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Li D, Zhu Z, Zhang Y, Zhang Y, Chao M. Logistic regression analysis of risk factors influencing childhood enuresis: a comprehensive survey study. Am J Transl Res 2024; 16:3157-3163. [PMID: 39114724 PMCID: PMC11301456 DOI: 10.62347/tqir5298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/20/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To identify risk factors associated with childhood enuresis. METHODS We conducted a retrospective analysis of 146 children aged 6 to 13 years diagnosed with enuresis at Anhui Province Children's Hospital between June 2020 and June 2023. Children were categorized based on bedwetting frequency: those with less frequent episodes (once a week to twice a month) were placed in the mild group (60 cases), and those with frequent episodes (two or more times per week) were placed in the severe group (86 cases). We compared demographic data, family histories, and personal characteristics between the groups and performed logistic regression to determine significant risk factors. RESULTS The analysis revealed that a stubborn personality, nocturnal polyuria, sleep-wake disorders, and bladder dysfunction significantly increased the risk of enuresis (P < 0.05). These findings underscore the importance of a holistic approach in evaluating psychological aspects, nocturnal urination patterns, sleep quality, and bladder health in managing enuresis. CONCLUSION The study identifies stubborn personality, nocturnal polyuria, sleep-wake disorders, and bladder dysfunction as independent risk factors for childhood enuresis. Understanding these factors is crucial for developing targeted interventions that can enhance the management and outcomes of enuresis. Future research should explore the interrelationships among these factors to refine preventive and therapeutic strategies for early childhood enuresis.
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Affiliation(s)
- Daolong Li
- Department of Urology Surgery, Anhui Province Children's Hospital 39 Wangjiang East Road, Baohe District, Hefei 230051, Anhui, China
| | - Ziqiang Zhu
- Department of Urology Surgery, Anhui Province Children's Hospital 39 Wangjiang East Road, Baohe District, Hefei 230051, Anhui, China
| | - Yin Zhang
- Department of Urology Surgery, Anhui Province Children's Hospital 39 Wangjiang East Road, Baohe District, Hefei 230051, Anhui, China
| | - Ye Zhang
- Department of Urology Surgery, Anhui Province Children's Hospital 39 Wangjiang East Road, Baohe District, Hefei 230051, Anhui, China
| | - Min Chao
- Department of Urology Surgery, Anhui Province Children's Hospital 39 Wangjiang East Road, Baohe District, Hefei 230051, Anhui, China
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Karamaria S, Mauel R, Van den Ende M, Oosterlinck A, Verheye A, De Bruyne E, Degrauewe E, Dhondt K, Dossche L, Raes A, Renson C, Samijn B, Spinoit AF, Everaert K, Walle JV. Transition in enuresis patients: Identifying the gaps and opportunities for the future. Neurourol Urodyn 2024; 43:1118-1126. [PMID: 38587243 DOI: 10.1002/nau.25460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers. AIM, MATERIALS & METHODS To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder). RESULTS These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%). DISCUSSION We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient.
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Affiliation(s)
- Sevasti Karamaria
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium
| | - Mauro Van den Ende
- Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium
| | - Ase Oosterlinck
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Alice Verheye
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Elke De Bruyne
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Eva Degrauewe
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Karlien Dhondt
- Department of Child & Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Catherine Renson
- Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium
| | - Bieke Samijn
- Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Azarfar A, Ghodsi A, Faravani F, Ghahremani S. Evaluation of Factors Affecting Enuresis in 6- to 12-Year-Old Children Referred to the Pediatric Nephrology Clinic. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1728728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractEnuresis 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.
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Affiliation(s)
- Anoush Azarfar
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnoosh Faravani
- Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Ghahremani
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhu B, Zou K, He J, Huang X, Zhu W, Ahmad Harb AK, Wang J, Luo A. Sleep Monitoring of Children With Nocturnal Enuresis: A Narrative Review. Front Pediatr 2021; 9:701251. [PMID: 34660477 PMCID: PMC8515414 DOI: 10.3389/fped.2021.701251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/26/2021] [Indexed: 01/12/2023] Open
Abstract
The purpose of this article is to provide a succinct summary of the sleep monitoring efforts that have been used in nocturnal enuresis (NE) and an overview of the knowledge that has accrued. This is not intended to be a comprehensive review, but rather is intended to highlight how polysomnography (PSG), a common sleep detection tool, has contributed to our understanding of NE, as arousal disorder is considered to be one of the important mechanisms. The authors have organized this report by analysis and display of different ingredients of PSG, starting with comparing the electroencephalogram (EEG) of controls and the enuretic children and then moving to evaluation of respiratory patterns of NE and comorbid disease obstructive sleep apnea (OSA). In addition, the authors' goal is to better understand the mechanism of NE by integrating various levels of sleep monitoring; those sleep-related clinical scale scores for NE are presented to date. Finally, we propose further research of NE to explore the microstructure alterations via PSG combined with EEG-fMRI or to use novel technology like portable device internet and deep learning strategy.
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Affiliation(s)
- Binbin Zhu
- Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Kun Zou
- Department of Electrophysiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jianhua He
- Department of Pediatric Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Xueqin Huang
- Department of Pediatric Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China.,Zhejiang Key Laboratory of Pathophysiology, Medical School of Ningbo University, Ningbo, China
| | - Weichao Zhu
- Department of Pediatric Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Ahmad Khaled Ahmad Harb
- Department of Anesthesia, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Aiping Luo
- Department of Pediatric Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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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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Lopes MC, Boarati MA, Fu-I L. Sleep and Daytime Complaints During Manic and Depressive Episodes in Children and Adolescents With Bipolar Disorder. Front Psychiatry 2019; 10:1021. [PMID: 32038338 PMCID: PMC6989543 DOI: 10.3389/fpsyt.2019.01021] [Citation(s) in RCA: 4] [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: 09/01/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Depressive and manic episodes of bipolar disorder can interact with sleep complaints, followed by a worsened psychiatric condition. The aim of this study was to examine the interaction of sleep disorders with bipolar disorder in youths during depressive and manic episodes. METHODS The target population was children and adolescents drawn from the Children and Adolescents Affective Disorder Program. Clinical assessment for current psychiatric diagnosis was done by direct clinical interview, Diagnostic Interview for Children and Adolescents (DSM-IV), and best-estimated clinical consensus. We applied sleep questionnaires from which we obtained sleep and daytime complaints during manic and depressive episodes. All statistical tests of significance were done using 2-tailed tests with α = 0.05. RESULTS Participants in this study comprised 29 children (age = 10 ± 3 years, boys = 23) and 43 adolescents (age = 15 ± 2.4 years, boys = 30). Sleep complaints were observed in 66.4% of participants during manic episodes and 52.3% during depressive episodes. 37.9% of patients had sleep complaints in both episodes. Time in bed was longer during depressive episodes than manic episodes (p = 0.01). We found a high prevalence of nocturnal enuresis in depressive episodes in children and adolescents, which was statistically significant compared with manic episodes (p < 0.05). Unrested sleep was higher in adolescents in both episodes, and it was statistically significant during manic episodes (p < 0.05). CONCLUSION According to our analyses, the minority of patients had sleep complaints in both episodes. Our data showed that nocturnal enuresis occurred more frequently during depressive than manic episodes. Further research is necessary to understand the implications of these data.
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Affiliation(s)
- Maria Cecilia Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Angelo Boarati
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Lee Fu-I
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
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Tsuji S, Takewa R, Ohnuma C, Kimata T, Yamanouchi S, Kaneko K. Nocturnal enuresis and poor sleep quality. Pediatr Int 2018; 60:1020-1023. [PMID: 30257061 DOI: 10.1111/ped.13703] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/03/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sleep disorders are strongly associated with childhood nocturnal enuresis (NE). In this study, we examined whether sleep disorders are present in children with NE, and whether NE is caused by sleeping disorders, or is simply comorbid. METHODS We examined 14 children with monosymptomatic NE and 15 age-matched controls. Sleep disorders were assessed for ≥5 days using contactless biomotion sensors to detect breathing and body movements during at-home sleep. To assess sleep quality, we compared median sleep efficiency and the number of shallow sleep episodes between the groups. We also investigated the change in sleep quality after successful NE treatment in five children. RESULTS Median sleep efficiency was significantly lower in the NE group (87.3%) than in the control group (93.4%; P < 0.001). The number of shallow sleep episodes per night was significantly higher in the NE group (5.11) than in the control group (1.50; P < 0.001). Neither sleep efficiency nor the number of shallow sleep episodes improved in the five children whose NE was successfully stopped after bedwetting-alarm therapy (P = 0.50 and 0.22, respectively). CONCLUSIONS Sleep disorders are present in children with NE. Although there are insufficient data to conclude that sleep disorders are not the cause of NE, we suggest that they are comorbid because sleep disorders persisted even after NE was halted.
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Affiliation(s)
- Shoji Tsuji
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Reiko Takewa
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Chikushi Ohnuma
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Takahisa Kimata
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | | | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
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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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Caldwell PHY, Lim M, Nankivell G. An interprofessional approach to managing children with treatment-resistant enuresis: an educational review. Pediatr Nephrol 2018; 33:1663-1670. [PMID: 29110081 DOI: 10.1007/s00467-017-3830-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.
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Affiliation(s)
- Patrina H Y Caldwell
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.
| | - Melissa Lim
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Gail Nankivell
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
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Caldwell PH. Tips for managing treatment-resistant enuresis. J Paediatr Child Health 2018; 54:1060-1064. [PMID: 30294999 DOI: 10.1111/jpc.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines.
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Affiliation(s)
- Patrina Hy Caldwell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Bahnasy WS, El-Heneedy YAE, El-Seidy EAS, Ibrahim ISE, Seleem MAH, Ahmed AY. Primary monosymptomatic nocturnal enuresis: an etiological study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018. [DOI: 10.1186/s41983-018-0020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention. Pediatr Nephrol 2017; 32:843-851. [PMID: 27988804 DOI: 10.1007/s00467-016-3510-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/06/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. METHODS This was a prospective study of MNE patients, aged 6-16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal. RESULTS Of the 82 patients [mean age 9.5 (SD ± 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group (p = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group (p = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement. CONCLUSIONS The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.
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Zaffanello M. Enuresis and sleep disordered breathing: An old and new link. World J Clin Urol 2016; 5:90-92. [DOI: 10.5410/wjcu.v5.i3.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/30/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
The causes of nocturnal enuresis (NE) are likely multifactorial. It has been related to several (urological-nephrological-hormonal) reasons but clear and univocal pathogenesis remains mostly undetermined. Sleep disordered breathing (SDB) is a syndrome of upper airway dysfunction that occurs during sleep and is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility. Adenotonsillar hypertrophy is the main cause of SDB in children. To date, several studies have associated childhood NE with coexistent SDB. Adenotonsillectomy was successful for both SDB and NE in about half of patients. Unfortunately, practical consensus guidelines for the management of primary NE do not mention, or marginally concern, SDB in these children, particularly in those who have treatment resistance and comorbidities. The concerns regard the concomitant presence of two relatively frequent sleep disorders, raising the question whether they are really coincidental problems of childhood.
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