An Alarm Watch for Daytime Urinary Incontinence: A Randomized Controlled Trial

OBJECTIVES: Daytime urinary incontinence is disabling and occurs in 17% of school-aged children. Timed-voiding is part of standard therapy. Can an alarm watch to aid timed-voiding improve treatment response to standard therapy? METHODS: The WATCH (Watch with Alarm for Timed-Voiding in Children) study is a randomized controlled trial. Participants were randomly assigned (1:1) to a vibrating alarm or nonalarming watch for 3-months. The primary outcome was the proportion who achieved a complete response (14 consecutive dry days) after 3-months of treatment. Children aged 5 to 13 years who were prescribed timed-voiding for daytime urinary incontinence. RESULTS: Overall, 243 children, with a mean age of 8 years, were enrolled, with 62% girls. At 3-months, the complete response rates were similar between the 2 groups (22% alarm versus 17% control; difference: 5%; 95% confidence interval (CI): −5% to 16%; P = .42). In the alarm group, treatment adherence was higher (40% vs 10%; difference: 30%; 95% CI: 20% to 40%; P < .001), frequency of incontinence was lower (25% dry; 40% had 1–3 wet days per week, 24% had 4–6 wet days per week, and 12% had daily wetting, compared with 19%, 30%, 35%, and 16%, respectively; P =.05), and fewer had abnormal postvoid residual urine volumes (12% vs 24%; difference: −12%; 95% CI: −21% to −1%; P = .04) compared with the control group. Improvement was transient and did not persist 6 months beyond the treatment period. CONCLUSIONS: Alarm watches do not appear to lead to complete resolution of urinary incontinence in children but did promote treatment adherence, normalization of postvoid residual volumes, and reduction in incontinent episodes while being used.

Impact from Functional Biological Management in the Electromyography Mode on the Psychological State of Children with Non-organic Urination and Defecation Impairment

Study Objective: To identify and evaluate the impact from functional biological management (FBM) in the electromyography (EMG) mode on clinical manifestations and psychological state in children with non-organic urination and defecation impairment. Study Design: prospective controlled clinical study in parallel groups. Materials and Methods. We examined 255 children of 7 to 18 years old (mean age: 10.3 ± 3.1 years) with urinary incontinence (as the only one complaint or one of a number of complaints upon hospitalisation) and non-organic (functional) urination impairment. The study group included 153 children (66 boys and 87 girls) who had daily FBM sessions (FBM therapy) in the EMG mode (10 sessions) with the standard intensity without prior electrical stimulation. The comparison group included 102 children (43 boys and 59 girls) who were treated with oral metabolic support (MS) for 1 month. A complex examination included history, physical examination, physical development assessment, complete blood test and biochemical blood assay, urinalysis, monitoring of spontaneous urination and defecation rhythms, qualimetric tables, US examination of kidneys, urinary bladder and abdominals, urofluometry, and, if indicated, X-ray or endoscopic examinations and rectum sphincter examination. A complex psychological assessment was performed prior to and after therapy, and prevailing emotions, anxiety levels, ambitions, and self-esteem were identified. Study Results. It was found out that the children with non-organic urination impairment had mostly non-monosymptomatic enuresis (non-ME) (148 (58%)); monosymptomatic enuresis (ME) was diagnosed in 61 (24%) patients, while daytime urinary incontinence (DUI) was recorded in 46 (18%) children, with the peak detectability being at the age of 7 to 10 years. In 41.2% and 43.1%, non-organic urinary impairments (33.3% children with non-ME and 7.8% and 9.8% children with DUI) were combined with chronic constipation and faecal incontinence associated with accompanying pelvic organs impairment. FBM therapy in EMG mode was highly efficient in children both with non-organic urination impairment (84.4%) and accompanying pelvic organs impairment (74.6%); while metabolic support was efficient only in 48.3% and 40.9% of cases, respectively (р < 0.001 in both cases). Children with non-organic urination impairment and accompanying pelvic organs impairment had mostly negative emotions, increased anxiety, low ambitions and self-esteem because of the disease. Unlike metabolic support, FBM therapy in EMG mode had statistically significant impact on the shift to positive emotions, reduced anxiety, improved ambitions and self-esteem. Conclusion. When used in children with non-organic urination impairment and accompanying pelvic organs impairment, FBM therapy in EMG mode can not only arrest clinical symptoms of the disease, but also replaces negative emotions with positive ones, reduces anxiety, improves ambitions and self-esteem, resulting in higher quality of life. Keywords: impaired urination, enuresis, daytime urinary incontinence, accompanying pelvic organs impairment, functional biological management, anxiety, ambitions, self-esteem.

A smartphone application to support bladder training in children and adolescents with daytime urinary incontinence: Design, development, and user testing of URApp (Preprint)

BACKGROUND Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes including depressive symptoms, peer victimisation, poor self-image, and problems with peer relationships. First line conservative treatment for UI is bladder training (standard urotherapy) which is aimed at establishing a regular fluid intake and a timed schedule of toilet visits. Success of bladder training is strongly dependent on good adherence, which can be challenging for young people. OBJECTIVE This paper describes the development of a smartphone app (URApp) which is aimed at improving adherence to bladder training in young people aged 11-20 years old. METHODS URApp was designed using participatory co-design methods and was guided by the Person-Based Approach to intervention design. Core app functions were based on clinical guidance and included setting a ‘daily drinking goal’, recording fluid intake and toilet visits, reminders to drink and go to the toilet, and recording progress towards drinking goals. The development of URApp comprised four stages: (i) review of current smartphone apps for UI; (ii) participatory co-design workshops with young people with UI to gather user requirements for the app and to develop wireframes; (iii) development of the app prototype; and (iv) user testing of the URApp prototype, qualitative interviews with 23 young people aged 10-19 years with UI and/or urgency and eight clinicians. The app functions and additional functionality to support adherence and behaviour change were iteratively optimised throughout the app development process. RESULTS Young people who tested URApp judged it to be a helpful way of supporting their adherence to a timed schedule of toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned to bladder training best practice guidelines. URApp was deemed age appropriate with all clinicians reporting they would use it within their own clinics. Clinicians felt URApp would be of particular benefit for patients whose symptoms were not improving or were not engaging with their treatment plans. CONCLUSIONS The next stage is to evaluate URApp in a range of settings including paediatric continence clinics, primary care and schools to test whether it could be an effective (and cost-effective) solution to provide personalised support for young people to improve their adherence to bladder training, and therefore reduce UI.