Clinical Practice Variation Between Paediatricians and Urologists in the Management of Daytime Urinary Incontinence in Children

AIMS: This study aimed to examine clinical practice variation between urologists and paediatricians managing children with daytime urinary incontinence (DUI) to identify unwarranted variation and improve care pathways. METHODS: A single-centre retrospective database study was conducted, including children aged 4-18 years referred for DUI between 2016 and 2018. Patient characteristics, diagnostic evaluations, and treatment trajectories were extracted using standardised case report forms and analysed descriptively, with comparative statistics applied to evaluate differences between urologists and paediatricians. RESULTS: Of the 395 included children, 327 (82.8%) were referred to paediatrics and 68 (17.2%) to urology. Median age was 6 years in paediatrics and 9.5 years in urology, with paediatricians receiving more GP referrals (96.6% vs. 77.9%). Paediatric care showed more comprehensive history-taking and more frequent physical examination (96.7% vs. 64.2%), whereas urologists routinely performed voiding diaries (98.5%) and uroflowmetry (100%), which paediatricians used less consistently (85.5% and 60.7%) and generally later in the care trajectory. Urotherapy was provided more often by paediatricians (97.5% vs. 74.6%), while urologists prescribed anticholinergics more frequently (70.1% vs. 16.4%). CONCLUSIONS: This study confirms our initial impression that notable practice variation exists in the care of children with DUI. Awareness of such variation is essential, and we aim to draw attention to this issue among clinicians. Based on our findings, we developed a consensus document outlining shared care pathways. Further research is needed to determine its impact on clinical practice and patient outcomes.