Inpatient 'Voiding School' Could Boost Continence in Kids With Refractory Non-neurogenic Overactive Bladder

By Reuters Staff

March 25, 2020

NEW YORK (Reuters Health) - An inpatient bladder rehabilitation "voiding school" appears to improve day- and night-time incontinence in children with refractory non-neurogenic overactive bladder, researchers from Belgium report.

Treatment of non-neurogenic overactive bladder (OAB), the most common dysfunction of the lower urinary tract in childhood, begins with urotherapy, which consists of lifestyle advice regarding micturition frequency, fluid intake, toilet posture and prevention of constipation.

Other therapies include biofeedback training, pelvic-floor physiotherapy and, when these fail, pharmacological therapy, alarm treatment, and/or neuromodulation.

Up to 20% of children have persistent symptoms despite these therapies, however, Dr. Lien Dossche and colleagues from Ghent University Hospital, in Belgium, note in the Journal of Pediatric Urology.

The researchers evaluated the short- and long-term outcome of a multidisciplinary voiding school that combined inpatient and outpatient bladder rehabilitation in 357 children with refractory OAB.

The program consisted of supervised adequate toilet posture, a standard daily fluid intake of 1.5 L, daily proprioceptive and relaxation exercises for the pelvic floor and thrice-weekly biofeedback training. During the inpatient portion, all children had a daily individual session with a psychologist.

Before entering the voiding school, all children had received standard urotherapy, which resulted in a decreased voiding score of one wet day and one wet night per week. But more than 56% of children continued to have daytime incontinence and 61% continued to have enuresis every night.

At the end of voiding school, 3.6% of children were dry day and night, and children overall experienced an additional one to two dry days and nights per week.

Three months following voiding school, 14.1% of children had become dry day and night, with an extra two dry days and nights per week. After six months, 33.5% were dry day and night.

At one-year follow-up, 36.6% of children were dry day and night, with an overall mean decline of approximately four wet nights and days per week.

Younger age, male sex, dysfunctional voiding and nocturnal polyuria were associated with less favorable outcomes.

"This study demonstrates that an inpatient rehabilitation program is a successful and safe treatment modality for children with refractory OAB," the authors conclude. "As an inpatient program is time-consuming and might be expensive for family and patient, this therapy should therefore be reserved for carefully selected children with severe and refractory OAB."

Dr. Dossche could not be reached for comments.

SOURCE: Journal of Pediatric Urology, online February 12, 2020


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