Bladder Training Video versus Standard Urotherapy for Bladder and Bowel Dysfunction: A Noninferiority Randomized, Controlled Trial
We evaluated whether an animated bladder training video was as effective as standard individual urotherapy in improving bladder/bowel symptoms.
Materials and Methods:
Patients 5 to 10 years old who scored greater than 11 on the bladder/bowel Vancouver questionnaire were included in a noninferiority randomized, controlled trial. Children with vesicoureteral reflux, neuropathic bladder, learning disabilities, recent urotherapy or primary nocturnal enuresis were excluded from analysis. Patients were randomly assigned to receive standard urotherapy or watch a bladder training video in clinic using centralized blocked randomization schemes. Bladder/bowel symptoms were evaluated at baseline and 3-month followup by intent to treat analysis. A sample size of 150 patients ensured a 3.5 difference in mean symptomology scores between the groups, which was accepted as the noninferiority margin.
Of 539 screened patients 173 (37%) were eligible for study and 150 enrolled. A total of 143 patients (95%) completed the trial, 5 (4%) were lost to followup and 2 (1%) withdrew. Baseline characteristics were similar between the groups. Baseline mean ± SD symptomology scores were 19.9 ± 5.5 for the bladder training video and 19.7 ± 6.0 for standard urotherapy. At 3 months the mean symptomology scores for the bladder training video and standard urotherapy were reduced to 14.4 ± 6.5 and 13.8 ± 6.0, respectively (p = 0.54). The mean difference was 0.6 (95% CI –1.4–2.6). The upper 95% CI limit of 2.6 did not exceed the preset 3.5 noninferiority margin.
The bladder training video was not inferior to standard urotherapy in reducing bladder/bowel symptoms in children 5 to 10 years old. The video allows families to have free access to independently review bladder training concepts as often as necessary.
- 1 : Recommendations for the management of bladder bowel dysfunction in children. Pediatr Therapeut2014; 4: 191. Google Scholar
- 2 : Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol2010; 184: 1134. Link, Google Scholar
- 3 : A population based study of 2,856 school-age children with urinary incontinence. J Urol2009; 181: 808. Link, Google Scholar
- 4 : Treatment of daytime urinary incontinence: a standardization document from the International
Children’s Continence Society. Neurourol Urodyn2015;
10.1002/nau.22911. Crossref, Google Scholar
- 5 : Evaluation and targeted therapy of voiding dysfunction in children. Urology2016; 92: 87. Google Scholar
- 6 : Prospective evaluation of inpatient and outpatient bladder training in children with functional urinary incontinence. Urology2006; 67: 176. Google Scholar
- 7 : Outpatient pelvic-floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology1996; 48: 923. Google Scholar
- 8 : A pilot randomized controlled trial evaluating the effectiveness of group vs individual urotherapy in decreasing symptoms associated with bladder-bowel dysfunction. J Urol2015; 193: 1347. Link, Google Scholar
- 9 : Half-day urotherapy improves voiding parameters in children with dysfunctional emptying. Eur Urol2006; 49: 570. Google Scholar
- 10 : Improving young children’s social and emotional competence: a randomized trial of the preschool “PATHS” curriculum. J Prim Prev2007; 28: 67. Google Scholar
- 11 : Development of a symptom score for dysfunctional elimination syndrome. J Urol2009; 182: 1939. Link, Google Scholar
- 12 : Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr Radiol1993; 23: 478. Google Scholar
- 13 : Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol2011; 25: 3. Google Scholar
- 14 : Internet-enabled interactive multimedia asthma education program: a randomized trial. Pediatrics2003; 111: 503. Google Scholar
- 15 : An internet-based program to improve self-management in adolescents with type 1 diabetes. Diabetes Care2010; 33: 602. Google Scholar
- 16 : Enhancing self-management in children with sickle cell disease through playing a CD-ROM educational game: a pilot study. Pediatr Nurs2007; 33: 60. Google Scholar
- 17 : A critical review of the use of technology to provide psychosocial support for children and young people with long-term conditions. J Pediatr Nursing-Nursing Care Child Fam2015; 30: 87. Google Scholar
- 18 : Prospective evaluation of clinical voiding reeducation or voiding school for lower urinary tract conditions in children. J Urol2011; 186: 648. Link, Google Scholar
- 19 : Urotherapy in children: quantitative measurements of daytime urinary incontinence before and after treatment according to the new definitions of the International Children’s Continence Society. J Pediatr Urol2011; 7: 213. Google Scholar
- 20 : Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction. J Pediatr Urol2010; 6: 490. Google Scholar
- 21 : Twenty years of urotherapy in children: what have we learned?. Eur Urol2006; 49: 426. Google Scholar
- 22 : Bladder and bowel dysfunction (BBD) and the resolution of urinary incontinence with successful management of bowel symptoms in children. Acta Paediatr2013; 102: e215. Google Scholar