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Carvalho TA, Vasconcelos MMDA, Guimarães ICDO, Dutra MF, Lima EM, Bastos Netto JM, de Bessa Junior J, Simões E Silva AC, de Carvalho Mrad FC. Relationship between toilet training process and primary nocturnal enuresis in children and adolescents - A systematic review. J Pediatr Urol 2022; 18:554-562. [PMID: 35987679 DOI: 10.1016/j.jpurol.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents. METHODS We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies. RESULTS A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process. CONCLUSION Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.
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Affiliation(s)
- Tânia Antunes Carvalho
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Isabela Cristina de Oliveira Guimarães
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Melissa Faria Dutra
- Federal University of Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Eleonora Moreira Lima
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, School of Medicine, Urology Department, Brazil; Faculdade de Ciências Médicas de Juiz de Fora e Maternidade Therezinha de Jesus, Urology Department, Brazil.
| | | | - Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil; Interdisciplinary Laboratory of Medical Investigation, UFMG, Brazil.
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
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Quiroz-Guerrero J, Ortega-Pardo A, Maldonado-Valadez RE, García-Díaz de León R, Mercado-Villareal L, Rodea-Montero ER. Maternal Anxiety Associated with Nocturnal Childhood Enuresis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081232. [PMID: 36010121 PMCID: PMC9406453 DOI: 10.3390/children9081232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Introduction: Nocturnal enuresis is a common problem affecting 20% of 5-year-old children; its prevalence decreases with age. Nocturnal bedwetting in children younger than 5 is generally accepted by parents and society, but the expectation of parents is that children will achieve a higher degree of responsibility and increased control with age. Some studies have identified maternal distress as a factor associated with childhood urinary incontinence; specifically, maternal stress, maternal depression, and maternal anxiety. The aim of this study was to compare the degree of anxiety (trait and state) among mothers of children with nocturnal enuresis and mothers of healthy children. Methods: This was a prospective, cross-sectional, comparative study including two groups: a control group of 25 mothers of healthy children from open population, and an enuresis group of 25 mothers of children with nocturnal enuresis of the pediatric urology clinic of a third-level Mexican Hospital. STAI-T and STAI-S tests were performed and assessed blindly. Quantitative variables were compared using the Mann−Whitney U test, and qualitative determinations using a chi-square test or Fischer’s exact test. Results: The STAI-S and STAI-T tests results identified 14 (56%) mothers of enuretic children with moderate-to-severe trait anxiety versus 4 (16%) mothers from the control group and moderate-to-severe state anxiety in 23 (92%) of the mothers of enuretic children compared to 7 (28%) control-group mothers. The anxiety scores were significantly higher for the enuresis group for both tests: STAI-T: 53.00 ± 8.39 versus 41.52 ± 9.61 (p < 0.001) and STAI-S: 56.48 ± 6.83 versus 43.84 ± 10.57 (p < 0.001). Conclusion: Mothers of children with nocturnal enuresis present state anxiety ranging from moderate to severe. In clinical practice, our results indicate that the transitory emotion experienced by mothers of enuretic children cannot be neglected in an enuresis treatment program, state anxiety needs to be evaluated, and psychological interventions need to be implemented.
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Affiliation(s)
- Javier Quiroz-Guerrero
- Department of Pediatric Urology, Hospital Regional de Alta Especialidad del Bajío, Leon 37660, Mexico
| | - Alejandra Ortega-Pardo
- Department of Pediatric, Hospital Regional de Alta Especialidad del Bajío, Leon 37660, Mexico
| | | | | | | | - Edel Rafael Rodea-Montero
- Department of Research, Hospital Regional de Alta Especialidad del Bajío, Leon 37660, Mexico
- Correspondence: ; Tel.: +52-477-267-2000
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Schuster S, Reece J, Florentzou A, Apos E. Treating enuresis in children with neurodevelopmental disorders using bell and pad alarm. J Pediatr Urol 2021; 17:645.e1-645.e8. [PMID: 34353751 DOI: 10.1016/j.jpurol.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is a high prevalence of enuresis in children with neurodevelopmental disorders, yet research regarding treatment for this group has been neglected. The efficacy of treatment using bell and pad alarm therapy is not well reported especially in children with neurodevelopmental disorders. This study sought to compare the treatment efficacy of practitioner-assisted bell-and-pad enuresis alarm therapy for children with neurodevelopmental disorders and typically developing children. STUDY DESIGN This study utilized the data of Apos et al. (2018), a retrospective medical record audit collected from multiple clinical settings across Australia. A total of 2986 patient records (3659 treatment records) were included. The participants were children aged 5-16 years, who were diagnosed with enuresis. Children with a neurodevelopmental disorder (n = 158) had a clinical diagnosis present in the medical history of attention deficit disorder, autism spectrum disorder, or intellectual disability. Children who indicated any of the following comorbidities were excluded: cerebral palsy, brain injury, malformation of the renal tract, previous bladder or renal surgery, spinal cord malformation, spinal cord trauma or tumor, or a neurodegenerative disorder. Treatment success was defined as ≥ 14 dry nights. Relapse was defined as one symptom recurrence per month post-interruption of treatment, as defined by the International Children's Continence Society definitions. RESULTS The success rate for children with neurodevelopmental disorders was 62% and typically developing children was 78%. There was no significant difference between the number of treatments received or relapse rates by those children with a neurodevelopmental disorder and typically developing children. The summary figure shows the percentage of children in each group after their first treatment who were successful (success defined as dry for ≥ 14 days), who succeeded (dry for ≥ 14 days) but then relapsed and those who showed no success. The percentage of children with no NDD who were successfully dry after the first treatment was 78%. Children with ID had success after the first treatment of 59%, the lowest of all groups analyzed. CONCLUSION The type of alarm therapy reported in this study is effective for treating enuresis in children with neurodevelopmental disorders.
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Affiliation(s)
- Sharynn Schuster
- Discipline of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - John Reece
- School of Psychological Sciences, Australian College of Applied Psychology, Melbourne, Victoria, Australia
| | - Andrew Florentzou
- Discipline of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Esther Apos
- Public Health and Preventative Medicine, Monash University, Victoria, Australia
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Taborga Díaz E, Martínez Suárez V, Alcántara-Canabal L, Suárez Castañón C, Cebrián Muíños C. Valoración de los criterios diagnósticos de la enuresis nocturna. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Taborga Díaz E, Martínez Suárez V, Alcántara-Canabal L, Suárez Castañón C, Cebrián Muíños C. Assessment of nocturnal enuresis diagnostic criteria. An Pediatr (Barc) 2021; 95:101-107. [PMID: 34210621 DOI: 10.1016/j.anpede.2020.08.005] [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: 03/27/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Nocturnal enuresis (NE) is a common disorder that affects both children and their families. The objective is to determine its prevalence in an extensive sample of children considering different diagnostic criteria. PATIENTS AND METHODS Cross-sectional descriptive study using a survey of parents of a selection of primary and secondary school Asturian children (6, 10 and 13 years). The questionnaire consisted of 80 or 55 questions (10 of which were answered by the children) for those who urinated or not in bed, respectively. NE was registered as primary or secondary, and the presence or not of enuresis as the only symptom. In addition, the prevalence was compared according to the different diagnostic criteria. RESULTS Of the 3548 questionnaires distributed, 56.6% were answered completed correctly. A total of 102 children urinated in bed (5.52%), which corresponds to a prevalence of 2.82% according to the DSM-IV-TR/5 and the (International Continence Society) ICC, 3.7% with the DSM-III and ICD-10. It was more frequent in boys than in girls (2.8:1), with a predominance of primary forms (81.2%), and non-monosymptomatic (68.66%). The spontaneous resolution in the older age group was higher in boys than in girls, with the different prevalences of previous ages being equal to 13 years. CONCLUSIONS The prevalence of NE in the studied region coincides with that observed in some other studies. There are differences according to the criteria used, which should draw attention to the need to unify the methodology of the studies and the criteria used in its diagnosis.
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Tan DJY, Weninger J, Goyal A. Mirabegron in Overactive Bladder and Its Role in Exit Strategy After Botulinum Toxin Treatment in Children. Front Pediatr 2021; 9:801517. [PMID: 35252075 PMCID: PMC8894583 DOI: 10.3389/fped.2021.801517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Mirabegron is a recent addition to the management options of overactive bladder (OAB) in children. The purpose of this study was to ascertain the role of Mirabegron in the treatment algorithm of therapy-resistant OAB especially after botulinum toxin. METHODS Case notes of all children receiving Mirabegron between July 2017 and February 2020 were reviewed. RESULTS Forty one children (21 females, 20 males), mean age 12.6 [8-17] years old, commenced Mirabegron: 35 idiopathic OAB, 6 neuropathic OAB. The mean duration of treatment was 20.7 [3-45] months. In total 24 (59%) had Mirabegron after partial/no response to anticholinergics, and 17 (41%) patients had Mirabegron subsequent to botulinum toxin A (BtA) as an exit strategy. In total 35 (85%) patients had combination therapy (Mirabegron and anticholinergics), and 6 (15%) patients had Mirabegron only. Fourteen (34%) had complete response, 17 (41%) had partial response, and 10 (24%) had no response. Side effects were reported in 7 (17%) patients with discontinuation necessitated in 3. CONCLUSION Mirabegron when used alone or in combination with anticholinergics resulted in complete/partial response in 76% of anticholinergic therapy-resistant OAB. In addition to being an important step in treatment escalation after no/partial response to anticholinergics, it has a crucial role in the exit strategy for recurring symptoms after BtA wears off.
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Affiliation(s)
- Denise Jia Yun Tan
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Julia Weninger
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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Keten T, Aslan Y, Balci M, Erkan A, Senel C, Oguz U, Kayali M, Guzel O, Karabulut E, Tuncel A. Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis. J Pediatr Urol 2020; 16:645.e1-645.e7. [PMID: 32826183 DOI: 10.1016/j.jpurol.2020.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. OBJECTIVE To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. STUDY DESIGN A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. RESULTS The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). DISCUSSION With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. CONCLUSIONS Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation.
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Affiliation(s)
- Tanju Keten
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Yilmaz Aslan
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey. https://twitter.com/urodrya
| | - Melih Balci
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Anil Erkan
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Cagdas Senel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Ural Oguz
- University of Giresun, Department of Urology, Giresun, Turkey
| | - Mustafa Kayali
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Ozer Guzel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Erdem Karabulut
- University of Hacettepe, Department of Biostatistics, Ankara, Turkey
| | - Altug Tuncel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
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Ferrara P, Franceschini G, Bianchi Di Castelbianco F, Bombace R, Villani A, Corsello G. Epidemiology of enuresis: a large number of children at risk of low regard. Ital J Pediatr 2020; 46:128. [PMID: 32917238 PMCID: PMC7488742 DOI: 10.1186/s13052-020-00896-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022] Open
Abstract
Aim To describe the epidemiological aspects of nocturnal enuresis (NE). In this study we identify the prevalence and the familial conditions in a large, representative sample of children with monosymptomatic NE (MNE) and nonmonosyptomatic NE (NMNE). Material and methods In this descriptive-analytic study the Italian Society of Pediatrics (SIP) promoted a prevalence study of NE using a questionnaire involved 320 primary care Pediatricians from Northern, Central and Southern Italy, from January 2019 to July 2019, with a total of 130,000 children analyzed by questionnaire related to epidemiology and type of NE, familiarity, quality of sleep, eating and drinking habits, pharmacological and psychological/behavioural interventions and family involvement. Results 270/320 (84.4%) Paediatrician replied to our questionnaire. We enrolled a total of 9307/130,000 (7.2%) children with NE, aged between 5 and 14 years: 2141 diagnosed with MNE and 7176 qualified as NMNE. Poor quality of sleep were reported in 7064 patients; 90% of children did not consider a dietary and drinking recommendation. Pediatrician reported a total of 54.1% of parents who declared to have a negative reaction to their children because of the bedwetting. A percentage of 71.4% of parents declared to use or to have used alternative therapies and not to prefer, at first, a pharmacological intervention. Conclusion The choice of treatment should include psychological/behavioural interventions in all cases to improve the therapeutic outcome. All primary care Pediatricians should be aware of the all aspects of NE to choose the best way to treat every patient.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Largo A. Gemelli, 8, 00168, Rome, Italy. .,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy.
| | | | | | | | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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Bilal M, Haseeb A, Saeed A, Saeed A, Sarwar T, Ahmed S, Ishaque A, Raza M. Prevalence of Nocturnal Enuresis Among Children Dwelling in Rural Areas of Sindh. Cureus 2020; 12:e9590. [PMID: 32923196 PMCID: PMC7478510 DOI: 10.7759/cureus.9590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Nocturnal enuresis (NE) is usually a condition of childhood and refers to involuntary urinary incontinence during sleep. Due to its impact on a child’s mental and social health, it is important to determine the prevalence of this condition among a population. Therefore, the aim of our study is to evaluate its prevalence and associated risk factors among children living in rural areas of Sindh province, Pakistan. Methods Fifteen-hundred children aged between three and 12 years of age who lived in rural areas of Sindh and visited a tertiary care hospital for various complaints were selected at random. Their parents were asked to fill in a questionnaire regarding the symptoms and risk factors of NE. The data were gathered over a period of three months, starting from June 2019 to August 2019. The data were then analyzed to draw associations between the findings. Results Out of the total 1500 participants, 570 (38%) were male and the remaining 930 (62%) were female. Among these, the majority with NE were males (70%) and children between the age of six and seven years (65%). The first and fourth to fifth born were more likely to develop symptoms of NE. There was also a positive association between family history (P=0.003), delayed milestones (0.001), psychological problems (0.005), and urinary tract infection (P=0.001). However, a child suffering from chronic illness, parasitic infection, or anemia did not have a significant relationship with developing NE. Conclusion The total prevalence of NE among rural areas was 40%, which was higher than in urban areas. This could be due to limited awareness among parents and limited healthcare facilities to manage the condition in rural areas. However, it is important to identify the symptoms of NE earlier among children to reduce the impact it leaves on them.
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Affiliation(s)
- Muhammad Bilal
- Pediatrics, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Abdul Haseeb
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Alina Saeed
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Aena Saeed
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Tooba Sarwar
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Sana Ahmed
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Alina Ishaque
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Maryam Raza
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
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Current pharmacological management of idiopathic overactive bladder in children in the UK: a national survey of practice. J Pediatr Urol 2020; 16:37.e1-37.e8. [PMID: 31810880 DOI: 10.1016/j.jpurol.2019.10.013] [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: 07/18/2019] [Accepted: 10/14/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Children with daytime urinary incontinence secondary to idiopathic overactive bladder (IOAB) commonly present to paediatric urologists following failure of standard urotherapy and/or 1st-line anticholinergics. Off-label oral medications and intravesical botulinum toxin A (BtA) are being increasingly used for treatment-refractory IOAB, despite the paucity of high-quality evidence and guidelines. Knowledge of contemporary paediatric urologists' practice allows specialists to keep up-to-date with current trends in the management of IOAB in children. OBJECTIVES 1. To present an analysis of contemporary tertiary management of IOAB in children and 2. to highlight current trends in practice and identify areas of high variability in care for targeted research. METHODS Paediatric urologists (55 individuals) who attended the 2018 national British Association of Paediatric Urologists (BAPU) congress responded to a 20-question survey presented at the congress. Respondents could submit one answer per question, and one survey was taken per respondent, using secure software to disable any manipulation. Answers were analysed prospectively by a single reviewer. RESULTS Of UK paediatric urologists, 98% regularly manage children with IOAB, 48% use 48-h frequency/volume charts and others use three or seven-day bladder diaries to aid diagnosis. Oxybutynin is the 1st-line therapy for 85%, 2nd-line is tolterodine (53%), and 3rd-line is solifenacin (41%). Mirabegron is used either alone or in combination with solifenacin as 4th-line management by 55%. Those who use intravesical Botulinum toxin A (BtA) accounted for 81% and 84% of these perform invasive urodynamic assessment prior to BtA administration. Post-BtA, assessment was clinical in 18%, 24% use invasive urodynamics, whereas uroflowmetry is preferred by 58%. Of the paediatric urologists, 72% believe the most clinically significant outcome of treatment is patient-reported improvement. Treatment success is defined variably: 49% define success as completely dry, whereas 35% accept a 90% improvement as success. CONCLUSIONS Off-label medications are being used widely either alone or in combination by paediatric urologists. In oral therapy-resistant IOAB, BtA is being used by the majority of specialists, usually after formal urodynamic assessment. However, post-BtA assessment and evaluation of treatment success for IOAB are variable.
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Refugee Status as a Possible Risk Factor for Childhood Enuresis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071293. [PMID: 30978908 PMCID: PMC6479745 DOI: 10.3390/ijerph16071293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/25/2022]
Abstract
This study investigated the influence of refugee status on the occurrence of enuresis. It was performed among school children aged 6 to 11 years and their parents in the Vukovarsko-srijemska County (eastern Croatia), which had many displaced persons and refugees (mostly women and children) in the 1990s due to the wars in Croatia and Bosnia and Herzegovina. A specially designed questionnaire (about the child’s age and gender, the child’s enuresis history and that of the parents, and data on parental refugee status in childhood) was completed by one of the parents. Adequate data were collected for 3046 children. The prevalence of enuresis among the studied children was quite low (2.3%) but the prevalence distribution according to gender, the decline by age, and the higher odds ratio for paternal enuresis were in line with the results of other studies. The prevalence of parental enuresis in childhood was higher than their children’s enuresis (mothers: 5.8%, fathers: 3.6%, p < 0.001), and significantly higher among parents who had been refugees (mothers: p = 0.001, fathers: p = 0.04). Parental refugee status had no influence on the children’s enuresis. The results suggest that refugee status is a risk factor for the occurrence of enuresis in childhood.
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Su MS, Xu L, Pan WF, Li CC. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World J Pediatr 2019; 15:109-116. [PMID: 30446975 DOI: 10.1007/s12519-018-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA. DATE SOURCES We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE. RESULTS Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation. CONCLUSIONS Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched.
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Affiliation(s)
- Miao-Shang Su
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Li Xu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Wen-Feng Pan
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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Alshahrani A, Selim M, Abbas M. Prevalence of nocturnal enuresis among children in Primary Health Care Centers of Family and Community Medicine, PSMMC, Riyadh City, KSA. J Family Med Prim Care 2018; 7:937-941. [PMID: 30598936 PMCID: PMC6259524 DOI: 10.4103/jfmpc.jfmpc_32_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Nocturnal enuresis (NE) is commonly known as any intermittent incontinence while asleep in a child being at least 5-year old. The families of the children having this disorder can be greatly worried because this disorder can lead to considerable emotional distress and some psychological consequences. This study is aimed to estimate the prevalence of NE among children and to identify the characteristics of children who has NE. The third aim is to identify the consultation pattern to solve this problem. Methods: A cross-sectional survey was performed in Primary Health Care Centers of Family and Community Medicine, PSMMC, Riyadh City, KSA, during 2017. Results: Out of 65 families that have children with NE, 38.7% was the frequency of bedwetting every night; 22.6% of the children were stressed as a result of new child birth; 14% of the families did not feel a family load of having children with NE; 29% of the families did not try to treat their children because of their improvement with time; and 12% of the families that tried to treat their children used fluid restriction and waked their children up frequently at night. Conclusions: The prevalence of NE was 18.5% among families with a higher prevalence in boys. Prevalence of NE decreased with increasing age with many children found of having stressful events in their life other than parents’ divorce. We would like to refer that it is important for families that have children with NE to seek medical consultation immediately, which can lead to behavioral modifications.
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Affiliation(s)
- Abdullah Alshahrani
- Department of Family Medicine, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mohie Selim
- Department of Family Medicine, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mostafa Abbas
- Department of Family Medicine, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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Tai TT, Tai BT, Chang YJ, Huang KH. Parental perception and factors associated with treatment strategies for primary nocturnal enuresis. J Pediatr Urol 2017; 13:272.e1-272.e8. [PMID: 28190701 DOI: 10.1016/j.jpurol.2016.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim was to investigate the factors influencing parents seeking reasonable managements for their child and their overall outlook toward primary nocturnal enuresis (PNE). STUDY DESIGN We recruited 93 children with PNE from enuresis clinics and requested their parents to complete questionnaires regarding their child's medical history and behavior, their methods for coping with PNE, and their perception of enuresis. Logistic regression models were applied to investigate factors influencing the parents to adopt a positive approach toward enuresis and to subsequently seek a medical consultation. RESULTS One-third of the parents had an encouraging attitude toward children with PNE, whereas slightly less than half reacted with anger. The more educated the father or the younger the child with NE, the larger the possibility of the parents utilizing a positive approach, such as encouragement, for coping with NE. Factors that influenced parents to seek medical consultation for NE were socioeconomic status, maternal educational level, and the age and birth order of their child. DISCUSSION From our results, angry and frustrated parents (43.0%) were significantly more likely to punish their child for bedwetting than were parents who approached NE positively (comfort and encouragement; 33.3%). A lack of encouragement may negatively affect the self-esteem of children with NE. Moreover, an individual's self-esteem or confidence, both of which can help them eliminate NE, determines the person's behavioral response to bedwetting. In our study, approximately 50% of the parents who approached NE positively (comfort and encouragement) or inconsistently (ambivalence) reported that they comforted their child after bedwetting. CONCLUSIONS Nearly half the parents reacted angrily to children with NE, and some parents even punished their child. The parents' socioeconomic background, education, and the age and birth order of the child were the factors associated with their seeking active treatment for NE. A father's education and young age of the child were factors that influenced parents who preferred positive approaches, such as encouragement, for coping with NE.
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Affiliation(s)
- Thomson T Tai
- Department of Neuroscience, Hamilton College, Clinton, NY, USA
| | - Brent T Tai
- Department of Biology, College of the Holy Cross, Worcester, MA, USA
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Kuo-Hsuan Huang
- Department of Surgery, Erlin Christian Hospital, Chanhua, Taiwan; Division of Urology, Changhua Christian Hospital, Changhua, Taiwan
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Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: A follow-up study. J Pediatr Urol 2017; 13:44.e1-44.e9. [PMID: 27825586 DOI: 10.1016/j.jpurol.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To understand the remission rates, shifts in treatment methods used by parents, and parents' attitudes towards their children with primary nocturnal enuresis (NE). STUDY DESIGN A total of 408 children aged 6-12 years and diagnosed with primary nocturnal enuresis from a 2004 epidemiological study in Taiwan were enrolled. After a 5.5-year follow-up period, the remission rates of the children of each age group were evaluated, and the corresponding treatment methods were employed daily. Furthermore, the major risk factors that influenced the remission rates in these children were investigated. RESULTS The overall remission rate was 93.1% among all age groups, and the median age of remission was 9.9 years (95% CI 9.5-10.2 years). Comparing the previous and after results of this study, the treatment methods utilized by the parents in response to enuresis were significantly different. More parents chose combination therapy and sought medical attention as the children grew older, particularly the parents of children with severe NE. Few parents still continued to use punishment method. A Cox proportional hazards regression model revealed that girls, young children, those with low enuresis frequency, and light sleepers had higher remission rates than did their counterparts. CONCLUSION Parents' attitudes towards enuresis influence their choice of therapy for their children. In most cases, parents chose a combination of therapies, particularly combining limited fluid intake and regular voiding. Only 37 (9.1%) children received medicine. The older the enuretic child, the more likely the parents were to seek medical treatment for their children. Enuresis might disappear spontaneously but not always. A small proportion of children will continue to wet till adulthood. The treatment of NE at this age would be challenging. Children who were deep sleepers or affected by severe enuresis had a low probability of achieving dryness. However, girls and young children had a higher probability of achieving remission than did their counterparts.
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A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children. Int Neurourol J 2016; 20:311-315. [PMID: 28043109 PMCID: PMC5209575 DOI: 10.5213/inj.1632566.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/30/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose This study aims to evaluate the prevalence of headaches and migraine in children with nocturnal enuresis (NE) and to improve knowledge on these conditions. In particular, for this purpose, a possible pathogenic relationship linking both conditions and the impact of headaches and migraine on NE persistence was evaluated. Methods Researchers enrolled 123 children with NE, aged between 5 and 15 years, referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome between January 2014 and January 2015. Parents of all children enrolled in the study were invited to complete a self-reported questionnaire. The study protocol was approved by the Human Research Ethics Committee of Campus-Bio-Medico University. The NE group data was compared with the data of a control group (107 children). Results Of the eligible patients, 7.8% suffer from headaches/migraine (mean age, 9.63 years; interquartile range [IQR], 3.5 years) and 47.1% have a family history of headaches (mean age, 8.46 years; IQR, 3.75 years). Of the 8 patients with headaches, all are male, 3 have tension-type headaches (2 of them have maternal family history) and 5 have migraine (3 of them have maternal family history). Of the 35.3% with a migraine family history (mean age, 8.36 years; IQR, 3.5 years), 22 are male, and 14 are female. Three of these patients have migraine. A total of 92.2% suffer from NE but not from headaches (mean age, 8.43 years; IQR, 3 years). Of these patients, 33 are female (35.1%), and 61 are male (64.9%). In the control group, 4.7% (5 out of 107) of the children suffer from headaches, and of these, 4 are affected by nonmigraine headaches and 1 by migraine. Conclusions In conclusion, according to the hypothesis, NE and headaches/migraine could be linked by several similarities.
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Melatonin's Effect on the Efficacy of Desmopressin in the Treatment of Enuresis. Int Neurourol J 2016; 20:203-208. [PMID: 27706008 PMCID: PMC5083826 DOI: 10.5213/inj.1632518.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/29/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study aims to evaluate and compare the efficacy of exogenous melatonin associated with desmopressin (dDAVP) and dietary recommendations. METHODS A total of 189 patients were enrolled from the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to June 2015. Of the 189 original patients, 153 children, aged between 5 and 14 years (mean age, 8.7 years) were included in the study. After clinical evaluation and a 3-month period of observation without treatment, children were assigned to receive treatment in one of 3 groups: group 1, dDAVP at a dose of 120 mcg a day (Minirin); group 2, dDAVP at a dose of 120 mcg and dietary recommendations; or group 3, dDAVP at a dose of 120 mcg, dietary recommendations, and melatonin at a dose of 1 mg a day (Melamil plus). Each patient was treated for 3 months. RESULTS After the 3 months of therapy, a desiderable response was achieved in 30 of 51 patients (58.82%) treated with dDAVP, 35 of 53 patients (66.04%) treated with dDAVP and dietary recommendations, and 35 of 49 patients (71.43%) treated with dDAVP, dietary recommendations, and melatonin. CONCLUSIONS Although not statistically significant, the results show that the association between dDAVP treatment with dietary recommendations and melatonin could be considered a safe and effective treatment of NE. Considering that the statistically insignificant results might be due to the small sample size, the study will be continued to increase the number of subjects.
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Ferrara P, Fabrizio GC, Franco D, Spina G, Ianniello F, Sbordone A, Vitelli O, Quintarelli F, Verrotti A, Saggese G. Association among nocturnal enuresis, body weight and obstructive sleep apnea in children of south Italy: an observational study. Minerva Pediatr 2016; 71:511-514. [PMID: 27077684 DOI: 10.23736/s0026-4946.16.04497-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the rate of nocturnal enuresis (NE), body weight and obstructive sleep apnea in children 5 to 10 years of age in South Italy and the possible association among these disorders. METHODS We have administered 1100 validated questionnaires, in Italian language, to parents and we have analyzed data with a logistic regression. RESULTS Forty-two percent of children had a BMI≥85th (group 1) vs 58.0% normal weight children at the same age (group 2). There is a higher number of overweight males compared to females without statistically differences. In group 1 there was a higher number of children with NE and obstructive sleep disorders and some children present with the association among these three disorders. CONCLUSIONS There are no statistically differences between two study groups for the association body weight-NE, body weight-NE-obstructive sleep disorders.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Sacred Heart Catholic University, Rome, Italy - .,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy -
| | | | - Daniele Franco
- Unit of Food Sciences and Human Nutrition, Campus Bio-Medico University, Rome, Italy
| | - Giulia Spina
- Service of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | | | | | - Ottavio Vitelli
- Service of Pediatrics, Campus Bio-Medico University, Rome, Italy
| | | | | | - Giuseppe Saggese
- Unit of Pediatric Endocrinology, Department of Pediatrics, Pisa University Hospital, Pisa, Italy
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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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Eneh CI, Okafor HU, Ikefuna AN, Uwaezuoke SN. Nocturnal enuresis: prevalence and risk factors among school-aged children with sickle-cell anaemia in a South-east Nigerian city. Ital J Pediatr 2015; 41:66. [PMID: 26416787 PMCID: PMC4587835 DOI: 10.1186/s13052-015-0176-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/21/2015] [Indexed: 11/23/2022] Open
Abstract
Background Sickle-cell anaemia (SCA) is the most common inherited haemoglobinopathy affecting the Negroid race. Renal complications such as enuresis can occur during childhood. Reports show that children and adolescents with SCA may be at a higher risk of nocturnal enuresis than their counterparts with normal haemoglobin genotype. Aims The study aims to determine the prevalence of nocturnal enuresis and possible risk factors among school-aged children with SCA in a South-east Nigerian city. Methods A hospital-based and cross-sectional descriptive study of 70 school-aged children with SCA who met the study criteria, and 70 age- and sex-matched controls with normal haemoglobin genotype was conducted in the Paediatric Sickle-cell Anaemia Clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu. Data was subjected to multivariate analysis using logistic regression model with nocturnal enuresis as the dependent variable and the possible risk factors as the independent variables. Results The prevalence of nocturnal enuresis among the Subjects and the Controls was 31.4 and 21.4 % respectively (p = 0.180). It was significantly higher among male Subjects (48.7 %) than among male Controls (23.1 %) [OR (95 % CI) =8.14 (2.12–31.24), p < 0.001]; and among Subjects whose parents had a childhood history of enuresis [OR (95 %) =10.39 (2.45–44.05), p = 0.002]. The difference in the prevalence of enuresis in the female cohort was however not significant. Conclusions Children with SCA have a tendency to develop nocturnal enuresis when compared to their non-affected counterparts. Male gender and parental childhood history of nocturnal enuresis are potential socio-demographic risk factors.
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Affiliation(s)
- Chizoma I Eneh
- Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria.
| | - Henrietta U Okafor
- Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria.
| | - Anthony N Ikefuna
- Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria.
| | - Samuel N Uwaezuoke
- Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria.
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de Vries GJ, Forger NG. Sex differences in the brain: a whole body perspective. Biol Sex Differ 2015; 6:15. [PMID: 26279833 PMCID: PMC4536872 DOI: 10.1186/s13293-015-0032-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/28/2015] [Indexed: 12/29/2022] Open
Abstract
Most writing on sexual differentiation of the mammalian brain (including our own) considers just two organs: the gonads and the brain. This perspective, which leaves out all other body parts, misleads us in several ways. First, there is accumulating evidence that all organs are sexually differentiated, and that sex differences in peripheral organs affect the brain. We demonstrate this by reviewing examples involving sex differences in muscles, adipose tissue, the liver, immune system, gut, kidneys, bladder, and placenta that affect the nervous system and behavior. The second consequence of ignoring other organs when considering neural sex differences is that we are likely to miss the fact that some brain sex differences develop to compensate for differences in the internal environment (i.e., because male and female brains operate in different bodies, sex differences are required to make output/function more similar in the two sexes). We also consider evidence that sex differences in sensory systems cause male and female brains to perceive different information about the world; the two sexes are also perceived by the world differently and therefore exposed to differences in experience via treatment by others. Although the topic of sex differences in the brain is often seen as much more emotionally charged than studies of sex differences in other organs, the dichotomy is largely false. By putting the brain firmly back in the body, sex differences in the brain are predictable and can be more completely understood.
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Affiliation(s)
- Geert J. de Vries
- Neuroscience Institute, Georgia State University, P.O. Box 5030, Atlanta, GA 30302-5030 USA
| | - Nancy G. Forger
- Neuroscience Institute, Georgia State University, P.O. Box 5030, Atlanta, GA 30302-5030 USA
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Doganer YC, Aydogan U, Ongel K, Sari O, Koc B, Saglam K. The Prevalence and Sociodemographic Risk Factors of Enuresis Nocturna among Elementary School-age Children. J Family Med Prim Care 2015; 4:39-44. [PMID: 25810988 PMCID: PMC4367005 DOI: 10.4103/2249-4863.152250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction and Aim: Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to research prevalence and severity of EN among elementary school-age children and sociodemographic risk factors related to it. Materials and Methods: The study was performed in three elementary schools in Ankara, Turkey between January and May 2011. It was planned to have 2500 students of 6–14 ages in the study. The questionnaire, which consisted of questions, aiming to evaluate the EN condition of participants and their characteristics, were distributed to the parents. It was observed that 2314 participants’ questionnaires (92.56%) were in accordance with evaluation criteria. Statistical Analysis: The relation between EN and the sociodemographic factors was evaluated through Chi-square test and logistic regression analysis. Results: The mean age of 2314 participants was 9.21 ± 2.08. 48.5% (n = 1123) of the students were male and 51.5% (n = 1191) were female. While the general EN prevalence was 9.9% (n = 230); 10.7% (n = 120) for males, as 9.2% (n = 110) for females. Statistical significant difference was determined between the two groups, with EN and without EN, regarding age groups (P < 0.001), education level of parents (P < 0.001, P < 0.001), and the number of sibling (P = 0.002), income level (P < 0.001), and positive family history (P < 0.001). However, logistic regression analysis revealed that there was a significant difference only between EN and age groups (odds ratio [OR] =4.42, P < 0.001), education level of mother (OR = 2.13, P = 0.017) and family history (OR = 0.12, P < 0.001). Conclusions: As a consequence, such factors as age groups, education level of parents, positive family history could be accepted as a risk of concerning EN. It is important to perform a detailed evaluation on population, carrying risk of having EN.
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Affiliation(s)
- Yusuf Cetin Doganer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Family Medicine, Turkish Military Academy Primary Care Examination Center, Ankara, Turkey
| | - Umit Aydogan
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kurtulus Ongel
- Department of Family Medicine, Katip Celebi University, Izmir, Turkey
| | - Oktay Sari
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Bayram Koc
- Department of Family Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kenan Saglam
- Department of Internal Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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Mota DM, Barros AJD, Matijasevich A, Santos IS. Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil. J Pediatr (Rio J) 2015; 91:52-8. [PMID: 25193596 DOI: 10.1016/j.jped.2014.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/17/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management.
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Affiliation(s)
- Denise M Mota
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil.
| | | | - Alicia Matijasevich
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil; Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPEL), Pelotas, RS, Brazil
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Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2014.04.010] [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
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Does Structured Withdrawal of Desmopressin Improve Relapse Rates in Patients with Monosymptomatic Enuresis? J Urol 2014; 192:530-4. [DOI: 10.1016/j.juro.2014.01.094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/18/2022]
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Merhi BA, Hammoud A, Ziade F, Kamel R, Rajab M. Mono-symptomatic nocturnal enuresis in lebanese children: prevalence, relation with obesity, and psychological effect. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2014; 8:5-9. [PMID: 24653655 PMCID: PMC3948714 DOI: 10.4137/cmped.s13068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 01/05/2014] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nocturnal enuresis is involuntary urination while sleeping after a certain age, usually five years, when children should have established bladder control. The prevalence has been found to be up to 20% in five year old children, and it is considered the most common urological childhood complication. MATERIAL AND METHODS This study was conducted on Makassed School children aged 5–18 years. This was a two-step study, the first step was a questionnaire distributed to the children to be answered by their parents. The second step included individually meeting with every child who met the inclusion criteria and his/her parents and physically examining the child. RESULTS 11,440 questionnaires were distributed to school children aged 5–18 years, to be answered by their parents. Of the 7270 parents who responded back, 6620 reported no enuresis, 90 (1.25%) reported only diurnal enuresis, 107 (1.5%) reported diurnal and nocturnal enuresis, and 453 parents reported their child having nocturnal enuresis only. The data collected was analyzed according to age, sex, area, body mass index (BMI), and the PMQOL-SF score. The prevalence of mono-symptomatic nocturnal enuresis (MNE) in Lebanon was found to be 5.3%. The results showed that the prevalence of MNE is inversely proportional to age. The prevalence of male to female ratio was 1.4:1. As for the prevalence according to different geographic areas, the results have shown that the North had the majority of cases with 7.6% prevalence. Results showed that 82.4% of children had a score more than 50, and only 28% of parents had a score above 50. DISCUSSION The prevalence of nocturnal enuresis in Lebanon is lower than that in neighboring countries such as Turkey8 and Saudi Arabia,9 but higher than that in Italy10 and Hong Kong. Our study has managed to show the same results, with a peak in incidence at seven years then dropping back to 0% at the age of 16. Our study has shown a male to female predominance but the male to female ratio was 1.4:1, a value lower than that described in earlier studies. Our study has shown that more than 80% of children were psychologically affected whereas only less than 30% of parents were affected. CONCLUSION To our knowledge, this was the first study in Lebanon conducted to determine the prevalence of MNE. The relatively low prevalence rate found may be because of differences in genetic predisposition, psychosocial or environmental conditions, and traditional and cultural backgrounds. No relation was found between obesity and nocturnal enuresis. The psychological impact on children is significant but that on the parents is minimal.
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Affiliation(s)
- Bassem Abu Merhi
- Makassed General Hospital, Department of Pediatrics, Beirut, Lebanon
| | - Ahmad Hammoud
- Makassed General Hospital, Department of Pediatrics, Beirut, Lebanon
| | - Fouad Ziade
- Makassed General Hospital, Department of Pediatrics, Beirut, Lebanon
| | - Raymond Kamel
- Makassed General Hospital, Department of Pediatrics, Beirut, Lebanon
| | - Mariam Rajab
- Makassed General Hospital, Department of Pediatrics, Beirut, Lebanon
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Ferrara P, Romano V, Cortina I, Ianniello F, Fabrizio GC, Chiaretti A. Oral desmopressin lyophilisate (MELT) for monosymptomatic enuresis: structured versus abrupt withdrawal. J Pediatr Urol 2014; 10:52-5. [PMID: 23791016 DOI: 10.1016/j.jpurol.2013.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate whether a structured withdrawal program from a sublingual formulation of fast-melting oral desmopressin lyophilisate (MELT) is superior to a sudden withdrawal from this formulation in the treatment of monosymptomatic nocturnal enuresis. MATERIALS AND METHODS One hundred and three children presented to our pediatric nephrology outpatient clinic for bedwetting. Eighty-one children, aged between 5½ and 14 years (mean age 8.64 years), were treated with MELT at a dosage of 120 mcg a day. Responders were randomized to been withdrawn from therapy, after 3 months, abruptly or in a structured withdrawal program (60 mcg/day for 15 days and then 60 mcg every second evening for another 15 days). Main outcome parameter was relapse rate 1 month after the end of treatment. Relapse was defined as bedwetting occurring more than 2 nights per month after the 1-month treatment-free period. RESULTS Relapse rate at 1 month after the end of treatment was 47.83% in the group on a structured program versus 45.83% in the abrupt termination group (p = 0.89). CONCLUSION Our study suggests that a structured withdrawal program from MELT therapy doesn't offer advantages compared to an abrupt termination in children with monosymptomatic nocturnal enuresis.
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Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy.
| | - Valerio Romano
- Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy
| | | | | | | | - Antonio Chiaretti
- Institute of Pediatrics, "A. Gemelli" University Hospital, Rome, Italy
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Chang SJ, Chiang IN, Lin CD, Hsieh CH, Yang SSD. Obese children at higher risk for having overactive bladder symptoms: A community-based study. Neurourol Urodyn 2013; 34:123-7. [DOI: 10.1002/nau.22532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - I-Ni Chiang
- Department of Urology; National Taiwan University Hospital; Taipei Taiwan
| | - Chia-Da Lin
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology; Department of Surgery; Taipei Tzu Chi Hospital; The Buddhist Tzu Chi Medical Foundation; Taipei Taiwan
- Department of Urology; School of Medicine, Buddhist Tzu Chi University; Hualien Taiwan
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Ferrara P, Ianniello F, Romani L, Fabrizio GC, Gatto A, Chiaretti A. Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going. Urol Int 2013; 92:223-9. [PMID: 24246887 DOI: 10.1159/000354388] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nocturnal enuresis (NE) is a very common pediatric disorder. The aim of this study was to evaluate the characteristics of patients with NE or urinary incontinence (UI) during a period of 5 years to increase the knowledge on these conditions and optimize their diagnosis and treatment. METHODS We enrolled 278 children with NE or UI referred to the pediatric nephrology ambulatory, 'A. Gemelli' University Hospital of Rome, from December 2006 to December 2011. RESULTS We observed that heredity, parasomnias, left-handedness, polythelia and constipation are correlated to NE and UI. CONCLUSIONS We wanted to clarify the definition of NE and UI and describe our experience on the main characteristics of these conditions by referring to the latest knowledge reported in the literature.
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Affiliation(s)
- P Ferrara
- Institute of Pediatrics, 'A. Gemelli' University Hospital, Rome, Italy
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Nocturnal enuresis in sickle cell disease and thalassemia major: associated factors in a clinical sample. Int J Hematol 2013; 98:430-6. [DOI: 10.1007/s12185-013-1422-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 08/20/2013] [Accepted: 08/23/2013] [Indexed: 11/29/2022]
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Park S, Kim BN, Kim JW, Hong SB, Shin MS, Yoo HJ, Cho SC. Nocturnal enuresis is associated with attention deficit hyperactivity disorder and conduct problems. Psychiatry Investig 2013; 10:253-8. [PMID: 24302948 PMCID: PMC3843017 DOI: 10.4306/pi.2013.10.3.253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/10/2013] [Accepted: 02/20/2013] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE There are no published prevalence estimates of elimination disorders and their association with disruptive-behavior disorders among children in the Asian region using standardized diagnostic interviews. This study was conducted to determine the prevalence of elimination disorders and its association with disruptive-behavior disorders in a representative sample of children in Seoul, Korea. METHODS The diagnosis of enuresis and encopresis was derived from parent-reported data for "enuresis and encopresis," collected using the Diagnostic Interview Schedule for Children, from a representative sample of 6- to 12-year-old children (n=1,645) who participated in the 2005 Seoul Child and Adolescent Mental Health Survey. Prevalence data for attention deficit and disruptive-behavior disorders were collected from the same sample. RESULTS The overall 12-month prevalence of nocturnal enuresis and encopresis was 1.8% and 0.6%, respectively. Enuresis and encopresis prevalence in boys was significantly greater than that in girls. Enuresis and encopresis was most common at 7 to 9 years of age. Enuresis was significantly associated with ADHD (OR 2.6, 95% CI 1.0-6.9) and conduct disorder (CD; OR 4.7, 95% CI 1.0-22.4). CONCLUSION Enuresis is significantly associated with ADHD and CD, so these conditions must be assessed together during the evaluation of children with enuresis.
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Affiliation(s)
- Subin Park
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Sup Shin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Jeong Yoo
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Churl Cho
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Is nocturia of young adulthood a remnant of childhood nocturnal enuresis? Int Urogynecol J 2013; 25:273-8; quiz 277-8. [PMID: 23974805 DOI: 10.1007/s00192-013-2203-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Nocturia and nocturnal enuresis (NE) share similar aetiopathological factors, and may represent two different situations involving the same underlying issue. In this study, we tried to evaluate the relation between NE of childhood and nocturia of young adulthood. METHODS A total of 577 female university students aged 17-24 years were included in the survey. A face-to-face questionnaire was administered concerning present nocturia and past NE history. A non-validated questionnaire, created by the authors, was used to evaluate the presence and the frequency of childhood NE and present nocturia. All participant data were checked by telephone contact with their parents. RESULTS The overall prevalence rates of nocturia and history of nocturnal enuresis in the study population were 8.6 % and 15 % respectively. Sixteen per cent of nocturics and 15 % of non-nocturics had a history of childhood NE (p = 0.837). The childhood NE was graded as severe or infrequent. The presence of nocturia was compared between participants with severe NE and infrequent NE, and no significant difference was observed (11.1 % vs 7.8 %, p = 0.713). Nocturia frequency was compared with the history of childhood NE and we found that as the nocturia frequency increased, the rate of childhood NE also increased. CONCLUSIONS There was no relation between young adulthood nocturia and childhood NE in our study population, but as the severity of nocturia increased, the relation between nocturia and NE became more relevant.
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Changizi Ashtiyani S, Shamsi M, Cyrus A, Tabatabayei SM. Rhazes, a genius physician in the diagnosis and treatment of nocturnal enuresis in medical history. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:633-8. [PMID: 24578827 PMCID: PMC3918184 DOI: 10.5812/ircmj.5017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 04/19/2013] [Accepted: 04/28/2013] [Indexed: 12/03/2022]
Abstract
Context Nocturnal enuresis has undoubtedly occurred since man's earliest days and the first references are found in the Ebers papyri of 1550 BC. The purpose of this study is to review of Rhazes opinion about diagnosis and treatment of nocturnal enuresis and compare his belief and clinical methods with modern medical practice. Evidence Acquisition In the review study we searched all available and reliable electronic and paper sources using appropriate keywords about the views of Rhazes, and compared them with recent medical evidence about diagnosis and treatment of nocturnal in medication. Results Our findings proved that Rhazes described the symptoms, signs, and the treatment of nocturnal enuresis in accordance with contemporary medicine. Conclusions A review of opinion Rhazes and other ancient Islamic medical textbooks on nocturnal enuresis reveals that medical practice in those days was comparable to modern medicine yet avoiding the side effects that are commonly experienced with the modern medical approach.
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Affiliation(s)
| | - Mohsen Shamsi
- Department of Public Health, Arak University of Medical Sciences, Arak, IR Iran
| | - Ali Cyrus
- Department of Urology, Arak University of Medical Sciences, Arak, IR Iran
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Esposito M, Gallai B, Parisi L, Roccella M, Marotta R, Lavano SM, Mazzotta G, Patriciello G, Precenzano F, Carotenuto M. Visuomotor competencies and primary monosymptomatic nocturnal enuresis in prepubertal aged children. Neuropsychiatr Dis Treat 2013; 9:921-6. [PMID: 23847418 PMCID: PMC3700782 DOI: 10.2147/ndt.s46772] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Primary monosymptomatic nocturnal enuresis (PMNE) is a common problem in the developmental ages; it is the involuntary loss of urine during the night in children older than 5 years of age. Several clinical observations have suggested an association between bedwetting and developmental delays in motricity, language development, learning disability, physical growth, and skeletal maturation. The aim of the present study is to evaluate the prevalence of fine motor coordination and visuomotor integration abnormalities in prepubertal children with PMNE. METHODS The study population included 31 children (16 males, 15 females; mean age 8.14 years ± 1.36 years), and the control group comprised 61 typical developing children (32 males, 29 females; mean age 8.03 years ± 1.44 years). The whole population underwent a clinical evaluation to assess total intelligence quotient level, visuomotor integration (VMI) skills, and motor coordination performance (using the Movement Assessment Battery for Children, or M-ABC). RESULTS No significant differences between the two study groups were found for age (P = 0.725), gender (P = 0.886), z-body mass index (P = 0.149), or intellectual abilities (total intelligence quotient) (P = 0.163). The PMNE group showed a higher prevalence of borderline performance on M-ABC evaluation and in pathologic performance on VMI Total Task compared to controls (P < 0.001). No significant differences between the two study groups were found for pathologic performances on the M-ABC (P = 0.07), VMI Visual Task (P = 0.793), and VMI Motor Task (P = 0.213). CONCLUSION Our findings pinpointed that PMNE should not be considered as a voiding disorder alone and, consequently, the children affected should be referred to specific rehabilitative programs that aim to improve motor coordination and visuomotor integration.
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Affiliation(s)
- Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Italy
| | - Beatrice Gallai
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Italy
| | - Rosa Marotta
- Department of Psychiatry, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | | | - Giovanni Mazzotta
- Unit of Child and Adolescent Neuropsychiatry, AUSL Umbria 2, Terni, Italy
| | - Giuseppina Patriciello
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Italy
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Esposito M, Gallai B, Parisi L, Roccella M, Marotta R, Lavano SM, Mazzotta G, Carotenuto M. Primary nocturnal enuresis as a risk factor for sleep disorders: an observational questionnaire-based multicenter study. Neuropsychiatr Dis Treat 2013; 9:437-43. [PMID: 23579788 PMCID: PMC3621720 DOI: 10.2147/ndt.s43673] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary nocturnal enuresis (PNE) is a common problem in developmental age with an estimated overall prevalence ranging from 1.6% to 15%, and possible persistence during adolescence. There is a growing interest in the sleep habits of children affected by PNE, which is derived from the contradictory data present in clinical literature. The aim of the present study was to evaluate the presence of sleep disturbances in a population of children affected by PNE, and to identify whether PNE could be considered as a risk factor for sleep disturbances among children. MATERIALS AND METHODS A total of 190 PNE children (97 males, 93 females) aged 7-15 years, (mean 9.64 ± 1.35 years), and 766 typically developing children matched for age (P = 0.131) and gender (P = 0.963) were enrolled. To evaluate the presence of sleep habits and disturbances, all of the subjects' mothers filled out the Sleep Disturbances Scale for Children (SDSC), a questionnaire consisting of six subscales: Disorders in Initiating and Maintaining Sleep (DIMS), Sleep Breathing Disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DOES), and Nocturnal Hyperhidrosis (SHY). The results were divided into "pathological" and "normal" scores using a cut-off value (pathological score = at least three episodes per week), according to the validation criteria of the test. Then, the Chi-square test was used to calculate the statistical difference and a univariate logistic regression analysis was applied to determine the role of PNE as a risk factor for the development of each category of sleep disorders and to calculate the odds ratio (OR). RESULTS PNE children show a higher prevalence of all sleep disturbances (41.03% DIMS; 85.12% SBD; 63.29% DA; 67.53% SWTD; 31.28% DOES; 37.92% SHY; 25.33% SDSC total score), and according to OR results (SDSC total score OR = 8.293, 95% confidence interval [CI] = 5.079-13.540; DIMS OR = 7.639, 95% CI = 5.192-11.238; SBD OR = 35.633, 95% CI = 22.717-55.893; DA OR = 13.734, 95% CI = 9.476-19.906; SWTD OR = 14.238, 95% CI = 9.829-20.625; DOES OR = 5.602, 95% CI = 3.721-8.432; SHY OR = 6.808, 95% CI = 4.608-10.059), PNE could be considered as a risk factor for the development of sleep disorders. CONCLUSION Among PNE children, sleep could be strongly altered, thus helping to affirm the hypothesis that PNE tends to alter sleep architecture, or it could itself be the consequence of an abnormal sleep structure. The findings also point to the existence of a potential increase in the risk of developing sleep disorders in the presence of PNE.
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Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Beatrice Gallai
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | - Rosa Marotta
- Department of Psychiatry, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | | | - Giovanni Mazzotta
- Unit of Child and Adolescent Neuropsychiatry, AUSL Umbria 2, Terni, Italy
| | - Marco Carotenuto
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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Patra PB, Patra S. Sex differences in the physiology and pharmacology of the lower urinary tract. Curr Urol 2013; 6:179-88. [PMID: 24917740 DOI: 10.1159/000343536] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 12/04/2012] [Indexed: 12/13/2022] Open
Abstract
Sexual dimorphism is not only noticed in the prevalence of many diseases, but also in multiple physiological functions in the body. This review has summarized findings from published literature on the sex differences of the pathophysiology and pharmacology of the lower urinary tract (LUT) of humans and animals. Sex differences have been found in several key areas of the LUT, such as overactive bladder, expression and function of neurotransmitter receptors in the bladder and urethra, and micturition patterns in humans and animals. It is anticipated that this review will not only evoke renewed interest for further research on the mechanism of sex differences in the pathophysiology of the LUT (especially for overactive bladder), but might also open up the possibilities for gender-based drug development by pharmaceutical industries in order to find separate cures for men and women with diseases of the LUT.
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Children Treated for Nocturnal Enuresis: Characteristics and Trends Over a 15-Year Period. CHILD & YOUTH CARE FORUM 2013. [DOI: 10.1007/s10566-013-9195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Aloni MN, Ekila MB, Ekulu PM, Aloni ML, Magoga K. Nocturnal enuresis in children in Kinshasa, Democratic Republic of Congo. Acta Paediatr 2012; 101:e475-8. [PMID: 22834641 DOI: 10.1111/j.1651-2227.2012.02791.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine the prevalence of nocturnal enuresis in children of Kinshasa in Democratic Republic of Congo. METHODS In all, 506 questionnaires were sent to parents of children aged 6-12 years randomly selected from four primary schools in Kinshasa, Democratic Republic of Congo. The questionnaire was designed to collect information about prevalence and factors associated with nocturnal enuresis. RESULTS A total of 415 (82.0%) were correctly completed. In this series, 109 children were identified as nocturnal enuresis in which 50 boys and 56 girls (p > 0.05). Factors associated with nocturnal enuresis were deep sleep, young age and familial history of enuresis (p < 0.05). Only 11% of patients have been consulted by doctors. Twelve children (11.0%) were treated by healers traditional. In the other part, 43 children (39.4%) were frequently punished by their parents. The common self-help strategies were 79 children (72.5%) were submitted to fluid restrictions before going to sleep and 68 (62.4%) were waking the child at night to void. CONCLUSION In Kinshasa, the prevalence of nocturnal enuresis was high to those reported in Asian and Western countries. Nocturnal enuresis remains an important clinical problem in children but only a small percentage of parents seek medical help.
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Affiliation(s)
- Michel N Aloni
- Division of Paediatric Haemato-oncology and Nephrology, Department of Paediatrics University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
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Fockema MW, Candy GP, Kruger D, Haffejee M. Enuresis in South African children: prevalence, associated factors and parental perception of treatment. BJU Int 2012; 110:E1114-20. [PMID: 22958477 DOI: 10.1111/j.1464-410x.2012.11416.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Study Type--Symptom Prevalence (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Nocturnal enuresis is a common childhood problem. Although its prevalence is known in many countries, no data are available from South Africa and it is difficult to extrapolate data from developed countries to a population with such diverse conditions and resource-poor settings. This study is the first to report on the 16% prevalence rate and the low level of parental knowledge of enuresis in South African children aged between 5 and 10 years. OBJECTIVES • To establish the prevalence of NE in 5-10 year old South African children in a cross-sectional study using a parent-completed questionnaire. • To establish the parental perception and associated factors of mono-symptomatic nocturnal enuresis (MNE) treatment and treatment success rates in 5-10 year old children from South Africa. PATIENTS AND METHODS • A total of 4700 questionnaires were distributed to children at 37 selected schools willing to participate from South Africa. Parents anonymously filled out the questionnaire. • Data were reported as frequencies and percentages of NE in tables according to different gender and age groups. • The Chi-square test compared proportions between groups and Fisher's Exact test corrected for small numbers of observations (n ≤ 5). Age differences were determined using Student's t-test. A P-value ≤ 0.5 was considered to be statistically significant. RESULTS • The questionnaire's response rate was 72.1%, with 3389 children included in the study. • The overall prevalence of NE was 16.0%-14.4% of children suffered from mono-symptomatic NE (MNE). The prevalence of NE in boys was double that in that in girls. • Only 28.3% had received some form of treatment, whereas 13.5% had been medically treated by a doctor. Parents' awareness of treatment modalities available is outdated and most of the management of MNE was done by parents themselves, albeit with low success rates. • A positive family history was found in 50.5% of children suffering from MNE. • Constipation was a problem in 15.8% of children with enuresis. CONCLUSIONS • This is the first study to estimate the prevalence of NE and report on the parental perception and possible associated factors of enuresis in children from South Africa. The study showed that South African children have a similar prevalence rate of NE (16%) when compared with other countries. • The possible associated factors with MNE in South Africa include constipation and a family history of enuresis. • Finally, there are low levels of parental knowledge of treatment modalities of MNE, leaving many children untreated.
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Affiliation(s)
- Margaret W Fockema
- Divisions of Urology, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Exploratory factory analysis and predicted probabilities of a Chinese version of Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Neurourol Urodyn 2012; 31:1247-51. [DOI: 10.1002/nau.22254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 03/13/2012] [Indexed: 11/07/2022]
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Coppola G, Costantini A, Gaita M, Saraulli D. Psychological correlates of enuresis: a case-control study on an Italian sample. Pediatr Nephrol 2011; 26:1829-36. [PMID: 21533628 DOI: 10.1007/s00467-011-1880-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 02/09/2011] [Accepted: 03/18/2011] [Indexed: 11/26/2022]
Abstract
The psychological correlates of enuresis are receiving growing attention, coherently with a multi-factorial approach to this problem, but to date the empirical findings are still inconsistent and incomplete. The aim of this study is to contribute to the understanding of the socio-affective functioning of enuretic children by exploring four central dimensions: attachment, self-esteem, self-control, and temperament. Twenty-two enuretic children with their mothers were enrolled in the study and matched, based on gender and age, to a control group of continent healthy children. Measures were collected through mothers' reports and individual administrations to all children. Controlling for socio-demographic variables, we found a significantly lower incidence of secure attachment, lower self-esteem, and higher rates of behavioral problems among the enuretic group, compared with the control group. No differences in the temperamental dimensions were found. These preliminary findings support the view of enuresis as a bio-behavioral problem and, from a practical standpoint, underline the urgency for physicians not to underestimate this disturbance, but, indeed, to treat the problem through medical strategies and to devote attention to the psychological difficulties of these patients.
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Affiliation(s)
- Gabrielle Coppola
- Department of Neuroscience and Imaging, University "G. D'Annunzio" of Chieti, Blocco A di Psicologia, Via dei Vestini n. 31, 66013 Chieti Scalo, Italy.
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Su MS, Li AM, So HK, Au CT, Ho C, Wing YK. Nocturnal enuresis in children: prevalence, correlates, and relationship with obstructive sleep apnea. J Pediatr 2011; 159:238-42.e1. [PMID: 21397910 DOI: 10.1016/j.jpeds.2011.01.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 11/22/2010] [Accepted: 01/19/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To examine the prevalence and correlates of nocturnal enuresis (NE) in primary school children, and to compare the prevalence of NE in children with and those without obstructive sleep apnea (OSA). STUDY DESIGN Parents of children aged 6-11 years completed a questionnaire eliciting information on sleep-related symptoms, demography, and family and past medical history. Children screened due to high risk for OSA, along with a randomly chosen low-risk group, underwent overnight polysomnography (PSG). RESULTS A total of 6147 children (3032 girls) were studied. The overall prevalence of NE (≥1 wet night/month) was 4.6% (6.7% of boys and 2.5% of girls). Boys had a significantly greater prevalence across all age groups. In 597 children (215 girls) who underwent PSG, the prevalence of NE was not greater in children with OSA, but was increased with increasing severity of OSA in girls only. Boys with NE had longer deep sleep duration. Sex and sleep-related symptoms were associated with NE. CONCLUSIONS This community-based study demonstrated a sex-associated prevalence of NE in relation to increasing OSA severity.
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Affiliation(s)
- Miao Shang Su
- Department of Respiratory Medicine, Wenzhou Medical College Affiliated Second Hospital-Yuying Children's Hospital, Zhejiang, People's Republic of China
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De Sousa A, Kapoor H, Jagtap J, Sen M. Prevalence and factors affecting enuresis amongst primary school children. Indian J Urol 2011; 23:354-7. [PMID: 19718287 PMCID: PMC2721563 DOI: 10.4103/0970-1591.36703] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and Objectives: The aim of the study was to establish the prevalence of enuresis in school children and to determine contributing factors along with treatment methods used in these children. Materials and Methods: The parents of 1473 children aged between 6-10 years completed a self-administered semi-structured questionnaire. Socio-demographic profiles, enuresis data, medical and psychiatric disorders and family stressors were collected. The data was analyzed and the results presented. Results: The response rate was 89.22%. The overall prevalence of enuresis was 7.61%. Enuresis was more common in boys. A positive family history of enuresis was seen in 28.57% children; 14.29% of the children had daytime wetting as well. Only 24.11% of the parents had taken their child to a doctor for the problem. Family stressors, significant birth history and lower socioeconomic status was present to a larger extent in the enuretic group. Scholastic backwardness was also an important factor in this group. Conclusions: This study reports on the prevalence of enuresis in school-going children and stresses on the need for parental education and awareness about this problem.
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Ozkan S, Durukan E, Iseri E, Gürocak S, Maral I, Ali Bumin M. Prevalence and risk factors of monosymptomatic nocturnal enuresis in Turkish children. Indian J Urol 2011; 26:200-5. [PMID: 20877597 PMCID: PMC2938543 DOI: 10.4103/0970-1591.65387] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.
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Affiliation(s)
- Seçil Ozkan
- Gazi University Medical Faculty, Department of Public Health, Ankara, Turkey
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Yang SSD, Zhao LL, Chang SJ. Early initiation of toilet training for urine was associated with early urinary continence and does not appear to be associated with bladder dysfunction. Neurourol Urodyn 2011; 30:1253-7. [PMID: 21394761 DOI: 10.1002/nau.20982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/11/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To report the relationship between the ages initiating toilet training for urinary continence (TTU) and bladder function in healthy kindergarteners. PATIENTS AND METHODS In 3 years, we evaluated urinary continence status and bladder function in 318 healthy kindergarteners. Children with congenital anomaly, neurological disorder, or developmental disability were excluded. A parent completed the questionnaire including the age at initiation and the duration of TTU, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, frequency of defecation and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) examinations. RESULTS Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating TTU was 24.4 ± 8.4 months (range: 1-52 months). Girls started TTU earlier than boys (23.3 months vs. 25.7 months, P = 0.03). Children started daytime TTU earlier (≤ 18, 19-24, and >24 months, N = 66, 71, and 98, respectively) was associated with earlier attainment of both daytime and nighttime continence (correlation coefficient = 0.60 and 0.31, respectively, P < 0.01). Children started nighttime TTU earlier (<30 months vs. ≥ 30 months) was associated with early attainment of nighttime continence and lower rate of enuresis (14.3% vs. 33.3%, P < 0.01). The prevalence rate of repeat abnormal uroflow patterns and repeat elevated PVR (>20 ml) was not different between early and late TTU. CONCLUSION Early toilet training for urine was associated with early attainment of both daytime and nighttime urinary continence, and does not appear to be associated with bladder dysfunction.
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Affiliation(s)
- Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei, Taiwan
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Montaldo P, Tafuro L, Narciso V, Apicella A, Iervolino LR, Del Gado R. Correlations between enuresis in children and nocturia in mothers. ACTA ACUST UNITED AC 2010; 44:101-5. [PMID: 20059408 DOI: 10.3109/00365590903510737] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To demonstrate a relationship between enuresis and nocturia. MATERIAL AND METHODS The study investigated 250 mothers (average age 34.6 +/- 3.3 years) whose children attended the Department of Pediatrics of the Second University of Naples because they suffered from enuresis. Data were collected by self-reported questionnaire and personal interview. All women provided written informed consent with guarantees of confidentiality. Both the presence of nocturia in adulthood and enuresis in childhood were taken into account. RESULTS The overall prevalence of nocturia was 38% (n = 95). There was a history of childhood bedwetting in eight mothers (5%) without nocturia and in 61 mothers (65%) with nocturia; the difference was significant (chi(2) p < 0.01). Moreover, among the 110 enuretic children of nocturic mothers, 69 (62%) suffered from non-monosymptomatic nocturnal enuresis (NMNE), and 34 (56%) of their mothers suffered from NMNE in childhood. Nocturic mothers suffering from non-monosymptomatic enuresis during their childhood had offspring with a higher risk of developing non-monosymptomatic enuresis (odds ratio 4.3 95%, confidence interval 2.6-7.1, p < 0.01). CONCLUSIONS These findings enabled a close connection between nocturia in adulthood and enuresis in childhood to be hypothesized. Furthermore, this analysis provided evidence of the link between suffering from nocturia, and previously from enuresis, and having children affected by enuresis.
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Affiliation(s)
- Paolo Montaldo
- Department of Pediatrics, Second University of Naples, Naples, Italy.
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La enuresis nocturna. Un trastorno frecuente con una prevalencia difícil de estimar. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ramírez-Backhaus M, Agulló EM, Guzmán SA, Pérez LG, Oliva FD, García RM, Cruz JFJ. [Prevalence of nocturnal enuresis in the Valencian Community. Pediatric section of the National Incontinence Survey. The EPICC Study]. Actas Urol Esp 2010; 33:1011-8. [PMID: 19925763 DOI: 10.1016/s0210-4806(09)72902-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To ascertain the prevalence of enuresis among primary school children in Spain. MATERIALS AND METHODS A multicenter, observational, cross-sectional, epidemiologic, regional study. After sample size calculation, a total of 1687 questionnaires were sent to schools. Nocturnal enuresis was defined as <<loss of urine occurring during sleep, at least once a month>>. RESULTS The prevalence of enuresis found in primary school children aged 6-11 years was 7.8%, decrease with age, and was significantly greater in boys (70%). Children without enuresis were taller and had a greater weight than those with enuresis, but the differences were not statistically significant. No differences were found in the family or educational setting between children with and without enuresis. Seventy-three percent of children with enuresis had a family history of the condition. The disorder also occurred in some sibling of 21% of children with enuresis who had siblings. Fifty-five percent of the bedwetting population had primary enuresis. Thirty-one percent of children with enuresis reported losses every night, 38% at least once a week, and 31% at least once a month. Eighty-seven percent of this population was under treatment for this condition. As regards subjective symptoms, 96.9% said they felt fine, but there were more bedwetting children who reported feeling a little bit uncomfortable (76.7% vs 23.1%; P=.004). CONCLUSIONS Enuresis is a common disorder which is significantly more frequent in boys as compared to girls and whose prevalence decreases with age. It has a significant hereditary component. Most enuresis sufferers take measures against urine losses.
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Sureshkumar P, Jones M, Caldwell PHY, Craig JC. Risk factors for nocturnal enuresis in school-age children. J Urol 2009; 182:2893-9. [PMID: 19846154 DOI: 10.1016/j.juro.2009.08.060] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE Although nocturnal enuresis is common in children, its etiology is multifactorial and not fully understood. We evaluated potential risk factors for presence and severity of nocturnal enuresis. MATERIALS AND METHODS A validated, reproducible questionnaire was distributed to 8,230 school children in Sydney, Australia. Nocturnal enuresis was defined as any wetting in the previous month and categorized as mild (1 to 6 nights), moderate (7 or more nights but less than nightly) or severe (nightly). RESULTS Parents of 2,856 children (mean +/- SD age 7.3 +/- 1.3 years) completed the questionnaire (response rate 35%). Overall prevalence of nocturnal enuresis was 18.2%, with 12.3% of patients having mild, 2.5% moderate and 3.6% severe enuresis. Multivariate analysis showed that daytime incontinence (OR 4.8, 95% CI 2.9 to 7.9), encopresis (OR 2.7, 95% CI 1.6 to 4.4), bladder dysfunction (OR 3.6, 95% CI 2.4 to 5.3) and male gender (OR 2.0, 95% CI 1.3 to 3.1) were associated with severe nocturnal enuresis after adjustment for age. Emotional stressors (OR 2.3, 95% CI 1.2 to 4.2) and social concerns (OR 2.4, 95% CI 1.2 to 4.5) were associated with moderate nocturnal enuresis only. CONCLUSIONS Encopresis and daytime incontinence are significant modifiable risk factors for nocturnal enuresis. Expressed as population attributable risk, 23% of nocturnal enuresis is associated with encopresis and daytime incontinence. Psychosocial factors appear to contribute to moderate but not severe nocturnal enuresis.
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Martínez-García R. Tiempo de reflexión sobre la enuresis. Actas Urol Esp 2009; 33:935-8. [DOI: 10.1016/s0210-4806(09)72889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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