Diurnal enuresis (in children with attention disorders)

Support and education of parents, appropriate school placement and pharmacotherapy (tricyclic antidepressants), usually handled by child psychiatrists, are the treatment options.

Urinary incontinence

If recurrent UTIs are present, long-term antibiotic therapy should be started, initially for 6 months. Urinary incontinence is treated according to the aetiology and to urodynamic findings.

Incontinence associated with anatomical abnormalities of the urinary tract Treatment is within the framework of the operative repair of the abnormality.

Incontinence associated with neurogenic disorder

The cornerstone of treatment in young children is oriented towards the protection of renal function and efficient evacuation of the bladder. When the child becomes motivated to be dry (usually after the age of 5 years), the persistent urinary incontinence is addressed. Clean intermittent catheterization to ensure an efficient bladder emptying is mostly applied in patients with detrusor-sphincter dyssynergia. Medical therapy is applied according to the urodynamic findings:

• Detrusor hyperreflexia: oxybutinin, propiverin, tolterodine

• Detrusor sphincter dyssynergia: alpha-blockers, polysynaptic inhibitor (baclofenum)

Surgical therapy can be conducted in the case of renal function deterioration, in persistent high filling detrusor pressure and/or urinary incontinence. Options include bladder augmentation, treatment of sphincter weakness and formation of a catheterizable channel.

Functional incontinence in non-neuropathic bladder-sphincter dysfunction

Urge syndrome: Bladder rehabilitation (counselling about regular voiding and drinking habits, about the

technique of voiding); pharmacotherapy (oxybutynin, propiverin, tolterodine); intravesical stimulation and

transcutaneous neuromodulation (optional).

Dysfunctional voiding (detrusor sphincter dysco-ordination): Bladder rehabilitation (counselling about regular voiding and drinking habits, about the technique of voiding, biofeedback, clean intermittent catheterization if residual urine is significant) and pharmacotherapy (alpha blockers, polysynaptic inhibitor-baclofenum).

Lazy bladder syndrome: Counselling about regular voiding; clean intermittent catheterization; treatment of constipation and intravesical stimulation.

Hinman syndrome: According to urodynamic examination; counselling about regular voiding, usually clean intermittent catheterization if emptying not complete.

REFERENCES

Chandra M.

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Cisternino A, Passerini Glazel G.

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Elder JS.

Bladder rehabilitation: the effect of a cognitive training programme on urge incontinence. J Urol 1997; 158: 1642.

Hjalmas K.

What's new in nocturnal enuresis? Old concepts and new knowledge.

European Union of General Practitioners Reference Book - Clinical Care. Kennedy (ed), 1998/99.

Hoebeke P, Vande Walle J, Everaert K, Van Laecke E, Van Gool JD.

Assessment of lower urinary tract dysfunction in children with non- neuropathic bladder sphincter dysfunction. Eur Urol 1999; 35: 57-69.

Hoebeke P, Raes A, Vande Walle J, Van Laecke E.

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Hoekx L, Wyndaele JJ, Vermandel A.

The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity. J Urol 1998; 160: 858-860.

Holland AJ, King PA, Chauvel PJ, O'Neill MK, McKnight DL, Barker AP.

Intravesical therapy for the treatment of neurogenic bladder in children. Aust N Z J Surg 1997; 67: 731-733.