Reduction of daytime wetting and urinary tract infection can be achieved regardless of the type of biofeedback used. Although symptoms improved, patients using a shorter but more intensive approach aimed at teaching control of the pelvic floor musculature were more likely to demonstrate persistent post-void residuals and abnormal flow curves. A considerable degree of enthusiasm was reported using both of these non-invasive forms of treatment.

BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common health care–associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. METHODS: An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children’s hospital over a 3-year period (June 2009 to June 2012). RESULTS: Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: −1.28 to −0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CONCLUSIONS: CAUTI is a common pediatric health care–associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.

Screening renal/bladder ultrasound, careful voiding history and medical but not surgical therapy are recommended for renal and bladder anomalies associated with 22q11.2 deletion. The need for surgery for cryptorchidism and hypospadias is slightly higher than in the general population.

ABSTRACT. Objective. Dysfunctional voiding is a major problem leading to daytime-wetting and recurrent urinary tract infection (UTI). Our center is devoted to treating children with dysfunctional voiding. We offer a multidisciplinary approach with a pediatric nephrologist, nurse practitioners, and a psychologist. This article is the first to describe the efficacy of this approach on a large population of American children.Patients. Between 1992 and 1995, 366 children with symptoms of voiding dysfunction were referred for urodynamic studies. Criteria were based on the child's age, symptoms, and failure to respond to empirical therapy. Females made up 77% of the population, and the mean age at referral was 8.5 years (range, 4 to 18 years). Daywetting occurred in 312 (89%), night-wetting in 278 (79%), recurrent UTI in 218 (60%), and vesicoureteral reflux (VUR) in 48 (20%) of those undergoing voiding cystourethrography.Results. A minimum of 6 months' follow-up data (mean, 22 months) is available on 280 children (77% studied). Urge syndrome was the predominant urodynamic finding in 52%, followed by bladder sphincter dysfunction in 25%. Treatment consisted of antibiotic prophylaxis (59%), anticholinergic medication (49%), biofeedback (25%), and psychological counseling (15%). Of the 222 children with daytime-wetting (45%), 100 are cured (off all medication, no wetting) and 82 (37%) are improved (on medication or >50% reduction in symptoms). Improvement or cure was seen in 69% of children with night-wetting. Of the 199 children with UTI, 127 (64%) never developed another infection. Vesicoureteral reflux resolved in 16 of 30 (53%) children undergoing repeat voiding cystourethrography.Conclusion. Our comprehensive approach demonstrates a favorable outcome that promises to reduce the medical and psychological morbidity seen in patients with voiding dysfunction. Pediatrics 1999;103(3). URL: http://www.pediatrics.org/cgi/content/full/103/3/e31; urinary incontinence, urinary tract infections, vesicoureteral reflux, biofeedback.ABBREVIATIONS. UTI, urinary tract infection; VUR, vesicoureteral reflux; EMG, electromyogram; VCUG, voiding cystourethrogram. P ersistent daytime-wetting, frequent urinary tract infection (UTI) and, in some cases, vesicoureteral reflux (VUR) are common manifestations or sequelae of voiding dysfunction. Primary care practitioners commonly encounter children with these complaints and usually refer them to urologists. Treatment is directed to correcting the voiding dysfunction by retraining the child through either pharmacologic and/or nonpharmacologic means, but treatment is time-consuming. Surgical intervention (ie, urethral dilatation) is no longer acceptable.In 1973, Hinman and Baumann described neurogenic voiding disturbances in children without neurologic lesions.1 This was elaborated by Allen, who reviewed 21 children with severe obstructive uropathy without an anatomic or neurologic cause.2 Children who wet themselves have significant psychological morbidity.3 In rare cases, chronic renal insuffic...