title: Which treatments do children with newly diagnosed non-organic urinary incontinence receive? An analysis of 3,188 outpatient cases from Germany.
abstract: OBJECTIVE
  Objectives of this study were to examine the administrative incidence of urinary incontinence in children and to assess related outpatient health services utilization in this cohort.
  
  
  METHODS
  Data of a statutory health insurance company were analyzed and outpatients from 1 to 18 years of age with a first recorded ICD-10 code for non-organic urinary incontinence during a 1-year-period (2007) were identified. For this cohort, the prescription of desmopressin, antispasmodics, non-selective monoamine reuptake inhibitors, alarm devices, and incontinence pads in the quarter of the first diagnosis and in the following one (i.e., 6 months) was evaluated with respect to age and gender.
  
  
  RESULTS
  3,188 patients (59.4% male; mean age 6.8 years) matched the inclusion criteria, of whom 25.4% were under 5 years old. 7.9% were prescribed desmopressin, 7.4% received urinary antispasmodics, and 7.0% were treated with alarm devices. For 77.9% of patients, no specific incontinence-related treatments were prescribed. We found considerable differences in treatment patterns between age groups, with patients ≥ 7 years receiving desmopressin more frequently than alarm devices. Regarding gender differences, the proportion of males treated with alarm devices (prevalence ratio [PR] 1.46; 95% confidence interval [95%CI] 1.11-1.92) and at least one specific treatment (PR 1.19; 95%CI 1.04-1.35) remained statistically significantly higher, even after adjusting for age.
  
  
  CONCLUSIONS
  In our study, we found evidence that treatment modalities only partly comply with the current guidelines for treatment of children and adolescents with non-organic urinary incontinence. Therefore, the dissemination of current guidelines remains a major educational goal.
authors.affiliation: Division Health Economics, Health Policy and Outcomes Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany. hoffmann@zes.uni-bremen.de
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.forename: Christian
authors.initials: C
authors.lastname: Steuber
authors.forename: Judith
authors.initials: J
authors.lastname: Günther
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Bachmann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D050034:Antidiuretic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D056902:Clinical Alarms; D015331:Cohort Studies; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D016496:Incontinence Pads; D007223:Infant; D008297:Male; D010045:Outpatients; D010276:Parasympatholytics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000628:therapy*
chemical_list: D050034:Antidiuretic Agents; D010276:Parasympatholytics; D003894:Deamino Arginine Vasopressin