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Voiding postponement in children—a systematic review

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Abstract

Voiding postponement (VP) has been defined as a habitual postponement of micturition using holding maneuvers. VP can represent both a symptom, as well as a condition. As divergent definitions are used internationally, the aim was to review the current state of knowledge on VP and provide recommendations for assessment, diagnosis and treatment. A Scopus and a Pubmed search was conducted, entering the terms ‘voiding postponement’ without any restrictions or specifications. Other publications relevant to the topic were added. VP can represent a symptom in healthy children. As a condition, VP in combination with nocturnal enuresis (NE) is a subtype of non-monosymptomatic NE. Most studies have focused on daytime urinary incontinence (DUI) with VP, or more aptly termed voiding postponement incontinence (VPI). It is a behaviorally defined syndrome, i.e., by the habitual deferral of micturition and DUI. VPI is associated with a low micturition frequency, urgency and behavioral problems. The most common comorbid disorder is oppositional defiant disorder (ODD). VP as a symptom and VPI as a condition should be differentiated. VPI is a common disorder with many associated problems and disorders. Urotherapy and timed voiding are the main treatment approaches. Due to the high rate of comorbid ODD, other forms of treatment, especially cognitive behavioral therapy, are often needed.

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Abbreviations

DSM-5:

Diagnostic and statistical manual (5th edition)

DUD:

Detrusor underutilization disorder

DUI:

Daytime urinary incontinence

DV:

Dysfunctional voiding

FI:

Fecal incontinence

ICCS:

International Children’s Continence Society

ICD-10:

International classification of diseases

LUTS:

Lower urinary tract symptoms

LUTD:

Lower urinary tract dysfunction

NE:

Nocturnal enuresis

OAB:

Overactive bladder

ODD:

Oppositional defiant disorder

UB:

Underactive bladder

UUI:

Urge urinary incontinence

VP:

Voiding postponement

VPI:

Voiding postponement incontinence

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany

    Alexander von Gontard, Justine Niemczyk & Catharina Wagner

  2. Department of Clinical Psychology, Saarland University, Saarbrücken, Germany

    Monika Equit

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  1. Alexander von Gontard
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  2. Justine Niemczyk
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  3. Catharina Wagner
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  4. Monika Equit
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Correspondence to Alexander von Gontard.

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von Gontard, A., Niemczyk, J., Wagner, C. et al. Voiding postponement in children—a systematic review. Eur Child Adolesc Psychiatry 25, 809–820 (2016). https://doi.org/10.1007/s00787-015-0814-1

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