5 歲以下兒童的尿失禁

周奕儒、張嘉論、蔡曜州、楊緒棣

台北慈濟醫院泌尿科

Urinary incontinence in children under 5 years of age

Yi-Ju Chou, Chia-Lun Chang, Yao-Chou Tsai, Stephen Shei-Dei Yang

Division of Urology, Taipei Tzu Chi Hospital

Purpose: Urinary incontinence (UI) is defined as an involuntary leakage of urine in a socially inappropriate place or time for a child with bladder control. According to International Children’s Continence Society (ICCS) guidelines, the suggested age for diagnosis of UI is 5 years of age and above. However, in Taiwan and some other countries, many children have already finished toilet training after 2-3 years of age and UI can be a problem for these children aged between 3-5 years, and the clinical characteristics of these age groups are unknown. The aim of this study was to characterize the nature and therapeutic outcomes of urinary incontinence in children under 5 years of age with complete toilet training.

Materials and Methods: All the children under 5 years of age treated for UI were retrospectively reviewed. Only children with complete toilet training were included. We analyzed the data from their patient’s medical records such as Dysfunctional Voiding Symptom Score (DVSS) questionaries, voiding diaries, treatments and clinical outcomes. Uroflowmetry was performed twice for each child. We also did telephone consultation for long term follow up.

Results: Totally, 27 children with a mean age of (4.1 ± 0.8) years were treated for UI and girls represented 56%. The percentage of high DVSS (>6) for boys and (>9) for girls were 58% and 66% respectively. In addition, 74% of children were having DVSS (>6.6) which was the cutoff value for Taiwanese boys and girls. Based on voiding diary, 13 (48%) had a maximum voided volume (MVV) greater than estimated bladder capacity (EBC), while 9 (33%) had a MVV lesser than 2/3 of EBC. Constipation was noted in eight children (32%) and half of them needed medication. Three (12%) children showed persistent abnormal uroflow patterns without bladder over distention. Of them, 11 (41%) were successfully treated with advice for lifestyle modification alone; 2(7%) had loss of follow up and 14 (52%) were unsuccessful. Of these unsuccessful cases, 12(86%) showed well response to medical treatment. There were no significant differences in age, DVSS score and MVV between these two groups (life style modification alone and life style modification with additional medical treatment).

Conclusion:  Children under 5 years after toilet training may suffer from urinary incontinence and 41% of them just needed lifestyle advice. DVSS questionaries and voiding diary can be helpful in this age group.