Pediatric Urinary Incontinence--shouldn't we speak the same language?

THE 2 reports in this issue of The Journal by Neveus (page 441) and Hoebeke (page 699) et al from the International Children’s Continence Society (ICCS) follow on the heels of the standardization of terminology for lower urinary tract function document that the ICCS promulgated 3 years ago. 1 To comprehend and compare what different clinicians and investigators are attempting to communicate it is imperative that everyone speak the same language and address conditions uniformly. The International Continence Society recognized this problem more than 30 years ago and, as a result, came up with a series of definitions that gradually became the vernacular and currently form the framework for the discussion of various pathological conditions involving the urinary tract in adults. 2– 4 Now it is possible for researchers and clinician scientists to make meaningful comparisons of protocols and perform evidence-based analyses to confirm or abrogate conclusions regarding specific diseases affecting lower urinary tract function in adults. 4 A group of forward thinking individuals believed that it was time for pediatric oriented physicians to advance the field of lower urinary tract dysfunction in children along lines similar to what the International Continence Society had proposed for adults. 5 Hence, the idea was born in the ICCS to further this process in children. The ICCS developed a list of vexing topics that needed standardization statements from an authoritative body to minimize confusion, address underlying issues, promote investigational studies and issue efficacious management based on scientific evidence. The result of this effort is the publication of these first 2 of an eventual sequence of 10 reports on lower urinary tract conditions and their ramifications. A group of renowned international experts constitute the authorship of these reports. The importance of these manifestos cannot be overstated. Although not perfect, they represent the latest knowledge about monosymptomatic nocturnal enuresis (MNE) and the evaluation of daytime urinary incontinence (without nighttime wetting). These documents are not meant to function as guidelines but rather as the minimum standard for understanding the causes of these conditions and the rationale for potential treatment options. MNE without daytime symptoms has a multifactorial etiology. Thus, understanding and differentiating its causes help the clinician (the primary care physician as well as the specialist) promote a systematic, safe and efficacious treatment approach to MNE. A similar argument can be raised for the document concerning children with only daytime incontinence. Defining the problem, excluding specific anatomical and neurological causes, assessing severity, promoting a stepwise investigational format using noninvasive tools and uncomplicated radiological assessment followed by more intensive maneuvers are approaches designed to provide physicians and pediatric health care providers with the most up-to-date facts to determine the cause(s) of daytime incontinence. The logical outcome of this systematic analysis will ultimately be efficient and effective treatments for daytime incontinence (the subject of a future standardization report). In these 2 published reports and in the 8 more that are expected to follow the aim of the ICCS is to promulgate a common language between researchers and health care providers. At the least they should serve as the clarion for future communication about assessment and management. These efforts make it easier to promote evidence-based approaches that will enhance the effective management of abnormal lower urinary tract conditions in children.