Risk Factors for Daytime or Combined Incontinence in Children with Cerebral Palsy

Bieke Samijn; Christine Van den Broeck; Ellen Deschepper; Catherine Renson; Piet Hoebeke; Frank Plasschaert; Johan Vande Walle; Erik Van Laecke

doi:10.1016/j.juro.2017.05.067

Risk Factors for Daytime or Combined Incontinence in Children with Cerebral Palsy

J Urol. 2017 Oct;198(4):937-943. doi: 10.1016/j.juro.2017.05.067. Epub 2017 May 19.

Authors

Bieke Samijn¹, Christine Van den Broeck², Ellen Deschepper³, Catherine Renson⁴, Piet Hoebeke⁵, Frank Plasschaert⁶, Johan Vande Walle⁷, Erik Van Laecke⁵

Affiliations

¹ Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium. Electronic address: [email protected].
² Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
³ Department of Public Health, Ghent University, Ghent, Belgium.
⁴ Department of Urology, Ghent University Hospital, Ghent, Belgium.
⁵ Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
⁶ Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.
⁷ Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium.

PMID: 28533005
DOI: 10.1016/j.juro.2017.05.067

Abstract

Purpose: We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy.

Materials and methods: A cross-sectional case-control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP-Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were 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. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence 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 daytime or combined urinary incontinence 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 daytime or combined urinary incontinence.

Conclusions: Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy.

Keywords: cerebral palsy; neurogenic; risk factors; urinary bladder; urinary incontinence; urodynamics.

MeSH terms

Case-Control Studies
Cerebral Palsy / complications*
Child
Cross-Sectional Studies
Drinking Behavior / physiology
Electromyography
Enuresis / diagnosis*
Enuresis / etiology
Enuresis / physiopathology
Female
Humans
Intellectual Disability / diagnosis
Intellectual Disability / epidemiology*
Intellectual Disability / physiopathology
Logistic Models
Male
Models, Biological*
Prognosis
Rheology
Risk Factors
Surveys and Questionnaires
Urinary Bladder / physiopathology
Urinary Incontinence / diagnosis*
Urinary Incontinence / etiology
Urinary Incontinence / physiopathology
Urodynamics / physiology