Some Evidence Supports Bladder Stimulation In Pre-Continent Children

Bladder-stimulation techniques may be effective in stimulating urine in children who are not toilet-trained, but there is still too little data to determine which approach is best, according to a new systematic review.

"Further randomized controlled trials are required to provide evidence on the most effective technique and in which population of patients they will be most beneficial," Dr. Mathew Chandy of Portsmouth Hospitals NHS Trust in the UK, the study's first author, told Reuters Health in an email.

Gathering a sterile urine specimen for diagnosing urinary-tract infection (UTI) is "difficult and time consuming" in children who aren't yet toilet-trained, Dr. Chandy and his team note in the Emergency Medicine Journal. In the UK, the researcher noted, the most frequently used approach is the clean-catch method, or catheterization if a sample is needed immediately.

The researchers reviewed three randomized controlled trials of three different non-invasive techniques including 568 patients: rubbing the suprapubic region in cold saline-soaked gauze; tapping and paravertebral massage; and bladder stimulation with a vibrating device. The first two studies found improved success in voiding within 5 minutes compared to a control condition, but the third did not.

The review also included eight non-randomized and observational studies, with a total of 729 patients, with most evaluating the finger tapping and lumbar-massage technique. The authors rated six of the studies as poor-quality and two as fair.

"We are currently in the analysis stage of a qualitative study looking at the acceptability to parents/care givers of the techniques reviewed in our paper," Dr. Chandy said. "Dependent on the results of this study we would seek funding to undertake a study comparing the available techniques to see which was the most effective."

He added: "The majority of studies reviewed were of small size and of variable quality and so it was not possible to make definitive recommendation on which technique was the most effective. Practitioners should therefore be cautious about changing clinical practice based solely on this review."

—By Anne Harding

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