OBJECTIVE: To evaluate the effect of an inpatient cognitive and biofeedback training program for children with urge complaints and urge incontinence based on overactive bladder (OAB) after failed earlier treatment by anticholinergic medication and by outpatient urotherapy. A search for predictors for success of treatment outcome is included in the study.
PATIENTS AND METHODS: Seventy children with therapy refractory incontinence based on OAB went through a 10-day in-hospital training program between 2007 and 2010. The children were aged between 7 and 13 years (mean 9.29 years). An essential part of this program is teaching the children central inhibition of their bladder to suppress bladder overactivity. Patients had, on average, 41.1 months of fruitless treatment by urotherapy and medication before attending this training program. The training result was evaluated 6 months after completion of the inpatient training program. A questionnaire was subsequently conducted 2 years after the training to evaluate the long-term efficacy of this program.
RESULTS: Six months after training, evaluation showed that 30 of the 70 patients (42.9%) were free of complaints, 22 (31.4%) had a significant reduction in complaints and 18 (25.7%) had no improvement. Logistic regression analysis was used to look at several variables predicting training outcome. A higher age during clinical training was found to be a predictor for a good training outcome. After 2 years, 44 (62.9%) patients were reached for long-term follow-up. Of these patients, 28 (63.6%) reported a good effect of the training and 12 (27.3%) experienced no improvement in symptoms compared with before clinical training. Objectively, 26 (59.1%) were dry and 18 (40.9%) were incontinent to some extent. A total of 14 (31.8%) patients had relapsed into urge complaints.
CONCLUSION: The inpatient cognitive and biofeedback training program for refractory OAB complaints has been demonstrated to cure or improve 74.3% of patients, and conveyed favorable long-term results in approximately 75.0% of patients. A higher age during clinical training was found to be a predictor for good training outcome.
Written by:
Meijer EF, Nieuwhof-Leppink AJ, Dekker-Vasse E, de Joode-Smink GC, de Jong TP. Are you the author?
Pediatric Urology Centre, University Children's Hospital UMC Utrecht, Utrecht, The Netherlands; Pediatric Urology, University Children's Hospital AMC, Amsterdam, The Netherlands. ; ; ; ;
Reference: J Pediatr Urol. 2014 Aug 11. pii: S1477-5131(14)00221-6.
doi: 10.1016/j.jpurol.2014.06.024
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PubMed Abstract
PMID: 25205144