Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 기능성 요실금의 진단과 치료

Diagnosis and therapy for functional urinary incontinence in childhood

  • 강주형 (을지대학교 의과대학 소아과학교실)
  • Kang, Ju Hyung (Department of Pediatrics, College of Medicine, Eulji University)
  • 투고 : 2008.09.30
  • 심사 : 2008.10.01
  • 발행 : 2008.11.15
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초록

Functional urinary incontinence, the absence of any neurologic or structural abnormality as a cause of urinary incontinence in children, is one of the most common clinical problems encountered in pediatric and urologic departments, and it can be socially and emotionally distressing for the affected children. The prevalence rates of functional urinary incontinence in school-aged children are not very high and differ between boys and girls. The underlying mechanisms of functional urinary incontinence are heterogenous and can be associated with the following dysfunctions of both the storage and voiding patterns of the bladder: overactive bladder, dysfunctional voiding, lazy bladder syndrome, HinmanAllen syndrome, giggle incontinence, and vaginal voiding. Treatment methods for urinary incontinence in children should be chosen according to these clinical conditions. Treatment modalities generally consist of the treatment of comorbid conditions such as urinary infection and constipation, behavior therapy to modify learned voiding patterns, and pharmacotherapy primarily with anticholinergics and ${\alpha}$-adrenergic blockers. This review discusses the optimal treatment modalities, including treatment of the underlying voiding disorders, and diagnostic approaches related to functional urinary incontinence in children.

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참고문헌

  1. Noorgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom A L. Standardization and definitions in lowerurinary tractdy sfunction in children. International Children's Continence Society. Br J Urol 1998;81(S uppl 3):S1-16
  2. Hellstrom A L, Hanson E, Hansson S, Hjalmas K, Jodal U. Micturition habits and incontinence in 7-year-old Swedish schoolentrants. Eur J Pediatr 1990;149:434-7 https://doi.org/10.1007/BF02009667
  3. Deluca F G, Swenson O, Fisher JH, Loutfi A H. The dysfunctional lazy bladdersyndrome in children. Arch Dis Child 1962;37:117-21 https://doi.org/10.1136/adc.37.192.117
  4. Bauer S B, Koff S A, Jayanthi V R. Voiding dysfunction in children: neurogenic and non-neurogenic. In: Walsh P C, Retik A B, Vaughn E D, Wein A J, editors. Campbell's Urology. 8th Ed. Philadelphia: W.B. Saunders Co, 2002:2231-83
  5. Sher P K, Reinberg Y. Successful treatment of giggle incontinence with methylphendiate. J Urol 1996;156:656-8 https://doi.org/10.1016/S0022-5347(01)65776-8
  6. Hoebeke P, Vande Walle J, Everaert K, Van Laecke E, Van Gool JD. Assessment of lowerurinary tract dysfunction in children with nonneuropathic bladder sphincter dysfunction. Eur Urol 1999;35:57-69 https://doi.org/10.1159/000019820
  7. Wehby M C et al. Occult tight filum terminale syndrome: results of surgicaluntethering. Pediatr Neurosurg 2004;40: 51-8 https://doi.org/10.1159/000078908
  8. Saedi N A, Schulman S L. Natural history of voiding dysfunction. Pediatr Nephrol 2003;18:894-7 https://doi.org/10.1007/s00467-003-1210-5
  9. van G ool JD, K uitjen R H, D onckerw olcke R A, M esser A P, Vijverberg M. B ladder-sphincter dysfunction, urinary infection and vesico-ureteral reflux with special reference to cog nitiv e bladder training. Contrib Nephrol 1984;39:190-210
  10. Smellie JM, Gruneberg R N, Bantock H M, Prescod N. Prophylactic co-trim oxazole and trimethoprim in the management of urinary tract infection in children. Pediatr Nephrol 1988;2:12-7 https://doi.org/10.1007/BF00870372
  11. Bauer S B. Special considerations of the overactiv e bladder in children. Urology 2002;60:43-9 https://doi.org/10.1016/S0090-4295(02)01793-4
  12. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997;100:228-32 https://doi.org/10.1542/peds.100.2.228
  13. Erickson B A, Austin JC, Cooper C S, Boyt M A. Polyethyleneglycol 3350 for constipation in children with dysfunctional elim ination. J Urol 2003;170:1518-20 https://doi.org/10.1097/01.ju.0000083730.70185.75
  14. Wiener JS, Scales M T, Hampton J, King L R, Surwit R, Edwards C L. Long-term efficacy of simple behavioral therapy for daytime wetting in children. J Urol 2000;164:786-90 https://doi.org/10.1016/S0022-5347(05)67313-2
  15. Goode P S. Behavioral and drug therapy for urinary incontinence. Urology 2004;63(3 S uppl 1):S58-64 https://doi.org/10.1016/j.urology.2003.10.032
  16. Hellstrom A L, Hjalmas K, Jodal U. Rehabilitation of the dysfunctional bladder in children: method and 3-year follow - up. J Urol 1987;138:847-9 https://doi.org/10.1016/S0022-5347(17)43395-7
  17. Wiener JS, Scales M T, Hampton J, K ing L R, Surwit R, Edwards C L. Long-term efficacy of simple behavioral therapy for daytime wetting in children. J Urol 2000;164:786-90 https://doi.org/10.1016/S0022-5347(05)67313-2
  18. Allen H A, Austin JC, Boyt M A, Hawtrey C E, Cooper C S. Initialtrial of timedvoidingis warranted for all children with day time incontinence. Urology 2007;69:962-5 https://doi.org/10.1016/j.urology.2007.01.049
  19. Appel R A. Oxybutynin. The clinicalex perience. Contemp Urol 1991;3:60-7
  20. Andersson K E. Antimuscarinics for treatment of overactive bladder. Lancet Neurol 2004;3:46-53 https://doi.org/10.1016/S1474-4422(03)00622-7
  21. Kim K M, Lee S W. Efficacy and Tolerability of Tolterodine Compared to Oxybutynin in Children with a Neurogenic Bladder. Korean J Urol 2005;46:598-603
  22. R aes A, H oebeke P, S eg aert I, V an L aecke E, D ehoorne J, Vande W alle J. R etrospectiv e analysis of efficacy and tolerability of tolterodine in children with overactiv e bladder. Eur Urol 2004;45:240-4 https://doi.org/10.1016/j.eururo.2003.10.009
  23. Ayan S, Kaya K, Topsakal K, Kilicarslan H, Gokce G, Gultekin Y. Efficacy of tolterodine as a first-line treatment for non-neurog enic voiding dy sfunction in children. BJU Int 2005;96:411-4 https://doi.org/10.1111/j.1464-410X.2005.05641.x
  24. Nijman R J, Borg stein N G, Ellsworth P, Djurhuus JC. Tolterodine treatment for children with symptoms of urinaryurge incontinence suggestive of detrusor overactivity: results from 2 randomized, placebocontrolled trials. J Urol 2005; 173:1334-9 https://doi.org/10.1097/01.ju.0000152322.17542.63
  25. Austin P F, Homsy Y L, Masel JL, Cain M P, Casale A J, Rink R C. a-A drenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol 1999;162:1064-7 https://doi.org/10.1016/S0022-5347(01)68067-4
  26. Cain M P, Wu S D, Austin P F, Herndon C D, Rink R C. Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol 2003;170:1514-7 https://doi.org/10.1097/01.ju.0000085961.27403.4a
  27. Kramer S A, Rathbun S R, Elkins D, Karnes R J, Husmann D A. Double-blind placebo controlled study of a-adrenergic receptorantag onists (dox azosin) for treatment of voiding dysfunction in the pediatric population. J Urol 2005;173: 2121-4 https://doi.org/10.1097/01.ju.0000157689.98314.69
  28. Fouron JC, Chicoine R. E C Gchanges in fatal imipram ine (T ofranil) intoxication. Pediatrics 1971;48:777-81
  29. Sureshkumar P, Bower W, Craig JC, Knight JF. Treatment of daytim Eurinary incontinence in children: a system atic review of randomized controlled trials. J Urol 2003;170:196-200 https://doi.org/10.1097/01.ju.0000072341.34333.43