29 Conclusion David is a boy with urinary incontinence during day and night. Based on symptoms and bladder diary, a diagnosis of an overactive bladder is made. He has no constipation or other complaints. The first step is starting urotherapy. Since he has a small bladder volume, also prescribe Oxybutynin 2,5 mg twice a day, before school and after school, to help him to control his bladder urgency. Starting with Oxybutynin is not only for urological reasons but also for mental support; the sooner he experiences control of his bladder, the better motivation he will have to continue his training and, it will help to improve his self-confidence. 1-3,6,9 Treatment phase Conditions for the success of urotherapy. The rationale of the therapy, the patient's motivation and expectations have been thoroughly questioned and discussed. Final goal: At the end of the urotherapy treatment, he has less or no wetting accidents during the day and night. He and his parents are satisfied. Short term goals: 1. Explanation & demystification: He and his mother have gained an adequate understanding of how the bladder works and what goes wrong in an overactive bladder. They are aware of why it is difficult to stay dry during the day: Wee factory 2. Voiding regimes: See textbox below and the Training Instructions He and his mother know what average fluid intake is appropriate for his age and how to properly distribute the fluid intake throughout the day. How to void: he has gained insight into his toilet position, knows how to adjust it, and what aids are needed for this.
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