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Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1196-e1200 (doi:10.1542/peds.2007-1652)
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ARTICLE

Behavior Profiles in Children With Functional Urinary Incontinence Before and After Incontinence Treatment

An Bael, MDa, Pauline Winkler, MSb, Hildegard Lax, MSc, Herbert Hirche, MSc, Elisabeth Gäbel, MSd, Marianne Vijverberg, BSe, Roelie van Zon, RNf, Eline Van Hoecke, MS, PhDg, Jan D. van Gool, MD, PhDa

a Department of Pediatric Nephrology, University Hospital Antwerp, University of Antwerp, Faculty of Medicine, Antwerp, Belgium
Departments of b Pediatric Urology
e Psychology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
c Institute for Medical Informatics, Biometry, and Epidemiology
d Department of Pediatric Nephrology, Children's Hospital, University of Duisburg-Essen, Essen, Germany
f Department of Pediatric Urology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, Netherlands
g Pediatric Renal Center, University Hospital Ghent, Ghent, Belgium

OBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence.

METHODS. A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfunction Study, in branches for urge syndrome (branch 1) and dysfunctional voiding (branch 2); 188 filled out Achenbach's Child Behavior Checklist before treatment and 111 after treatment. Child Behavior Checklist scales for total behavior problems were used along with subscales for externalizing problems and internalizing problems.

RESULTS. After European Bladder Dysfunction Study treatment, the total behavior problem score dropped from 19% to 11%, the same prevalence as in the normative population; in branch 1 the score dropped from 14% to 13%, and in branch 2 it dropped from 23% to 8%. The prevalence of externalizing problems dropped too, from 12% to 8%: in branch 1 it was unchanged at 10%, and in branch 2 it dropped from 14% to 7%. The decrease in prevalence of internalizing problems after treatment, from 16% to 14%, was not significant.

CONCLUSION.More behavioral problems were found in dysfunctional voiding than in urge syndrome, but none of the abnormal scores related to the outcome of European Bladder Dysfunction Study treatment for incontinence. With such treatment, both the total behavior problem score and the score for externalizing problems returned to normal, but the score for internalizing problems did not change. The drops in prevalence are statistically significant only in dysfunctional voiding.

Key Words: urinary incontinence • nonneuropathic bladder-sphincter dysfunction • urge syndrome • dysfunctional voiding • behavior profile • child behavior checklist • European Bladder Dysfunction Study • attention- deficit disorder • urinary tract infection

Abbreviations: NNBSD—nonneuropathic bladder-sphincter dysfunction • MNE—monosymptomatic nocturnal enuresis • ADD—attention-deficit disorder • CBCL—Child Behavior Checklist • EBDS—European Bladder Dysfunction Study • UTI—urinary tract infection • TBP—total behavior problem • CI—confidence interval

Accepted Oct 3, 2007.


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