title: Urotherapy in children: quantitative measurements of daytime urinary incontinence before and after treatment according to the new definitions of the International Children's Continence Society.
abstract: OBJECTIVE
  To assess the effectiveness of urotherapy in children with lower urinary tract dysfunction, according to the new definitions of the International Children's Continence Society.
  
  
  METHODS
  We performed a retrospective review of 122 children (aged 8.8 ± 2.0 years) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria included all neurologic abnormalities. In 98 children (80%) daytime urinary incontinence was a predominant symptom. Therapy consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regulation of defecation. Before and at the end of training, patients were evaluated for number and severity of daytime wet accidents per week, using a scoring system to grade the severity of incontinence. Secondary measurements of accompanying voiding symptoms were performed.
  
  
  RESULTS
  Of the 90 children with daytime urinary incontinence for whom sufficient objective data were collected, 42% became completely dry during the daytime and 36% showed a 50% or greater level of response. Secondary measurements showed a significant reduction in daily voiding frequency (mean 7.0 ± .3, P<0.0001) and mean post-void residual (P<0.003), and an improvement in flow pattern (P<0.05).
  
  
  CONCLUSIONS
  Urotherapy is successful for the treatment of daytime urinary incontinence in children. Additional benefit was evident in improvement of accompanying voiding symptoms. A combination of the definitions of the International Children's Continence Society and a scoring system to grade severity improved the evaluation method. Further research into long-term efficacy will be performed.
authors.affiliation: Radboud University Nijmegen Medical Centre, Pediatric Urology Center Nijmegen, GA Nijmegen, The Netherlands. mariannemulders@hotmail.com
authors.forename: M M
authors.initials: MM
authors.lastname: Mulders
authors.forename: H
authors.initials: H
authors.lastname: Cobussen-Boekhorst
authors.forename: R P E
authors.initials: RP
authors.lastname: de Gier
authors.forename: W F J
authors.initials: WF
authors.lastname: Feitz
authors.forename: B B M
authors.initials: BB
authors.lastname: Kortmann
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D001676:Biofeedback, Psychology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D053207:Diurnal Enuresis / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014039:Toilet Training; D016896:Treatment Outcome; D014554:Urination