Based on observations of Reiner and Gearhart  that children with exstrophy/epispadius suffered from clinically significant anxiety disorder, we decided to study the impact of long standing voiding dysfunction on psychological and mental health of children in order to assess whether long standing incontinence regardless of its cause could affect pychological and mental function of children
  Reiner, W.G. and Gearhart, J. P: Anxiety disorders in children with epispadias-exstrophy. Urol. 68: 172–174, 2006

Forty nine children were enrolled in this clinical non- surgical prospective study. Informed consent was obtained from parents of those children. 
History taking, urological examination and pad test was completed. Childhood Behavior Checklist (CBCL) and Intelligence quotient (IQ) standard test all collected through specialized team of child psychiatrist and psychologist.
Data of a cohort of age matched children who attended pediatric psychiatry clinic for variety of reasons were taken as a control group
data were collected, tabulated and analysed. Standard t test was used for comparison of IQ results.

Mean age of children is 9.93 years. 31 were males and 18 were females. Median number of surgical interventions on our patients was 3; including open and endoscopic procedures. The aetiology of incontinence was myelomeningocele in 14, exstrophy in 8, incontinent epispadius in 4, valve bladder in 4, sacral agenesis in 3, 2 common urogenital sinus, 3 had contracted bladder following bilateral urterovesical re-implantation and 11 children had different neurogenic and dysfunctional causes of incontinence. All were maintained on pads and their mean pads were  5 per day. 
Median total score of CBCL was 27. Different domains of the score were assessed. Mean IQ among the study group was 88.3.

Median scores for anxious/depressed domain was 6, 1 for withdrawn/depressed domain, 1 for somatic complaints, 3 for social problems,3 for attention problems,1 for Rule breaking behavior, 5 for  aggressive behavior, 8 for internalizing problems and 6 for externalizing problems.
Mean IQ was found in the low average range, according to Wechsler IQ classification. Because of the importance of the impact on IQ, we collected the data of consecutive 50 children of the same age group with no incontinence problems and was found to be 94.65. the difference was statistically significant (p=0.005)

Children with long standing incontinence of different etiologies suffer from protracted psychological impact affecting most domains of the CBCL. It is also evidence that their IQ is lower than their peers with no such complaint. This might affect their IQ and accordingly their educational activity