title: Long-term effect of conservative treatment versus low threshold endoscopic desobstruction on urine incontinence and urgency in boys with persistent overactive bladder symptoms: A cohort study.
abstract: OBJECTIVE
  To assess the long-term effects of two treatment strategies (low threshold endoscopic desobstruction vs. conservative treatment) on urinary incontinence (UI) and urgency-frequency in boys.
  
  
  METHODS
  Boys with persistent overactive bladder symptoms treated in two tertiary referral centers between 2006 and 2009 were included. Treatment strategy in center 1 was urethrocystoscopy (UCS) and in case of obstruction urethral desobstruction and in center 2 conservative. The primary outcome was time to being dry during daytime, secondary outcomes were being dry both day and night and presence of urgency-frequency, using the "provisional" International Consultation on Incontinence Questionnaires Children's Lower Urinary Tract Symptoms (LUTS) questionnaire.
  
  
  RESULTS
  Median age at start of treatment was 8.0 (IQR 6.4-9.4) years in center 1 and 8.4 (IQR 6.0-10.1) years in center 2. At baseline daytime incontinence was present in 100/104 children (96%, center 1) and 37/44 (84%, center 2). In center 1, UCS was performed in 98 (93%) boys, with desobstruction in 93 (88%), while in center 2 these numbers were 16 (36%), and 5 (11%). There were no differences between groups after a mean follow-up of 5 years concerning dryness at daytime (HR 0.86, 0.56-1.30), dryness day and night (HR 0.72, 0.51-1.14), and presence of urgency-frequency (HR 0.67, 0.38-1.25).
  
  
  CONCLUSIONS
  The benefit of a strategy including low-threshold UCS and endoscopic desobstruction in boys with urge incontinence and suspected infravesical obstruction to prevent LUTS and incontinence on the longer term could not be confirmed.
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pauline M L
authors.initials: PML
authors.lastname: Hennus
authors.affiliation: Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
authors.forename: Joop
authors.initials: J
authors.lastname: van den Hoek
authors.affiliation: Division Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Division Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Rolf H H
authors.initials: RHH
authors.lastname: Groenwold
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J L Ruud
authors.initials: JLR
authors.lastname: Bosch
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.|Pediatric Renal Center, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Tom P V M
authors.initials: TPVM
authors.lastname: de Jong
authors.affiliation: Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.|Pediatric Renal Center, Wilhelmina Children's Hospital and University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Laetitia M O
authors.initials: LMO
authors.lastname: de Kort
mesh_terms: D002648:Child; D015331:Cohort Studies; D000072700:Conservative Treatment; D003558:Cystoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000628:therapy; D008297:Male; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D014524:Urethral Obstruction / Q000150:complications / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000209:etiology / Q000628:therapy*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000175:diagnosis
keywords: boys; endoscopic treatment; long-term effect; overactive bladder; urethral obstruction