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Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence.

Journal article
Authors Jan D van Gool
Tom P V M de Jong
Pauline Winkler-Seinstra
Tytti Tamminen-Möbius
Hildegard Lax
Herbert Hirche
Rien J M Nijman
Kelm Hjälmås
Ulf Jodal
Hannsjörg Bachmann
Piet Hoebeke
Johan Vande Walle
Joachim Misselwitz
Ulrike John
An Bael
Published in Neurourology and Urodynamics
Volume 33
Issue 5
Pages 482-487
ISSN 0733-2467
Publication year 2014
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 482-487
Language en
Links dx.doi.org/10.1002/nau.22446
Keywords anticholinergics; bladder training; corticotropin-releasing factor; cognitive treatment; dysfunctional voiding; incontinence; urinary tract infection; urge syndrome; urodynamics; pelvic floor training
Subject categories Pediatrics

Abstract

OBJECTIVE: Functional urinary incontinence causes considerable morbidity in 8.4% of school-age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi-center controlled trial was designed, the European Bladder Dysfunction Study. METHODS: Seventy girls and 27 boys with clinically diagnosed OAB and urge incontinence were randomly allocated to placebo, oxybutynin, or bladder training (branch I), and 89 girls and 16 boys with clinically diagnosed DV to either cognitive treatment or pelvic floor training (branch II). All children received standardized cognitive treatment, to which these interventions were added. The main outcome variable was daytime incontinence with/without urinary tract infections. Urodynamic studies were performed before and after treatment. RESULTS: In branch I, the 15% full response evolved to cure rates of 39% for placebo, 43% for oxybutynin, and 44% for bladder training. In branch II, the 25% full response evolved to cure rates of 52% for controls and 49% for pelvic floor training. Before treatment, detrusor overactivity (OAB) or pelvic floor overactivity (DV) did not correlate with the clinical diagnosis. After treatment these urodynamic patterns occurred de novo in at least 20%. CONCLUSION: The mismatch between urodynamic patterns and clinical symptoms explains why cognitive treatment was the key to success, not the added interventions. Unpredictable changes in urodynamic patterns over time, the response to cognitive treatment, and the gender-specific prevalence suggest social stress might be a cause for the symptoms, mediated by corticotropin-releasing factor signaling pathways. Neurourol. Urodynam. © 2013 Wiley Periodicals, Inc.

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