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Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence.
Neurourol Urodyn. 2014 Jun; 33(5):482-7.NU

Abstract

OBJECTIVE

Functional urinary incontinence causes considerable morbidity in 8.4% of school-age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi-center controlled trial was designed, the European Bladder Dysfunction Study.

METHODS

Seventy girls and 27 boys with clinically diagnosed OAB and urge incontinence were randomly allocated to placebo, oxybutynin, or bladder training (branch I), and 89 girls and 16 boys with clinically diagnosed DV to either cognitive treatment or pelvic floor training (branch II). All children received standardized cognitive treatment, to which these interventions were added. The main outcome variable was daytime incontinence with/without urinary tract infections. Urodynamic studies were performed before and after treatment.

RESULTS

In branch I, the 15% full response evolved to cure rates of 39% for placebo, 43% for oxybutynin, and 44% for bladder training. In branch II, the 25% full response evolved to cure rates of 52% for controls and 49% for pelvic floor training. Before treatment, detrusor overactivity (OAB) or pelvic floor overactivity (DV) did not correlate with the clinical diagnosis. After treatment these urodynamic patterns occurred de novo in at least 20%.

CONCLUSION

The mismatch between urodynamic patterns and clinical symptoms explains why cognitive treatment was the key to success, not the added interventions. Unpredictable changes in urodynamic patterns over time, the response to cognitive treatment, and the gender-specific prevalence suggest social stress might be a cause for the symptoms, mediated by corticotropin-releasing factor signaling pathways.

Authors+Show Affiliations

Institute for Medical Informatics, Biometry and Epidemiology, Essen-Duisburg University, Essen, Germany; Pediatric Renal Center, WKZ/UMC, Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23775924

Citation

van Gool, Jan D., et al. "Multi-center Randomized Controlled Trial of Cognitive Treatment, Placebo, Oxybutynin, Bladder Training, and Pelvic Floor Training in Children With Functional Urinary Incontinence." Neurourology and Urodynamics, vol. 33, no. 5, 2014, pp. 482-7.
van Gool JD, de Jong TP, Winkler-Seinstra P, et al. Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence. Neurourol Urodyn. 2014;33(5):482-7.
van Gool, J. D., de Jong, T. P., Winkler-Seinstra, P., Tamminen-Möbius, T., Lax, H., Hirche, H., Nijman, R. J., Hjälmås, K., Jodal, U., Bachmann, H., Hoebeke, P., Walle, J. V., Misselwitz, J., John, U., & Bael, A. (2014). Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence. Neurourology and Urodynamics, 33(5), 482-7. https://doi.org/10.1002/nau.22446
van Gool JD, et al. Multi-center Randomized Controlled Trial of Cognitive Treatment, Placebo, Oxybutynin, Bladder Training, and Pelvic Floor Training in Children With Functional Urinary Incontinence. Neurourol Urodyn. 2014;33(5):482-7. PubMed PMID: 23775924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence. AU - van Gool,Jan D, AU - de Jong,Tom P V M, AU - Winkler-Seinstra,Pauline, AU - Tamminen-Möbius,Tytti, AU - Lax,Hildegard, AU - Hirche,Herbert, AU - Nijman,Rien J M, AU - Hjälmås,Kelm, AU - Jodal,Ulf, AU - Bachmann,Hannsjörg, AU - Hoebeke,Piet, AU - Walle,Johan Vande, AU - Misselwitz,Joachim, AU - John,Ulrike, AU - Bael,An, AU - ,, Y1 - 2013/06/15/ PY - 2013/01/04/received PY - 2013/05/15/accepted PY - 2013/6/19/entrez PY - 2013/6/19/pubmed PY - 2015/2/13/medline KW - anticholinergics KW - bladder training KW - cognitive treatment KW - corticotropin-releasing factor KW - dysfunctional voiding KW - incontinence KW - pelvic floor training KW - urge syndrome KW - urinary tract infection KW - urodynamics SP - 482 EP - 7 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 33 IS - 5 N2 - OBJECTIVE: Functional urinary incontinence causes considerable morbidity in 8.4% of school-age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi-center controlled trial was designed, the European Bladder Dysfunction Study. METHODS: Seventy girls and 27 boys with clinically diagnosed OAB and urge incontinence were randomly allocated to placebo, oxybutynin, or bladder training (branch I), and 89 girls and 16 boys with clinically diagnosed DV to either cognitive treatment or pelvic floor training (branch II). All children received standardized cognitive treatment, to which these interventions were added. The main outcome variable was daytime incontinence with/without urinary tract infections. Urodynamic studies were performed before and after treatment. RESULTS: In branch I, the 15% full response evolved to cure rates of 39% for placebo, 43% for oxybutynin, and 44% for bladder training. In branch II, the 25% full response evolved to cure rates of 52% for controls and 49% for pelvic floor training. Before treatment, detrusor overactivity (OAB) or pelvic floor overactivity (DV) did not correlate with the clinical diagnosis. After treatment these urodynamic patterns occurred de novo in at least 20%. CONCLUSION: The mismatch between urodynamic patterns and clinical symptoms explains why cognitive treatment was the key to success, not the added interventions. Unpredictable changes in urodynamic patterns over time, the response to cognitive treatment, and the gender-specific prevalence suggest social stress might be a cause for the symptoms, mediated by corticotropin-releasing factor signaling pathways. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/23775924/Multi_center_randomized_controlled_trial_of_cognitive_treatment_placebo_oxybutynin_bladder_training_and_pelvic_floor_training_in_children_with_functional_urinary_incontinence_ L2 - https://doi.org/10.1002/nau.22446 DB - PRIME DP - Unbound Medicine ER -