PEDIATRIC UROLOGY

Initial Trial of Timed Voiding is Warranted for All Children with Daytime Incontinence
Allen HA, Austin JC, Boyt MA, Hawtrey CE, Cooper CS
Division of Pediatric Urology, Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1089, USA
Urology. 2007; 69: 962-5

• Objectives: To analyze the relationship between potential prognostic factors and early success after treatment of childhood daytime urinary incontinence without anticholinergic medication.
• Methods: A total of 63 patients with daytime urinary incontinence met the inclusion criteria for a retrospective review of the effect of a timed voiding regimen. The severity, duration, and frequency of wetting, along with age, sex, and uroflow parameters, were recorded. Statistical analysis was used to determine the factors predictive of improvement in wetting without anticholinergic treatment.
• Results: Of 315 children evaluated with daytime incontinence, only 24% were treated with nonanticholinergic methods. At the first follow-up visit, 6.3% of patients treated without anticholinergics became dry, 38.1% showed significant improvement, 36.5% were slightly improved, and 19.0% were unchanged. Age, sex, duration or severity of wetting, constipation, bladder capacity, and uroflow pattern and parameters were not predictive of early improvement with timed voiding. Patients with good compliance with timed voiding were significantly more likely to improve than those with poor compliance (P = 0.014).
• Conclusions: The results of our study have indicated that anticholinergic therapy appears to be overused as a first-line treatment for children with daytime urinary incontinence in our clinic population. The lack of reliable predictive factors regarding the response to nonanticholinergic treatment suggests a trial of timed voiding should be used as an initial treatment for all children with daytime urinary incontinence. Almost 45% of our patients had significant improvement in the frequency of wetting within 4 months without anticholinergics.
  
  
• Editorial Comment
  It is interesting in this study to have nearly 45% of the patients have significant improvement without pharmacotherapy and this study would suggest that patients who come to the office for evaluation of daytime incontinence should all have an initial treatment of timed voiding and elimination diaries and a follow up visit prior to instituting drug therapy. Since compliance was the only positive correlate, it would suggest that all efforts in a urologists’ office to encourage parental and patient compliance should be attempted to gain the best outcome.
  It is surprising in this manuscript that constipation did not have any correlation. Other studies suggest that this is highly correlated but perhaps with the highly selective group and small numbers the authors were not able to find this correlation.

Dr. Brent W. Snow
University of Utah Health Sci Ctr
Division of Urology
Salt Lake City, Utah, USA
E-mail: brent.snow@hsc.utah.edu