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  • Review Article
  • Published:

Overactive bladder in children

Nature Reviews Urology volume 13, pages 520–532 (2016)Cite this article

Subjects

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.

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Figure 1: Typical holding manoeuvres used by children with urinary urgency.
Figure 2: The location of afferent nerves and their receptor subtypes.
Figure 3: Schematic depiction of probable connections between the forebrain and brainstem structures in the control of micturition.
Figure 4: Responses to bladder filling in children.
Figure 5: Image reconstruction models of bladder autonomic innervation.
Figure 6: Mechanism of action of established treatment options for patients with overactive bladder.

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Authors and Affiliations

  1. Yale New Haven Hospital, Children's Bladder and Continence Program, 789 Howard Avenue, FMP 300, PO Box 208058, New Haven, 06520–8058, Connecticut, USA

    Israel Franco

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Correspondence to Israel Franco.

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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.

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Franco, I. Overactive bladder in children. Nat Rev Urol 13, 520–532 (2016). https://doi.org/10.1038/nrurol.2016.152

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