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The aim was to examine associations of specific anxiety disorders, depressive symptoms, and incontinence in a representative, population-based sample of preschool children.All preschool children of a defined geographical area examined before school-entry were included. Parents completed a questionnaire including the Preschool Feelings Checklist (PFC), eight questions referring to nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI) and constipation, and 30 items regarding Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of separation anxiety disorder (SAD), social phobia (SOC), specific phobia (PHOB), and generalized anxiety disorder (GAD). Data of 1206 children (mean age = 5.7 years; 53.5% boys) are presented.34.6% of incontinent children had an anxiety disorder based on DSM-5 criteria and 13.3% had clinically relevant depressive symptoms (measured by the PFC). Rates of incontinence overall were 14.1% (11.9% NE, 3.1% DUI, and 1.8% FI) and 6.3% for constipation. Rates of SOC and PHOB were increased in NE (20.8% and 25.4%), DUI (39.3% and 34.5%) and FI (35.3% and 50.0%) compared to continent children (13.5% and 17.2%). Children with constipation had higher rates of SOC, PHOB, and GAD than those without. Compared to continent children (9.7%), depressive symptoms were more frequent in children with NE (26.8%), DUI (50.0%), and FI (61.9%).Anxiety disorders and depressive symptoms are common in children with incontinence. The most specific DSM-5 disorders associated with incontinence are SOC and PHOB, which can be incapacitating and may require treatment. Due to the high rates of anxiety disorders, it is important to screen all children with incontinence, for example, with specific questionnaires.

Aim of the study was to evaluate the Florence intracorporeal neobladder (FloRIN) oncological and functional outcomes at the end of assessment phase (phase 3) IDEAL-Guidelines.This single-institution prospective series included consecutive patients treated with robot-assisted radical cystectomy (RARC) and FloRIN reconfiguration technique from February 2016 to June 2020. Functional features were evaluated six months after surgery. Patients were grouped into four quartiles according to time of radical cystectomy and impact of learning curve improvement was evaluated.One-hundred FloRIN were completed with a median console time of 373 (IQR: 312-415) minutes. Two cases were converted to open surgery. No intraoperative complications occurred. At pathological examination, 30% of patients were staged as pT ≤ 1 and 47% as pT ≥ 3. Transitional cell carcinoma was present in 87% of cases. Carcinoma in situ (CIS) and nodal involvement were observed in 38% and 29% of patients, respectively. At a median follow-up time of 17 (IQR: 7-28) months, 20 clinically relevant events (Clavien-Dindo≥3) occurred. Operative time significantly decreased throughout the series (median minutes 435; 395; 365 and 330 in the four quartiles, respectively; p 0.001). Similarly, early Clavien-Dindo≥3 postoperative complications rate significantly decreased across the series (number of events: 1; 4; 0; 0; p = 0.03). Overall, 75% and 65% of patients achieved day-time and nigh-time continence, respectively. Twenty-seven patients experienced disease recurrence. Cancer-specific and overall survival were equal to 80%.RARC with FloRIN reconfiguration showed worthy functional and survival outcomes, with learning curve improvement significantly influencing operative time and early complications rate across series.

AIM Information about healthy children's urinary tract symptoms is scarce but would be helpful in children with congenital urinary tract conditions. The aim of this study was to develop and evaluate a Lower Urinary Tract Dysfunction (LUTD) questionnaire. METHODS A 15-item questionnaire based on definitions by the International Children's Continence Society (ICCS) about urinary tract function, was given to children 4-15 years old with no gastrointestinal or urinary tract conditions. The study was approved ethically. RESULTS The response rate was 82% (311/377), 50% (n = 155) were girls. Children were of the age groups 3.5-7 years (n = 136), 8-12 years (n = 127), and 13-15 years (n = 48). More girls than boys reported urinary tract infections (20% vs 3%, p

Objects: Approximately, 1% of school children have daytime urinary incontinence. The symptoms may be caused by an overactive bladder (OAB). In the evaluation of boys with OAB complaints, one should...

Aims Headaches in preschool children are associated with behavioral and gastrointestinal symptoms. As the co-occurrence with incontinence is not known in young children, the aim of the study was to examine associations of headache, psychological symptoms and nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in a population-based sample of preschool children. Methods All preschool children of a defined geographical area were examined at school-entry. Parents completed a 22-item questionnaire, including 14 headache, 4 incontinence, and 25 items of the Strength and Difficulties Questionnaire (SDQ). Five hundred eighty-five children (50.4% males) with a mean age of 5.8 years were included. Results In total, 27.2% of all children had headaches. 15.7% had secondary and 11.3% primary headaches. Five children had migraine and five tension-type headaches, while all others were unclassifiable. 9.4% of children had incontinence (7.7% NE; 2.4% DUI, 1.2% FI) and 4.0% constipation. The rates of incontinence did not differ between children with primary and those without headache for NE (12.9% vs 7.5%), DUI (3.1% vs 2.7%) or FI (3.0% vs 1.0%), but for constipation (12.1% vs 2.6%). Incontinent children had significantly more behavioral and externalizing symptoms, children with headache more internalizing problems. Primary headache was a significant predictor for internalizing, while constipation and FI were predictors for externalizing symptoms. Conclusions This population-based study showed that headache is associated with constipation, but not with incontinence in preschool children. Headache and incontinence are common risk factors for specific psychological symptoms and should be assessed in clinical practice.

Incontinence, psychological symptoms, parental stress and psychopathology were examined in 51 children (43 boys, mean age = 9.7 years) presented in an outpatient clinic for autism spectrum disorders (ASD) and in 53 matched controls (43 boys, mean age = 10.2 years). All children were clinically assessed for ASD, incontinence and psychopathology according to current guidelines. ASD was confirmed in 37 children and excluded in 14. Enuresis (16.2%) and daytime urinary incontinence (16.2%), but not fecal incontinence (8.2%) were more common in ASD than in controls. Children with ASD showed significantly more comorbid psychiatric disorders. Parents of children with ASD experience more stress. Parental stress was predicted by parental psychopathology, role restriction and group (patient/control), but not by incontinence.

Aim Giggle incontinence is a distinct entity of childhood daytime urinary incontinence (DUI), where children wet themselves only when they laugh. The prevalence of true giggle incontinence is unknown, with confusion about the diagnosis of urinary incontinence occurring during laughter and true giggle incontinence. The aim of the study is to improve our understanding of urinary incontinence during laughter by comparing those children with children who have DUI at other times, but not with laughter. Methods We conducted a retrospective medical record review of children with DUI who presented to a tertiary continence service from 2017 to 2018, collecting data on age, gender, associated comorbidities, lower urinary tract symptoms, investigations, provisional diagnosis at first visit and initial treatment responses. Differences between those with DUI occurring during laughter and those with DUI at other times, but not with laughter were compared using standard statistical methods. Results Of the 277 new patients seen during the study period, 140 (51%) had DUI, and of these, 72 (51%) had DUI occurring during laughter. Children with incontinence occurring during laughter were more likely to have incontinence associated with other activities. One child had giggle incontinence according to the International Children's Continence Society's definition. Four other children were referred specifically for urinary incontinence associated with laughter, with the term giggle incontinence sometimes used by the referring doctor. Conclusion Children with DUI commonly experience incontinence during laughter, but true giggle incontinence is rare. Correct diagnosis is essential as it directs treatment.

INTRODUCTION: Daytime urinary incontinence (UI) can have an enormous impact on a child's life, lowering both self-esteem and quality of life. Although most children start therapy after their first visit to our outpatient clinic, no studies have reported on parents' or patients' expectations of care for daytime UI in this setting.OBJECTIVE: We aimed to explore the expectations of the parents of children referred to an outpatient clinic for daytime UI.STUDY DESIGN: This was a qualitative study that involved performing semi-structured interviews with the parents of children who had been referred for daytime UI (with or without nocturnal enuresis). Interviews took place between July 2018 and October 2018 and continued until saturation was reached. The results were transcribed verbatim and analyzed according to Giorgi's strategy of phenomenological data analysis.RESULTS: Nine parents of children, aged 5-12 years old, were interviewed, revealing "(Experienced) Health," Self-management," and "Social Impact" as the main themes that influenced parental expectations. All parents wanted to know if there was a medical explanation for UI, some were satisfied when diagnostics revealed no underlying condition, and others wanted treatment. Parents expressed no preferences about diagnostics or the content and duration of treatment, but they hoped that any previously attempted ineffective steps would not be repeated. Some parents defined treatment success as their child becoming completely dry, but most stated that learning coping strategies was more important.DISCUSSION: This is the first study to explore the expectations of parents when attending outpatient care for children with daytime UI. We employed a strong theoretical framework with a clear interview guide. The main limitations are that we only interviewed parents and that this was a qualitative study, precluding the drawing of firm conclusions. Nevertheless, our results point to the need for quantitative evaluation.CONCLUSION: Expectations seem to be influenced by (experienced) health, efforts at self-management, and the social impact of UI, making it critical that these themes are addressed. It was interesting to note that parents do not always attend outpatient departments with the goal of completely resolving daytime UI. Instead, some only want to know if there is an underlying medical condition or want to reduce the social impact by learning coping mechanisms. Excluding underlying medical conditions may therefore stimulate acceptance of watchful waiting without the need to start treatment.

Summary Background Urotherapy is an umbrella term for all non-surgical, non-pharmacological interventions for lower urinary tract disorders (LUTD) in children and adolescents. Urotherapy is a specialized practice, which has become mainstay therapy not only for daytime urinary incontinence, but also for nocturnal enuresis, functional constipation and fecal incontinence. The aim of urotherapy is to achieve the normalization of the micturition and bowel pattern and to prevent further functional disturbances by repeated training. It is well known that in the treatment of adult and childhood incontinence a team approach is best, where there are shared areas of expertise and also discipline-specific expertise available. Aim We present a consensus view from a cross-professional team of experts affiliated with the International Children's Continence Society on definitions, indications and practice of urotherapy. This is a selective, non-systematic review with practical recommendations for the implementation and research on urotherapy. Methods The document uses the globally accepted ICCS terminology. Evidence-based literature serves as the basis, but in areas lacking in primary evidence, expert consensus is used. Before submission, a full draft was made available to all ICCS members for additional comments. Results Urotherapy uses non-pharmacological, non-surgical methods and focuses on behavioral interventions, largely based on cognitive-behavioral psychotherapy (CBT). Standard urotherapy comprises components such as provision of information, instructions, life-style advice, counselling and registration of symptoms. Specific urotherapy is tailored towards specific disorders and includes alarm treatment, biofeedback training, pelvic floor training, neurostimulation and other interventions. Fig. 1. Urotherapy is a treatment that addresses all aspects of incontinence, leading to the best clinical outcome. This includes somatic, psychosocial, and behavioral problems and quality of life. Therefore urotherapy is recommended by the ICCS as the first-line treatment for most types of LUTD. The document is intended to be clinically useful in primary, secondary and tertiary care. Download : Download high-res image (226KB) Download : Download full-size image Summary Figure 1 . Daytime urinary incontinence and enuresis.

Bupropion hydrochloride (HCl) is an antidepressant that has many different biological targets, acting as both a norepinephrine-dopamine reuptake inhibitor as well as a nicotinic antagonist. This second-generation antidepressant is available in 3 bioequivalent formulations: immediate release, sustained release, and extended release, allowing providers to customize a patient's regimen for maximum tolerability and compliance. Although bupropion HCl's safety and tolerability have been demonstrated through several clinical trials, there are still a number of adverse effects that have been reported in the literature. These include headache, agitation, tremor, and insomnia. There is also an increased risk of developing seizures during bupropion treatment. Although urinary symptoms were noted during the clinical trials, these are relatively rare adverse effects. Here we report the case of a 61-year-old man who developed diurnal enuresis during treatment with bupropion HCl sustained release. We will review the adverse effect burden associated with the use of bupropion and discuss the neuropharmacology of urinary symptoms associated with antidepressant treatment.

Summary Introduction Girls with an anterior deflected urinary stream (ADUS) are known to wet the toilet rim and their buttocks while voiding. This deviation may prevent adopting an ideal toileting position and can thus develop into a functional voiding disorder. Although surgical correction of the urinary stream by a meatotomy is part of standard care in girls with ADUS and lower urinary tract symptoms (LUTS) at our center, little is known about the effect of this procedure on daytime urinary incontinence (DUI). Objective To assess the effect of meatal correction on incontinence in girls with ADUS and DUI, and to find predictors for therapy success. Study design A retrospective chart study including all girls with ADUS and DUI who underwent a dorsally directed meatal correction at our tertiary referral center between 2005 and 2018 (n = 274). The main outcome measurement was continence according to the International Children's Continence Society criteria, expressed as the percentage of children that were continent at post-surgical follow-up (complete response). Multivariate logistic regression was used to identify predictors of continence. Results In 93% of girls, the direction of the urinary stream was no longer anterior deflected. 29% (n=79) of all girls were continent at post-surgical follow-up. We could not find a convincing predicting factor for achieving continence. Discussion Although meatal correction is successful on normalizing the direction of the urinary stream, less than one-third of girls became continent. In addition, we were unable to indicate which girls will profit from this procedure in terms of continence. Since not every girl with ADUS develops incontinence complaints, it may also be questionable whether ADUS and incontinence are directly related. Since other, less invasive and more effective treatment options for DUI are available, meatal correction should therefore be considered a last-resort option in the treatment of pediatric DUI in girls with ADUS. Conclusion Of the 274 girls with ADUS and DUI, 29% did benefit from a meatotomy. No convincing indicator for therapy success could however be found. Therefore, we discourage a meatotomy as standard treatment in girls with ADUS and DUI. Download : Download high-res image (170KB) Download : Download full-size image Summary Figure . Treatment outcome.

Summary Introduction Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common disorders in children. Although standard treatment is highly effective, subgroups of incontinence (combinations of nocturnal enuresis (NE), DUI and/or FI, or with psychological comorbidity) can relapse or take a chronic course. For these complex, therapy-resistant cases, a manualized outpatient bladder and bowel training program was developed. The aim of the study was to evaluate prospectively treatment effects of this training program, including a follow-up assessment. Material & methods The training program was developed for small groups of 2–6 children (of same age and sex) aged 5–12 years with adaptations for 13-16 year-old adolescents. It consists of 7–9 weekly sessions for group training and 3 weekly sessions for individual training. The training comprises information about anatomy/physiology of the urogenital tract, pathophysiology, hygiene and balanced nutrition. Voiding and drinking diaries, stress management, relaxation and emotion regulation techniques are also included. Data of 32 children (mean age 8.6 years, range 5–13 years; 21 boys), who had received standard treatment (and did not reach complete response) are presented. 14 children received group therapy, 18 (younger children) were treated individually. Children were assessed before and after the treatment, as well as at a follow-up of 6 months later. Treatment effects were measured by incontinence frequency and treatment success according to the ICCS (complete response: 100% reduction of symptoms; partial response: 50–99% reduction of symptoms). Psychological symptoms were measured by the Child Behavior Checklist questionnaire (CBCL). Results Frequencies of DUI were significantly reduced from 5.7 wetting episodes/week (before training) to 4.9 (after training) to 2.0 (6 months after training). Frequencies of FI were reduced from 2.9 soiling episodes/week (before training) to 1.9 (after training), but increased to 2.6 (6 months after training). According to the ICCS classification, 11.1% of children with DUI had a complete response after training and 47.6% at follow-up after 6 months. In children with FI, 33.3% reached a complete response at the end of the training and 25% at follow-up. Additionally, psychological symptoms, especially internalizing, decreased significantly during training. Further, in 14 children with comorbid NE, nighttime wetting reduced from 5.9 before training to 1.5 episodes/week at follow-up. Conclusions This bladder and bowel training program is an effective and successful treatment option for children with therapy-resistant subtypes of incontinence. Symptoms still improved 6 months after training in DUI. Additionally, the training program is helpful to decrease psychological symptoms. Summary Table . Incontinence frequency, symptom reduction and psychological symptoms Baseline (t1) Post training (t2) Follow-up (t3) Overall effect (t1, t2, t3) Children with DUI, total n 27 27 21 21 Incontinent episodes/week, mean (SD) 5.7 (3.9) 4.9 (5.1) 2.0 (3.2) Symptom reduction in %, median – 11.1 87.5 Children with FI, total n 15 15 12 12 Incontinent episodes/week, mean (SD) 2.9 (2.2) 1.9 (2.1) 2.6 (2.7) 0.153 (n. s.) Symptom reduction in %, median – 57.1 15.0 Children with NE, total n 14 14 13 13 Incontinent episodes/week, mean (SD) 5.9 (1.9) 5.1 (2.3) 1.5 (2.6) 0.001∗∗ All incontinent children, total n 32 32 24 24 CBCL Total T value, mean (SD) 62.1 (9.0) 61.2 (8.9) 58.5 (9.7) 0.001∗∗

Aims Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) are common in adolescents. The aim of this paper was to review studies on prevalence, clinical symptoms and associated risk factors and to formulate recommendations for assessment and treatment. Materials and methods A systematic Scopus search was performed and relevant publications were selected. The topic was discussed during the ICI-RS meeting in 2015. Results One to two percent of older adolescents are affected by NE and 1% by DUI. NE and DUI are associated with multiple risk factors such as fecal incontinence and constipation, obesity, chronic illness, and psychological impairment. Chronic treatment-resistant, relapsing and new-onset cases can occur. Adolescent NE and DUI can be treated by a multidisciplinary team according to pediatric principles. Additional treatment components have been developed for adolescents. Transition from pediatric to adult services is frequently disorganized. Conclusions Incontinence in adolescents is a neglected research topic and clinical care is often suboptimal. As adolescents are seen by both pediatric and adult services, alignment and harmonization of diagnostic and therapeutic principles is needed. Also, an organized transition process is recommended to improve care for adolescent patients. Neurourol. Urodynam. 36:843-849, 2017. © 2017 Wiley Periodicals, Inc.

Context Gender-specific functional and health-related quality of life (HRQOL) outcomes following radical cystectomy (RC) for bladder cancer (BCa) remain unclear, with many studies excluding women from the study population. Objective To better characterize female-specific functional outcomes following RC and urinary diversion for BCa. Evidence acquisition We performed a critical review of PubMed/Medline and Embase in August 2015 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Outcomes of interest included urinary function (for orthotopic neobladder), sexual function, bowel function, and quality of life. Excluded were nonbladder malignancies, RCs performed for neurogenic bladder dysfunction, and patients with exposure to radiation therapy prior to surgery. Forty-five publications were selected for inclusion in this analysis. Evidence synthesis Included reports addressed urinary function (34 studies), sexual function (11 studies), and HRQOL (9 studies). All studies had a high risk of bias and ranged significantly in sample size, inclusion criteria, and follow-up time, precluding meaningful meta-analysis. Daytime incontinence approximated 20%, nighttime incontinence 20%, and hypercontinence 10–20%. Sexual function appeared to be better among those patients undergoing genitalia-sparing RC, but generally poor outcomes were noted among those undergoing routine RC. Only 40% of studies assessed sexual function using standardized instruments. HRQOL differences between diversion types appeared to be minimal, whereas comparisons with the general population revealed significant differences in emotional problems, role functioning, fatigue, and appetite. Conclusions Functional outcomes among women undergoing RC for BCa are poorly studied with limitations regarding use of validated questionnaires, heterogeneous patient populations, and small sample sizes. Collaborative efforts will be needed to better define functional outcomes among this poorly studied patient population. Patient summary We reviewed functional outcomes following cystectomy among women with bladder cancer. We found that urinary, sexual, and bowel function and quality of life are poorly studied among women, with function ranging significantly across studies.

Aripiprazole is an atypical antipsychotic commonly used in the treatment of childhood disorders, such as bipolar disorder, psychosis, and irritability associated with autism spectrum disorder. Common side effects of its use include extrapyramidal side effects, somnolence, tremor, fatigue, nausea, and akathisia. Enuresis is an additional and rare side effect of aripiprazole use. There is limited data on the subject of enuresis induced as a result of treatment with aripiprazole. To our knowledge, there are no reports in the literature on aripiprazole-induced enuresis continuum in children. In this report, we present the case of a 9-year-old boy who developed enuresis continuum after the initiation of a low dose of aripiprazole and describe his rapid improvement when administration of the drug was ended.

Background To assess the health-related quality of life (HRQOL) of children with daytime urinary incontinence (DUI) based on pre- and post-treatment self-reports and parent proxy-reports. Methods The study population comprised 117 children with at least one episode of DUI per week and their caregivers as well as 999 healthy children (control group). The Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaire was administered to assess the HRQOL of children. To assess the degree of improvement in HRQOL, we categorized children into two groups: group A achieved complete response (CR) to treatment within 12 months and group B did not achieve CR within 12 months. CR was defined as the complete resolution of symptoms or alleviation of symptoms to Results Valid responses were collected from 84 children [53 boys and 31 girls; mean age: 7.9 ± 1.5 years (range, 6–12)]. Sixty-two patients (73.8%) were classified into group A and 22 (26.1%) into group B. Based on self-reports, significant post-treatment improvement was observed in the scores of all PedsQL items (mean total score: 82.2 ± 11.3 vs. 87.2 ± 9.8; P = 0.003). Group A showed significant improvement in the scores of all PedsQL items after achievement of CR based on child self-reports; however, this was improvement not observed in group B. Conclusions To the best of our knowledge, this is the first study to demonstrate the complete resolution of DUI with treatment for improving the HRQOL of these children.

BACKGROUND: In children, functional daytime urinary incontinence is the term used to describe any leakage of urine while awake that is not the result of a known underlying neurological or congenital anatomic cause (such as conditions or injuries that affect the nerves that control the bladder or problems with the way the urinary system is formed). It can result in practical difficulties for both the child and their family and can have detrimental effects on a child’s well‐being, education and social engagement. OBJECTIVES: To assess the effects of conservative interventions for treating functional daytime urinary incontinence in children. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains studies identified from CENTRAL, MEDLINE, MEDLINE In‐Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 11 September 2018). We also searched Chinese language bibliographic databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang. No language restrictions were imposed. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi‐randomised, multi‐arm studies, cross‐over studies and cluster‐randomised studies that included children aged between 5 and 18 years with functional daytime urinary incontinence. DATA COLLECTION AND ANALYSIS: Two review authors independently screened records and determined the eligibility of studies for inclusion according to predefined criteria. Where data from the study were not provided, we contacted the study authors to request further information. Two review authors assessed risk of bias and processed included study data as described in the Cochrane Handbook for Systematic Reviews of Interventions. Where meta‐analysis was possible, we applied random‐effects meta‐analysis using the Mantel‐Haenszel method for dichotomous outcomes. MAIN RESULTS: The review included 27 RCTs involving 1803 children. Of these, six were multi‐arm and one was also a cross‐over study. Most studies were small, with numbers randomised ranging from 16 to 202. A total of 19 studies were at high risk of bias for at least one domain. Few studies reported data suitable for pooling due to heterogeneity in interventions, outcomes and measurements. Individual conservative interventions (lifestyle, behavioural or physical) versus no treatment Transcutaneous electrical nerve stimulation (TENS) versus sham (placebo) TENS. More children receiving active TENS may achieve continence (risk ratio (RR) 4.89, 95% confidence interval (CI) 1.68 to 14.21; 3 studies; n = 93; low‐certainty evidence). One individual conservative intervention versus another individual or combined conservative intervention Pelvic floor muscle training (PFMT) with urotherapy versus urotherapy alone. We are uncertain whether more children receiving PFMT with urotherapy achieve continence (RR 2.36, 95% CI 0.65 to 8.53, 95% CI 25 to 100; 3 studies; n = 91; very low‐certainty evidence). Voiding education with uroflowmetry feedback and urotherapy versus urotherapy alone. Slightly more children receiving voiding education with uroflow feedback and urotherapy may achieve continence (RR 1.13, 95% CI 0.87 to 1.45; 3 studies; n = 151; low‐certainty evidence). Urotherapy with timer watch versus urotherapy alone. We are uncertain whether urotherapy plus timer watch increases the number of children achieving continence compared to urotherapy alone (RR 1.42, 95% CI 1.12 to 1.80; 1 study; n = 58; very low‐certainty evidence). Combined conservative interventions versus other combined conservative interventions TENS and standard urotherapy versus PFMT with electromyographic biofeedback and standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.11, 95% CI 0.73 to 1.68; 1 study; n = 78; very low‐certainty evidence). PFMT with electromyography biofeedback and standard urotherapy versus PFMT without feedback but with standard urotherapy. We are uncertain whether there is any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 1.05, 95% CI 0.72 to 1.52; 1 study; n = 41; very low‐certainty evidence). Individual conservative interventions versus non‐conservative interventions (pharmacological or invasive, combined or not with any conservative interventions) PFMT versus anticholinergics. We are uncertain whether more children receiving PFMT than anticholinergics achieve continence (RR 1.92, 95% CI 1.17 to 3.15; equivalent to an increase from 33 to 64 per 100 children; 2 studies; n = 86; very low‐certainty evidence). TENS versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportions of children achieving continence (RR 0.81, 95% CI 0.05 to 12.50; 2 studies; n = 72; very low‐certainty evidence). Combined conservative interventions versus non‐conservative interventions (pharmacological or invasive, combined or not with any conservative interventions) Voiding education with uroflowmetry feedback versus anticholinergics. We are uncertain whether there was any evidence of a difference between treatment groups in the proportion of children achieving continence (RR 1.02, 95% CI 0.58 to 1.78; 1 study; n = 64; very low‐certainty evidence). AUTHORS' CONCLUSIONS: The review found little reliable evidence that can help affected children, their carers and the clinicians working with them to make evidence‐based treatment decisions. In this scenario, the clinical experience of individual clinicians and the support of carers may be the most valuable resources. More well‐designed research, with well‐defined interventions and consistent outcome measurement, is needed.

Introduction: Urinary incontinence should be treated as a pathology in patients who are at least 5 years old, a few percent of patients continue to suffer from this disorderin adolescence. It can be qualified as day-time incontinence (DUI) and nocturnal-incontinence (enuresis-NE). The aim: To assess the incidence of micturition disorders in children aged 7 to 10, to analyze accompanying symptoms and compare the results with previous studies.Material and methods: Parents of 954 children (491 girls and 463 boys) were surveyed during parent-teacher meetings held in 2017 in 11 randomly selected schools in southern Poland. The questionnaire was based on International Children's Continence Society guidelines. Study population was divided into subgroups according to demographical data, presence of accompanying symptoms and the type of micturition disorder.Results: Minor wetting was common in the studied population, however the group of children with clinically significant incontinence becomes smaller after applying current ICCS criteria. ≥1 symptom of urinary bladder malfunction was reported in 18% of cases (17.5% girls and 18.8% boys). Significant (≥1/month) NE was present in 1,7 % of children and significant (≥1/month) DUI in 2,2%. Significant NE combined with significant DUI occurred in 1% of children. Relationships between incontinence and the age at which children stopped wearing diapers, urinary tract infections, soiling and constipation episodes were observed.Conclusions: Unified and clearly defined terminology should be used in order to correctly describe and compare the scale of this problem. Urinary incontinence should not be underestimated, because if untreated it may lead to physical, psychological and social disorders.

The purpose of this review is to describe and evaluate the existing research on the use of urine alarms in the daytime toilet training of children with intellectual and developmental disabilities (IDD). A systematic literature search yielded 12 studies, many of which were published over a decade ago. The findings suggest that interventions that incorporate the use of urine alarms are promising in the treatment of daytime enuresis for children with IDD; however, more carefully controlled research is needed to confirm these findings and elucidate the precise role urine alarms may play in toileting interventions. Methodological strengths and limitations of the body of research are discussed.

Objective: To characterize a cohort of children with non-neurogenic daytime urinary incontinence followed-up in a tertiary center. Methods: Retrospective analysis of 50 medical records of children who had attained bladder control or minimum age of 5 years, using a structured protocol that included lower urinary tract dysfunction symptoms, comorbidities, associated manifestations, physical examination, voiding diary, complementary tests, therapeutic options, and clinical outcome, in accordance with the 2006 and 2014 International Children's Continence Society standardizations. Results: Female patients represented 86.0% of this sample. Mean age was 7.9 years and mean follow-up was 4.7 years. Urgency (56.0%), urgency incontinence (56.0%), urinary retention (8.0%), nocturnal enuresis (70.0%), urinary tract infections (62.0%), constipation (62.0%), and fecal incontinence (16.0%) were the most prevalent symptoms and comorbidities. Ultrasound examinations showed alterations in 53.0% of the cases; the urodynamic study showed alterations in 94.7%. At the last follow-up, 32.0% of patients persisted with urinary incontinence. When assessing the diagnostic methods, 85% concordance was observed between the predictive diagnosis of overactive bladder attained through medical history plus non-invasive exams and the diagnosis of detrusor overactivity achieved through the invasive urodynamic study. Conclusions: This subgroup of patients with clinical characteristics of an overactive bladder, with no history of urinary tract infection, and normal urinary tract ultrasound and uroflowmetry, could start treatment without invasive studies even at a tertiary center. Approximately one-third of the patients treated at the tertiary level remained refractory to treatment. Resumo: Objetivo: Caracterizar uma coorte de crianças com incontinência urinária diurna não neurogênica acompanhada em serviço terciário. Métodos: Análise retrospectiva de 50 prontuários de crianças com controle miccional ou idade mínima de cinco anos, por meio de protocolo estruturado, que incluiu sintomas de disfunção do trato urinário inferior, comorbidades, manifestações associadas, exame clínico, diário miccional, exames subsidiários, opções terapêuticas e evolução clínica, conforme normatizações da International Children's Continence Society, de 2006 e 2014. Resultados: Eram do sexo feminino 86% dos pacientes. A idade média foi de 7,9 anos e o seguimento médio de 4,7 anos. Urgência (56,0%), urge-incontinência (56,0%), retenção urinária (8,0%), enurese noturna (70,0%), infecção do trato urinário (62,0%), constipação (62,0%) e perda fecal (16,0%) foram os principais sintomas e comorbidades. Exames de ultrassom apresentaram alterações em 53,0% dos casos, e o estudo urodinâmico, em 94,7%. Na última consulta, 32,0% dos pacientes ainda apresentavam incontinência urinária. Ao analisar os métodos diagnósticos, observou-se concordância de 85,0% entre o diagnóstico preditivo de bexiga hiperativa obtido pela história clínica mais exames não invasivos e o diagnóstico de hiperatividade detrusora obtido pelo estudo urodinâmico Conclusão: O subgrupo de pacientes com quadro clínico característico de bexiga hiperativa, sem antecedentes de infecção urinária, ultrassom de vias urinárias e urofluxometria normal poderia iniciar tratamento sem a necessidade de estudos invasivos, inclusive em serviço terciário. Aproximadamente um terço dos pacientes com incontinência urinária atendidos em serviços terciários permanecem refratários ao tratamento. Keywords: Diagnosis, Urinary incontinence, Pediatrics, Urinary tract, Quality of life, Child, Palavras-chave: Diagnóstico, Incontinência urinária, Pediatria, Sistema urinário, Qualidade de vida, Criança

Summary Background Globally, attitudes and practices towards toilet training have changed several decades ago and children are completing toilet training at a later age compared to previous generations. Concurrently, there has been an increase in the incidence of pediatric bladder bowel dysfunction (BBD), including lower urinary tract dysfunction (LUTD). Whether the fact of delayed toilet training may negatively impact the ability of children to obtain bladder and bowel control and cause LUT dysfunction remains controversial. Objectives To investigate the association between age at initiation of toilet training or approach to toilet training and the risks of lower urinary tract (LUT) dysfunction. Methods A comprehensive search of the CENTRAL, EMBASE and MEDLINE via Ovid SP, and CINAHL via EBSCO databases was conducted to identify RCTs, cohort or case-control studies investigating the association between age at initiation of toilet training, approach used for toilet training, and pediatric LUT dysfunction. Results A total of 10 studies with 24,121 participants (aged 5–17) were included for pooled analysis. Overall, the odds ratio (OR) with 95% confidence interval (95%CI) of LUT dysfunction in children who initiated toilet training at a younger age when compared to those who initiated toilet training at an older age, was 0.71 (0.63–0.81), P Discussion Although the definition about the age of initial toilet training varied greatly in studies, findings from the current study suggested that the optimal time for initiating toilet training may be prior to the age of 24 months; if toilet training was initiated after 24 months or later, it may result in increased prevalence of LUT dysfunction. Since no RCTs studies were included in the current meta-analysis, well-designed longitudinal studies with larger sample size and from different cultural background are needed to confirm these results. Conclusion This meta-analysis presents preliminary findings that show the incidence of LUTD may be decreased by initiating toilet training in children at a younger age. Summary Table . Summarized effect estimates for composite outcome assessed for association between age of toilet training (TT) and LUT dysfunction Outcome assessed Number of studies Odds ratio 95% confidence interval P value Composite earlier vs late TT with LUT dysfunction (pooled-effects estimate) 8 0.71 0.63–0.81 0.001 Subgroup Day-time incontinence 4 0.77 0.62–0.95 0.014 Enuresis 4 0.63 0.43–0.94 0.023 Initial TT before age of 24 months vs after 24 months 7 0.77 0.63–0.94 0.009

A voided volume (VV) of50% of the expected bladder capacity for age is considered small VV. It was recommended that a VV ≥50% of expected bladder capacity for age is required to assess uroflowmetry (UFM) curves because a small VV causes changes in UFM curve characteristics. However, no clear consensus has been reached on the criterion for evaluating UFM curve patterns.The aim of the study was to evaluate the reproducibility and characteristics of UFM curve patterns in children with daytime urinary incontinence (DUI) and with a variety of VVs.This study investigated 119 children (79 boys and 40 girls) with primary DUI who underwent UFM 3 times on the same day and were classified into two groups: small VV (50% of expected bladder capacity for age) in 0-1 of the 3 UFM measurements (group 1; normal VV) or in 2-3 of the 3 UFM measurements (group 2; small VV). The authors then evaluated the agreement of UFM curve patterns among the 3 measurements, classifying complete, partial, or no agreement according to the number of identical curve patterns. The authors also evaluated the most characteristic patterns of UFM curve patterns for each group.Group 1 comprised 45 children, and group 2 comprised 74 children. Rates of complete agreement (group 1, 24/45; group 2, 30/74), partial agreement (group 1, 19/45; group 2, 35/74), and no agreement (group 1, 2/45; group 2, 9/74) did not differ significantly between groups (p = 0.226). Bell curve patterns were significantly more common in group 1 than in group 2 (p = 0.025). Frequency of the tower pattern was significantly higher in group 2 than in group 1 (p = 0.006) (Summary table).No differences in agreement rates of UFM curve patterns were seen between two groups (small and normal VV). The authors thus suggest that UFM curve patterns can be validly assessed in children with DUI and with small VV. It was found that the bell pattern was significantly more common among children with normal VV, whereas the tower pattern was significantly more common among children with small VV. The tower pattern reflects an overactive bladder. The present results suggest that some children have DUI that is not attributable to urgency.Reproducibility of UFM curve patterns might be properly assessed even in children with DUI and with small VV. This result suggests the presence of various pathological conditions other than the conditions with urgency underlying DUI.

Introduction: Non-neurogenic dysfunctional voiding (NDV) accounts for a significant portion of pediatric urology outpatient clinic visits. Biofeedback (BF) is a promising, non-invasive modality for treating children with DV and daytime wetting. Our objective was to investigate BF’s efficacy as a single first-line treatment for children with NDV and diurnal enuresis. Methods: A retrospective cohort study was conducted with a total of 61 consecutive patient records from January 2009 to March 2016. All children with NDV who had BF as first-line treatment were included. Full urological histories, physical examinations, dysfunctional voiding symptom score (DVSS), urine analysis, ultrasound (US), and uroflowmetry (UFM), and electromyogram (EMG) were performed and recorded for all patients before and after finishing the last BF cycle. The patient’s satisfaction scale was also obtained. Results: The mean age was 10±2.6 years. Most patients (80.3%) were females. The presenting symptoms were diurnal enuresis, urinary tract infections, and voiding discomfort in 52 (85.2%), 16 (26.2%), and 38 (62.3%) patients, respectively. Six months after the last BF cycle, there was a statistically significant objective improvement in US and UFM+EMG findings, with the disappearance of EMG signals in 40 of 61 (65.5%) patients. There was also a significant subjective symptomatic improvement, as the mean DVSS had decreased from 14 to 7.9 (p=0.003). Forty-seven patients (77%) were satisfied, while only eight (13.1%) were not. Conclusions: BF is considered a potentially effective, single firstline treatment modality for children with DV and diurnal enuresis. Long-term outcome assessments are needed to assess the children’s compliance and symptom recurrence.

Enuresis can cause loss of self-esteem in children, change relations with family and friends, and decrease the school success. This study was conducted to determine the prevalence of urinary incontinence (UI) in school children aged between 11-14 years and identify the emotions and social problems of enuretic children.A mixed methods approach was used on a group of students who reported UI by combining quantitative data from school population-based cross-sectional design with qualitative data using in-depth interview techniques. The data of this descriptive and cross-sectional study were collected from 2750 primary school students aged between 11-14 years in Istanbul.The overall prevalence of UI was 8.6% and decreased with age. Prevalence of the diurnal enuresis in children was 67.9% and all of them had non-monosymptomatic enuresis. 83.3% of the children were identifiedwith secondary enuresis for 1-3 years. UI was significantly more common in boys and those who had frequent urinary infections, whose first degree relatives had urinary incontinence problem in childhood, and who reportedlow socioeconomic level in the family. The emotional and social effects of urinary incontinence were given in the context of children's own expressions.Urinary incontinence is an important problem of school-age children. In this study the prevalence of UI was found to be 8.6%, diurnal UI and secondary enuresis were very common, and all of the children werenon-monosymptomatic. Enuresis has negative emotional and social effects on children.

Abstract. Objective: Daytime urinary incontinence (DUI) is common in childhood. The aim of the study was to neurophysiologically analyse the central emotion processing in children with DUI. Method: In 20 children with DUI (mean age 8.1 years, 55 % male) and 20 controls (mean age 9.1 years, 75 % male) visual event-related potentials (ERPs) were recorded after presenting emotionally valent (80 neutral, 40 positive, and 40 negative) pictures from the International Affective Picture System (IAPS) as an oddball-paradigm. All children received a full organic and psychiatric assessment. Results: Children with DUI did not differ significantly from controls regarding responses to emotional pictures in the frontal, central, and parietal regions and in the time intervals 250–450 ms, 450–650 ms, and 650–850 ms after stimulus onset. The patient group had more psychological symptoms and psychiatric comorbidities than the control group. Conclusions: EEG responses to emotional stimuli are not altered in children with DUI. Central emotion processing does not play a major role in DUI. Further research, including a larger sample size, a more homogeneous patient group (regarding subtype of DUI) or brain imaging techniques, could reveal more about the central processing in DUI.

Purpose This study aims to evaluate the endoscopic morphological features of congenital posterior urethral obstructions in boys with refractory daytime urinary incontinence and/or nocturnal enuresis. Patients and Methods A total of 54 consecutive patients underwent endoscopy and were diagnosed with a posterior urethral valve (PUV) (types 1–4). PUV type 1 was classified as severe, moderate, or mild. A transurethral incision (TUI) was mainly performed for anterior wall lesions of the PUV. Voiding cystourethrography and pressure flow studies (PFS) were performed before and 3 to 4 months after TUI. Clinical symptoms were evaluated 6 months after TUI, and outcomes were assessed according to PFS waveform pattern groups (synergic pattern [SP] and dyssynergic pattern [DP]). Results All patients had PUV type 1 and/or 3 (i.e., n = 34 type 1, 7 type 3, and 13 types 1 and 3). There were severe (n = 1), moderate (n = 21), and mild (n = 25) cases of PUV type 1. According to PFS, SP and DP were present in 43 and 11 patients, respectively. TUI was effective in the SP group and symptoms improved in 77.4 and 69.3% of patients with daytime incontinence and nocturnal enuresis, respectively. Almost no effect was observed in the DP group. A significant decrease in the detrusor pressure was observed at maximum flow rate using PFS in the SP group. Conclusions PUV type 1 encompassed lesions with a spectrum of obstructions ranging from severe to mild, with mild types whose main obstructive lesion existed at the anterior wall of urethra occurring most frequently in boys with refractory daytime urinary incontinence and/or nocturnal enuresis.

Summary Objective The aim was to analyze the prevalence of eating problems and specific associations between overweight, obesity, and eating behavior in children with incontinence. Subjects and methods Forty-three consecutively presented children with incontinence, diagnosed to International Children's Continence Society standards, and 44 matched continent controls were examined prospectively. All children received a physical examination, sonography, and a one-dimensional intelligence test. Child psychopathology was measured with the Child Behavior Checklist (CBCL/4–18). Eating problems were assessed with the German version of the Dutch Eating Behaviour Questionnaire for Children (DEBQ-C) and a 40-item-parental questionnaire referring to atypical eating problems. Results Of the 43 children with incontinence, 23.3% had nocturnal enuresis (NE) only, 37.2% had any form of daytime urinary incontinence (DUI) (isolated or combined with NE) and 39.5% had fecal incontinence (FI) (isolated or combined with NE and/or DUI). Incontinent children showed significantly more CBCL externalizing symptoms (35.7% vs. 6.8%) and total problems (46.3% vs. 6.8%) in the clinical range (>90th percentile), as well as significantly lower mean IQ (105.5 vs. 120.6) than continent controls. Of the children with incontinence, 16.9% were affected by obesity (≥95th body mass index [BMI] percentile) compared with none of the continent controls. Especially in children with FI, the rate of obesity was significantly increased (23.5%). In addition, 46.5% of incontinent children, but none of the controls, had constipation. Again, children with FI (82.4%) had the highest rate of constipation (>DUI: 25% > NE only: 20%). “Food refusal” (FR) and “intense fear of gaining weight” (GW), but not other eating problems, were significantly more common among incontinent children (FR mean score 7.3; GW mean score 1.4) than in controls (FR mean score 5.6; GW mean score 0.7). After controlling for BMI percentiles, FR still was significantly higher in incontinent children. Children with FI had the highest score of FR among all subgroups of incontinence (mean score 9.1). Conclusions This study shows that overweight, obesity, behavioral and eating problems are especially associated with disorders of the gastrointestinal tract (FI and constipation), and only to a lesser degree with those of the urinary tract (DUI and NE). These problems should be addressed routinely in the clinical care of children with incontinence. Incontinent children Continent controls N (%) 43 (100) 44 (100) Boys: N (%) 25 (58.1) 24 (54.5) Age: mean (SD) 8.2 (2.1) 8.3 (1.9) IQ: mean (SD) 105 (16.2) 121 (17.5) Overweight + Obesity N: (%) 12 (38.6) 6 (14.0) CBCL Total score: mean T-values (SD) 61.0 (10.9) 49.4 (9.9) EDNOS-PQ Intense fear gaining weight: mean (SD) 1.4 (1.5) 0.7 (1.1) Food refusal: mean (SD) 7.3 (4.6) 5.6 (3.0)

Oppositional defiant disorder (ODD) and incontinence are common disorders of childhood. We have examined associations between ODD symptoms and incontinence in a representative sample of young children.A questionnaire with seven questions referring to incontinence, eight DSM-IV items of ODD, 15 items of the Home Situations Questionnaire and six items regarding eating, drinking or toileting refusal was administered to the parents of 718 children at school-entry from a defined geographical area at school-entry.Of the 718 6-year-old children included in the analysis, 8.2% had nocturnal enuresis (NE), 1.5% had daytime urinary incontinence (DUI) and 1.1% had faecal incontinence (FI). Significantly more boys than girls had NE (12 vs. 4.3%). Overall, 6.7% of children had ODD symptoms. Rates of ODD symptoms were significantly higher in incontinent children (19.5%) than in continent children (5.2%), with the highest rate of ODD symptoms in children with DUI (36.4%). Children with incontinence (mean 6.1 episodes) or ODD symptoms (mean 8.4 episodes) showed non-compliant behaviours in more problem situations than continent children (mean 4.5 episodes) or children without ODD symptoms (mean 4.5 episodes).Incontinence and ODD are common comorbid disorders at school-entry age. Boys are more affected by both disorders. Children with DUI have the highest rate of ODD symptoms. As ODD symptoms affect many daily family situations, ODD needs to be diagnosed and treated in children with incontinence, as it can negatively affect compliance.

Author(s): Vasconcelos, Monica MA; East, Patricia; Blanco, Estela; Lukacz, Emily S; Caballero, Gabriela; Lozoff, Betsy; Gahagan, Sheila | Abstract: ObjectiveTo investigate whether infant temperament and childhood internalizing, externalizing, and inattention symptoms increase the likelihood of daytime urinary incontinence or nocturnal enuresis at 10 years and adolescence (11.9-17.8 years).MethodData were from a longitudinal cohort of 1119 healthy Chilean children. We assessed behavioral symptoms at infancy, 5 years, and 10 years and their relationship with subsequent daytime urinary incontinence and nocturnal enuresis.ResultsDaytime urinary incontinence and nocturnal enuresis occurred in, respectively, 3.3% and 11.4% at 10 years and 1.1% and 2.7% at adolescence. Difficult infant temperament was associated with increased odds of 10-year daytime urinary incontinence. Inattention at 5 years was associated with increased odds for nocturnal enuresis at 10 years and adolescence. Internalizing and externalizing symptoms at 5 years were associated with increased odds of 10-year daytime urinary incontinence and nocturnal enuresis. Internalizing and externalizing symptoms at 10 years were associated with adolescent nocturnal enuresis.ConclusionTemperament and internal/externalizing symptoms may be risk factors for school-age and adolescent urinary incontinence.

Aims The "Parental Questionnaire: Enuresis/Urinary Incontinence" (PQ-EnU) is widely-used in clinical assessment of nocturnal enuresis (NE) and daytime urinary incontinence (DUI). It includes 18 items regarding daytime (DW) and nighttime wetting (NW), 24 items concerning toilet habits (TH), and 14 items regarding behavioral problems (BP). The aim of the study was to evaluate reliability and validity of the PQ-EnU. Methods Parents of 490 children (M = 8.7 years [SD = 2.9], 68.2% male) presented in an outpatient incontinence clinic completed the PQ-EnU and the Child Behavior Checklist (CBCL). Internal consistencies, factorial structure, and convergent validity regarding incontinence diagnoses and psychopathology were examined. Results 84.1% had NE, 38.8% DUI, and 20.8% fecal incontinence (FI). Internal consistencies were good for TH and BP. A factor analysis of the TH scale revealed three subscales ("Lower urinary tract symptoms (LUTS)," "Bowel symptoms," and "Voiding dysfunctions"). The LUTS and "Bowel symptoms" subscales were significantly correlated to clinical diagnoses of DUI and FI, respectively. A factor analysis of the BP scale revealed also three subscales ("attention/school deficits," "impulsive-aggressive behavior" and "internalizing problems," which were all significantly correlated with the CBCL. The questionnaire discriminated significantly between children with and without DUI or FI, and children with and without a clinical CBCL score. Conclusions The PQ-EnU is a valid and reliable parental questionnaire to measure incontinence, bladder/bowel symptoms, and behavioral problems in children. Due to its shortness, the PQ-EnU is an efficient measurement, which can be used in clinical settings and also as a screening tool for psychological symptoms.

Summary Introduction Since standardization of the ICCS terminology, only two small case series of children with extraordinary daytime only urinary frequency (EDOUF) have been published. The aims of the present study were i) to describe a large cohort of children affected by EDOUF, to evaluate its rate among the main micturition pediatric disturbances, and to determine if there is different EDOUF onset among seasons; ii) to investigate possible associations with urodynamic abnormalities by non-invasive techniques; iii) to evaluate whether postponing micturition exercise (PME) can objectively verify the anamnestic data hinting at the EDOUF diagnosis; and iv) to determine the effect of postponing micturition at home. Material and methods We reviewed the records of all patients with EDOUF, nocturnal enuresis, and/or overactive bladder firstly examined from March 2012 to February 2016. We evaluated post-void residual and bladder wall thickness by urinary ultrasound and uroflowmetry and recorded the season in which the EDOUF started. Through the PME, the EDOUF diagnosis was confirmed if patients were able to postpone micturition reaching at least 80% of the expected bladder capacity without showing urinary incontinence. At home, we recommended postponing micturition for a maximum of 3 h if EDOUF affected the normal daily activities of both children and parents. We set a telephone interview for 3 months later. Results The clinical characteristics of the EDOUF population are shown in the Table. The EDOUF rate was 12.1%. The rate of EDOUF onset was significantly lower during the summer than in other seasons (p = 0.02) and the OR for onset of EDOUF in the summer – compared with the other seasons – was 0.37 (95% CI 0.18–0.74; p = 0.005). Eighty-five (80.2%) patients reported an intermittent trend of the EDOUF with variable periods of improvement and worsening. All the EDOUF patients had normal uroflowmetry, 1/106 had post-micturition bladder wall thickness >5 mm and one post-void residual. At the PME, 106 out of 106 (100%) patients with EDOUF were able to reach at least 80% of the EBC without showing urinary incontinence or urgency incontinence. After 3 months, in 98.1% of the patients the symptoms had disappeared or improved. Discussion and conclusions Childhood EDOUF is rather common and is generally associated with normal non-invasive urodynamic patterns. The PME allows verification of anamnestic data of EDOUF. The sole recommendation to postpone micturition for a maximum of 3 h or until the micturition postponement became stressful could be considered as a possible approach. Table . Clinical characteristics of the 106 patients with EDOUF. Age at EDOUF diagnosis, yr 6.8 ± 2.3 Female sex, no. (%) 53 (50) SBP, SDS 0.31 ± 0.7 DBP, SDS 0.17 ± 0.8 Age at continence, yr 2.3 ± 0.5 Nocturia, no. (%) 1 (0.9) Constipation, no. (%) 19 (17.4) Urgency, no. (%) 0 (0) Incontinence, no. (%) 0 (0) EBC >80% at PME, no. (%) 106 (100) Post-micturition bladder wall thickness >5 mm, no. (%) 1 (0.9) Presence of post-void residual, no. (%) 1 (0.9) a Maximum flow, mL/s 19.34 ± 10.2 Normal uroflowmetry, no. (%) 106 (100) Normal urinalysis, no. (%) 106 (100) Previous UTIs, % 2 (1.9) b Daily micturitions, no. 20.1 ± 7.2 Mean daily voided volumes (% of the EBC) 28.7 ± 9.2 Data are given as means ± SDS, unless stated otherwise. DBP, diastolic blood pressure; EBC, expected bladder capacity; EDOUF, extraordinary daytime only urinary frequency; PME, postponing micturition exercise; SBP, systolic blood pressure; SDS, standard deviation score; UTI, urinary tract infection. a Only one patient presented a post-void residual of 30 mL. b All the UTIs were not febrile.

Aripiprazole is an atypical antipsychotic with dopaminergic and serotonergic effects. Enuresis as an adverse effect has been reported with aripiprazole use in children with autism spectrum disorders. Here, we report 2 cases without autism spectrum disorders who developed diurnal enuresis after starting aripiprazole and ceased after discontinuation of the medication.

According to the International Children’s Continence Society (ICCS) guidelines for the treatment of daytime urinary incontinence (DUI) in children and adolescents, the first-line intervention for all types of DUI is standard urotherapy (SU). Despite this recommendation there is still no meta-analysis available on the effectiveness of SU. The aim of this study is to provide a meta-analytic evaluation of the intervention. This meta-analysis is based on Odds Ratios (OR) and consists of 26 patient samples out of 19 studies (N = 1609), collected from well-established medical databases. Remission rates after SU are compared to spontaneous remission rates, which are matched to the individual follow-up period. The meta-analysis shows that SU is an effective treatment of DUI. Compared to a spontaneous remission rate of 15.40% per year, urotherapy increases the probability to recover by a factor of 7.27 (6.57 if corrected for publication bias). After exclusion of three outlying samples this effect can be generalized for all types of SU and all patient populations. Moderator analyses cannot identify variables which significantly influence the variance of effect sizes. However, RCTs seem to be associated with lower effects, even when the control group is not considered for effect size calculation. Based on the present meta-analysis, SU is an effective intervention for treating DUI in children and adolescents. Of 100 patients in 1 year, approximately 56 patients (54 if corrected for publication bias) remit after being treated with SU, while only 15 out of 100 remit spontaneously. However, to further quantify the effect size of SU in comparison to spontaneous remission rates and other treatments, additional RCTs are still needed.

Aripiprazole is a second-generation antipsychotic drug that is partial agonist of dopamine D2 receptor. It is used in the treatment of some psychiatric disorders such as schizophrenia, bipolar disorder. It has rarely been reported that aripiprazole has side effects of urinary retention and enuresis in children. In this case presentation diurnal enuresis secondary to aripiprazole treatment will be discussed., Aripiprazol parsiyel D2 reseptör agonisti olan ikinci kuşak bir antipsikotik ilaçtır. Bipolar bozukluk ve şizofreni gibi bazı psikiyatrik rahatsızlıkların tedavisinde kullanılmaktadır. Çocuklarda aripiprazolün üriner retansiyon ve enürezis yan etkileri nadiren bildirilmiştir. Bu olgu sunumunda, aripiprazol tedavisine sekonder gelişen bir diürnal enuüezis tartışılacaktır.

Urethral stricture defined as congenital only if it is not an inflammatory, it is a short-length and it is not associated with history of or potential for urethral trauma, or instrumentation. It is not considered a rare disease, and we must note the existence of such anomaly, especially in boys suffering from recurrent urinary tract infections, dysuria, disturbed voiding, drug- resistant diurnal enuresis, pollakisuria or hematuria in pediatric urological practice. Stricture also disturbs spontaneous healing of vesicoureteral reflux. Usually findings above the stenotic segment include a bladder wall thickening, hydronephrosis, and renal dysplasia. VCUG demonstrates the stenotic segment and the associated alterations.

Externalizing disorders as attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common in children with nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI). We examined the prevalence rates of ADHD, ODD and incontinence in a defined geographical area and analysed the association between externalizing disorders and subtypes of incontinence. 1,676 parents of children who were presented at the mandatory school-entry medical examination completed a questionnaire with all DSM-IV items of ADHD, ODD and six questions regarding incontinence. 50.2% were male and mean age was 5.7 years. 9.1% had at least one subtype of incontinence (8.5% had NE, 1.9% DUI and 0.8% FI). Boys were significantly more affected by incontinence overall, NE, FI and ADHD than girls. 6.4% had ADHD, 6.2% had ODD and 2.6% were affected by ADHD and ODD. 10.3% of the children with incontinence had ADHD and 10.3% ODD. Children with FI were significantly more affected by externalizing disorders (50%) than children with isolated NE (14.5%), children with DUI (9.5%) and continent children (9.5%). Children with incontinence, especially those with FI, are at much higher risk of externalizing disorders. An additional effect of children with both ADHD and ODD having higher rates of incontinence than children with only one disorder could not be found. However, these children represent a high-risk group with lower compliance to treatment and worse outcome. Therefore, screening not only for ADHD but also for ODD should be implemented for all children with incontinence.

On the basis of some research evidence and consensus, up to one-third of patients with enuresis will have daytime urinary symptoms indicative of lower urinary tract (LUT) dysfunction. (8)(9) On the basis of international consensus, children with enuresis and LUT dysfunction are correctly identified as having nonmonosymptomatic enuresis (NMSE) (formerly termed diurnal enuresis). (1)(2) On the basis of some research evidence and consensus, an adequate voiding and elimination history is the primary tool in differentiating between MSE and NMSE. (2)(7)(8). On the basis of some research evidence and consensus, therapy for NMSE is based on addressing underlying LUT dysfunction, constipation, and comorbid behavioral conditions before addressing enuresis. (2)(8)(9)(12) On the basis of some research evidence and consensus, treatment of underlying BBD and comorbid conditions will often result in improvement or resolution of enuresis. (2)(8)(9)(12). On the basis of international consensus, if enuresis is still present and a concern after treatment of underlying LUT, specific medical or behavioral therapy for enuresis should be offered to the family.(2)(8).

Objective To analyze treatment outcomes and the association between treatment effects and health-related quality of life (HRQoL) for incontinent children, and their parents. Subjects and methods Health-related quality of life in 70 consecutively treated children, and their parents, was assessed with the Pediatric Incontinence Questionnaire and the WHO-Quality-Of-Life-BREF questionnaire. This was assessed before and after three months of standardized treatment. Results In 44.3% of children, symptoms decreased by 50–89%. After three months of treatment, the HRQoL of children improved significantly. Children with bladder and bowel dysfunction had a significantly lower HRQoL than children with isolated nocturnal enuresis, daytime urinary incontinence or fecal incontinence. Parental HRQoL did not change significantly within three months of treatment. Parents showed a significantly lower mean in the ‘psychological’ domain of the WHO-QoL-BREF questionnaire compared to norms. Conclusion Children with different subtypes of incontinence can be treated effectively within three months of therapy. After three months, significant improvements of HRQoL were shown. Parents showed no general reduction in their quality of life (QoL). Specific aspects of parental QoL were impaired, but did not improve during the treatment of their children.

ADHD and incontinence are common childhood disorders which co-occur at much higher rates than expected by chance. The aim of this review was to provide an overview both of the comorbidity of nocturnal enuresis (NE), daytime urinary incontinence (DUI) and faecal incontinence (FI) in children with ADHD; and, vice versa, of the co-occurrence of ADHD in children with NE, DUI and FI. Most clinical studies have focussed on the association of ADHD and NE. Population-based studies have shown that children with DUI have an even greater risk for ADHD than those with NE. While children with FI have the highest overall comorbidity rates of psychological disorders, these are heterogeneous with a wide range of internalising and externalising disorders--not necessarily of ADHD. Genetic studies indicate that ADHD and NE, DUI and FI do not share the same genetic basis. The comorbidity is conferred by non-genetic factors. Possible aetiological and pathogenetic links between ADHD and incontinence are provided by neurophysiological, imaging and pharmacological studies. The co-occurrence has clinical implications: children with ADHD and NE, DUI and FI are more difficult to treat, show lower compliance and have less favourable treatment outcomes for incontinence. Therefore, both groups of disorders have to be assessed and treated specifically.

Objective: To review the classification, evaluation, and management of pediatric urinary incontinence. Methods: An examination of texts and peer-reviewed literature was performed to identify subject matter relevant to the stated objectives, with the experience of the senior author used in cases where the literature failed to provide guidance. Results: On the basis of our review, we identified the International Children’s Continence Society’s (ICCS) statement standardizing the terminology for lower urinary tract function in children and present a logical classification scheme for incontinence. After an epidemiology review, we discuss the appropriate evaluation of the incontinent child, of which the cornerstones are a detailed history and thorough physical exam. Finally, a concise discussion of the management of daytime incontinence, nocturnal enuresis, and neurogenic and anatomic incontinence is presented, with deference to evidence-based approaches where available. Depending on the type of incontinence, the management strategies can include behavioral, pharmacologic, and/or surgical approaches. Conclusion: Pediatric urinary incontinence is a common condition which, after appropriate evaluation, can be successfully treated. Keywords : Urinary incontinence; Diurnal enuresis; Nocturnal enuresis; Pediatrics

This study aimed at determining the prevalence and factors associated with enuresis in Dogarawa community of Kaduna state, North western Nigeria. Using a structured questionnaire, the prevalence of enuresis was determined amongst apparently healthy 300 children aged 5-17 years from 15 th September, 2010 to 20 th January, 2011.The prevalence of enuresis was 26.3%. Males accounted for 69.6% (55 subjects) while females made up 30.4% (24 subjects) of those who were enuretic. The relationship between gender and prevalence of enuresis was statistically significant (χc 2 = 8.92, df = 1, p< 0.05). All the enuretic children had primary enuresis, no case of secondary enuresis was recorded. There was also no case of strict diurnal enuresis. Sixty-five (21.7%) of the enuretic children had strict nocturnal enuresis and 14 (4.7%) had combined nocturnal and diurnal enuresis. The prevalence of enuresis decreased with increasing age and this was statistically significant (χ 2 = 16.3, df =3, p< 0.05).Although not statistically significant, enuresis was commoner in children from low socio-economic background and amongst first order births. There was a positive association between family history of bedwetting and prevalence of enuresis (χc 2 =124.2, df=4, p < 0.05). The 1 It is a worrying condition that involves repeated voiding of urine into clothes or bedclothes that persist beyond the normative age of maturation of urinary control. 2 Enuresis may be classified as nocturnal, diurnal or both. It can also be classified as primary or secondary consistent with the fashion of its onset. 3 The prevalence estimates of enuresis are highly