Treatment for daytime urinary incontinence in children: A systematic review of randomised controlled trials

P Sureshkumar, W Bower, JF Knight, JC Craig

Centre for Kidney Research, The Children's Hospital at Westmead, NSW

Introduction Bladder control problems can affect up to 20% of children aged 5-12 years, but many of the commonly used treatments are of uncertain benefit. This study aimed to evaluate the benefits and harms of the interventions used for children with daytime urinary incontinence.

Methods Randomised controlled trials (RCT) and quasi randomised controlled trials that evaluated interventions in children under the age of 18 years and whose primary diagnosis was daytime urinary incontinence were identified from the Cochrane Controlled Trials Register, Medline, Embase, reference lists of articles, abstracts from proceedings and contact with known experts in the field. Trial quality was assessed and data were extracted by two independent reviewers.

Results A total of six relevant randomised trials were identified which compared a contingent (sounded when wetting occurred) and a non-contingent (one that went off from time to time unrelated to wetting events) alarm system (1 trial), terodiline with placebo (2 trials), imipramine with placebo (1 trial), biofeedback with standard therapy (infection prophylaxis and treatment of constipation, when indicated, complemented with standardized sets of instruction,1 trial) and biofeedback with oxybutinin and placebo (1 trial). Quality of the studies were generally good. Allocation was adequately concealed in 5 trials. There was no evidence of reduction in wetting (RR 0.67, 95% CI 0.29 to 1.56) between the contingent and non-contingent alarm systems. There was no significant difference in the number of patients with no improvement in daytime wetting (RR 1.05, 95% CI 0.65 to 1.70) between the biofeedback and oxybutinin groups at 9 months. There was no significant difference in the number of patients who had no improvement in daytime wetting at 6 months (RR 1.47, 95% CI 0.70 to 3.10) or 9 months (RR 1.10, 95% CI 0.67 to 1.79) of follow up between biofeedback and standard therapy groups.

Conclusions No trials were identified which have tested whether any intervention is of benefit. RCTs either singly or in combination on the different behavioural(bladder training, psychotherapy), physical (pelvic floor muscle relaxation, electrical stimulation) and drug therapies that are currently being used in children as standard treatment are required.

Presented at The Royal Australasian College of Physicians Annual Scientific Meeting, Sydney, May 2001.

Correspondence
Premala Sureshkumar
PremalaS@chw.edu.au