Group Versus Individual Urotherapy for Children

Background Urotherapy has been the standard nonsurgical, nonpharmacologic treatment for children with nonneurogenic lower urinary tract dysfunction (NLUTD) and dysfunctional elimination syndrome (DES) for over two decades (Hoebeke, 2006). Children with NLUTD/DES represent a heterogenous group whose physical and mental health are affected (Afshar et al., 2009). There is no widely accepted diagnostic criteria (Afshar et al.) and urotherapy modalities that have been studied vary by setting, curriculum, length of treatment, outcome measurements and study participants. It is challenging to determine what modality of urotherapy is the most effective by reviewing the current literature. Furthermore, quality of life as an outcome measurement of urotherapy has not been reported in the literature.

Purpose The purpose of this study is to assess the feasibility of a group urotherapy session and evaluate the preliminary effectiveness of the group urotherapy session by measuring NLUTD/DES symptoms and quality of life and compare the group urotherapy session to standard urotherapy that takes place in pediatric urology clinics.

Methods Children aged 6-10 years old diagnosed with NLUTD/DES will be recruited from pediatric urology clinic at McMaster Children's Hospital over 12 to 15 weeks. The aim is to recruit at least 60 participants, 30 will be randomized to the control group and receive standard individual urotherapy in clinic and 30 will be randomized to the experimental group and receive a 1 hour group urotherapy session. Parents will be asked to complete a demographics questionnaire at the time of consent and children will be asked to complete 2 questionnaires at time of consent and again 3 months after receiving either individual or group urotherapy. At the 3 month follow up, parents and participants will be asked to complete an evaluation form to provide feedback about the teaching session received.

Outcome Measurements NLUTD/DES symptoms will be evaluated using the Vancouver NLUTD/DES questionnaire. This questionnaire assesses the following symptoms: incontinence, urgency, frequency, dysuria, hesitancy, straining and constipation. Quality of life (QOL) will be measured using the PinQ QOL measure. This questionnaire measures 6 domains of QOL: social, self-esteem, family, body image, independence and mental health. Both questionnaires have been deemed valid and reliable in children with the same diagnosis and age as the study population.

Impact This pilot study will provide new knowledge as a controlled trial comparing standard individual and group urotherapy which has not been reported on in the literature. Urotherapy is effective, but the search for the most effective program continues. This pilot study will provide information on the feasibility of the group urotherapy session as well as preliminary effectiveness. Furthermore, quality of life as an outcome measure has not been used to evaluate urotherapy. Again, this will provide new and valuable knowledge on the child's perception of their condition and the effect of urotherapy on their QOL.

References Afshar, K., Mirbagheri, A., Scott, H. & MacNeily, A.E. (2009). Development of a syndrome score for dysfunctional elimination syndrome. The Journal of Urology, 182, 1939-1944.

Bower, W.F., Sit, F.K.Y., Bluyssen, N., Wong, E.M.C. & Yeung, C.K. (2006). PinQ: A valid, reliable and reproducible quality-of-life measure in children with bladder dysfunction. Journal of Pediatric Urology, 2, 185-189.

Hoebeke, P. (2006). Twenty years of urotherapy in children: what have we learned? European Urology,49, 426-428.