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Correia Moretti E, da Silva IB, Boaviagem A, de Lima AMJ, Lemos A. Interventions for Enuresis in Children and Adolescents: An Overview of Systematic Reviews. Curr Pediatr Rev 2024; 20:76-88. [PMID: 36043721 DOI: 10.2174/1573396318666220827103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/06/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Enuresis is an involuntary and intermittent loss of urine during sleep, and its treatment can be done by pharmacological and non-pharmacological strategies. OBJECTIVE To conduct an overview to carry out a survey of the systematic reviews about treatment options for children/adolescents with enuresis. METHODS Databases used were Cochrane Library, PROSPERO, MEDLINE/PubMed, EMBASE, LILACS/BVS, PEDro, SciELO and Google Scholar. Any type of intervention for the treatment of enuresis in children/adolescents was selected by two independent researchers. Data extraction was done by two independent researchers. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2). RESULTS Seven systematic reviews were included. According to ROBIS, three reviews had a low risk of bias, while the others had a high risk of bias. Based on AMSTAR-2, four systematic reviews were of moderate quality, two were low quality, and one was critically low quality. CONCLUSION There is moderate confidence that the use of desmopressin plus an anticholinergic agent increases the chance of complete response compared to desmopressin alone. Neurostimulation may increase the risk of responses ≥50% and ≥90% compared to the control group. Likewise, it appears that electrical stimulation is superior to placebo about the chance of response ≥50%. In addition, there is clinical relevance in reducing enuresis episodes per week when neurostimulation is used compared to control groups.
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Affiliation(s)
- Eduarda Correia Moretti
- Department of Anatomy, Federal University of Pernambuco, Child and Adolescent Health, Federal University of Pernambuco - Recife (PE), Brazil
- Institute of Biological and Health Sciences, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
| | | | - Alessandra Boaviagem
- Department of Physiotherapy, Federal University of Pernambuco - Recife (PE), Brazil
| | | | - Andrea Lemos
- Department of Physical Therapy, Federal University of Pernambuco, Recife (PE), Brazil
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2
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Lestariningsih S, Wijayanti YT. Acupressure suppresses the frequency of enuresis in preschool children: A pilot non-randomized trial. ADVANCES IN INTEGRATIVE MEDICINE 2022. [DOI: 10.1016/j.aimed.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kimiya T, Shinjoh M, Asanuma H, Inoguchi T, Takahashi T. High success rate of nocturnal enuresis treatment during the stay-home period for COVID-19. Int J Urol 2022; 29:617-622. [PMID: 35240721 PMCID: PMC9111710 DOI: 10.1111/iju.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clarify whether enuresis treatment was more effective during the stay-home period for the coronavirus disease 2019 pandemic, when restrictions on activities enabled patients to concentrate on treatment. METHODS We performed a retrospective, nonrandomized cohort study for monosymptomatic enuresis during the coronavirus disease 2019 pandemic (March-June 2020) and a 2-year comparator period (March-June 2018 and March-June 2019). Primary outcome was treatment response, defined as a change in the number of wet nights per week within 6 months following enrollment. The time-dependent occurrence of treatment response was evaluated with the Kaplan-Meier method and the log-rank test. The Cox proportional hazards regression model was used to identify risk factors for treatment response. The range of appropriate sample sizes for this primary outcome was 39-48. RESULTS Of our 41 enrolled patients, 28 (68%) were male and mean age was 8.8 years. The complete response rate was 73% during the coronavirus disease 2019 pandemic period and 27% during the comparator period. Log-rank tests showed a higher cumulative incidence of complete response in the pandemic period (P = 0.020). Cox regression analysis identified treatment during the coronavirus disease 2019 pandemic (hazard ratio 2.533; 95% confidence interval 1.069-6.006) and dinner before 19:00 (hazard ratio 4.184; 95% confidence interval 1.56-11.252) as significantly associated with treatment response. CONCLUSIONS The rate of enuresis treatment response was uncommonly high during the stay-home period for the coronavirus disease 2019 pandemic. Restrictions on daily life may provide opportunities to concentrate on treatments for chronic illnesses, leading to more success.
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Affiliation(s)
- Takahisa Kimiya
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Inoguchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Ghogare A, Pole R, Vankar G. A clinical review of enuresis and its associated psychiatric comorbidities. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Enuresis, Lower Urinary Tract Dysfunction and Teachers’ Perceptions: A School-based Survey. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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Nelli ADM, Mrad FCDC, Alvaia MDA, Maia HAADS, Guimarães COS, Carvalho ESDS, Gomes CM, Bastos JM, de Bessa J. Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease. Int Braz J Urol 2019; 45:974-980. [PMID: 31626520 PMCID: PMC6844344 DOI: 10.1590/s1677-5538.ibju.2019.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. MATERIALS AND METHODS This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. RESULTS Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at fi ve years and about 15% of adolescents at 15 years of age. Enuresis was classifi ed as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identifi ed in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a signifi cant impact on the quality of life of 67% of the individuals. CONCLUSION Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.
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Affiliation(s)
- Alana de Medeiros Nelli
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | - Mateus de Andrade Alvaia
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | | | | | | | - Cristiano Mendes Gomes
- Programa de Pós-Graduacao em Saude Coeltiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - José Murillo Bastos
- Departamento de Cirurgia, Faculdade de Ciencias Medicas e da Saude de Juiz de Fora.,Faculdade de Ciencias Medicas e da Saude de Juiz de Fora, MG, Brasil.,Hospital e Maternidade Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Jose de Bessa
- Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil.,Programa de Pós-Graduacao em Saude Coeltiva, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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7
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Pandey S, Oza HJ, Shah H, Vankar GK. Rate and risk factors of nocturnal enuresis in school going children. Ind Psychiatry J 2019; 28:306-311. [PMID: 33223727 PMCID: PMC7659990 DOI: 10.4103/ipj.ipj_15_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/06/2018] [Accepted: 04/15/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose is to find out the rate of nocturnal enuresis in school going children (5-12 years) and the risk factors associated with it. MATERIALS AND METHODS The parents of children aged between 5 and 12 years studying in two primary schools in Ahmedabad completed a self-administered semi-structured questionnaire comprising of enuresis, sociodemographic profiles, and risk factors. Children with enuresis and those without were compared on demographic characteristics and risk factors using Chi-square and t-test for categorical and quantitative data respectively. The data were analyzed using SPSS version 17. RESULTS The response rate was 86.54% as 1904 responses were collected out of 2200. The overall rate of nocturnal enuresis was 6.7% (according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition definition of nocturnal enuresis). As the age increased, the rate of nocturnal enuresis declined. A positive family history was seen in 36.6% of children with enuresis. Enuresis was found to be more frequently in lower socioeconomic class. It was a neglected problem, only 20.6% of children received some kind of treatment. CONCLUSION The rate of nocturnal enuresis was 6.7% in school going children. Strong correlation was found with family history. Although the rate was high, most of the children with enuresis were not treated.
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Affiliation(s)
- Sunayna Pandey
- Department of Psychiatry, Dr. M. K. Shah Medical College and SMS Multispeciality Hospital, Ahmedabad, Gujarat, India
| | - Harsh J. Oza
- Department of Psychiatry, Dr. M. K. Shah and SMS Multispeciality Hospital, Ahmedabad, Gujarat, India
| | - Hemang Shah
- Department of Psychiatry, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Ganpat K. Vankar
- Department of Psychiatry, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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Mattsson S, Persson D, Glad Mattsson G, Lindström S. Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis. J Pediatr Urol 2019; 15:229.e1-229.e8. [PMID: 30857839 DOI: 10.1016/j.jpurol.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/02/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Night-time polyuria as the dominating pathophysiological mechanism for primary monosymptomatic nocturnal enuresis (PMNE) has been put in question with nocturnal detrusor overactivity and high arousal thresholds as alternatives. An earlier finding of night-time polyuria in 12% of healthy non-enuretic schoolchildren underscores that excessive night-time diuresis per se is unlikely the major cause of PMNE. OBJECTIVE The objective of this study was to compare the night-time diuresis pattern in children with and without PMNE and to evaluate the role of night-time polyuria in provoking enuretic episodes in children with PMNE. STUDY DESIGN Night-time diuresis pattern was recorded in 27 children with PMNE, aged 6-15 years, and 29 non-enuretic children, aged 6-13 years. Using a portable ultrasound recorder, the bladder volume was estimated at 15-min intervals for at least three nights with the child sleeping in its own bed at home. The volume of enuretic episodes was controlled using preweighed diapers. All voids were registered by time and volume. Diuresis during night time was estimated from the slope of regression lines fitted to ultrasound recording points. Mean night-time diuresis was calculated from total urine production during the night and time interval from the last void before bedtime to the first morning void. RESULTS Night-time bladder filling pattern was recorded from 189 nights, giving 149 interpretable patterns for analysis (77 children with PMNE and 72 dry children). The night-time diuresis pattern was similar for children with or without PMNE, showing large variability between different nights of the same child. Most nights displayed a smooth bladder filling at constant low rate, whereas other nights showed an early phase with high diuresis followed by a longer period of low diuresis with no difference between the two groups. DISCUSSION Night-time diuresis has been non-invasively monitored in children while asleep in their own beds at home. The pattern of night-time diuresis varies considerably between different nights of the same child, with no obvious differences in any diuresis parameters between children with or without PMNE. CONCLUSION Non-enuretic children have similar diuresis pattern and maximal night-time diuresis values as children with PMNE, making it unlikely that PMNE is caused by night-time polyuria per se (Summary figure). Delayed maturation of sleep mechanisms such as decreased arousability or sleep inhibition of the micturition reflex is more likely to be the main etiology for enuresis.
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Affiliation(s)
- S Mattsson
- H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden.
| | - D Persson
- H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden.
| | - G Glad Mattsson
- H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden.
| | - S Lindström
- H.K.H. Crown Princess Victoria´s Hospital for Children and Youth and Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, SE 58185 Linköping, Sweden.
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Su MS, Xu L, Pan WF, Li CC. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World J Pediatr 2019; 15:109-116. [PMID: 30446975 DOI: 10.1007/s12519-018-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA. DATE SOURCES We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE. RESULTS Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation. CONCLUSIONS Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched.
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Affiliation(s)
- Miao-Shang Su
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Li Xu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Wen-Feng Pan
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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10
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Abstract
Enuresis is a frequent complaint not always volunteered by parents or patients. The pediatric clinician has to inquire about enuresis to break the secrecy surrounding this symptom that could be related to a more serious underlying renal, endocrine, or psychosocial disease. Determining the type of enuresis is crucial to offer optimal treatment. We present a review for the pediatric clinician to optimize their care of the child with monosymptomatic enuresis. [Pediatr Ann. 2018;47(10):e390-e395.].
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11
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Ma J, Li S, Jiang F, Jin X, Zhang Y, Yan C, Tian Y, Shen X, Li F. Relationship between sleep patterns, sleep problems, and childhood enuresis. Sleep Med 2018; 50:14-20. [DOI: 10.1016/j.sleep.2018.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 01/18/2023]
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Mejias SG, Ramphul K. Nocturnal enuresis in children from Santo Domingo, Dominican Republic: a questionnaire study of prevalence and risk factors. BMJ Paediatr Open 2018; 2:e000311. [PMID: 30234177 PMCID: PMC6135422 DOI: 10.1136/bmjpo-2018-000311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/18/2018] [Accepted: 08/05/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the prevalence of paediatric nocturnal enuresis in Santo Domingo, Dominican Republic. DESIGN A cross-sectional study was performed using a pretested questionnaire. SETTING Three different schools in Santo Domingo, Dominican Republic. PARTICIPANTS 700 children aged 5-11 years attending one of the different schools in Santo Domingo, Dominican Republic. INTERVENTION The study was carried out from November 2017 to December 2017. MAIN OUTCOME MEASURES Prevalence of nocturnal enuresis. RESULTS 700 questionnaires were sent to be filled and 682 were returned. 655 fully filled questionnaires met the requirements of the study. 183 children were identified with nocturnal enuresis among which 88 were boys and 95 were girls. Only 11% of children with enuresis sought medical help. The prevalence of nocturnal enuresis was 27.9%. No statistical significance was found between gender, order in the family, constipation and breast feeding (p>0.05). Age, deep sleep and family history of enuresis were strongly associated with nocturnal enuresis. CONCLUSIONS The prevalence of nocturnal enuresis in Santo Domingo was found to be 27.9% and it was higher compared with some Asian countries but lower than Morocco and Jamaica. Only 11% of children with enuresis sought medical help. Nocturnal enuresis is an important problem in the paediatric population of Santo Domingo, but very few children receive treatment due to the financial costs of healthcare in the Dominican Republic.
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Affiliation(s)
- Stephanie Gonzalez Mejias
- Department of Pediatrics, Robert Reid Cabral Children's Hospital affiliated to the Universidad Iberoamericana (UNIBE) School of Medicine, Santo Domingo, National District, Dominican Republic
| | - Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Reddy NM, Malve H, Nerli R, Venkatesh P, Agarwal I, Rege V. Nocturnal Enuresis in India: Are We Diagnosing and Managing Correctly? Indian J Nephrol 2017; 27:417-426. [PMID: 29217876 PMCID: PMC5704404 DOI: 10.4103/ijn.ijn_288_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nocturnal enuresis is a common problem affecting school-aged children worldwide. Although it has significant impact on child's psychology, it is always under-recognized in India and considered as a condition which will outgrow with advancing age. Nocturnal enuresis classified as primary or secondary and monosymptomatic or nonmonosymptomatic. Factors that cause enuresis include genetic factors, bladder dysfunction, psychological factors, and inappropriate antidiuretic hormone secretion, leading to nocturnal polyuria. Diagnosis consists of detailed medical history, clinical examination, frequency-volume charts, and appropriate investigations. The frequency-volume chart or voiding diary helps in establishing diagnosis and tailoring therapy. The first step in treating nocturnal enuresis is to counsel the parents and the affected child about the condition and reassure them that it can be cured. One of the effective strategies to manage enuresis is alarm therapy, but currently, it is not easily available in India. Desmopressin has been used in the treatment of nocturnal enuresis for close to 50 years. It provides an effective and safe option for the management of nocturnal enuresis. This review covers the diagnosis and management of nocturnal enuresis and introduces the concept of “bedwetting clinics” in India, which should help clinicians in the thorough investigation of bedwetting cases.
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Affiliation(s)
- N M Reddy
- Department of Urology, Rainbow Hospitals, Hyderabad, Telangana, India
| | - H Malve
- Medical Affairs, Ferring Pharmaceuticals Pvt. Ltd., Mumbai, Maharashtra, India
| | - R Nerli
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, India
| | - P Venkatesh
- Department of Pediatric Urology, NU Hospitals, Bengaluru, Karnataka, India
| | - I Agarwal
- Department of Child Health Unit II, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Rege
- Department of Pediatric Urology, Wadia Hospital for Children, Mumbai, Maharashtra, India
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Sarici H, Telli O, Ozgur BC, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol 2016; 12:159.e1-6. [PMID: 26778419 DOI: 10.1016/j.jpurol.2015.11.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE According to the ICCS definitions, enuresis is defined by an intermittent, wetting during sleep after organic causes have been ruled out with a minimum wetting frequency of once per month. Previous studies reported a prevalence rate of 9-12%. Eighty to 90% of enuresis cases are identified as primary enuresis and are based on genetic predisposition, biological and developmental factors. On the other hand, secondary enuresis frequently arises from psychological factors. In this study we aimed to determine the prevalence and associated factors of nocturnal enuresis (NE) among primary school children. METHOD We initiated a prospective cross-sectional epidemiological study from January 2013 to May 2013 by sending a questionnaire to parents of 4250 school children, aged 6-13 years. The questionnaire consisted of three parts. The first part investigated the demographic characteristics of the child and family, such as age, gender, number of siblings, and enuresis history of the parents and siblings. The second part consisted of questions about the presence and frequency of bedwetting, presence of constipation/fecal incontinence, and presence of daytime incontinence (DI). The last part surveyed school performance and the effect of enuresis on quality of life of parents and children. Logistic regression analyses were conducted to determine the significant predictive factors for NE. RESULTS The overall prevalence of enuresis was 9.52%. The prevalence of NE among boys and girls was 12.4% and 6.5%, respectively. Daytime incontinence was present in 18% of children. Of enuretic children, 59.2% had a positive family history of enuresis. Constipation was found in 13.2% of children with enuresis and there was no significant association between NE and the presence of constipation. In addition, 48% of enuretic children had poor school performance. CONCLUSIONS The current study demonstrated that age, male gender, parents' history of enuresis, and siblings' history of enuresis were significant predictive factors for NE. The majority of the parents did not have adequate interest in enuretic children and most of the children were not treated. Physicians should inform parents of enuretic children with the aim of solving this problem to prevent future issues and development of adulthood lower urinary tract symptoms (LUTS).
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Affiliation(s)
- Hasmet Sarici
- Department of Urology, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Onur Telli
- Department of Pediatric Urology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Berat Cem Ozgur
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arif Demirbas
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Senem Ozgur
- Department of Pediatrics, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
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Choudhary B, Patil R, Bhatt GC, Pakhare AP, Goyal A, P A, Dhingra B, Tamaria KC. Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India. PLoS One 2016; 11:e0155808. [PMID: 27191620 PMCID: PMC4871538 DOI: 10.1371/journal.pone.0155808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/04/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To study the prevalence of primary monosymptopomatic nocturnal enuresis (PMNE) in children aged 5-10 year and to find its association with sleep disordered breathing (SDB) by using a 22 item pediatric sleep related breathing disorder (SRBD) scale. METHODS This was a school based cross sectional epidemiological study from July 2015 to November 2015. A questionnaire seeking information on socio-demographic variables, nocturnal enuresis (NE) frequency, school performance and a validated 22 item pediatric sleep related breathing disorder scale (SRBDs) was distributed to 1820 pupils in three primary schools. RESULTS A total of 1528(83.95%) questionnaires were retrieved. Out of 1528 forms, 182(11.9%) forms were incomplete for requested information and hence 1346 (73.9%) questionnaires were finally analyzed. The prevalence of NE was found to be 12.7% (95% CI; 11-14.6), whereas prevalence of primary nocturnal enuresis (PMNE) was 8.2% (95% CI; 7.1-10.1). SRBD scale score >0.33 (adjusted OR: 2.87; 95%CI: 1.67-4.92), paternal history of enuresis in childhood (adjusted OR:4.96; 95% CI: 2.36-10.45), and inappropriate toilet training (adjusted OR: 1.64; 95% CI: 1.01-2.66) were independently associated with PMNE. CONCLUSION Sleep disordered breathing, inappropriate toilet training and a history of childhood NE in father were found to be significant risk factors for PMNE in the present study. Thus, these findings suggest that it is imperative to rule out SDB in PMNE patients as they may require different therapeutic interventions.
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Affiliation(s)
- Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Rajesh Patil
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Girish Chandra Bhatt
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Abhijit P Pakhare
- Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Abhishek Goyal
- Department of Pulmonology and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Aswin P
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Bhavna Dhingra
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - K C Tamaria
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, India
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16
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Abstract
Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.
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Affiliation(s)
- Shikha Jain
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS) , Bhopal, Madhya Pradesh, India
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17
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Esezobor CI, Balogun MR, Ladapo TA. Prevalence and predictors of childhood enuresis in southwest Nigeria: Findings from a cross-sectional population study. J Pediatr Urol 2015; 11:338.e1-6. [PMID: 26264280 DOI: 10.1016/j.jpurol.2015.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/16/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Childhood enuresis is common, but the prevalence and factors associated with childhood enuresis in Africa have been poorly described. Furthermore, most studies from the continent have not provided data distinguishing monosymptomatic from non-monosymptomatic enuresis. This distinction is important as it guides enuresis therapy. OBJECTIVES The primary objective of this study was to determine the prevalence of enuresis in children aged 5-17 years in a community in Nigeria. The secondary objectives were to determine the relative proportions of monosymptomatic and non-monosymptomatic enuresis and identify independent sociodemographic and clinical predictors of enuresis. STUDY DESIGN Parents or guardians in the community were interviewed using a pretested questionnaire. Standardized definitions were used, as recommended by the International Children's Continence Society. RESULTS A total of 928 children were included in the study. The prevalence of enuresis or daytime incontinence and enuresis was 28.3% (enuresis 24.4%, and daytime incontinence and enuresis 4%); it decreased with age. Primary and monosymptomatic enuresis were the most common types of enuresis. In multiple logistic regressions, children aged 5-9 years were 10.41 (5.14-21.05) times more likely to have enuresis or daytime incontinence and enuresis compared with those aged 14-17 years. Other predictors of enuresis or daytime incontinence and enuresis were: male gender (OR 1.56 (1.13-2.14)); constipation (OR 2.56 (1.33-4.93)); and a sibling (OR 2.20 (1.58-3.06)) or parent (OR 3.14 (2.13-4.63)) with enuresis. Enuresis or daytime incontinence and enuresis was 1.92 (1.06-3.48) times more likely in fourth-born, or higher, children compared with first-born children. Only parents of nine (3.4%) children with enuresis had consulted a medical doctor about it. DISCUSSION The high prevalence of childhood enuresis in the present study was consistent with most studies from developing countries and contrasted sharply with the lower rates reported among children in developed countries. Common reasons for this disparity were the influence of socioeconomic status on enuresis rates and the low utilization of effective enuresis therapies in developing countries. Consistent with published literature, monosymptomatic enuresis was the commonest form of enuresis in the present study. Furthermore, younger age, male gender and a family history of enuresis were strongly associated with enuresis. A major limitation of the study was the lack of use of a voiding diary. CONCLUSION Childhood enuresis was common in the community but parents rarely sought medical attention. Predictors of enuresis were younger age, male gender, constipation, higher birth order, and a family history of enuresis.
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Affiliation(s)
- C I Esezobor
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria; Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.
| | - M R Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria; Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - T A Ladapo
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria; Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
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18
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Doganer YC, Aydogan U, Ongel K, Sari O, Koc B, Saglam K. The Prevalence and Sociodemographic Risk Factors of Enuresis Nocturna among Elementary School-age Children. J Family Med Prim Care 2015; 4:39-44. [PMID: 25810988 PMCID: PMC4367005 DOI: 10.4103/2249-4863.152250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction and Aim: Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to research prevalence and severity of EN among elementary school-age children and sociodemographic risk factors related to it. Materials and Methods: The study was performed in three elementary schools in Ankara, Turkey between January and May 2011. It was planned to have 2500 students of 6–14 ages in the study. The questionnaire, which consisted of questions, aiming to evaluate the EN condition of participants and their characteristics, were distributed to the parents. It was observed that 2314 participants’ questionnaires (92.56%) were in accordance with evaluation criteria. Statistical Analysis: The relation between EN and the sociodemographic factors was evaluated through Chi-square test and logistic regression analysis. Results: The mean age of 2314 participants was 9.21 ± 2.08. 48.5% (n = 1123) of the students were male and 51.5% (n = 1191) were female. While the general EN prevalence was 9.9% (n = 230); 10.7% (n = 120) for males, as 9.2% (n = 110) for females. Statistical significant difference was determined between the two groups, with EN and without EN, regarding age groups (P < 0.001), education level of parents (P < 0.001, P < 0.001), and the number of sibling (P = 0.002), income level (P < 0.001), and positive family history (P < 0.001). However, logistic regression analysis revealed that there was a significant difference only between EN and age groups (odds ratio [OR] =4.42, P < 0.001), education level of mother (OR = 2.13, P = 0.017) and family history (OR = 0.12, P < 0.001). Conclusions: As a consequence, such factors as age groups, education level of parents, positive family history could be accepted as a risk of concerning EN. It is important to perform a detailed evaluation on population, carrying risk of having EN.
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Affiliation(s)
- Yusuf Cetin Doganer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Family Medicine, Turkish Military Academy Primary Care Examination Center, Ankara, Turkey
| | - Umit Aydogan
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kurtulus Ongel
- Department of Family Medicine, Katip Celebi University, Izmir, Turkey
| | - Oktay Sari
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Bayram Koc
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kenan Saglam
- Department of Internal Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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