title: Long-term efficacy of simple behavioral therapy for daytime wetting in children.
abstract: OBJECTIVE
  Behavioral therapy has proved benefit for children with daytime wetting but most studies have used biofeedback techniques and provide no long-term assessment of results. We previously reported similar results using simple behavioral therapy without biofeedback. We report the long-term efficacy of behavioral therapy for daytime wetting.
  
  
  METHODS
  Our program of behavioral therapy included timed voiding, modification of fluid intake, positive reinforcement techniques and pelvic floor (Kegel) exercises to promote pelvic floor strengthening and relaxation. Questionnaires to assess therapeutic efficacy were mailed to patients who had completed therapy more than 1 year previously.
  
  
  RESULTS
  A total of 48 patients responded. Mean ages at the time of the initial clinic visit and questionnaire were 8.2 and 12.9 years, respectively. Improvement in symptoms was noted in approximately 74% of the cases during the first year following therapy. At a mean of 4. 7 years after treatment 59.4% of the patients had improved daytime urinary control, 51.1% improved daytime urinary frequency and 45.6% improved daytime urinary urgency. The frequency of urinary tract infections decreased in 56.4% of the cases. Measures of psychological well-being were also noted to be improved in a majority of patients. A total of 77.3% of the patients stated that they would recommend the program to others.
  
  
  CONCLUSIONS
  Simple behavioral therapy without biofeedback techniques is an effective and durable first line therapy for children with daytime wetting.
authors.affiliation: Departments of Pediatrics and Surgery, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Wiener
authors.forename: M T
authors.initials: MT
authors.lastname: Scales
authors.forename: J
authors.initials: J
authors.lastname: Hampton
authors.forename: L R
authors.initials: LR
authors.lastname: King
authors.forename: R
authors.initials: R
authors.lastname: Surwit
authors.forename: C L
authors.initials: CL
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004326:Drinking / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000502:physiology; D026741:Physical Therapy Modalities; D012054:Reinforcement, Psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000523:psychology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000517:prevention & control; D014554:Urination / Q000502:physiology