Delivery of Urotherapy for Pediatric Lower Urinary Tract Symptoms: History and Contemporary Practice

Lower urinary tract symptoms (LUTS) affect an estimated 5-15% of children and can negatively impact their self-esteem and overall quality of life. The International Children’s Continence Society’s (ICCS) first-line recommendation for LUTS management is standard urotherapy, a non-surgical, non-pharmacological intervention focused on behavioral change and lifestyle modification, including guidance on hydration, timed voiding, and proper toileting posture. This review outlines the evolution of standard urotherapy since 1987 and highlights challenges in its delivery and evaluation.

Urotherapy was traditionally delivered and taught as a one-to-one, clinic-based patient-provider encounter. However, novel formats such as video and group classes have emerged as promising alternatives that may expand patient reach by delivering select components of urotherapy when in-clinic care is not timely or accessible. Existing studies have identified key design and implementation challenges in the delivery and evaluation of urotherapy.

This review traces the evolution of standard urotherapy since 1987, introduces novel delivery formats, and, informed by implementation frameworks, provides recommendations for improving care delivery and reducing disease burden, particularly through scalable and accessible models to address clinic- and patient-level barriers to care.