Abstract
Objective To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis.Methods A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire.Results The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them.Conclusion All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups.
Highlights
Enuresis is a common condition and its prevalence varies from 5 to 10% in children aged 6 to 7 years
When the child presents enuresis associated with lower urinary tract symptoms (LUTS), such as increased voiding frequency, incontinence, urgency, nocturia, hesitancy, straining, weak stream, intermittency and dysuria, is defined as non-monosymptomatic nocturnal enuresis (NMNE); when enuresis is not associated with LUTS it is defined as monosymptomatic.(2)
By means of a software, the participants were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy (Control Group); Group II (n = 15), standard urotherapy associated with pelvic floor muscle training (PFMT); and Group III (n=11), standard urotherapy associated with PFMT and oxybutynin
Summary
Enuresis is a common condition and its prevalence varies from 5 to 10% in children aged 6 to 7 years. Its cause is defined as immaturity of the nervous systems.(1) It is defined by the International Children’s Continence Society (ICCS) as a symptom, and a condition of intermittent incontinence that occurs during sleep. It is divided into two subgroups, according to occurrence − concomitant or not − of other lower urinary tract symptoms (LUTS). A guideline published by the ICCS in 2013 recommended how to evaluate and treat children with NMNE. Conservative treatments are recommended as first line, authors warn that this guideline is not a systematic review, but it is based on good practices due to the lack of scientific evidence in this filed.(3)
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