童的尿失禁训练效果率较低，且随时间的变化更慢（图）。在 CP 儿童组中，在一年的训练中，日间尿失禁（p<0.001）、日间尿失禁频率（p=0.002）、遗尿频率（p=0.048）、储尿症状（p=0.011）、正确如厕姿势（p=0.034）和粪便失禁（p=0.026）均有显著变化。
CP 儿童在开始训练时的最大排尿量和液体摄入量明显较低，这可能解释了尿路治疗效果的延迟。治疗便秘对最大排尿量有积极影响，应在实施正确液体摄入计划后仍存在便秘时，与标准尿路治疗一起开始。建议进行更大样本量的未来研究。
尿路治疗结合尿失禁训练可有效治疗 CP 儿童的尿失禁。在当前队列中，与典型发育儿童相比，CP 儿童的尿失禁训练效果率较低，且变化较慢。
