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Incontinentie bij jonge kinderen (3 t/m 6 jaar) : Een retrospectieve evaluatie van diagnosen en behandeling

By N. Sijtema


Introduction Urinary incontinence is a common problem in the general pediatric and urology practice and is commonly seen in children aged 6 years and younger. Only a few studies have investigated the results of treatment of incontinence in this age group. Over the last years, there has been an increase in the number of young children presenting with incontinence at the outpatient incontinence clinic of the Deventer Ziekenhuis. The experiences with treatment of these children have been positive. The aim of this study is tot evaluate the treatment results of the multidisciplinary incontinence treatment programme in the Deventer Ziekenhuis in young children. Materials and methods This was a retrospective cohort study of children who were evaluated and treated for daytime incontinence between 2004 and 2010 at the outpatient clinic, and who were age 3-6 years at the time of the first visit. A review of patient files was performed. History of treatment, symptoms, micturation parameters, co-morbidity, diagnosis and treatment were investigated. Symptom frequencies before and after treatment were compared to determine treatment results. Follow-up was acquired by telephone to determine long-term treatment results. Statistical analysis was performed using PASW Statistical package, release 18. A significance level of p<0,05 was chosen. The statistical test were Pearson Chi-square test, Fisher’s Exact test, Student’s t-test, paired t-test, ANOVA, Mann-Whitney U test and Kruskal-Wallis test. Results Follow-up response was 94,6%. Statistical analysis was performed on the 143 patients of whom short term treatment results were known. Short term treatment results according to the ICCS definitions were: nonresponse 29,4%, partial response 16,8% , response 18,9% and full response 35,0%. There were nog significant differences between sexes, diagnosisgroups and agegroups. A significant decrease in symptom frequency was found in the total population. This decrease was also significant for the separate age groups of 4, 5 and 6 years. After 2 years, 77,9% of the children with initial response or full response, had complete success according to ICCS definitions (no relapse and less than 1 symptom occurrence monthly). The median ages at start and completion of toilet training were 24 and 33 months for girls, and 30 and 36 months for boys, respectively. These differences between sexes were significant. Psychosocial factors and start of primary school were a provoking factor in 7,7% of the population. Conclusion The multidisciplinary treatment of daytime incontinence in children aged 3-6 years at the Deventer Ziekenhuis is effective. Treatment results are comparable with results achieved in older populations. Therefore, evaluation and treatment of these young children in an outpatient programme is recommended. The global trend of later initiation and completion of toilet training is confirmed in this population. The relationship between later start and completion of toilet traing and incontinence could not be investigated, further investigation including controls is needed for that. Contrary to popular belief, the start of primary school or psychosocial factors do not appear to be important provoking factors.

Year: 2010
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