Research Topic

Urinary Incontinence in Children: Controversies Concerning the Bladder Outlet

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About this Research Topic

Background
Daytime and night-time urinary incontinence (UI) is very common in school-age children. Congenital anatomical anomalies as well as functional disorders of the lower urinary track (LUT) can result in UI. Although the majority of patients can be successfully cured by urotherapy and ...

Background
Daytime and night-time urinary incontinence (UI) is very common in school-age children. Congenital anatomical anomalies as well as functional disorders of the lower urinary track (LUT) can result in UI. Although the majority of patients can be successfully cured by urotherapy and pharmacotherapy, some patients need to have surgical treatment.
Both the bladder and the bladder outlet function must be thoroughly assessed in children with UI. For this purpose a variety of diagnostic tools can be used. Bowel and bladder diary, uroflowmetry, post-void residual volume, cystometry and pressure-flow studies are already standardized and included in the protocols as proposed by the International Children’s Continence Society (ICCS) and the European Society for Pediatric Urology (ESPU). The significance of the bladder wall thickness is still questionable. Dynamic perineal ultrasound investigation requires special experience and it is done only in a few centres. The place of these tools needs to be established. Lag-time is used in few institutions to provide additional information about the bladder neck function.
Parallel to this, treatment of constipation in all patients with LUT symptoms is of great importance. Neurogenic LUT dysfunction (NLUTD) must be excluded in children with refractory problems and there is enough literature on the management of UI in children with NLUTD. Although there are no gold standards, the well-established protocols are available for those patients in many centres. Hence, NLUTD and bowel management are out of the scope of this Research Topic.
There is little known about the role of the bladder neck in the paediatric population. We postulate that in children with UI who don’t respond to standard treatment special attention should be paid to the bladder outlet, particularly to the bladder neck.

Purpose
This Research Topic is focused on the bladder outlet in children with daytime UI. The diagnostic tools that are used to assess the bladder neck and the different/controversial issues regarding the treatment - conservative as well as surgical - in children with UI will be discussed.


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