ESPN 50th Annual Meeting

ESPN 2017


 
FACTORS INFLUENCING DAYTIME AND COMBINED INCONTINENCE IN CHILDREN WITH CEREBRAL PALSY
BIEKE SAMIJN 1 LIEN DOSSCHE 2 CHRISTINE VAN DEN BROECK 1 JOHAN VANDE WALLE 2 FRANK PLASSCHAERT 1 ERIK VAN LAECKE 2

1- GHENT UNIVERSITY
2- GHENT UNIVERSITY HOSPITAL
 
Introduction:

Incontinence is a major issue in children with cerebral palsy (CP) with important effects on quality of life, financial costs and risk for upper urinary tract dysfunction. This study aims to identify which factors increase the risk of daytime or combined urinary incontinence (UI) in children with CP.

Material and methods:

A cross-sectional case-control study was conducted including children with CP with or without UI. Explanatory variables were subdivided in three clusters, namely demographic and general medical data, CP classification and bladder and bowel dysfunction. Data was obtained using uroflowmetry with EMG testing, a questionnaire and bladder diaries. Univariate and multivariate analysis was performed for variables and clusters respectively. A final associative logistic model including all clusters was developed.

Results:

The study included 34 incontinent children and 45 continent children. UI was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), the use of external aids (OR 27.50) and the use of laxatives (OR 13.31). UI was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), gross motor function classification system level IV (OR 10.63) and V (OR 34.00) and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced UI negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for UI.

Conclusions:

Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with CP. Clinicians and caregivers should be alert to both bladder dysfunction and additional risk factors and adapt environment and treatment strategies to minimize the impact of these factors and enhance the probability of achieving continence.