Paediatric daytime urinary incontinence: Cochrane review finds no clearly best treatment

  • Buckley BS & al.
  • Cochrane Database Syst Rev
  • 18 Sep 2019

  • International Clinical Digest
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Takeaway

  • For children who have daytime urinary incontinence, the literature offers little evidence supporting 1 treatment candidate over others.

Why this matters

  • The authors of this Cochrane review say that for now, clinicians should rely on their clinical experience and turn to caregivers as resources. 
  • Support is key, as this phenomenon can harm a child’s sense of well-being and social engagement. 

Key results

  • Of the 27 randomised controlled trials (RCTs) these authors reviewed, most were small (n values, 16-202).
  • Bias risk was high for 19.
  • Pooling was difficult because of heterogeneity.
  • Interventions reviewed include lifestyle, behavioral, and transcutaneous electrical nerve stimulation (TENS).
  • For TENS, some hints at efficacy: risk ratio for achieving continence vs placebo, 4.89 (95% CI, 1.68-14.21), but only 3 studies and only 93 children. 
  • Pelvic floor muscle training also shows some promise vs urotherapy alone (risk ratio, 2.36; 95% CI, 0.65-8.53), but only 3 studies and only 91 children.
  • Other findings are similarly limited. 
  • Authors: Most of the studies were small, and many were poorly designed and not reported clearly.
  • Most evidence is “of very low certainty.”

Study design

  • Cochrane review of 27 RCTs covering 1803 children. 
  • Funding: National Institute for Health Research, UK. 

Limitations

  • The limitations are those of the included studies.

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