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Radojicic Z, Milivojevic S, Milin Lazovic J, Toplicic D, Milic N. Therapeutic effects of desmopressin in primary monosymptomatic noctural enuresis treatment depending on Patients'Age. J Pediatr Urol 2020; 16:646.e1-646.e7. [PMID: 32828683 DOI: 10.1016/j.jpurol.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 07/14/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To test the therapeutic effects of Desmopressin (dDAVP) in primary monosymptomatic nocturnal enuresis (PMNE) treatment depending on patients'age. MATERIAL AND METHODS The prospective research was carried out in the 2014-2018 period, during which 89 patients were observed who were treated with dDAVP due to the previously diagnosed PMNE. The patients were divided into two age groups. The first group (Group 1) consisted of 43 patients age 5 to 6, with the average age of 5.6 ± 0.5, out of whom 35 (81.4%) were boys, and 8 (18.6%) girls. The second group (Group 2) consisted of 46 patients age over 7 to 12, with the average age of 9.7 ± 1.6, out of whom 30 (65.2%) were boys, and 16 (34.8%) were girls. There was no statistically relevant difference according to sex (p = 0.086). After the 3-month treatment, all the patients in both groups were tested for the effects of dDAVP in PMNE treatment. RESULTS The average enuresis frequency in the first group (Group 1) before therapy was 26.0 ± 6.2 per month, whereas the average enuresis frequency after therapy was 11.0 ± 8.0 per month (p = 0.040). The average enuresis frequency in the second group (Group 2) before therapy was 23.1 ± 6.2 per month, whereas the average enuresis frequency after therapy was 3.8 ± 3.6 per month (p = 0.036). ANOVA data analysis of repeated measurements has indicated that there is a statistically relevant interaction between the groups (p = 0.006), i.e. enuresis frequency decreases considerably more in the second group (Group 2). CONCLUSION PMNE with dDAVP is noticeably more effective with patients over 7 years of age.
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Affiliation(s)
| | | | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Internal Medicine, Mayo Clinic, Rochester, USA
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UZUN ÇİÇEK A, BORA A, ALTUNTAŞ E. Adenoid hypertrophy and nocturnal enuresis are associated with sleep disturbances. ENT UPDATES 2020. [DOI: 10.32448/entupdates.729178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Hyuga T, Nakamura S, Kawai S, Nakai H. Evaluation of the Effectiveness of a Short-term Treatment and Repeat Treatment of Nocturnal Enuresis Using an Enuresis Alarm. Urology 2017; 105:153-156. [PMID: 28089888 DOI: 10.1016/j.urology.2017.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a 3-month enuresis alarm (EA) treatment and repeat EA treatment among pediatric patients with nocturnal enuresis, and to compare patient characteristics among "responders" and "nonresponders" to treatment. MATERIALS AND METHODS Clinical outcomes were retrospectively evaluated for 137 children (94 boys and 43 girls, mean age, 10.1 years). Effectiveness was evaluated after an initial 3-month treatment, using the International Children's Continence Society criteria. Among children in the no-response group at 3 months, those who continued the EA treatment for ≥4 months were subclassified into group 1, whereas children who repeated the EA treatment at an interval ≥6 months were subclassified into group 2. RESULTS Among our 137 cases, 19 achieved complete response and 47 achieved partial response at 3 months, for an overall treatment effectiveness rate of 48%. Among the no-response group, treatment was extended in 17 cases (group 1), with 3 (18%) achieving a successful outcome. Treatment was repeated in 18 cases (group 2). In group 2, 8 (44%) achieved successful outcome at 3-month time point. Daytime urinary incontinence did not modify treatment effectiveness. CONCLUSION EA treatment should be given for a short period of time and should not be continued without a definite purpose or clear response. Suspending and then repeating this treatment after an appropriate interval is effective for patients who do not respond to the initial course of treatment.
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Affiliation(s)
- Taiju Hyuga
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan.
| | - Shigeru Nakamura
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
| | - Shina Kawai
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
| | - Hideo Nakai
- Department of Pediatric Urology, Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan
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Madhu CK, Hashim H, Enki D, Drake MJ. Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women. Neurourol Urodyn 2015; 36:188-191. [DOI: 10.1002/nau.22912] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Chendrimada K. Madhu
- Department of Women's Health and Bristol Urological Institute; Southmead Hospital; Bristol England
| | - Hashim Hashim
- Urodynamics Unit; Bristol Urological Institute; Southmead Hospital; University of Bristol; Bristol England
| | - Doyo Enki
- Plymouth University Peninsula Schools of Medicine and Dentistry; Plymouth England
| | - Marcus J. Drake
- Bristol Urological Institute; Southmead Hospital; University of Bristol; Bristol England
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Wolf RB, Kassim AA, Goodpaster RL, DeBaun MR. Nocturnal enuresis in sickle cell disease. Expert Rev Hematol 2014; 7:245-54. [DOI: 10.1586/17474086.2014.892412] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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[Voiding disorders in childhood: from symptoms to diagnosis]. Arch Pediatr 2012; 19:1231-8. [PMID: 22999469 DOI: 10.1016/j.arcped.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 07/13/2012] [Accepted: 08/07/2012] [Indexed: 11/22/2022]
Abstract
The new definitions of voiding disorders in children should be used in clinical practice. Two major kinds of voiding disorders are identified: 1) isolated primary enuresis as a disorder occurring exclusively during sleep with no daytime leakage; 2) urinary dysfunctions that include uninhibited detrusor contraction, sphincter hypertonicity, and urethral instability. These dysfunctions may be primary or secondary. Constipation as an underlying cause is frequent and usually underestimated. The diagnostic process requires one (or more) long consultations. After ruling out a urine leak without a voiding disorder and secondary causes (constipation, inadequate hydration, poor voiding hygiene, crystalluria, etc.), the aim is to distinguish isolated sleep-time disorders (primary enuresis) from daytime ± sleep-time symptoms (primary urinary dysfunctions). Anamnesis, long and accurate, can be sensitized by a questionnaire completed at home. The physical examination focuses on the exclusion of anatomic abnormalities and local inflammation (vulvitis, balanitis, etc.). Diagnostic tests are rarely required at the beginning. Urodynamic exploration may be indicated, never at the first consultation, in case of primary urinary dysfunction. This diagnostic approach provides an appropriate therapeutic decision.
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Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S. Practical consensus guidelines for the management of enuresis. Eur J Pediatr 2012; 171:971-83. [PMID: 22362256 PMCID: PMC3357467 DOI: 10.1007/s00431-012-1687-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 01/25/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED Despite the high prevalence of enuresis, the professional training of doctors in the evaluation and management of this condition is often minimal and/or inconsistent. Therefore, patient care is neither optimal nor efficient, which can have a profound impact on affected children and their families. Once comprehensive history taking and evaluation has eliminated daytime symptoms or comorbidities, monosymptomatic enuresis can be managed efficaciously in the majority of patients. Non-monosymptomatic enuresis is often a more complex condition; these patients may benefit from referral to specialty care centers. We outline two alternative strategies to determine the most appropriate course of care. The first is a basic assessment covering only the essential components of diagnostic investigation which can be carried out in one office visit. The second strategy includes several additional evaluations including completion of a voiding diary, which requires extra time during the initial consultation and two office visits before treatment or specialty referral is provided. This should yield greater success than first-line treatment. CONCLUSION This guideline, endorsed by major international pediatric urology and nephrology societies, aims to equip a general pediatric practice in both primary and secondary care with simple yet comprehensive guidelines and practical tools (i.e., checklists, diary templates, and quick-reference flowcharts) for complete evaluation and successful treatment of enuresis.
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Affiliation(s)
- Johan Vande Walle
- Pediatric Nephrology Unit, Ghent University Hospital, Ghent, Belgium
- Pediatric Nephrology UZ Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Soren Rittig
- Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark
| | - Stuart Bauer
- Department of Urology, Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paul Eggert
- University Children’s Hospital, Kiel, Germany
| | | | - Serdar Tekgul
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Espino R. [Evaluation of anthropometric development in patients with enuresis]. An Pediatr (Barc) 2012; 77:184-92. [PMID: 22377445 DOI: 10.1016/j.anpedi.2012.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 01/11/2012] [Accepted: 01/16/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION An epidemiological study was conducted to assess the anthropometric development in children diagnosed with primary monosymptomatic nocturnal enuresis, depending on the treatment option selected. PATIENTS AND METHODS A longitudinal series of cases including 548 children aged 5-10 years. Anthropometric parameters of children were assessed at diagnosis, and after one and two years of treatment. RESULTS Children with primary monosymptomatic nocturnal enuresis showed no anthropometric changes when their data were compared to the standard deviation score of height, weight, and body mass index (BMI). Overall, no changes were seen in the above mentioned parameters after two years of treatment for enuresis (except for a weight standard deviation score (SDS) decrease in boys). We only found a decrease in the size and weight in those children undergoing behavioral therapy with or without an alarm, findings that, given the limitations of the study, were not considered significant. The odds ratio for cure after one and two years of treatment was 1.41 (95% CI: 0.85-2.34) and 1.52 (95% CI: 0.86-2.70) for desmopressin (and watchful waiting) as compared to all other options. CONCLUSIONS In this study, children had SDS values of height, weight, and BMI similar to healthy children of the same age and sex before and after treatment for primary monosymptomatic nocturnal enuresis. Desmopressin appeared to increase the probability of cure after one and two years of treatment, however these data should be corroborated in future randomized clinical trials.
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Affiliation(s)
- R Espino
- Hospital Universitario Nuestra señora de Valme, Sevilla, España.
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Marschall-Kehrel D, Harms TW. Structured desmopressin withdrawal improves response and treatment outcome for monosymptomatic enuretic children. J Urol 2009; 182:2022-6. [PMID: 19695616 DOI: 10.1016/j.juro.2009.03.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE In this national, multicenter, retrospective survey we tested whether structured withdrawal of desmopressin, in which dose frequency rather than dose quantity was gradually decreased, would improve outcome. MATERIAL AND METHODS Enrolled in the study were 487 monosymptomatic enuretic patients from a total of 181 centers (The Enuresis Algorithm of Marschall Survey Group). At study outset 41% of patients had 7 wet nights per week, 45% had 3 to 6 and 14% had fewer than 3. All patients were treated with desmopressin, which was abruptly terminated or tapered with analogue by a structured scheme. Response rates were compared in the groups according to International Children's Continence Society guidelines. RESULTS The 173 children with abrupt termination had a 51% response rate, including a full and partial response in 44.1% and 27%, respectively, and no response in 22%. The 314 children with tapering had a 72% response rate, including a full and partial response in 66.8% and 24%, and no response in 4% (p <0.0001). Enuresis frequency with abrupt termination decreased from 21 wet nights per month before treatment to 6. The tapering group had 21 wet nights per months before and 2 after treatment (p <0.0001). Followup at 1 month showed fewer than 2 wet nights per month in 57% of cases with abrupt termination and in 80% with tapering (p <0.0001). Pretreatment had no influence. No severe side effects occurred. CONCLUSIONS This national, multicenter, retrospective analysis proves that antidiuretic treatment followed by a structured withdrawal program is superior to regular treatment with abrupt termination in enuretic children. Hence, desmopressin followed by structured withdrawal should be the standard. It is also superior to published outcomes of alarm treatment.
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Wolfish NM, Pham C. Management of Nocturnal Enuresis in Children. Can Pharm J (Ott) 2009. [DOI: 10.3821/1913-701x-142.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kujubu DA, Aboseif SR. An overview of nocturia and the syndrome of nocturnal polyuria in the elderly. ACTA ACUST UNITED AC 2008; 4:426-35. [DOI: 10.1038/ncpneph0856] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 05/13/2008] [Indexed: 11/09/2022]
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Kim JM, Kim YS, Namgoong MK, Park KH, Park YH, Lee SD, Lee SJ, Chung JY. A Multicenter Prospective Study of the Effect of Imipramine and Desmopressin on Arousability in Children with Nocturnal Enuresis. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.2.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jun Mo Kim
- Department of Urology, College of Medicine, Soonchunhyang University, Bucheon, Korea
| | | | - Mee Kyung Namgoong
- Department of Pediatrics, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kwan Hyun Park
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Hoon Park
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University College of Medicine, Busan, Korea
| | - Seung Joo Lee
- Department of Pediatrics, Ewha Womans University College of Medicine, Korea
| | - Jae Yong Chung
- Department of Urology, College of Medicine, Inje University, Seoul, Korea
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Van Hoecke E, Bossche HV, Bruyne ED, Hoebeke P, Walle JV. Enuresis and daytime wetting as a biopsychosocial problem: a review. Expert Rev Pharmacoecon Outcomes Res 2007; 7:633-40. [PMID: 20528325 DOI: 10.1586/14737167.7.6.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enuresis is considered to be the most prevalent of all childhood problems with important psychosocial consequences. Thorough research by both medical and psychological disciplines has resulted in a lack of agreement concerning definitions and terminology. Psychiatric classification systems stress phenomenological aspects such as age, frequency and duration of wetting episodes, but are not based on pathophysiologic aspects, whereas the International Children's Continence Society recommend distinguishing between monosymptomatic enuresis and complex/non-monosymptomatic enuresis depending on the absence or presence of bladder dysfunctions. Several epidemiological and cross-sectional studies show higher scores for behavioral problems in children with enuresis. Parental reports suggest more externalizing problems, attention/hyperactive problems and anxious/withdrawn behavior, however, no difference has been demonstrated in children's self-report concerning internalizing problems. Four different viewpoints relating to the association between enuresis and psychopathology are described, including their clinical implications. In conclusion, enuresis and daytime wetting is seen as a 'biopsychosocial' problem with evidence for pathophysiologic causes and is often associated psychiatric/psychological problems.
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Affiliation(s)
- Eline Van Hoecke
- Clinical Psychologist, Ghent University Hospital, Pediatric Uro/Nephrologic Centre, De Pinetelaan 185, B-900 Ghent, Beligium.
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Wang QW, Wen JG, Song DK, Su J, Zhu QH, Liu K, Che YY, Du AM, Wei JX. Bed-wetting in Chinese children: epidemiology and predictive factors. Neurourol Urodyn 2007; 26:512-517. [PMID: 17315220 DOI: 10.1002/nau.20373] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS To estimate the prevalence and severity of bed-wetting in 1-18-year-old Chinese children. MATERIALS AND METHODS A cross-sectional study of bed-wetting was performed by using 13,515 self-administered questionnaires distributed to the parents of 1-18-year-old Chinese children in Henan province. The prevalence of bed-wetting was determined. The relationship of wetting to age, gender, community characteristics (rural or urban), arousal dysfunction, associated day-time symptoms (frequency, urgency, and incontinence), and family history were analyzed. RESULTS There was a response rate of 87% (5,978 boys and 5,786 girls). The overall prevalence of bed-wetting was 23.03% in those aged 1-4, 5.66% in those 5-12, and 1.37% in those 13-18. When a logistic regression analysis was applied to determine risk factors for the bed-wetting, a positive relationship was seen with male gender and living in rural areas. Further, living in rural areas, arousal dysfunction, and associated day symptoms were significantly related to more severe bed-wetting. Only 3.64% of the children had undergone professional evaluation. CONCLUSION The prevalence of bed-wetting is significant in Chinese children, but lower than in most western countries, which is likely due to cultural differences. Living in rural areas, having arousal dysfunction, and having associated day-time symptoms may be predicative factors for marked bed-wetting.
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Affiliation(s)
- Qing Wei Wang
- Department of Pediatric Surgery, Pediatric Urodynamic Centre of the First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
- Institute of Clinical Medical Research of Henan Universities, Zhengzhou City, Henan, China
| | - Jian Guo Wen
- Department of Pediatric Surgery, Pediatric Urodynamic Centre of the First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
- Institute of Clinical Medical Research of Henan Universities, Zhengzhou City, Henan, China
| | - Dong Kui Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
| | - Jing Su
- Institute of Clinical Medical Research of Henan Universities, Zhengzhou City, Henan, China
| | - Qing Hua Zhu
- The Nursing College of Henan University, Kaifeng City, Henan, China
| | - Kui Liu
- Department of Pediatric Surgery, Pediatric Urodynamic Centre of the First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
| | - Ying Yu Che
- Department of Pediatric Surgery, Pediatric Urodynamic Centre of the First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
| | - Ai Min Du
- Institute of Clinical Medical Research of Henan Universities, Zhengzhou City, Henan, China
| | - Jin Xing Wei
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China
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Wen JG, Wang QW, Wen JJ, Su J, Chen Y, Liu K, Yang HY. Development of nocturnal urinary control in Chinese children younger than 8 years old. Urology 2006; 68:1103-8; discussion 1108. [PMID: 17113902 DOI: 10.1016/j.urology.2006.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 05/02/2006] [Accepted: 06/15/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the development of nocturnal urinary control (NUC) with age in Chinese children younger than 8 years of age using cross-sectional and retrospective surveys. METHODS We used a cross-sectional survey of 4754 children (1 to 8 years old), a retrospective investigation of 2745 children younger than 9 years old, and an anonymous questionnaire of 8222 children 9 to 18 years old . The children without NUC were subdivided into infant (1 to 3 years old), preschool age (4 to 6 years old), and primary school (7 to 8 years old) groups. RESULTS The response rate to the cross-sectional and retrospective surveys was 90% and 89%, respectively. In the cross-sectional survey, the prevalence of children attaining NUC was 52% for those younger than 2 years of age, 76% for those aged 2 to 3 years, and 93% at age 8. Girls were more likely than boys to acquire NUC earlier. In the retrospective survey, the prevalence of children attaining NUC before age 2 was 17% and was 72% for those aged 2 to 3 years, and 98% by age 8. The proportion of nonmonosymptomatic bedwettings in children without NUC was 14%. Arousal difficulty and a positive family history were found in 67% and 11% of children with nocturnal wetting, respectively. The severity of bedwetting and arousal difficulty was significantly greater in infants than in preschool and school-age children. CONCLUSIONS The results from the cross-sectional and retrospective surveys showed that the most important period of attaining NUC is 2 to 3 years of age. Nearly 90% of children attained NUC by the age of 5.
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Affiliation(s)
- Jian Guo Wen
- Department of Pediatric Surgery, Pediatric Urodynamic Centre, First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China.
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Hagstroem S, Kamperis K, Rittig S, Djurhuus JC. Bladder Reservoir Function in Children With Monosymptomatic Nocturnal Enuresis and Healthy Controls. J Urol 2006; 176:759-63. [PMID: 16813939 DOI: 10.1016/s0022-5347(06)00296-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE We investigated bladder reservoir function in children with monosymptomatic nocturnal enuresis and in healthy controls. MATERIALS AND METHODS A total of 18 children with monosymptomatic nocturnal enuresis and 119 controls who were 7 to 13 years old were recruited. Children completed frequency volume charts and measurements of nocturnal urine production. Mean diuresis in the period preceding each voiding was calculated. Those with enuresis were grouped according to bladder capacity and hospitalized for 4 nights, including a baseline night and 3 with an oral water load. Enuresis volumes and post-void residual volume were estimated, allowing the calculation of bladder volume at the time of enuresis. RESULTS Nine children with monosymptomatic nocturnal enuresis were characterized as having normal bladder capacity and 9 had decreased bladder capacity. We found large intra-individual variability in daytime voided volume in all 3 groups of participants. Children with enuresis and small bladder capacity generally voided with volumes close to maximal voided volume. A total of 93 enuresis episodes were recorded. Large intra-individual variability was seen in bladder volume at enuresis and it was lower than maximal voided volume in more than 50% of episodes. Variability in bladder volume at enuresis was greatest in the patient group with decreased bladder capacity. We found a significant correlation between diuresis and bladder capacity in all groups during the day and night. CONCLUSIONS There is a great intra-individual diurnal variability in voided volume in children with enuresis and in healthy children. Enuresis seems to occur at bladder volumes that are smaller and larger than the maximal voided volume obtained from voiding charts.
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Affiliation(s)
- Søren Hagstroem
- Clinical Institute, University of Aarhus and Department of Pediatrics, Skejby University Hospital, Denmark.
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Chandra M, Saharia R, Hill V, Shi Q. PREVALENCE OF DIURNAL VOIDING SYMPTOMS AND DIFFICULT AROUSAL FROM SLEEP IN CHILDREN WITH NOCTURNAL ENURESIS. J Urol 2004; 172:311-6. [PMID: 15201802 DOI: 10.1097/01.ju.0000132363.36007.49] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We analyzed the relative contribution of detrusor instability and difficult arousal from sleep in the genesis of nocturnal enuresis (NE), and evaluate a clinical feature that may prospectively help differentiate patients with monosymptomatic NE (mono NE) from those with diurnal voiding symptoms (DVSs) of urgency and urge incontinence associated with NE (NE + DVSs). MATERIALS AND METHODS Patients referred for voiding problems and 627 controls were evaluated for NE, DVSs, nocturia and arousal from sleep on a scale of 1 to 8. Patients were categorized into 3 groups-mono NE of primary or secondary onset (200, boys 71%, girls 29%), primary or secondary NE + DVSs (329, boys 43%, girls 57%) and isolated DVSs (146, boys 21%, girls 79%). RESULTS DVSs were noted in 49% of boys and 76% of girls with NE, although 40% of patients or parents did not complain of DVSs. The DVSs were elicited on detailed interrogation or on finding evidence of urinary incontinence on perineal examination. While one-third of controls and patients with isolated DVSs manifested nocturia at least twice a month, only 6% of bedwetters did so. Difficult arousal from sleep (scores 6 to 8) was more prevalent in patients with NE (59%) than controls (20%) or patients with isolated DVSs (5%), and in patients with mono NE and primary NE than in NE + DVSs or secondary NE, with reverse prevalence for nocturia. Easy sleep arousal (scores 1 to 3) was noted in 65% of patients with secondary NE + DVSs vs up to 6% of other NE subgroups. Compared to patients with mono NE, those with NE + DVSs had a higher prevalence of urinary tract infection (UTI), encopresis, psychosocial/learning problems, and family history of UTI and DVSs, ie problems associated with detrusor instability. CONCLUSIONS DVSs accompany NE in two-thirds of patients but can be missed during a cursory history. Difficult sleep arousal seems to have a major role in primary mono NE, and detrusor instability in secondary NE + DVSs. In patients with NE a history of frequent nocturia, easy sleep arousal, UTI, encopresis, psychosocial learning problems or family history of UTI and DVSs should raise the suspicion for associated undisclosed DVSs.
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Affiliation(s)
- Manju Chandra
- Division of Pediatric Nephrology, Schneider Children's Hospital at North Shore and North Shore University Hospital, Manhasset, New York 11030, USA.
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Hvistendahl GM, Kamperis K, Rawashdeh YF, Rittig S, Djurhuus JC. THE EFFECT OF ALARM TREATMENT ON THE FUNCTIONAL BLADDER CAPACITY IN CHILDREN WITH MONOSYMPTOMATIC NOCTURNAL ENURESIS. J Urol 2004; 171:2611-4. [PMID: 15118431 DOI: 10.1097/01.ju.0000110762.45940.fa] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We studied the characteristics of a group of monosymptomatic nocturnal enuretics successfully treated with the alarm system, with special reference to changes in functional bladder capacity. MATERIALS AND METHODS The diaries of 7 girls and 19 boys 7 to 13 years old with severe nocturnal enuresis, small daytime bladder capacity (70% or less of expected capacity for age) and poor or absent response to desmopressin were analyzed. Patients were treated with an alarm until complete dryness was achieved for 21 consecutive nights before ending therapy. Immediately after the treatment they recorded a 1-week followup diary of voiding and fluid intake. RESULTS Mean duration of the alarm treatment was 82 days, and there was no change in nocturnal or 24-hour diuresis from baseline to followup. Nocturia developed during the alarm treatment in 48% of the children. The nocturnal diuresis on nocturia nights was significantly higher than on nights without nocturia. Daytime functional bladder capacity increased significantly in children with and without nocturia. CONCLUSIONS Treatment with an alarm system increases daytime functional bladder capacity significantly in children with and without nocturia. A higher nocturnal urine production on nocturia nights explains why some children have nocturia and others do not.
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Affiliation(s)
- G M Hvistendahl
- International Enuresis Research Center, Institute of Experimental Clinical Research, Skejby Hospital, Aarhus, Denmark
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Karlidag R, Ozisik HI, Soylu A, Kizkin S, Sipahi B, Unal S, Ozcan C. Topographic abnormalities in event-related potentials in children with monosyptomatic nocturnal enuresis. Neurourol Urodyn 2004; 23:237-40. [PMID: 15098219 DOI: 10.1002/nau.20031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS A functional maturational delay in the central nervous system is dwelled upon in the pathogenesis of monosymptomatic nocturnal enuresis (MNE). In this study we studied whether according to controls N200 and P300, components of the event-related potential (ERP), which is related to aspects of cognitive processing, showed any difference in its topographic distribution in children within the age group 10-13 with monosymptomatic nocturnal enuresis and discussed its relation to the pathogenesis of MNE. METHODS We performed P300 in 18 patients with MNE and in 16 age-matched healthy subjects. P300 were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. RESULTS There was no statistical difference between the enuretic group and the controls in N200 and P300 latency and amplitude in the midline frontal (Fz), central (Cz), and parietal (Pz) recording site of the 10-20 International System. In the enuretic group while P300 amplitude in the Fz site was significantly less than the P300 amplitude in the Cz site, there was no statistical difference between the Fz and Pz P300 amplitude values. CONCLUSIONS When different levels of maturational delay are considered in MNE, it may be claimed that maturational delay in children whose enuresis lasts until older ages will be different from those whose enuresis ends at an early age. The determination of P300 amplitude in parietal records being less in enuretics when compared to the controls may show that there are regional differences in stimuli processing rate/quality.
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Affiliation(s)
- Rifat Karlidag
- Inonu University Medical Faculty, Turgut Ozal Medical Center, Research Hospital, TR-44069 Malatya, Turkey.
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Wolfish NM, Barkin J, Gorodzinsky F, Schwarz R. The Canadian Enuresis Study and Evaluation--short- and long-term safety and efficacy of an oral desmopressin preparation. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2003; 37:22-7. [PMID: 12745738 DOI: 10.1080/00365590310008631] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the long-term (12 months) efficacy and safety of oral desmopressin (DDAVP). MATERIAL AND METHODS A total of 256 healthy children (6-18 years old) with nocturnal enuresis with a frequency of > or = 10 wet nights during a 4-week observation period were eligible for inclusion in the study. Initially 0.2 mg of DDAVP was given for 14 nights. Those achieving a > 90% reduction in the number of wet nights over the observation period (full responders) began a 12-week continuous treatment period at this dose. The remaining children received 0.4 mg for an additional 14 nights. Those achieving a > or = 50% reduction in the number of wet nights (responders) commenced a 12-week continuous treatment period at this dose. Children with a < 50% reduction in the number of wet nights at this point were withdrawn from the study. Each 12-week treatment period was followed by a treatment-free period of 7-28 days. Children who remained dry during that period were assigned a full response and terminated the trial. Children with > or = 2 wet nights during that period immediately began a new 12-week treatment period at the previous dose. This was repeated for 12 months and thereafter the medication dose was tapered by halving over a 4-week period. RESULTS A total of 117/236 children who completed the titration period (49.6%; 95% confidence interval 40-57%) responded (> 50% reduction over baseline). Throughout the study their response rate remained constant at approximately 74%. Continuous treatment reduced the median number of wet nights during the observation period from 5.75 to 1.00 per week. A total of 12.4% of children received the 0.2 mg dose and 87.6% the 0.4 mg dose. The proportion of full responses increased over the course of the study from 5.8% to 37.5%. DDAVP was well tolerated: the majority of reported adverse events were mild, although two adverse events leading to withdrawal were reported. CONCLUSIONS Oral DDAVP provides an effective and well-tolerated means of providing long-term control in children with nocturnal enuresis. Long-term treatment increases the response rate.
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De Wachter S, Vermandel A, De Moerloose K, Wyndaele JJ. Value of increase in bladder capacity in treatment of refractory monosymptomatic nocturnal enuresis in children. Urology 2002; 60:1090-4. [PMID: 12475676 DOI: 10.1016/s0090-4295(02)02127-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate children with refractory monosymptomatic nocturnal enuresis to determine whether detrusor overactivity (DOA) plays a role in 4 weeks of unsuccessful treatment with retention control training (RCT); whether an increase in bladder capacity can eventually be obtained by RCT plus oxybutynin; and whether the increase in capacity is the primary key to success. METHODS Sixty-eight children with refractory monosymptomatic nocturnal enuresis were included. They all had a maximal cystometric capacity less than the age-expected value. RCT was done by water loading and retention to the point of urgency once daily. During training, changes in bladder capacity were evaluated by voiding charts. If after 4 weeks of RCT, less than a 10% increase in bladder capacity was noted, oral oxybutynin was added. RESULTS The incidence of DOA was 66%. After 4 weeks of RCT, the bladder capacity increased in 20.6%. Combining RCT with oxybutynin led in the end to normalization of the bladder capacity in 79.4%. Older age and high-pressure DOA negatively influenced the ability to increase the bladder capacity. Fifteen children became completely dry, mainly by converting enuresis to nocturia. CONCLUSIONS Unsuccessful RCT is often caused by DOA, especially if a bladder capacity rise of at least 10% cannot be achieved within 4 weeks. If oxybutynin is added to the treatment, normalization of bladder capacity can be obtained in most. This increased bladder capacity cures enuresis only in a minority by sharpening their arousal and provoking nocturia.
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Affiliation(s)
- S De Wachter
- Department of Urology, University Antwerp, Wilrijk, Belgium
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Abstract
ENURESIS IS NOT A DISEASE, BUT A DISORDER CAUSED BY DELAYS IN THE MATURATION OF THREE PHYSIOLOGICAL PROCESSES: persistence of spontaneous bladder contractions, bladder volume exceeding the nocturnal functional bladder capacity and persistence of elevated sleep/arousal thresholds. Enuresis has been subtyped into two different groups, depending on whether the predominant feature is frequent small voidings (excessive bladder contractions) or large urinary volume (volume-dependent). The clinical pattern demonstrated by the enuretic child depends on the severity of the maturational lag. In practice, a mix of these types is most common.
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