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Non-invasive techniques for stimulating urine production in non-toilet trained children: a systematic review
  1. Mathew Chandy1,
  2. Ann Dewey2,
  3. Carole Fogg3,
  4. Karen Pilkington2
  1. 1 Emergency Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  2. 2 School of Health and Care Professions, University of Portsmouth, Portsmouth, Hampshire, UK
  3. 3 Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
  1. Correspondence to Dr Mathew Chandy, Emergency Department, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3AD, UK; matthew.chandy{at}


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.

  • paediatric emergency med
  • emergency department
  • paediatrics, paediatric emergency medicine
  • uro-genital

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  • Twitter @mattchandy

  • Contributors Study design: MC, KP, AD, CF. Study conduct: MC, KP, AD. Drafting of manuscript: MC, KP. Review of manuscript: MC, KP, AD, CF.

  • Funding This systematic review was undertaken with funding for authors MC, KP and AD from the Royal College of Emergency Medicine.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.