This meta-analysis aimed to determine the comparative effectiveness of timed alarm device-assisted urotherapy vs. standard urotherapy alone in managing pediatric daytime urinary incontinence (pDUI).
A systematic literature search was performed in December 2021, with an update search in July 2022. Comparative studies assessing the pDUI treatment effectiveness of timed alarm device-assisted urotherapy vs. urotherapy alone were identified and evaluated according to Cochrane collaboration recommendations. The assessed outcome includes pDUI complete response and adherence rates. Relative risk (RR) with 95% confidence intervals (CI) was extrapolated. A random-effects model was used to pool effect estimates. Heterogeneity was assessed with sensitivity and subgroup analysis performed according to study design and comparative group characteristics. GRADE criteria were used to assess evidence certainty. PROSPERO (CRD42022299173).
Four studies (three randomized controlled trials [RCTs] and one retrospective cohort) with 635 cases were included. The pooled effect estimates of pDUI complete response showed no differences between intervention groups (RR 1.20, 95% CI 0.81, 1.76). Pooled effect estimates for treatment adherence were generated from two studies, which showed significantly better adherence for the timed-alarm device group (RR 2.97, 95% CI 1.46, 6.06). Significant interstudy heterogeneity was noted; the source is likely from the study design and comparator device characteristics. The quality of evidence was assessed to be of very low certainty.
Based on very low certainty evidence, timed alarm device-assisted urotherapy does not seem to have the advantage of complete treatment response over standard urotherapy alone in managing pDUI; however, a timed-alarm device is likely able to improve urotherapy treatment adherence.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2022 Dec 06 [Epub ahead of print]
Michael Chua, Mandy Rickard, Jin Kyu Kim, Natasha Brownrigg, Joana Dos Santos, Luzelle Kate Aba, Armando Lorenzo, Niraj Mistry
Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada., Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada., Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines., Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.