Key Points
-
Overactive bladder (OAB) in children is a common problem affecting up to 12% of this population
-
Evidence exists indicating a genetic aetiology of OAB; furthermore, epigenetic factors might trigger the onset of OAB in some patients
-
A correlation between obesity and an increased risk of OAB is present in children
-
Neuropsychiatric problems seem to be a common comorbidity in children with OAB and might involve alterations in regions of the brain that are common to both pathologies
-
Electrical stimulation modalities, whether invasive or superficial, offer significant benefits to children with OAB, aside from the standard pharmacological approaches
Abstract
Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5–12% in children (5–10 years of age) and a prevalence of 0.5% in older adolescents (16–18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Austin, P. F. et al. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society. J. Urol. 191, 1863–1865.e13 (2014).
Abrams, P. et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am. J. Obstet. Gynecol. 187, 116–126 (2002).
Franco, I. et al. Are seasonal and income variations accountable for bowel and bladder dysfunction symptoms in children? Neurourol. Urodyn. http://dx.doi.org/10.1002/nau.22896 (2015).
Kalo, B. B. & Bella, H. Enuresis: prevalence and associated factors among primary school children in Saudi Arabia. Acta Paediatr. 85, 1217–1222 (1996).
Butler, R. J., Golding, J. & Northstone, K. Nocturnal enuresis at 7.5 years old: prevalence and analysis of clinical signs. BJU Int. 96, 404–410 (2005).
Bakker, E., van Sprundel, M., van der Auwera, J. C., van Gool, J. D. & Wyndaele, J. J. Voiding habits and wetting in a population of 4,332 Belgian schoolchildren aged between 10 and 14 years. Scand. J. Urol. Nephrol. 36, 354–362 (2002).
Cher, T. W., Lin, G. J. & Hsu, K. H. Prevalence of nocturnal enuresis and associated familial factors in primary school children in taiwan. J. Urol. 168, 1142–1146 (2002).
Gur, E. et al. Enuresis: prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey. Pediatr. Int. 46, 58–63 (2004).
Liu, X., Sun, Z., Uchiyama, M., Li, Y. & Okawa, M. Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years. J. Am. Acad. Child Adolesc. Psychiatry 39, 1557–1564 (2000).
Chung, J. M. et al. Prevalence and associated factors of overactive bladder in Korean children 5–13 years old: a nationwide multicenter study. Urology 73, 63–67 (2009).
Stone, J. J., Rozzelle, C. J. & Greenfield, S. P. Intractable voiding dysfunction in children with normal spinal imaging: predictors of failed conservative management. Urology 75, 161–165 (2010).
Fitzgerald, M. P. et al. Childhood urinary symptoms predict adult overactive bladder symptoms. J. Urol. 175, 989–993 (2006).
Minassian, V. A., Lovatsis, D., Pascali, D., Alarab, M. & Drutz, H. P. Effect of childhood dysfunctional voiding on urinary incontinence in adult women. Obstet. Gynecol. 107, 1247–1251 (2006).
Loening-Baucke, V. Effect of childhood dysfunctional voiding on urinary incontinence in adult women. Obstet. Gynecol. 107, 1247–1251 (2006).
Bael, A. et al. The relevance of urodynamic studies for Urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J. Urol. 180, 1486–1493 (2008).
Birder, L. & Drake, M. in Incontinence (ed. Abrams, P., Cardozo, L., Khoury, S., Wein, A.) 167–254 (Paris Health Publications Ltd).
Birder, L. et al. Neural control of the lower urinary tract: peripheral and spinal mechanisms. Neurourol. Urodyn. 29, 128–139 (2010).
Michel, M. C. & Chapple, C. R. Basic mechanisms of urgency: preclinical and clinical evidence. Eur. Urol. 56, 298–307 (2009).
Bschleipfer, T. et al. Expression and distribution of cholinergic receptors in the human urothelium. Life Sci. 80, 2303–2307 (2007).
Zarghooni, S. et al. Expression of muscarinic and nicotinic acetylcholine receptors in the mouse urothelium. Life Sci. 80, 2308–2313 (2007).
Oliver, S., Fowler, C., Mundy, A. & Craggs, M. Measuring the sensations of urge and bladder filling during cystometry in urge incontinence and the effects of neuromodulation. Neurourol. Urodyn. 22, 7–16 (2003).
Pezzone, M. A., Liang, R. & Fraser, M. O. A model of neural cross-talk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders. Gastroenterology 128, 1953–1964 (2005).
Ustinova, E. E., Fraser, M. O. & Pezzone, M. A. Colonic irritation in the rat sensitizes urinary bladder afferents to mechanical and chemical stimuli: an afferent origin of pelvic organ cross-sensitization. Am. J. Physiol. Renal Physiol. 290, F1478–F1487 (2006).
Ustinova, E. E., Gutkin, D. W. & Pezzone, M. A. Sensitization of pelvic nerve afferents and mast cell infiltration in the urinary bladder following chronic colonic irritation is mediated by neuropeptides. Am. J. Physiol. Renal Physiol. 292, F123–F130 (2007).
Yoshimura, N. & Chancellor, M. in Campbell-Walsh Urology Vol. 3 Ch. 60 (eds Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A. V. & Peters, C. A.) (Saunders, 2011).
Wyndaele, M. et al. Mechanisms of pelvic organ crosstalk: 1. Peripheral modulation of bladder inhibition by colorectal distention in rats. J. Urol. 190, 765–771 (2013).
Griffiths, D., Derbyshire, S., Stenger, A. & Resnick, N. Brain control of normal and overactive bladder. J. Urol. 174, 1862–1867 (2005).
Griffiths, D. & Tadic, S. D. Bladder control, urgency, and urge incontinence: evidence from functional brain imaging. Neurourol. Urodyn. 27, 466–474 (2008).
Drake, M. J. et al. Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms. Neurourol. Urodyn. 29, 119–127 (2010).
Fowler, C. J. & Griffiths, D. J. A decade of functional brain imaging applied to bladder control. Neurourol. Urodyn. 29, 49–55 (2010).
Bush, E. in Cingulate Neurobiology and Disease (ed. Vogt, B. A.) 245–274 (Oxford University Press, 2009).
Bush, G. Neuroimaging of attention deficit hyperactivity disorder: can new imaging findings be integrated in clinical practice? Child Adolesc. Psychiatr. Clin. N. Am. 17, 385–404 (2008).
Bush, G. Cingulate, frontal, and parietal cortical dysfunction in attention-deficit/hyperactivity disorder. Biol. Psychiatry 69, 1160–1167 (2011).
Bush, G. et al. Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop. Biol. Psychiatry 45, 1542–1552 (1999).
Bush, G., Luu, P. & Posner, M. I. Cognitive and emotional influences in anterior cingulate cortex. Trends Cogn. Sci. 4, 215–222 (2000).
Kitta, T. et al. Functional role of anterior cingulate gyrus in the control of micturition reflex in rats. J. Urol. 187, (Suppl.) e12 (2012).
Joinson, C., Heron, J. & von Gontard, A. Psychological problems in children with daytime wetting. Pediatrics 118, 1985–1993 (2006).
Joinson, C. et al. Early childhood risk factors associated with daytime wetting and soiling in school-age children. J. Pediatr. Psychol. 33, 739–750 (2008).
Beckel, J. & Holstge, G. in Urinary Tract (Handbook of Experimental Pharmacology) Vol. 202 (eds Andersson, K. E. & Michel, M. C.) (Springer, 2011).
Labrie, J. et al. The relationship between children with voiding problems and their parents. J. Urol. 183, 1887–1891 (2010).
Rohr, G., Kragstrup, J., Gaist, D. & Christensen, K. Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women. Acta Obstet. Gynecol. Scand. 83, 978–982 (2004).
Wennberg, A. L. et al. Genetic influences are important for most but not all lower urinary tract symptoms: a population-based survey in a cohort of adult Swedish twins. Eur. Urol. 59, 1032–1038 (2011).
Tettamanti, G., Altman, D., Iliadou, A. N., Bellocco, R. & Pedersen, N. L. Depression, neuroticism, and urinary incontinence in premenopausal women: a nationwide twin study. Twin Res. Hum. Genet. 16, 977–984 (2013).
Richter, H. E. et al. Genetic contributions to urgency urinary incontinence in women. J. Urol. 193, 2020–2027 (2015).
Haghsheno, M. A. et al. Lower urinary tract symptoms are associated with low levels of serum serotonin, high levels of adiponectin and fasting glucose, and benign prostatic enlargement. Scand. J. Urol. 49, 155–161 (2015).
Lumeng, J. C., Gannon, K., Cabral, H. J., Frank, D. A. & Zuckerman, B. Association between clinically meaningful behavior problems and overweight in children. Pediatrics 112, 1138–1145 (2003).
Mustillo, S. et al. Obesity and psychiatric disorder: developmental trajectories. Pediatrics 111, 851–859 (2003).
Chang, S. J., Chiang, I. N., Lin, C. D., Hsieh, C. H. & Yang, S. S. Obese children at higher risk for having overactive bladder symptoms: a community-based study. Neurourol. Urodyn. 34, 123–127 (2015).
Erdem, E., Lin, A., Kogan, B. A. & Feustel, P. J. Association of elimination dysfunction and body mass index. J. Pediatr. Urol. 2, 364–367 (2006).
Oliver, J. L., Campigotto, M. J., Coplen, D. E., Traxel, E. J. & Austin, P. F. Psychosocial comorbidities and obesity are associated with lower urinary tract symptoms in children with voiding dysfunction. J. Urol. 190, (Suppl 4) 1511–1515 (2013).
Pashankar, D. S. & Loening-Baucke, V. Increased prevalence of obesity in children with functional constipation evaluated in an academic medical center. Pediatrics 116, e377–e380 (2005).
Loening-Baucke, V. Prevalence rates for constipation and faecal and urinary incontinence. Arch. Dis. Child 92, 486–489 (2007).
Erdem, E., Kogan, B. A. & Feustel, P. J. Relationship between body mass index and pediatric urologic diagnoses. J. Pediatr. Urol. 3, 268–272 (2007).
Fishman, L., Lenders, C., Fortunato, C., Noonan, C. & Nurko, S. Increased prevalence of constipation and fecal soiling in a population of obese children. J. Pediatr. 145, 253–254 (2004).
Alonso-Alonso, M. & Pascual-Leone, A. The right brain hypothesis for obesity. JAMA 297, 1819–1822 (2007).
Sullivan, P. F., Daly, M. J. & O'Donovan, M. Genetic architectures of psychiatric disorders: the emerging picture and its implications. Nat. Rev. Genet. 13, 537–551 (2012).
Berridge, C. W., Espana, R. A. & Stalnaker, T. A. in The Asymmetrical Brain (ed. Hugdahl, K.) (MIT Press, 2003).
Wood, S. K., Baez, M. A., Bhatnagar, S. & Valentino, R. J. Social stress-induced bladder dysfunction: potential role of corticotropin-releasing factor. Am. J. Physiol. Regul. Integr. Comp. Physiol. 296, R1671–R1678 (2009).
Romens, S. E., McDonald, J., Svaren, J. & Pollak, S. D. Associations between early life stress and gene methylation in children. Child Dev. 86, 303–309 (2015).
Vrijens, D. et al. Affective symptoms and the overactive bladder - a systematic review. J. Psychosom. Res. 78, 95–108 (2015).
Franco, I. et al. Can a simple question predict prolonged lag times in children? J. Pediatr. Urol. 157, e1–e8 (2016).
Schwartz, C. E. & Rauch, S. L. Temperament and its implications for neuroimaging of anxiety disorders. CNS Spectr. 9, 284–291 (2004).
Schwartz, C. E. et al. Structural differences in adult orbital and ventromedial prefrontal cortex predicted by infant temperament at 4 months of age. Arch. Gen. Psychiatry 67, 78–84 (2010).
Moore, K. H. & Sutherst, J. R. Response to treatment of detrusor instability in relation to psychoneurotic status. Br. J. Urol. 66, 486–490 (1990).
Franco, I. et al. Treatment of lower urinary tract symptoms in children with constipation using tegaserod therapy. Urotoday Int. J. 3, 5784–5792 (2010).
Blankstein, U., Chen, J., Diamant, N. E. & Davis, K. D. Altered brain structure in irritable bowel syndrome: potential contributions of pre-existing and disease-driven factors. Gastroenterology 138, 1783–1789 (2010).
Peterson, B. S. et al. Cortical thinning in persons at increased familial risk for major depression. Proc. Natl. Acad. Sci. USA 106, 6273–6278 (2009).
Hyde, T. M. et al. Enuresis as a premorbid developmental marker of schizophrenia. Brain 131, 2489–2498 (2008).
Baeyens, D. et al. Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study. Acta Paediatr. 94, 1619–1625 (2005).
Duel, B. P., Steinberg-Epstein, R., Hill, M. & Lerner, M. A survey of voiding dysfunction in children with attention deficit-hyperactivity disorder. J. Urol. 170, 1521–1524 (2003).
von Gontard, A., Moritz, A. M., Thome-Granz, S. & Freitag, C. Association of attention deficit and elimination disorders at school entry: a population based study. J. Urol. 186, 2027–2032 (2011).
Niemczyk, J., Equit, M., Hoffmann, L. & von Gontard, A. Incontinence in children with treated attention-deficit/hyperactivity disorder. J. Pediatr. Urol. 11, 141.e1–141.e6 (2015).
Franco, I. Functional bladder problems in children: pathophysiology, diagnosis, and treatment. Pediatr. Clin. North Am. 59, 783–817 (2012).
Berger, M. Y., Tabbers, M. M., Kurver, M. J., Boluyt, N. & Benninga, M. A. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J. Pediatr. 161, 44–50.e2 (2012).
Millar, T. A. Health literacy and adherence to medical treatment in chronic and acute illness: a meta-analysis. Patient Educ. Couns. 99, 1079–1086 (2016).
Butler, R. J., Redfern, E. J. & Holland, P. Children's notions about enuresis and the implications for treatment. Scand. J. Urol. Nephrol. Suppl. 163, 39–47 (1994).
Hagstroem, S., Rittig, S., Kamperis, K. & Djurhuus, J. C. Timer watch assisted urotherapy in children: a randomized controlled trial. J. Urol. 184, 1482–1488 (2010).
Bower, W. F. & Chase, J. W. in Pediatric Incontinence evaluation and clinical management (eds Franco, I., Austin, P., Bauer, S., von Gontard, A. & Homsy, Y.) 133–137 (Wiley Blackwell, 2015).
Bush, N. C. et al. Randomized, double-blind, placebo-controlled trial of polyethylene glycol (MiraLAX(®)) for urinary urge symptoms. J. Pediatr. Urol. 9, 597–604 (2013).
Wald, A. Constipation: Advances in Diagnosis and Treatment. JAMA 315, 185–191 (2016).
Finney, S. M., Andersson, K. E., Gillespie, J. I. & Stewart, L. H. Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int. 98, 503–507 (2006).
Andersson, K. E. Antimuscarinic mechanisms and the overactive detrusor: an update. Eur. Urol. 59, 377–386 (2011).
Wein, A. J. & Rackley, R. R. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J. Urol. 175, S5–S10 (2006).
Kullmann, F. A., Artim, D. E., Birder, L. A. & de Groat, W. C. Activation of muscarinic receptors in rat bladder sensory pathways alters reflex bladder activity. J. Neurosci. 28, 1977–1987 (2008).
Eglen, R. M., Hegde, S. S. & Watson, N. Muscarinic receptor subtypes and smooth muscle function. Pharmacol. Rev. 48, 531–565 (1996).
Andersson, K. Antimuscarinics for treatment of overactive bladder and detrusor overactivity. Campbell's Urol. Updates 2, 1–12 (2004).
Ferrara, P., D'Aleo, C. M., Tarquini, E., Salvatore, S. & Salvaggio, E. Side-effects of oral or intravesical oxybutynin chloride in children with spina bifida. BJU Int. 87, 674–678 (2001).
Sommer, B. R., O'Hara, R., Askari, N., Kraemer, H. C. & Kennedy, W. A. 2nd.The effect of oxybutynin treatment on cognition in children with diurnal incontinence. J. Urol. 173, 2125–2127 (2005).
Giramonti, K. M., Kogan, B. A. & Halpern, L. F. The effects of anticholinergic drugs on attention span and short-term memory skills in children. Neurourol. Urodyn. 27, 315–318 (2008).
Todorova, A., Vonderheid-Guth, B. & Dimpfel, W. Effects of tolterodine, trospium chloride, and oxybutynin on the central nervous system. J. Clin. Pharmacol. 41, 636–644 (2001).
Gupta, S. K. et al. Quantitative characterization of therapeutic index: application of mixed-effects modeling to evaluate oxybutynin dose-efficacy and dose-side effect relationships. Clin. Pharmacol. Ther. 65, 672–684 (1999).
Austin, P. F. et al. alpha-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J. Urol. 162, 1064–1067 (1999).
Franco, I., Caglisotro, S., Collett T. & Reda E. in American Academy of Pediatrics Meeting (San Francisco, 2007).
Vanderbrink, B. A., Gitlin, J., Toro, S. & Palmer, L. S. Effect of tamsulosin on systemic blood pressure and nonneurogenic dysfunctional voiding in children. J. Urol. 181, 817–822 (2009).
Spradling, K. et al. Redefining the autonomic nerve distribution of the bladder using 3-dimensional image reconstruction. J. Urol. 194, 1661–1667 (2015).
Hunsballe, J. M. & Djurhuus, J. C. Clinical options for imipramine in the management of urinary incontinence. Urol. Res. 29, 118–125 (2001).
Young, R., Kwon, E., Collett, T., Reda, E. & Franco, I. in American Academy of Pediatrics (Boston, 2008).
de Groat, W. C., Griffiths, D. & Yoshimura, N. Neural control of the lower urinary tract. Compr. Physiol. 5, 327–396 (2015).
Numata, A. et al. Micturition-suppressing region in the periaqueductal gray of the mesencephalon of the cat. Am. J. Physiol. Regul. Integr. Comp. Physiol. 294, R1996–R2000 (2008).
Goel, K. M. & Shanks, R. A. Amitriptyline and imipramine poisoning in children. Br. Med. J. 1, 261–263 (1974).
Schuessler, B. What do we know about duloxetine's mode of action? Evidence from animals to humans. BJOG 113 (Suppl. 1), 5–9 (2006).
Critchley, H. D. et al. Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain 126, 2139–2152 (2003).
Andersson, K. et al. in Incontinence Ch. 8,(ed. Abrams, P., Cardozo, L., Khoury, S., Wein, A.) (Paris Health Publications Ltd, 2009).
Uchida, H., Shishido, K., Nomiya, M. & Yamaguchi, O. Involvement of cyclic AMP-dependent and -independent mechanisms in the relaxation of rat detrusor muscle via beta-adrenoceptors. Eur. J. Pharmacol. 518, 195–202 (2005).
Frazier, E. P., Mathy, M. J., Peters, S. L. & Michel, M. C. Does cyclic AMP mediate rat urinary bladder relaxation by isoproterenol? J. Pharmacol. Exp. Ther. 313, 260–267 (2005).
Kobayashi, H., Adachi-Akahane, S. & Nagao, T. Involvement of BK(Ca) channels in the relaxation of detrusor muscle via beta-adrenoceptors. Eur. J. Pharmacol. 404, 231–238 (2000).
Kavia, R., Dasgupta, R., Critchley, H., Fowler, C. & Griffiths, D. A functional magnetic resonance imaging study of the effect of sacral neuromodulation on brain responses in women with Fowler's syndrome. BJU Int. 105, 366–372 (2010).
Walsh, I. K., Johnston, R. S. & Keane, P. F. Transcutaneous sacral neurostimulation for irritative voiding dysfunction. Eur. Urol. 35, 192–196 (1999).
Hoebeke, P., Renson, C., Petillon, L., Vande Walle, J. & De Paepe, H. Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: a pilot study. J. Urol. 168, 2605–2607 (2002).
Bower, W. F., Moore, K. H. & Adams, R. D. A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence. J. Urol. 166, 2420–2422 (2001).
Lordelo, P., Teles, A., Veiga, M. L., Correia, L. C. & Barroso, U. Jr. Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial. J. Urol. 184, 683–689 (2010).
van Balken, M. R., Vergunst, H. & Bemelmans, B. L. The use of electrical devices for the treatment of bladder dysfunction: a review of methods. J. Urol. 172, 846–851 (2004).
Capitanucci, M. L. et al. Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children. J. Urol. 182, 2056–2061 (2009).
Barroso, U. et al. Posterior tibial nerve stimulation versus parasacral transcutaneous neuromodulation for overactive bladder in children. J. Urol. 190, 673–677 (2013).
Roth, T. J., Vandersteen, D. R., Hollatz, P., Inman, B. A. & Reinberg, Y. E. Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J. Urol. 180, 306–311 (2008).
Hoebeke, P. et al. The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J. Urol. 176, 328–330 (2006).
Lahdes-Vasama, T. T., Anttila, A., Wahl, E. & Taskinen, S. Urodynamic assessment of children treated with botulinum toxin A injections for urge incontinence: a pilot study. Scand. J. Urol. Nephrol. 45, 397–400 (2011).
Marte, A. et al. Effectiveness of botulinum-A toxin for the treatment of refractory overactive bladder in children. Eur. J. Pediatr. Surg. 20, 153–157 (2010).
Khoury, A. E., Hendrick, E. B., McLorie, G. A., Kulkarni, A. & Churchill, B. M. Occult spinal dysraphism: clinical and urodynamic outcome after division of the filum terminale. J. Urol. 144, 426–428 (1990).
Steinbok, P., Garton, H. J. & Gupta, N. Occult tethered cord syndrome: a survey of practice patterns. J. Neurosurg. 104, 309–313 (2006).
Drake, J. M. Occult tethered cord syndrome: not an indication for surgery. J. Neurosurg. 104, (Suppl 3) 305–308 (2006).
Selcuki, M. et al. Is a filum terminale with a normal appearance really normal? Childs Nerv. Syst. 19, 3–10 (2003).
Selden, N. R., Nixon, R. R., Skoog, S. R. & Lashley, D. B. Minimal tethered cord syndrome associated with thickening of the terminal filum. J. Neurosurg. 105, 214–218 (2006).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
I.F. is the founder and chief scientific officer of Franco Intelligent Agent Solutions, a computer software company that analyses urodynamic studies. I.F. has acted as a consultant of Allergan and Astellas.
Rights and permissions
About this article
Cite this article
Franco, I. Overactive bladder in children. Nat Rev Urol 13, 520–532 (2016). https://doi.org/10.1038/nrurol.2016.152
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrurol.2016.152
This article is cited by
-
The prevalence of probable overactive bladder and associated risk factors among medical students in Jordan: a cross-sectional study
BMC Urology (2024)
-
Digital health information on surgical treatment options for overactive bladder is underrepresented
World Journal of Urology (2023)
-
Harninkontinenz und Enuresis
Pädiatrie (2023)
-
Relationship between nocturnal enuresis and sleep in children and adolescents
Pediatric Nephrology (2023)
-
The Role of Physical Therapy in the Treatment of Pediatric Bladder Dysfunction
Current Bladder Dysfunction Reports (2023)