Childhood Enuresis: Current Diagnostic Formulations, Salient Findings, and Effective Treatment Modalities

Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center

Background/Aim

To identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis.

Materials and Methods

A total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5-18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non-MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients.

Results

Detrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2-75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively).

Conclusion

There was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.

Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children

The objective was to explore the efficacy of Tongdu Tuina manipulation in the treatment of primary single-symptom enuresis in children. A total of 102 children aged 5-16 with primary single-symptom enuresis were included in this study and randomly assigned to the Tuina group, the medication group and the control group, with 34 children in each group. The Tongdu Tuina group included manipulation of the Guanyuan, Qihai, Zhongji, Mingmen, kidney, Baihui, Sishencong and bladder acupoints, five times a week, the medication group was treated with 0.1 mg desmopressin acetate every night, and in the control group, the patients were given foods with high water content and underwent water deprivation 2 h before bedtime every night. The intervention time of each group was 1 month. The participants were followed up on Day 1 following treatment, as well as half a month, 1 month and 3 months after the implementation of the intervention measures, and the effective rate, the incidence of enuresis per week and the recurrence rate were calculated. As a result baseline demographic characteristics were comparable among 102 patients. Overall, 32 patients in the Tongdu Tuina group, 30 patients in the medication group and 34 patients in the control group completed the intervention. After half a month of treatment, there was no significant difference in the therapeutic efficacy among the three groups (P = 0.158), but each treatment could effectively reduce the frequency of weekly enuresis. The frequency of weekly enuresis in the Tongdu Tuina group was 3.8 ± 1.1 times, while that in the medication group was 4.0 ± 2.0 times. The frequency of weekly enuresis in the control group was 4.7 ± 1.8 times, and the difference was statistically significant (P = 0.016). After 1 month of treatment, the effective rates of the Tongdu Tuina group and the medication group were significantly increased (87.5% vs 83.33%, P < 0.0001), which was not the case with the control group. The frequency of enuresis was 1.9 ± 2.1 times per week in the Tongdu Tuina group, 2.4 ± 1.8 times per week in the medication group and 4.0 ± 0.9 times per week in the control group after 1 month of treatment. The difference between the three groups was statistically significant (P = 0.021), and there was a difference between the Tongdu Tuina group and the medication group (P < 0.0001). There was no significant difference between recurrence rate and the incidence of adverse events (P = 0.837, P = 0.856). In conclusion, both Tuina manipulation and desmopressin treatment can effectively improve children's primary single-symptom enuresis with safety. However, Tongdu Tuina therapy may be superior to desmopressin treatment.

A randomised, double-blind, placebo-controlled clinical trial found that a novel herbal formula Urox® (Bedtime Buddy®) assisted children for the treatment of nocturnal enuresis

BACKGROUND

Nocturnal enuresis or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed.

HYPOTHESIS/PURPOSE

To determine if a herbal capsule formulation taken once daily can reduce incidence and frequency of nocturnal enuresis in children.

STUDY DESIGN

This randomised double-blind placebo-controlled trial evaluated the efficacy of an herbal medicine product to reduce the symptoms of nocturnal enuresis. Participants, aged between 6 and 14 years of age, were recruited from the community in Australia. They were randomised via computerised random-number generation at study enrolment to receive one or two oral capsules in the morning of either Urox® (Bedtime Buddy®) or placebo. The Paediatric Quality of life (Pin-Q) was used as a quality-of-life measure and waking wet, fluid intake and urinary urgency per week were monitored.

RESULTS

Forty-one children completed the trial with an attrition rate of 16%. There were more males (64.6%) compared to females (35.4%) and the mean age was 8.6 years. Forty-one point seven percentages (41.7%) of participants had improvements in bed wetting by two months which was a highly clinically relevant effect (Cohen's D = 0.98). The primary outcome found that there was a statistically significant reduction in NE (p = 0.034; CI 0.086-2.095) and between groups using longitudinal analysis (p = 0.04, Coefficient -1.12, CI 95% -2.20 - -0.04). In the secondary outcomes, urinary urgency reduced statistically significantly for the intervention (p = 0.002; a reduction of 18.3% difference for Bedtime Buddy compared to an increase of 3.7% for the placebo).

CONCLUSION

Urox® (Bedtime Buddy®) may assist children in reducing nocturnal enuresis compared to placebo. In addition, it may assist in reducing daily incontinence and urinary urgency.

Evaluation of Factors Affecting Enuresis in 6- to 12-Year-Old Children Referred to the Pediatric Nephrology Clinic

Enuresis is one of the most common disorders in children, and if left untreated can cause anxiety, low self-esteem, and family problems. The aim of this study was to investigate the factors associated with enuresis to provide recommendations for more efficient prevention and treatment. A cross-sectional study was performed on children aged 6 to 12 years with enuresis, referred to the pediatric clinic between April 2017 and April 2018. Children were divided into two groups: monosymptomatic enuresis and healthy subjects. Then, a questionnaire was completed by their parents to assess the factors related to enuresis. The data were analyzed using SPSS software. In this study, out of 140 children with an average age of 8.22 ± 2.01 years, 77 cases (55%) had enuresis, of which 57 (40.7%) had primary enuresis, and 20 cases (14.3%) had secondary enuresis. There was a significant difference between the control and the case groups in terms of: father's education, family income, family history, number of people sleeping in the room, family problems, problems at school, history of urinary tract infections, history of pinworms, difficulty falling asleep, difficulty in waking up, feeling tired after waking up, and drowsiness during the day. Enuresis is associated with several physiological, psychological, and genetic factors. Controlling these factors requires paying attention to the elements such as the mental health of the family and child's sleep health through education, family awareness, and counseling.

Enhancing the Lives of Foster Youth with Behavioral Interventions

As members of state-funded team to monitor psychotropic medication use and examine cost-effective methods for behavioral treatment in foster care, the authors review behavioral studies on interventions for foster youth who engage in challenging behavior. Four behavioral technologies-preference assessments, teaching procedures, functional behavioral assessment and intervention, and parent training-are discussed. Four case studies and behavioral data for foster youth treated using these technologies are provided. Finally, pediatric providers are encouraged to recommend a practitioner with specialized training in behavior analysis to foster parents if a child displays disruptive behavior.

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

BACKGROUND

Nocturnal enuresis (NE), or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE.

METHODS

This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion.

DISCUSSION

This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registration Number: 12618000288224.

PROTOCOL

23 February 2018, version 1.1.

Doctor, Snitch, and Weasel: Narrative Family Therapy With a Child Suffering From Encopresis and Enuresis

Children who experience enuresis and encopresis can face many difficulties, including social isolation, shame, embarrassment, anxiety, and depression. Due to the prevalence of enuresis and encopresis, it is essential for mental health professionals to understand the common symptoms and available treatment options for enuresis and encopresis, particularly to assist parents struggling to help their children overcome these challenges. Despite this need, there is very little clinical literature that incorporates a systemic approach for families who have a child diagnosed with enuresis and encopresis. Furthermore, common treatment approaches may unwittingly reinforce children’s perception that these problems are rooted in their identity. In an effort to address these concerns, the present case study aims to illustrate how a narrative therapy approach was utilized to effectively treat a child with enuresis and encopresis. Narrative therapy can uniquely assist children and their parents by helping them externalize the problem, overcome the problem-saturated view of their lives, and create new experiences where the problem is nonexistent.