Urinary incontinence (UI) is prevalent among children, affecting approximately 7% to 10% (aged 5-13 years) during the day [1] and 9% to 12% (aged 5-15 years) during the night [2-4]. UI often leads to low self-esteem, shame, and stress, negatively impacting the child’s psychosocial well-being and overall quality of life [5-9]. The primary treatment approach for pediatric UI, once anatomical and neurogenic causes are excluded, mainly involves lifestyle advice and behavioral methods [10-12]. These methods vary depending on whether the UI occurs during the day or at night.

For daytime UI (DUI), the recommended first-line approach is standard urotherapy. It encompasses patient education, keeping track of symptoms through bladder diaries, regulating fluid intake and toilet routines, adhering to scheduled voiding, and providing support and encouragement [13-16]. An important part of this treatment is teaching children appropriate responses to their bladder signals. Standard urotherapy achieves success rates ranging from 40% to 56% [17-19]. For nighttime UI, also known as nocturnal enuresis (NE), one of the recommended first-line treatments is NE alarm training [20]. This method uses a moisture sensor that triggers an alarm to wake the child upon bed-wetting. Through this approach, children are conditioned to recognize and respond to bladder signals, ultimately helping reduce bed-wetting episodes. The success rate of alarm training is between 50% and 70% [21]. However, motivation and adherence, both crucial for these behavioral methods to be successful [22,23], are low in practice [22,24,25].

There are many factors that influence motivation and adherence [15,24-27], including duration of therapy, required effort, symptom bother, and awareness but also the supporting tools’ usability and acceptance. The evaluation and management of pediatric UI traditionally rely on pen-and-paper bladder diaries [28-30], along with verbal and written instructions for behavioral techniques [16] and traditional NE alarms [31]. However, these analogue methods may seem outdated to today’s “digital native” children, who are accustomed to using technology and digital tools [32]. Consequently, traditional approaches to pediatric UI management may no longer meet today’s children’s needs and expectations, potentially affecting motivation and adherence. Meanwhile, digital interventions have already proven effective as alternatives to traditional methods in other pediatric health care areas such as pain tracking [33], attention-deficit/ hyperactivity disorder therapy [34], childhood obesity prevention [35], and asthma management [36].

Therefore, our objective was to identify and map innovative, technology-driven, digital tools for pediatric UI management as alternatives to conventional approaches such as pen-and-paper solutions. In addition, we aimed to provide an overview of these tools’ characteristics, including their features, design drivers, and any reported evidence supporting their use.

Eligibility criteria were determined based on the population, concept, and context framework. The population for this review included pediatric patients experiencing conditions such as bladder and bowel dysfunction (BBD), NE, overactive bladder (OAB), underactive bladder, and dysfunctional voiding (DV), as well as neurogenic conditions such as spina bifida. Studies involving adult populations (aged ≥18 years) or unrelated conditions (eg, cancer or rare diseases) were excluded.

The concept focused on innovative, technology-driven, digital tools for managing pediatric UI and related dysfunctions. Eligible tools included smartphone apps, multimedia resources, and remote monitoring technologies, whereas conventional methods or treatment plans without tangible tools were excluded.

The context was limited to studies that addressed noninvasive therapeutic approaches, particularly behavioral methods such as urotherapy, bladder training, and alarm training. Invasive approaches, including surgeries and their associated tools, were excluded.

All types of literature were considered, including gray literature (eg, conference proceedings, preprints, and technical reports), to provide a broad range of available literature and reduce publication bias. However, articles not presenting results or findings, not written in English, or lacking full-text availability were excluded.

The search (see Multimedia Appendix 2 for the full search strategy) was conducted in March 2022 across 3 databases—PubMed, Web of Science, and the Cochrane Library—with no limitations on publication dates. The population, concept, and context framework guided the selection of search terms.

Key search terms for population included “children,” “adolescents,” “pediatric,” “bladder bowel dysfunction,” and “enuresis.” For concept, terms such as “digital,” “mHealth,” “gamification,” “multimedia,” and “remote monitoring” were used. Context-related search terms included “urotherapy,” “bladder training,” “alarm therapy,” “self-monitoring,” and “behavior management.”

The study selection process was conducted by the first author (LB), with consultation and supervision provided by the team of authors. After removing duplicates, potential studies underwent screening based on their titles and abstracts in line with the eligibility criteria, with any uncertainties discussed with the author team.

Subsequently, LB read and assessed the full-text articles, periodically consulting with the team to ensure consistency and rigor. To reduce selection bias from database choice, we conducted cross-referencing, scanning the reference lists of the included articles to identify additional relevant studies.

The selected studies underwent final review and confirmation by the entire author team. A formal critical appraisal or methodological quality assessment was not conducted as the aim of this scoping review was to identify and map the available evidence on innovative, technology-driven, digital tools rather than draw formal conclusions on their effectiveness.

Data were extracted and charted using Microsoft Excel (Microsoft Corp) according to four main heading groups: (1) article information, (2) participant characteristics (population), (3) tool description (concept), and (4) research methods and results (context). Article information encompassed details such as article title, authors, journal, publication year, country, and database source. Participant characteristics included sample size, age range, sex distribution, and dysfunction indication. Tool description covered intended therapy type, tool design details, and its design drivers. Finally, research methods and results comprised study design, intervention groups, study outcomes, and conclusions.

A combination of descriptive statistics and basic qualitative content analysis was used for data analysis. Descriptive statistics were used to analyze study characteristics, providing frequency counts and proportions for extraction items such as study design and dysfunction indication. Basic qualitative content analysis was used to identify and classify innovative, technology-driven, digital tools into distinct categories. The process began with multiple readings of the extraction items related to the tool description to familiarize ourselves with the data. Following an inductive approach, initial notes were made to generate codes, and coding was manually conducted in Microsoft Excel, where relevant terms were highlighted and grouped into emerging patterns. Through iterative refinement and team discussions, codes were merged, removed, or redefined to eliminate overlap and ensure sufficient distinction. The final set of codes was organized into 6 broad categories, 3 of which were further subdivided to capture more specific aspects. LB conducted the preliminary analysis, and to ensure consistency and reliability, the coding process was reviewed and refined collaboratively by the coauthors at multiple stages. Any disagreements on categorization were addressed through discussions to achieve consensus.

The search retrieved a total of 2030 articles (PubMed: n=951, 46.85%; Web of Science: n=760, 37.44%; Cochrane Library: n=319, 15.71%). After removing duplicates (372/2030, 18.33%), a total of 81.67% (1658/2030) of the studies were included in the title and abstract screening. Following title and abstract screening, of the 1658 articles, 1575 (94.99%) were excluded, leaving 83 (5.01%) for full-text evaluation. Finally, 60 articles were included in the data extraction process, with an additional 6 identified through cross-referencing, resulting in a total of 66 included articles. Figure 1 illustrates the flowchart of the screening and selection process.

Of the included studies (n=66), most were randomized controlled trials (RCTs; 14/66, 21%) and validation studies (13/66, 20%), followed by quasi-experiments (10/66, 15%), prospective studies with no control group (7/66, 11%), and qualitative or mixed methods studies (8/66, 12%), as shown in Table 1. Nearly one-third (21/66, 32%) of the identified tools targeted children with NE, followed by DV (9/66, 14%), BBD (7/66, 11%), and DUI (7/66, 11%). More than one-third (25/66, 38%) of the studies evaluated outcomes related to patient experience, such as satisfaction, motivation, and usability. A mean sample size of 82 (SD 83; range 14-353) participants was found for the RCTs, quasi-experiments, and prospective studies (no control), indicating a large variation in sample size.

We identified and established a total of six primary categories of innovative, technology-driven, digital tools (Figure 2): (1) digital self-management (7/66, 11%), (2) serious games (7/66, 11%), (3) reminder technology (6/66, 9%), (4) educational media (12/66, 18%), (5) telehealth and remote patient monitoring (RPM; 13/66, 20%), and (6) enuresis alarm innovations (21/66, 32%). Further subcategories were identified within educational media, including video (5/12, 42%) and other media (7/12, 58%); within telehealth and RPM, including communication (5/13, 38%) and technological advances (8/13, 62%); and within enuresis alarm innovations, including novel configurations (8/21, 38%) and prevoid alarms (13/21, 62%).

Overall, we found that the distribution of dysfunction types was generally well balanced across the different tool categories. Digital self-management exhibited a diverse distribution, addressing a range of dysfunctions including BBD (1/7, 14%), DUI or nighttime UI (1/7, 14%), and neurogenic disorders (2/7, 29%). Serious games were predominantly used for DV (5/7, 71%). Reminder technology was used for timed voiding in cases of DUI and OAB (3/6, 50%), as well as for self-management of neurogenic and developmental or neurodevelopmental disorders (3/6, 50%). Educational media was used across a range of dysfunctions, with slightly more use for NE (4/12, 33%) and urinary tract infections (UTIs; 3/12, 25%). Telehealth was primarily used for BBD (4/13, 31%) and DUI or nighttime UI (4/13, 31%), with additional use also observed for DV (3/13, 23%). Finally, enuresis alarm innovations were predominantly associated with NE (16/21, 76%), as expected, although not exclusively. They were also applied for other conditions, such as DUI (2/21, 10%) and developmental or neurodevelopmental disorders (2/21, 10%).

In this scoping review, we identified and mapped innovative, technology-driven, digital tools for managing pediatric UI. The field of pediatric UI demonstrates a considerable level of innovation, as evidenced by the inclusion of 66 articles, with nearly one-third (21/66, 32%) focusing on NE. Our analysis led to the identification of six primary categories of tools, 3 of which were divided into subcategories. (1) Digital self-management tools, which leveraged the widespread use of smartphones, tablets, and computers, offering a convenient and accessible medium for health-related purposes such as electronic bladder diaries [40,41] and self-management apps or portals [42-46]. (2) Serious games, which engaged children through playful interactions, such as games for pelvic floor biofeedback training [47-52] and standard urotherapy [53]. (3) Reminder technology, which aimed to enhance therapy adherence without constant parental prompting, such as timer watches [54-56] and self-management reminder tools [57-59]. (4) Educational media for delivering health-related information to patients, which was subdivided into videos and other types of educational media. Videos offered visually engaging, 24/7-accessible, and anonymous dissemination of health information on topics ranging from behavioral therapy, such as bladder training and NE therapy [60-63], to preparing for surgical interventions [64]. A variety of other materials were found that provided child-friendly and engaging patient education, such as UI homework books [65,66], an NE multimedia program [67,68], and educational materials for UTIs [69-71]. (5) Telehealth and RPM for remote health information exchange, which was subdivided into communication and technological advances. Remote communication between patients and health care professionals through videoconferencing [72], home monitoring systems [73], and an embodied conversational agent [74-76] can lead to time, cost, and travel savings. Technological advances such as machine learning algorithms [79], new technologies [78,80,81], and new applications enabling home use [77,78,80-84] aimed to overcome the limitations of in-clinic procedures. (6) Enuresis alarm innovations, which were subdivided into novel configurations of traditional enuresis alarms and prevoid alarms. Enuresis alarm configurations encompassed pad-and-bell and body-worn alarms [86-88], wired and wireless systems [86], smart textiles [85,89], and a variety of alarm signals [86,90-92]. Prevoid alarms aimed to predict enuretic incidents and provide warnings in advance [93-105], with most using bladder ultrasound technology [93-104].

Many of the tools identified in this review were described as promising alternatives to traditional methods, with studies reporting their feasibility [40-46,57-59,65,66,93,95-98, 102,104,105], potential to improve outcomes [43,47-53,60, 61,64,74-76,82-84,90], and ability to save time for health care providers [49,60,61,64,68-70]. In addition, these tools were described as engaging for children, improving patient compliance [43,46,52,54-56,66,67,74-76] and leading to high levels of patient satisfaction and preference [40-46,53,58,72-77, 89,100,101,103].

However, the current body of evidence has methodological limitations, including retrospective designs [49,55,82,83]; absence of control groups [47,57,75,76,84,94,101,103]; and small sample sizes, with almost one-quarter of the studies (16/66, 24%) having a sample size of ≤15 participants [45,58,59,73,75,83,85,91,96,98-101,103-105]. While 21% (14/66) of the included studies were RCTs [43,50-52,56,60, 61,64,68,77,88-90,92], some of these (3/14, 21%) did not compare equivalent therapies [43,50,51]. Furthermore, the findings varied, with some studies (10/66, 15%) demonstrating differences in outcomes between the novel tools and traditional methods [49,55,56,74-76,88-90,94], whereas others (9/66, 14%) reported similar outcomes [40,50,60,68-70,77,87,92]. These observations highlight the need for more rigorous research to better establish the effectiveness of these tools.

The variability in the reported findings and gaps in robust evidence may also reflect the complexity of managing pediatric UI. This review highlights the multifaceted and multifactorial influences on pediatric UI management.

Given the multifaceted and multifactorial nature of pediatric UI management, we propose that novel tools should be designed as health care ecosystems that are (1) connected, (2) adaptive, (3) personalized, and (4) aligned with the needs of all stakeholders.

The concept of health care ecosystems for managing pediatric UI is rooted in a broader transformation of the health care industry driven by innovation [115]. Advances such as electronic health records, networked computer systems, and telehealth have revolutionized health care delivery, shifting from a model centered on face-to-face interactions with individual clinicians to a smart, interconnected health care community emphasizing shared decision-making [116]. The COVID-19 pandemic further accelerated this transition, highlighting the critical role of digital technologies in maintaining access to health care [117]. Furthermore, recent breakthroughs in computational power and artificial intelligence promise to expand the capabilities of health care systems even further [116].

A fair part of the currently available medical devices already has the ability to connect and communicate with other devices or systems. This connectivity transforms previously isolated tools into collaborative systems that operate within closed feedback loops, tailoring outputs to the individual [118]. For example, in glucose monitoring, sensors measure blood glucose levels, which then inform insulin delivery systems to maintain optimal glucose control [119]. Similarly, smart pillboxes improve medication adherence by tracking remaining doses, providing reminders through a connected alarm device [120].

While many of these systems have been tested primarily in contexts such as monitoring older patients at home [121]—where they support independence and reduce health care burdens—pediatric urology presents a significant opportunity for similar innovations. For example, a recently published article on the Minze Homeflow system demonstrates how a connected ecosystem can enhance pediatric UI management [122]. It integrates physical products (uroflowmeter and accessories) with digital tools (Minze app and clinician portal) for remote monitoring of uroflowmetry and bladder diary data. By shifting diagnostics to the home environment, the Homeflow system minimizes stress for pediatric patients while providing more reliable data compared to in-clinic measurements. Such a system demonstrates the feasibility and benefits of connected health care ecosystems in addressing specific challenges in pediatric urology.

Another study demonstrated how the Homeflow ecosystem could be further expanded by connecting additional products to the system, such as a smart drinking bottle and reminder technology, to personalize urotherapy [123]. The smart drinking bottle and home uroflowmeter monitored fluid intake and urinary output, whereas a reminder watch linked these devices, offering personalized voiding prompts based on the child’s bladder capacity and fluid intake. This demonstrates the potential of connected ecosystems to adapt and align with the individual care needs of pediatric patients.

The successful implementation of health care innovation and ecosystems requires addressing important challenges, such as regulatory and privacy concerns, equitable access, screen time considerations, and keeping health care human centered. Thoughtful strategies are needed to overcome these challenges and maximize benefits.

This scoping review has certain methodological limitations that should be considered when interpreting its results. First, the search was limited to 3 electronic databases, and only English-language papers were included. Second, only 1 reviewer screened the entire set of search results. However, the team engaged in frequent and extensive discussions throughout the study selection process to ensure rigorous screening. Third, our search had an extensive scope due to our broad criteria for defining innovative, technology-driven, digital tools, as well as having no time limits. The broad field and the potential abundance of relevant tools made it challenging to provide a concise overview of all the information. Consequently, this review encompassed a broad range of studies and a wide variety of innovative, technology-driven, digital tools.

This scoping review offers valuable insights into various categories of innovative, technology-driven, digital tools for managing pediatric UI and their supporting evidence. The inclusion of 66 articles highlights a considerable level of innovation in the field.

We identified 6 main categories of tools: digital self-management, serious games, reminder technology, educational media, telehealth and RPM, and enuresis alarm innovations. Further subcategories were found within these main categories, such as video and other media within educational media, communication and technological advances within telehealth and RPM, and novel configurations and prevoid alarms within enuresis alarm innovations.

Many of these tools were described as promising alternatives to traditional methods, with studies reporting feasibility, effectiveness in improving outcomes, and potential time savings for health care providers. In addition, these tools were described as engaging children effectively, potentially enhancing patient compliance and contributing to high patient satisfaction and preference. However, this review identified gaps in research, highlighting the need for more rigorous research to better assess the effectiveness of these tools and address the complex, multifaceted challenges of pediatric UI management. We propose the development of connected, adaptive, and personalized health care ecosystems that integrate diverse strategies for UI management, including education, diagnosis, therapy, monitoring, and feedback. By enabling synergies and links between these different strategies, such ecosystems could create a closed-loop system that enhances the alignment and efficiency of care.

We suggest that future research and development in this field adopt a human-centered and multidisciplinary approach, combining quantitative and qualitative methods to incorporate user perspectives and involve all stakeholders from the start. This mixed methods approach may help ensure that both objective evidence and subjective experiences are equally valued, supporting impactful innovations in the complex field of pediatric UI management.