Practice patterns, barriers, and attitudes toward urotherapy for pediatric lower urinary tract symptoms: A societies for pediatric urology survey.

Background: Pediatric lower urinary tract symptoms (LUTS) are common in school-age children. Urotherapy (UT), the first-line treatment involving education on behavioral changes, is typically delivered through in-person 1:1 clinic visits, which can limit access and strain clinic resources. Although novel formats such as group classes and self-paced videos show comparable efficacy to standard UT, their adoption remains limited by a lack of understanding provider acceptability and operational feasibility. This study surveyed pediatric urologists to understand clinical practice patterns and perceptions toward adoption of novel UT formats. Two UT programs at our institution, Bladder Bootcamp (virtual group class) and Bladder Basics (self-paced video curriculum) were included. The findings aim to guide the development and implementation of scalable UT programs to improve LUTS care.

Methods: A 35-item survey was distributed to members of the Societies for Pediatric Urology, assessing clinical practice patterns, beliefs regarding UT, and attitudes and perceived barriers toward adoption of a virtual group education class and self-paced video curriculum. Descriptive analyses and Wilcoxon signed-rank tests to compare attitudes and perceived barriers between the two programs were conducted.

Results: The response rate was 12.3 % (46/374). Most respondents were White/European (73.2 %), male (65.1 %), employed at an academic center (57.8 %), and in practice for ≥20 years (35.6 %), and 47.8 % held a leadership position in their practice. Commonly recommended UT resources included physical resources (73.9 %), institution-specific patient education materials (63 %), wearable devices (47.8 %), and online resources (39.1 %), with 52.2 % agreeing these resources allow for optimal care. Additional resources that would improve care included online resources (63 %), healthcare apps (50 %), and wearable devices (37 %). Most respondents (60.9 %) preferred in-person 1:1 visits as the ideal method for first-line LUTS treatment. There was greater interest in offering (p = 0.0204) and feasibility in operating (p = 0.0068) the self-paced video curriculum. No significant difference was found for need (p = 0.856) between the two programs. Primary adoption barriers included adequate funding and institutional support. Staffing (p = 0.00388) and funding (p < 0.001) were greater barriers for operating the virtual group education class.

Conclusions: While traditional in-person UT is preferred among pediatric urologists, there is interest and need for novel formats, such as virtual self-paced and group educational programs. Addressing key barriers, such as funding and institutional support, is critical for successful implementation. Engaging implementation partners and positioning these formats as complementary to standard care will be crucial for overcoming practical challenges and optimizing UT delivery.