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Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review

Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review
Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review

BACKGROUND: Urinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques.

METHODS: MEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders.

RESULTS: Three randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress.

DISCUSSION: The results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.

emergency department, paediatric emergency med, paediatrics, paediatric emergency medicine, uro-genital
1472-0205
162-169
Chandy, Mathew
ec7bc70d-80de-45a6-9770-cf01ab20c9aa
Dewey, Ann
e0734bf3-5ad8-4c6b-8658-089a3b7d36d2
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Pilkington, Karen
711ed80f-063c-4b82-b3f8-6743ef943ff3
Chandy, Mathew
ec7bc70d-80de-45a6-9770-cf01ab20c9aa
Dewey, Ann
e0734bf3-5ad8-4c6b-8658-089a3b7d36d2
Fogg, Carole
42057537-d443-462a-8944-c804252c973b
Pilkington, Karen
711ed80f-063c-4b82-b3f8-6743ef943ff3

Chandy, Mathew, Dewey, Ann, Fogg, Carole and Pilkington, Karen (2020) Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review. Emergency Medicine Journal, 37 (3), 162-169. (doi:10.1136/emermed-2019-208580).

Record type: Article

Abstract

BACKGROUND: Urinary tract infection requires collection of a sterile urine specimen for diagnosis, which is difficult and time consuming in pre-continent children. This systematic review summarises evidence of the effectiveness of bladder stimulation techniques on urine collection in pre-continent children, compared with standard techniques.

METHODS: MEDLINE, PubMed, EMBASE and CINAHL were searched to May 2019. Selection, data extraction, risk of bias and quality assessment were undertaken by two independent reviewers. Inclusion: (1) all study designs; (2) pre-continent, age <3 years receiving bladder stimulation techniques; (3) outcomes including time to urine collection or contamination rates; (4) English-language articles. Exclusion: coexisting neurological disorders.

RESULTS: Three randomised controlled trials (RCTs) were identified using three techniques in 568 participants aged 1 day to 35 months. Two RCTs demonstrated an increased success in voiding within 5 min, one using a finger tapping and lumbar paravertebral massage technique and the other cold saline-soaked gauze rubbed over the suprapubic region, compared with no active intervention. A third RCT using a mechanical vibration device demonstrated no difference in time to voiding from advice alone. Non-randomised studies compared different temperatures for the gauze intervention and tapping alone versus urine bags. Six uncontrolled studies tested the finger tapping and massage technique. Risk of bias was low for one RCT and unclear for two RCTs with the other studies rated poor to fair quality. Overall, the evidence on success rates was graded low for tapping plus massage and moderate for the gauze rubbing intervention. Adverse effects included crying and mild distress.

DISCUSSION: The results suggest a positive effect of stimulation techniquesbut lack of replication in rigorous RCTs and heterogeneity of techniques and outcomes assessed prevent conclusive recommendations being made. Further RCTs are required comparing non-invasive stimulation methods and assessing time to successful collection, contamination rates, adverse effects, caregiver and clinical staff acceptability.

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Accepted/In Press date: 4 January 2020
e-pub ahead of print date: 7 February 2020
Additional Information: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: emergency department, paediatric emergency med, paediatrics, paediatric emergency medicine, uro-genital

Identifiers

Local EPrints ID: 437451
URI: http://eprints.soton.ac.uk/id/eprint/437451
ISSN: 1472-0205
PURE UUID: 85ff66f3-44e8-41d6-a227-819e15302f3d
ORCID for Carole Fogg: ORCID iD orcid.org/0000-0002-3000-6185

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Date deposited: 30 Jan 2020 17:38
Last modified: 31 Aug 2022 01:59

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Contributors

Author: Mathew Chandy
Author: Ann Dewey
Author: Carole Fogg ORCID iD
Author: Karen Pilkington

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