Critical Appraisal of Guidelines for Daytime Urinary Incontinence in Children: Comparison of Recommendations on Treatment.

Abstract

Aims: This study aimed to compare the recommendations on therapy from currently available guidelines on non-neurogenic daytime urinary incontinence (DUI) in children.

Methods: We conducted a systematic search for guidelines on non-neurogenic DUI in children. We extracted the therapy recommendations from all the guidelines for a descriptive comparison.

Results: Eight guidelines were included. All guidelines advise urotherapy as the first step of treatment in children with DUI. They all agree on the importance of addressing co-existing bowel dysfunction and urinary tract infections. Neuromodulation was recommended as an early treatment modality in three guidelines, while the others reserve it for special cases (n = 2) or do not mention it at all (n = 3). Pharmacotherapy with anticholinergics is often recommended, sometimes when urotherapy is insufficient, and by some guidelines simultaneously. The use of newer beta-3-agonists was only mentioned by recently (2019 and 2021) published guidelines. Only half of the guidelines mentioned the level of evidence with their recommendations, and when mentioned, the quality of the evidence is generally low.

Conclusion: Overall, the recommendations for treating non-neurogenic DUI in children are generally consistent, with all the guidelines endorsing urotherapy as the initial treatment. However, differences exist regarding additional treatments such as neuromodulation and pharmacotherapy, both areas of active research with evolving insights. The observed differences can be explained by the publication date of the guidelines and the target audience. The evidence supporting the recommendations is generally of low quality, indicating a need for further research in the field of DUI in children.

Trial registration: As this is a review, no clinical trial registration was conducted. The review protocol has been registered in PROSPERO (CRD42021149059).