Hsi-Yang Wu

Publication Details

• Can evidence-based medicine change toilet training practice?

  Wu HY, Arab J Urol. 2013; 11 (1): 13-18

  OBJECTIVES: Physician recommendation of a toilet training (TT) method faces obstacles since parents rarely request advice on TT from physicians, and TT practices vary tremendously across cultures and socioeconomic levels. Is there evidence showing that a specific method of TT is more effective? METHODS: We reviewed the English language literature between 1946-2012 on the natural course of urinary incontinence in children and different methods of TT. We specifically investigated historical recommendations on TT, the prevalence of urinary incontinence during childhood, outcome of TT methods, and the impact of culture and socioeconomic status on the choice of TT method and timing. RESULTS: TT now occurs at later ages than it did in the past. This progression reflects changing ideas regarding normal childhood physiology and psychology. The prevalence of urinary incontinence in European countries progressively decreased in children from 6-7 years to 16-17 years of age. TT methods shift with increasing socioeconomic levels to “child-centered” techniques applied at older ages, but the prevalence of urinary incontinence after “parent-centered” techniques of TT at younger ages has not been studied. There is currently no evidence that a specific timing or method of TT is more effective or prevents voiding dysfunction. CONCLUSIONS: Follow-up studies of urinary continence in children toilet trained at 6-12 months of age may provide evidence whether a given method or timing of TT is beneficial to prevent voiding dysfunction. Physician recommendations may be more readily adopted if they fit culturally accepted ideas of good parenting techniques.