Functional urinary incontinence in children. Clinical and urodynamic diagnosis, co-morbidity, and interventions, in a multi-center controlled trial

In school-age children, functional urinary incontinence is the leading symptom of non-neuropathic bladder-sphincter dysfunction, NNBSD. NNBSD is strongly associated with recurrent urinary tract infections (uti) and vesicoureteral reflux (vur).;To find the most effective treatment for NNBSD, the European Bladder Dysfunction Study was designed. For urge syndrome, we hypothesized that both oxybutynin chloride and bladder training, added to standard treatment, would be more effective than placebo plus standard treatment; for dysfunctional voiding pelvic floor training plus standard treatment would be more effective than standard treatment alone. The outcome was contrary to expectations: in urge syndrome neither oxybutynin nor bladder training had a higher cure rate than placebo, in dysfunctional voiding standard therapy had almost the same cure rate as standard treatment plus pelvic floor training. Standard treatment results in cure rates between 40% and 50%.;Diagnostic evaluation. Self-reported data from questionnaires, frequency-volume charts, and pad tests suffer from biases, with a significant discrepancy between the data obtained by the different methods. The pivotal role of the urotherapist, providing checks for self-reported data, has to be emphasized. Our findings indicate the need for a more objective assessment. Urodynamic findings do not correlate well with clinical diagnosis. The interpretation of urodynamic findings is difficult, we found substantial inter- and intra-observer differences. A significant relation between urodynamic patterns and treatment outcome was absent.;Comorbidity. Functional urinary incontinence often co-exists with constipation and functional fecal incontinence. In the ebds, this had no influence on the cure rate of treatment for urinary incontinence.;Behavioral problems reportedly play an important role in urinary incontinence. In the ebds, behavioral problems had the same incidence in children with urge syndrome as in the normative population. Behavioral problems in children with dysfunctional voiding occurred at twice the rate for the normative population. However, they did not influence the cure rate of treatment for urinary incontinence.;Conclusion. Children with nnbsd could benefit from a two-tiered approach, starting with a clinical diagnosis and 'remedial teaching' by a urotherapist, and, when failed, followed by sophisticated paediatric urodynamics and more objective assessment of incontinence and comorbidity.