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Bastos JM, Rondon AV, de Lima GRM, Zerati M, Schneider-Monteiro ED, Molina CAF, Calado ADA, Barroso U. Brazilian consensus in enuresis-recomendations for clinical practice. Int Braz J Urol 2019; 45:889-900. [PMID: 31408290 PMCID: PMC6844333 DOI: 10.1590/s1677-5538.ibju.2019.0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/06/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
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Affiliation(s)
- José Murillo Bastos
- Universidade Federal de Juiz de Fora (UFJF) e Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil
| | - Atila Victal Rondon
- Universidade do Estado do Rio de Janeiro (UERJ) e Hospital Federal Cardoso Fontes (HFCF), Rio de Janeiro, RJ, Brasil
| | | | - Miguel Zerati
- Instituto de Urologia e Nefrologia de São José do Rio Preto (IUN) e Faculdade Regional de Medicina(FAMERP), Hospital de Base, São José do Rio Preto, SP, Brasil
| | | | - Carlos Augusto F Molina
- Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil
| | | | - Ubirajara Barroso
- Universidade Federal da Bahia (UFBA) e Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil
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Wang TM, Yang SSD, Tsai JD, Yu MC, Chiou YH, Chen KL, Cheng HL, Lin J, Chen HW, Kuo HC, Chen SC. Management of nocturnal enuresis in Taiwan: Consensus statements of the Taiwan enuresis expert committee. J Formos Med Assoc 2018; 118:965-972. [PMID: 29779924 DOI: 10.1016/j.jfma.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/11/2018] [Accepted: 04/30/2018] [Indexed: 01/31/2023] Open
Abstract
Nocturnal enuresis causes significant psychological distress to affected children and their family and requires appropriate management. A 12-member expert committee of pediatric urologists and pediatric nephrologists in Taiwan with extensive experience in treating enuresis was established to develop consensus statements and a recommended treatment algorithm for the management of patients with nocturnal enuresis in Taiwan after careful consideration of current evidence, existing guidelines, and expert opinion as well as local practice and culture. The finalized consensus statements were reviewed by and have received endorsement from the Taiwan Urological Association and the Taiwan Pediatric Association. Patients with suspected enuresis should undergo a thorough initial assessment to fully evaluate urinary signs and symptoms and to rule out underlying causes of diurnal and nocturnal incontinence. Behavioral therapy is recommended throughout the course of management. Desmopressin in the fast-melting formulation is the recommended first-line pharmacological treatment. Combination therapy may be effective in patients who have failed first-line treatment. These consensus statements and a recommended treatment algorithm were created by the expert committee to provide practical support for clinical decision making by physicians in Taiwan.
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Affiliation(s)
- Ta-Min Wang
- Division of Pediatric Urology, Chang Gung Memorial Hospital, Medical College, Chang Gung University, Taoyuan, Taiwan
| | | | - Jeng-Daw Tsai
- Department of Pediatrics, Mackay Children's Hospital, Taipei, Taiwan
| | - Mei-Ching Yu
- Division of Pediatric Nephrology, Chang Gung Memorial Hospital, Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuo-Liang Chen
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Hong-Lin Cheng
- Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jesun Lin
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiao-Wen Chen
- Division of General Urology and Renal Transplantation, Chang Gung Memorial Hospital, Medical College, Chang Gung University, Taoyuan, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
| | - Shyh-Chyan Chen
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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Borg B, Kamperis K, Olsen LH, Rittig S. Evidence of reduced bladder capacity during nighttime in children with monosymptomatic nocturnal enuresis. J Pediatr Urol 2018; 14:160.e1-160.e6. [PMID: 29174376 DOI: 10.1016/j.jpurol.2017.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Bladder capacity in children with nocturnal enuresis is assessed by maximal voided volumes (MVV) obtained through daytime frequency volume (FV) charts. Although a degree of association has been demonstrated, daytime MVV does not consistently correspond with the nocturnal bladder capacity (NBC) in monosymptomatic nocturnal enuresis (MNE). It was hypothesized that isolated reduced NBC is a common phenomenon in children with nocturnal enuresis, despite normal daytime bladder function. OBJECTIVE The aim of this study was to evaluate NBC in children with MNE and normal daytime voided volumes. Specifically, it aimed to determine the prevalence and degree of reduced NBC when using nocturnal urine production (NUP) during wet nights as a surrogate estimate of NBC. Furthermore, it aimed to investigate the relationship between NBC and desmopressin response. MATERIALS AND METHODS Data from 103 children aged 5-15 years consecutively treated for MNE in a tertiary referral centre and with normal MVV on daytime FV charts were collected for this cohort study. Home recordings were completed for 2 weeks at baseline and during desmopressin dose titration. Estimated nocturnal bladder capacity (eNBC) was assessed separately each night as the total NUP causing a wet night. If NUP during a wet night was less than MVV, it was considered to be reduced eNBC during that particular night. RESULTS Surprisingly, 82% (n = 84) of the children with MNE and normal daytime MVV experienced at least one wet night, with NUP below the daytime MVV indicative of a reduced eNBC. For 84 patients, mean percentage of wet nights with reduced eNBC (NUP below MVV) was 49% (SD ± 31). A total of 11% of children with frequently reduced eNBC (>40% of wet nights with reduced eNBC) responded to desmopressin (Summary Fig.). Of the children with frequently reduced NBC, 91% experienced wet nights, with NUP <65% of expected bladder capacity (EBC). CONCLUSIONS A significant proportion of children with MNE and normal MVV during the daytime frequently experienced wet nights, with a NUP well below their MVV and even <65% of EBC. This indicated that bladder reservoir dysfunction during sleep is relatively common in MNE. This abnormality was not reflected on daytime recordings, and thus nighttime data with NUP must be collected. This phenomenon may explain treatment failure to desmopressin, despite adequate antidiuretic response.
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Affiliation(s)
- B Borg
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Centre for Child Incontinence, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - K Kamperis
- Centre for Child Incontinence, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L H Olsen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Section of Paediatric Urology, Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - S Rittig
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Centre for Child Incontinence, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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Haid B, Tekgül S. Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment. Eur Urol Focus 2017; 3:198-206. [DOI: 10.1016/j.euf.2017.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 01/21/2023]
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Čorejová A, Jánošiková D, Pospíšilová V, Rauová D, Kyselovič J, Hrabovská A. Cessation of Nocturnal Enuresis after Intervention with Methylcobalamin in an 18-Year-Old Patient with Autism. J Child Adolesc Psychopharmacol 2015; 25:821-3. [PMID: 25325786 DOI: 10.1089/cap.2014.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Adela Čorejová
- 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University , Bratislava, Slovak Republic
| | - Daniela Jánošiková
- 2 Department of Psychology, Faculty of Philosophy and Arts, Trnava University , Slovak Republic
| | | | - Drahomíra Rauová
- 4 Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy of Comenius University , Bratislava, Slovak Republic.,5 Toxicological and Antidoping Centre, Comenius University , Bratislava, Slovak Republic
| | - Jan Kyselovič
- 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University , Bratislava, Slovak Republic
| | - Anna Hrabovská
- 1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University , Bratislava, Slovak Republic.,5 Toxicological and Antidoping Centre, Comenius University , Bratislava, Slovak Republic.,6 Biomedical Research Center, University Hospital , Hradec Králové, Czech Republic
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Ebiloglu T, Ergin G, Irkilata HC, Kibar Y. The biofeedback treatment for non-monosymptomatic enuresis nocturna. Neurourol Urodyn 2014; 35:58-61. [PMID: 25358855 DOI: 10.1002/nau.22678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/27/2014] [Indexed: 11/06/2022]
Abstract
AIMS Enuresis is a child older than 5 years wetting in discrete portions during sleep. It has two subgroups: monosymptomatic enuresis nocturna (MSEN) and non-monosymptomatic enuresis nocturna (NMSEN). In this research, we specifically aimed to examine the effect of biofeedback in NMSEN. METHODS We retrospectively analyzed the hospital records of 182 children with NMSEN who were refractory to urotherapy modifications and directed to biofeedback therapies between 2005 and 2010. Enuresis before and after biofeedback therapies was evaluated. One or less enuretic night in a month was defined as success. RESULTS There were 118 (64%) girls and 64 (35%) boys. With biofeedback therapy, 117 of 182 patients recovered with a success rate of 64% (P < 0.001), but 65 patients still had enuresis. Seventy-two out of 118 girls recovered with a success rate of 61% (P < 0.001), whereas 45 out of 64 boys recovered with a success rate of 70% (P = 0.001). The NMSEN complaints of daytime incontinence, dysuria, urgency, holding maneuvers, and urgency incontinence disappeared significantly concomitant to the enuresis component, as well (P < 0.05). CONCLUSIONS Biofeedback therapy is an effective treatment option for the enuresis component of NMSEN with a 64% success rate.
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Affiliation(s)
- Turgay Ebiloglu
- Department of Urology, Etimesgut Military Hospital, Ankara, Turkey
| | - Giray Ergin
- Department of Urology, Agri Military Hospital, Agri, Turkey
| | - Hasan Cem Irkilata
- Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy, Ankara, Turkey
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