Background Pediatric voiding dysfunction (VD) significantly impacts a child’s quality of life (QoL), necessitating effective management strategies. This large-scale retrospective study examines the impact of urotherapy on validated QoL metrics, namely the Pediatric Urinary Incontinence (PINQ) and Vancouver Non-neurogenic Lower Urinary Tract Dysfunction Elimination Syndrome (VNLUTD) questionnaires. The goal of this study is to enhance understanding of how urotherapy influences QoL outcomes.
Methods A retrospective chart review examined 5-17-year-old patients presenting for VD between 2018 and 2022 (n=366). Patients who completed both PINQ (N=288) and VNLUTD (N=270) surveys across multiple visits (N=81 patients, 201 visits) were included. Those with continuous incontinence, known anatomical abnormalities, voiding/neurologic disorders, and secondary etiologies were excluded. Dependent variables of interest were survey-derived QoL scores. Independent variables of interest were demographics, symptoms, and interventions. Treatments examined were desmopressin, alpha-blockers, anticholinergics, polyethylene glycol, fiber supplements, biofeedback, and pelvic floor physical therapy. Wilcoxon Two-Sample tests compared PINQ and VNLUTD items. Simple linear models were used to build a multiple linear regression model to examine the associations of independent variables on QoL scores. Longitudinal analyses of PINQ and VNLUTD were conducted individually for patients who presented for visits > 1. Treatments were assessed in mixed models individually with time and significant demographics. Statistical analyses employed SAS 9.4 with an alpha level of 0.05.
Results PINQ and VNLUTD scores were positively correlated (r=0.3822, p<0.0001). Pearson’s correlation coefficients indicated significant associations between changes in PINQ (r=0.231, p=0.0397) and VNLUTD scores (r=0.2948, p=0.0076) over time. In the multiple visits analysis, the majority of patients completed two visits. Pearson’s correlation coefficients for change in PINQ and VNLUTD scores with time were statistically significant, indicating decreasing scores over time. While PINQ and VNLUTD scores differed across the total number of symptoms (p=0.0167 and 0.0064, respectively), no significant differences were found after adjusting for multiple comparisons. None of the treatments significantly impacted PINQ scores over time. However, fiber showed a significant impact on VNLUTD scores (p=0.0450), indicating a decrease over time for patients taking fiber. Desmopressin (DDAVP) was the only treatment associated with lower VNLUTD scores (p=0.0473) in categorical analysis.
Conclusions This large-scale single-institution analysis underscores the discrepancy between subjective symptom reporting and standardized surveys, suggesting that these surveys may not fully capture the QoL parameters targeted by urotherapy. While time influences both PINQ and VNLUTD scores, the only treatment significantly impacting QoL was fiber. Treatment strategies focusing on managing constipation and allowing children to age may suffice for improved QoL, potentially managed by pediatricians. Collaborative efforts with parents and patients are essential to address the multifaceted nature of pediatric VD. This study provides valuable insights into optimizing management strategies for pediatric patients with VD, emphasizing a holistic approach to care. Further research is warranted to explore the long-term effects of urotherapy on QoL scores and to better understand the underlying mechanisms of these findings.
| Time interaction with treatment | PINQ (p-value) | VNLUTD (p-value) |
| DDAVP | 0.8796 | 0.7566 |
| Alpha-Blocker | 0.4687 | 0.5826 |
| Anticholinergics | 0.9840 | 0.8480 |
| Polyethylene glycol | 0.5251 | 0.0607 |
| Fiber | 0.6672 | 0.0450 |
| Biofeedback | 0.7201 | 0.6900 |
| Pelvic floor physical therapy | 0.9471 | 0.8984 |
