A critical evaluation on additional treatment in children with refractory incontinence

Abstract

Daytime urinary incontinence (DUI) is a common condition affecting 21.7% of school-aged children. Regardless of the subtype, standard urotherapy is considered the initial treatment for all children with functional DUI. This non-pharmacological and non-chirurgical treatment option aims to improve bladder control by i.e. demystification of the underlying dysfunction and providing instruction on voiding and bowel habits in order to encourage behavioural change. However, in 44% of children standard urotherapy does not result in continence and persistent DUI can affect self-esteem, social relationships and lead to isolation. Given its major impact on quality of life, treatment-resistant DUI is therefore a major societal challenge that requires attention. In order to improve continence care for children, the objective of this thesis was to critically evaluate the effect of additional (invasive) treatment options in children with treatment-resistant DUI. We conclude after extensive research that specific urotherapy in the form of in-patient training has additional value in the treatment of DUI, regardless of the cause. It not only helps to achieve continence in childhood, but also helps with acceptance in the case of persistent symptoms. Given that the long-term outcomes are less stable and treatment is costly due to hospitalizations and staffing, we also believe that the focus should be on improving quality of life rather than achieving complete continence at all costs.