Mp50-20 the Role of Conservative Management in Bladder and Bowel Dysfunction: A Meta-Analysis of Comparative Studies

You have accessJournal of UrologyPediatrics III (MP50)1 May 2024MP50-20 THE ROLE OF CONSERVATIVE MANAGEMENT IN BLADDER AND BOWEL DYSFUNCTION: A META-ANALYSIS OF COMPARATIVE STUDIES Adree Khondker, Ihtisham Ahmad, Zwetlana Rajesh, Sabrina Balkaran, Zizo Al-daqqaq, Jin K. Kim, Natasha Brownrigg, Michael Chua, Mandy Rickard, Armando Lorenzo, and Joana Dos Santos Adree KhondkerAdree Khondker , Ihtisham AhmadIhtisham Ahmad , Zwetlana RajeshZwetlana Rajesh , Sabrina BalkaranSabrina Balkaran , Zizo Al-daqqaqZizo Al-daqqaq , Jin K. KimJin K. Kim , Natasha BrownriggNatasha Brownrigg , Michael ChuaMichael Chua , Mandy RickardMandy Rickard , Armando LorenzoArmando Lorenzo , and Joana Dos SantosJoana Dos Santos View All Author Informationhttps://doi.org/10.1097/01.JU.0001008684.57262.97.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bowel and bladder dysfunction (BBD) accounts for the majority of lower urinary tract dysfunction (LUTD) in children. The first-line treatment is urotherapy, which involves education on LUTD, optimizing bowel and bladder habits, and lifestyle modifications. Additional conservative treatments include home education, as well as biofeedback and exercise-based therapies. This meta-analysis aims to evaluate the effect of conservative adjuncts to urotherapy on clinical outcomes for BBD. METHODS: A systematic literature search (PROSPERO registration: CRD42023422168) was performed in May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Comparative studies were assessed with the Cochrane recommendations. Heterogeneity and publication bias were assessed. Clinical outcomes, including incontinence rate, recurrent urinary tract infections (UTIs), and abnormal uroflowmetry pattern, were evaluated. Odds ratios (ORs) were determined comparing standard and adjunct therapy groups. RESULTS: We included 18 studies with a total of 1228 children. The median age at presentation was 7 years (range 3-12) and median follow-up was 9 months (range 2-24). Adjunct therapies included home education (5 studies, 27%), biofeedback or cognitive behavioral therapy (7 studies, 39%), pelvic-floor physiotherapy or exercise-based treatment (5 studies, 27%), or miscellaneous (2 studies, 11%). Conservative adjuncts were associated with reduced incontinence (OR 0.33, 95%CI 0.21, 0.51; p<0.01), reduced rates of recurrent UTI (OR 0.60, 95%CI 0.37, 0.96; p=0.03), and reduced rates of abnormal uroflowmetry (OR 0.11, 95%CI 0.06, 0.19; p<0.001). Subgroup differences were not significant between therapies. The risk of bias was low for 8 studies (44%), moderate for 8 studies (44%), and severe for 2 studies (11%) studies. CONCLUSIONS: Our findings show that conservative therapies enhance standard urotherapy for BBD in children. Conservative adjuncts led to improved urinary function and reduced UTI rates. Addressing uncertainty in the literature for BBD management, the synthesis of these findings delivers actionable insights for clinicians. We endorse the role of adjunctive conservative therapies as a vital component in the therapeutic arsenal against BBD. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e840 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Adree Khondker More articles by this author Ihtisham Ahmad More articles by this author Zwetlana Rajesh More articles by this author Sabrina Balkaran More articles by this author Zizo Al-daqqaq More articles by this author Jin K. Kim More articles by this author Natasha Brownrigg More articles by this author Michael Chua More articles by this author Mandy Rickard More articles by this author Armando Lorenzo More articles by this author Joana Dos Santos More articles by this author Expand All Advertisement PDF downloadLoading ...