Frequency Of Enuresis Research Articles

Posterior tibial nerve stimulation versus desmopressin in treating children with primary mono-symptomatic nocturnal enuresis. A randomized clinical trial

ABSTRACT Objective Assessment of the efficacy of Posterior Tibial Nerve Stimulation (PTNS) versus Desmopressin in treating Primary Mono-symptomatic Nocturnal Enuresis (PMNE). Patients and methods This randomized clinical trial was conducted at the Urology department of Abo Elreesh pediatric hospital, Cairo University on 80 children, aged between 5 and 13 years old, diagnosed to have PMNE between June 2020 and November 2020. Children were divided into two equal groups; those who underwent PTNS (as one session per week for 12 weeks) (Group A) and those who received Desmopressin 0.2 mg. single evening dose for 12 weeks (Group B). Both groups were constructed to adhere to behavioral therapy and were statistically evaluated regarding the frequency of nocturnal enuresis (NE) before, after treatment, and after 1 month of follow-up. Results Both groups showed statistically significant improvement in the frequency of NE before and after treatment (p < 0.001), but there were no statistically significant differences between them (p = 0.763). There was a statistically significant relapse of NE frequency after 1 month of follow-up after completion of treatment in both groups (p < 0.001), with no statistically significant differences between the two groups (p = 0.075). Conclusion Posterior tibial nerve stimulation and Desmopressin are viable treatment options for children with primary mono-symptomatic nocturnal enuresis. However, relapse in some responders with time suggests the need for maintenance therapy.

The Effect of Montelukast on Urinary Symptoms in Children With Bladder Pain Syndrome: A Randomized Clinical Trial.

Montelukast by inhibiting leukotriene receptors in the bladder can prevent the activation of mast cells. We investigated the effectiveness of Montelukast in reducing the symptoms of children with bladder pain syndrome (BPS). In this randomized clinical trial, children were allocated into groups of intervention (Montelukast and oxybutynin) and the control (oxybutynin). At the beginning and after 14 days, questions from mothers of children about their urinary condition were asked about the frequency of nocturnal enuresis, frequent urination, urinary incontinence, urinary urgency, and their pain severity. There was no significant difference between two groups in terms of frequency of nocturnal enuresis, frequent urination, urinary incontinence, and urinary urgency. Regarding the frequency of pain distribution, the frequency of pain-free people in the Montelukast group was higher than control group (84.4% vs 56.3%, P = .023). The results showed that adding Montelukast to oxybutynin has a significant decrease in pain in children with BPS.

Predictors of response and adherence to enuresis alarm therapy-a confirmatory study.

To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently. We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own. We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554). Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.

Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children.

The objective was to explore the efficacy of Tongdu Tuina manipulation in the treatment of primary single-symptom enuresis in children. A total of 102 children aged 5-16 with primary single-symptom enuresis were included in this study and randomly assigned to the Tuina group, the medication group and the control group, with 34 children in each group. The Tongdu Tuina group included manipulation of the Guanyuan, Qihai, Zhongji, Mingmen, kidney, Baihui, Sishencong and bladder acupoints, five times a week, the medication group was treated with 0.1 mg desmopressin acetate every night, and in the control group, the patients were given foods with high water content and underwent water deprivation 2 h before bedtime every night. The intervention time of each group was 1 month. The participants were followed up on Day 1 following treatment, as well as half a month, 1 month and 3 months after the implementation of the intervention measures, and the effective rate, the incidence of enuresis per week and the recurrence rate were calculated. As a result baseline demographic characteristics were comparable among 102 patients. Overall, 32 patients in the Tongdu Tuina group, 30 patients in the medication group and 34 patients in the control group completed the intervention. After half a month of treatment, there was no significant difference in the therapeutic efficacy among the three groups (P = 0.158), but each treatment could effectively reduce the frequency of weekly enuresis. The frequency of weekly enuresis in the Tongdu Tuina group was 3.8 ± 1.1 times, while that in the medication group was 4.0 ± 2.0 times. The frequency of weekly enuresis in the control group was 4.7 ± 1.8 times, and the difference was statistically significant (P = 0.016). After 1 month of treatment, the effective rates of the Tongdu Tuina group and the medication group were significantly increased (87.5% vs 83.33%, P < 0.0001), which was not the case with the control group. The frequency of enuresis was 1.9 ± 2.1 times per week in the Tongdu Tuina group, 2.4 ± 1.8 times per week in the medication group and 4.0 ± 0.9 times per week in the control group after 1 month of treatment. The difference between the three groups was statistically significant (P = 0.021), and there was a difference between the Tongdu Tuina group and the medication group (P < 0.0001). There was no significant difference between recurrence rate and the incidence of adverse events (P = 0.837, P = 0.856). In conclusion, both Tuina manipulation and desmopressin treatment can effectively improve children's primary single-symptom enuresis with safety. However, Tongdu Tuina therapy may be superior to desmopressin treatment.

PD06-09 EFFECTS OF DESMOPRESSIN PLUS PROPIVERINE FOR THE TREATMENT OF MONOSYMPTOMATIC PRIMARY NOCTURNAL ENURESIS IN CHILDREN

You have accessJournal of UrologyCME1 Apr 2023PD06-09 EFFECTS OF DESMOPRESSIN PLUS PROPIVERINE FOR THE TREATMENT OF MONOSYMPTOMATIC PRIMARY NOCTURNAL ENURESIS IN CHILDREN Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Seong Hyeon Yu, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Seung Il Jung, Taek Won Kang, Kwangsung Park, Dong Deuk Kwon, and Sun-Ouck Kim Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Seong Hyeon YuSeong Hyeon Yu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Eu Chang HwangEu Chang Hwang More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , Dong Deuk KwonDong Deuk Kwon More articles by this author , and Sun-Ouck KimSun-Ouck Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We evaluated the efficacy of a combination treatment of desmopressin and propiverine for treating children with monosymptomatic primary nocturnal enuresis. METHODS: A total of 53 children aged 6 to 15 years old with monosymptomatic nocturnal enuresis prospectively were enrolled in this study. Children with a minimum of 3 wet nights weekly were included in the study. Children were randomly assigned groups and treated with desmopressin 0.2mg, or a combination of desmopressin plus propiverine 10mg. Of these patients 43 (31 boys and 12 girls, mean age 8.4±2.5 years, range 4 to 13) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency after treatment. RESULTS: Of the 43 children finally analysed 23 received combination therapy of desmopressin and propiverine and 20 received desmopressin alone. The frequency of nocturnal enuresis at baseline in monotherapy group and combination therapy was similar (5.45±1.57 vs 5.82±1.44). However, decrease of the nocturnal enuresis was significantly pronounced in combination group after 6 months treatment than in monotherpy group (1.8±1.01 vs 1.29±0.67). Combination therapy produced better outcomes than monotherapy in terms of number of nocturnal enuresis episode. The adverse event was minimal. CONCLUSIONS: Combination therapy with desmopressin plus propiverine for the treatment of monosymptomatic nocturnal enuresis was well tolerated, and gave significantly effective results in reducing enuresis episode than single therapy of desmopressin in children. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e159 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Seong Hyeon Yu More articles by this author Ho Seok Chung More articles by this author Eu Chang Hwang More articles by this author Kyung Jin Oh More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Kwangsung Park More articles by this author Dong Deuk Kwon More articles by this author Sun-Ouck Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of short-term treatment with vibegron for refractory nocturnal enuresis.

Long-term nocturnal enuresis treatment leads to stress and lowered self-esteem for children and their parents. This study evaluated the short-term effectiveness and safety of vibegron 50 mg for children with refractory nocturnal enuresis. A retrospective cohort study of children with therapy-resistant enuresis was conducted using data for July 2019 through December 2019. Enuresis frequency was recorded during 30 days before and after additional vibegron administration with prior treatment. We assessed the treatment effectiveness based on enuresis frequencies between before and after treatment with vibegron 50 mg. Statistical evaluation was performed using a paired t-test. Among 29 children receiving vibegron, 14 (48.3%) exhibited partial or complete response to vibegron. Enuresis frequencies were, respectively, 15.8 ± 9.2 (± SD) and 9.5 ± 9.6 (± SD) before and after treatment with vibegron during the observed 30 days. Statistically significant reduction in enuresis frequency was found (p < 0.001). Moreover, maximum morning urine of 200 ± 62.9 mL (± SD) before treatment with vibegron changed to 232 ± 76.6 mL (± SD) after treatment. Significant increase in voiding volume in the early morning was found (p < 0.05). No drug-related severe adverse event was found. Short-term treatment with vibegron is safe and effective for children with refractory enuresis.

First-morning urine osmolality and nocturnal enuresis in children: A single-center prospective cohort study.

To investigate the treatment outcome of nocturnal enuresis (NE) according to first-morning urine osmolality (Uosm) before treatment. Ninety-nine children (mean age, 7.2±2.1 y) with NE were enrolled in this retrospective study and divided into two groups according to first-morning Uosm results, that is, into a low Uosm group (<800 mOsm/L; 38 cases, 38.4%) or a high Uosm group (≥800 mOsm/L; 61 cases, 61.6%). Baseline parameters were obtained from frequency volume charts of at least 2 days, uroflowmetry, post-void residual volume, and a questionnaire for the presence of frequency, urgency, and urinary incontinence. Standard urotherapy and pharmacological treatment were administered initially in all cases. Enuresis frequency and response rates were analyzed at around 1 month and 3 months after treatment initiation. The level of first-morning Uosm was 997.1±119.6 mOsm/L in high Uosm group and 600.9±155.9 mOsm/L in low Uosm group (p<0.001), and first-morning voided volume (p=0.021) and total voided volume (p=0.019) were significantly greater in the low Uosm group. Furthermore, a significantly higher percentage of children in the low Uosm group had a response rate of ≥50% (CR or PR) at 1 month (50.0% vs. 24.6%; p=0.010) and 3 months (63.2% vs. 36.1%; p=0.009). Treatment response rates are higher for children with NE with a lower first-morning Uosm.

Management of treatment-resistant nocturnal enuresis.

Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children 5 years of age and older, occurring at least once a month for at least 3 months. In Japan, pediatricians who do not specialize in nocturnal enuresis have become more proactive in treating the condition since 2016, when the guidelines for treating it were revised for the first time in 12 years. For monosymptomatic nocturnal enuresis, the first step is lifestyle guidance, with a focus on the restriction of fluid intake at night; however, if lifestyle guidance does not decrease the frequency of nocturnal enuresis, aggressive treatment should be added. The first choice of aggressive treatment is oral desmopressin, an antidiuretic hormone preparation, or alarm therapy. However, there remain patients whose wet nights do not decrease with oral desmopressin or alarm therapy. In such cases, it is necessary to reconfirm the method of desmopressin administration and check for factors that may decrease the efficacy of desmopressin. If alarm therapy does not increase the number of dry nights, it is possible that the patient is fundamentally unsuitable for alarm therapy. If dry nights do not increase with oral desmopressin or alarm therapy, the next treatment strategy should be considered immediately to keep the patient motivated for treatment.

The value of case history and early treatment data as predictors of enuresis alarm therapy response

Two central problems with the enuresis alarm are the family workload and the lack of predictors of therapy response. We wanted to look at predictors of alarm response in a setting reflecting clinical reality. An alarm linked to a smartphone app was provided to enuretic children managed at pediatric outpatient wards. Baseline data (sex, age, daytime incontinence, urgency, previous therapies, arousal thresholds and baseline enuresis frequency) were recorded. Further information, such as enuretic episodes and actual alarm use, was gathered via the app during therapy. Therapy was given for 8-12 weeks or until 14 consecutive dry nights had been achieved. For the 196 recruited children the outcome was as follows: full responders (FR) 18.4%, partial responders (PR) 20.4%, nonresponders (NR) 22.4% and dropouts 38.8%. We found no clear predictors of response or adherence among baseline data. But as treatment progressed responders reduced their enuresis frequency as compared to NR (week two P=0.003, week three and onwards P<0.001). This is further illustrated in the Figurebelow. Furthermore, the children unable to complete the full treatment had more non-registered nights already from the second week (week two P=0.005, week three P=0.002 and so on). Anamnestic data give little predictive information regarding enuresis alarm response or adherence. Contrary to common belief neither daytime incontinence nor previous alarm attempts influenced treatment success. But after 2-4 weeks of therapy the children with a good chance of treatment success could be discerned by decreasing enuresis frequency, and the families that would not be able to comply with the full treatment showed incomplete adherence already during the first weeks. Maybe the enuresis alarm strategy should be changed so that the treatment is reassessed after one month and only children with a high chance of success continue. This way, unnecessary frustration for the families of therapy-resistant children may be reduced.

Clinical Effect of Pressing Needle on Nocturnal Enuresis in Children

Objective: With the fast development of economy and culture, medical professionals parents are paying more and more attention to nocturnal enuresis (NE) since it rais ed the negative impact on children's health and imposes a long -term burden on families. The present clinical investigation aims to evaluate the clinical effect of pressing needle on nocturnal enuresis in children through a randomized controlled clinical trial. Materials and Methods: A total of 120 children with nocturnal enuresis were randomly assigned into pressing needle group, desmopressin group and pills Capsule group, 40 cases in each group. The children in pressing needle group were treated with pressing needles, and those in the desmopressin group and Suoquan pills were orally administrated with desmopressin and Suoquan pills, respectively. Combined behavioral therapy was also given in all the three groups during the treatment. Enuresis frequency, degree of arousal, functional bladder capacity (FBC) and postvoid residual urine volume (PRUV) were employed as the indicators to evaluate the clinical efficacy in the three groups. After 6 months of follow-up, the recurrence rate of the three groups was also analyzed for efficacy assessment. Results: The total responsive rate in pressing needle group was 95.0%, which was higher than 87.5% of Suoquan pills group (p &lt; 0.05), and significantly higher than 77.5% of desmopressin group (p &lt; 0.01). The frequency of enuresis was significantly lowered after treatment (p &lt; 0.01), concurrently with an evident improvement in arousal levels in all of the three groups (p &lt; 0.01), and the inter-group difference in post-treatment enuresis frequency and arousal level between pressing needle group and the other two groups was also statistically significant (p &lt; 0.05). The recurrence rate of pressing needle group, desmopressin group and Suoquan pills group was 7.89%, 48.39% and 22.86%, respectively, with a difference which was statistically significant between pressing needle group and desmopressin group (p &lt; 0.01), but not between pressing needle group and Suoquan pills group (p &gt; 0.05). Conclusion: Pressing needle treatment showed a substantial clinical effect on enuresis in children by improving the bladder function, increasing the FBC and reducing PRUV of the bladder, as well as by enhancing the degree of arousal and lowering the recurrence rate, therefore is suggested to be considered as an option for enuresis treatment for children.

Transcutaneous electrical nerve stimulation for at-home treatment of nocturnal enuresis in children: Determining optimal pad placement

Introduction:Nocturnal enuresis (NE) is a common problem encountered in children that can be recalcitrant to currently available treatment options. Neuromodulation techniques are used to treat various urologic disorders but can be limited by convenience and compliance. Transcutaneous electrical nerve stimulation (TENS) is a neuromodulator that can be used at home to treat various conditions. The aim of this study was to determine if TENS can be offered as an effective at-home option that shows durability for NE in children, and to determine which pad placement is the most efficacious. Materials & Methods:A randomized clinical trial including 90 patients aged 5–18 years presenting with monosymptomatic NE was performed. After one month of behavioral therapy, they were treated with TENS therapy after randomization to three groups based on pad placement: suprapubic (SP), parasacral (PS), and ankle/posterior tibial (PT). TENS therapy was performed nightly for one month. Voiding diaries recording the number of wet nights, wet scale severity score (0–3), TENS compliance, quality of life (QOL) questionnaires, and any adverse reactions were collected monthly at baseline, during TENS therapy, and after TENS for durability assessment, and statistically analyzed after study completion. Results:No patient was cured of NE, and our study failed to show a statistical difference between the study arms in enuresis frequency during TENS. The only statistically significant improvement was QOL during TENS therapy (2.95 improvement for the PT group versus 1.2 and 1.5 regression for SP and PS groups, respectively, p=0.003). PT TENS therapy also showed improvements for enuresis frequency with 2.7 less episodes/month (versus 4.1 and 8.2 more episodes/month in the SP and PS groups, respectively, p=0.06) and the severity of wetness each night with a 0.17 improvement (versus 0.06 and 0.13 regression in the SP and PS groups, respectively, p=0.06) after TENS therapy was completed, however these did not meet statistical significance. Patients were compliant with using TENS therapy (90% or more in all groups) and there were no adverse events. Discussion:This study found that patients who used the PT pad placement for TENS showed significant improvements in QOL during therapy, however we were unable to show a significant difference in enuresis frequency during TENS between groups. The major limitation of our study was the high number of patients lost to follow-up during the COVID-19 pandemic. Conclusion:TENS therapy when combined with behavioral techniques can be an easy and safe tool that can be used at home to help treat NE, however, further studies are needed to optimize this type of therapy to show a clinically significant benefit.

Acupressure suppresses the frequency of enuresis in preschool children: A pilot non-randomized trial

BackgroundEnuresis management necessitates both non-pharmacological and pharmacological approaches that are safe and effective. The purpose of this study is to examine the effects of acupressure on the treatment of enuresis in children. MethodsA total of thirty-two children who suffered from enuresis were recruited and received acupressure was performed by a certified therapist. ResultsThere was a significant decrease in the frequency of enuresis in children after being given acupressure therapy compared to before acupressure therapy (p < 0.05). ConclusionsIt was concluded that acupressure can reduce the frequency of enuresis in children. Acupressure may be an alternative treatment that is safe, inexpensive, and not invasive for enuresis, but further studies are required to confirm results.

Serum Sodium Alterations in Children with Primary Monosymptomatic Nocturnal Enuresis Using Desmopressin

Background: Hyponatremia/water intoxication has been considered a rare but serious complication of desmopressin (DDAVP) for the treatment of primary monosymptomatic nocturnal enuresis (PMNE). Objectives: This study aimed to identify the incidence and risk factors of serum sodium (Na) alterations in children with PMNE treated with oral or intranasal DDAVP. Methods: A total of 201 patients with PMNE were evaluated in 2 groups using intranasal (n = 127) or oral DDAVP (n = 74) for approximately 6 months. Treatment efficacy was defined as a more than 50% decrease in wet nights after 1 month of treatment. Serum Na was measured before, during, and after treatment in all patients. Predisposing factors of serum Na disturbance were evaluated concomitantly. Results: The mean age of patients was 8.8 ± 2.6 (5 - 17.5) years, and males outnumbered females (M/F = 1.68). Treatment efficacy was 100% in 93 (46.2%), and &gt; 90% in 157 (78.1%) cases. Oral DDAVP had significantly more therapeutic effects than intranasal treatment (P = 0.024). However, serum Na had no significant difference between the 2 groups (P = 0.52). Hyponatremia occurred in 7 (3.5%) patients (3 in oral treatment and 4 in intranasal treatment; P = 0.73) with no significant correlation to age, gender, body weight, frequency of enuresis, and initial serum Na. However, decreased serum Na &gt; 5 mEq/L was a significant risk factor for the prediction of hyponatremia in our patients (P &lt; 0.001). Conclusions: Oral DDAVP had more therapeutic effects than intranasal treatment for the treatment of PMNE. Serum Na had no significant alteration in both oral and intranasal treatments, and hyponatremia was a rare complication of DDAVP, which occurred significantly in children with a &gt; 5-mEq/L decrease of initial serum Na concentration. As a suggestion, monitoring serum Na is not an essential follow-up in asymptomatic patients in DDAVP treatment.

Incontinence training in children with cerebral palsy: A prospective controlled trial

Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment. To investigate the effectiveness of incontinence training with urotherapy in children with CP. A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis. Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p<0.001), frequency of daytime incontinence (p=0.002), frequency of enuresis (p=0.048), storage symptoms (p=0.011), correct toilet posture (p=0.034) and fecal incontinence (p=0.026). Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended. Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.

Fecal disimpaction in children with enuresis and constipation does not make them dry at night

Constipation, daytime incontinence and nocturnal enuresis often overlap. Treatment of constipation has been shown to be an important aspect of therapy for children with daytime incontinence. However, the value of fecal disimpaction, as a part of constipation therapy, in children with enuresis has not been evaluated. Our aim was to evaluate the antienuretic effect of fecal disimpaction in children with enuresis and concomitant constipation. The bladder and bowel function was assessed noninvasively in children aged six to ten years who sought help for enuresis for the first time. If they were constipated according to the Rome IV criteria or had a rectal diameter exceeding 30mm, as assessed by ultrasound, they were given standard evacuation with mini-enemas and macrogol therapy for at least two weeks. Enuresis frequency was documented 14 nights preceding and following therapy. In total, 66 children (20 girls, 46 boys) were evaluated, 23 (35%) of whom were constipated. There were no differences in age, sex or baseline bladder function between the two groups. The enuresis frequency per two weeks was 9.8±4.1 nights before and 9.3±5.1 nights after constipation therapy (p=0.43). This study found that fecal disimpaction in children with enuresis who are also constipated did not alleviate nocturnal enuresis. Bowel problems may still need to be addressed but the child should not be given the false hope that this approach alone will make them dry at night. It might be that evidenced based therapies, such as the enuresis alarm and desmopressin, could be less efficient in children with enuresis and constipation unless their bowel disturbance is first properly addressed. Fecal disimpaction in children with enuresis and concomitant constipation will, by itself, not make the children dry at night.

Primary and Secondary Enuresis in Children Presenting At Pediatric Outpatient Department of Combined Military Hospital Malir Cantt Karachi

Objective: To determine the frequency of primary and secondary enuresis in the children presenting at outpatient department of Tertiary Care Hospital.&#x0D; Study Design: A cross sectional study.&#x0D; Place and Duration of Study: Outpatient Department of Combined Military Hospital Malir, Karachi, from Feb to July 2019.&#x0D; Methodology: A total of 1200 children with age range of 5-12 years were included in the study. Children presenting with severe acute illness or those with non-willing caregivers were excluded from the study.&#x0D; Result: Out of the total 1200 study participants, 167 (13.9%) children gave the history of enuresis. There were 109 (65.6%) boys and 58 (34.4%) girls. The children with primary enuresis were 141 (84.3%) while 26 (15.62%) children had secondary enuresis. About 31 (18.7%) children had daytime enuresis, 115 (68.5%) had night-time and 21 (12.5%) children had both day and night time bed wetting. About 57 (34.37%) children previously got the treatment for enuresis which included fluid restriction in 21 (12.5%) and desmopressin in 36 (21.87%). Out of them 52 (91.2%) children showed complete response while 5 (8.77%) showed incomplete response.&#x0D; Conclusion: Our study found that enuresis is more frequent among boys. Primary enuresis is more common than secondary enuresis and nocturnal enuresis is more common than diurnal enuresis.

Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial

ObjectiveAccording to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this...

Topical Use of Saussurea costus (Falc.) Lipsch. (Qost) Oil in Pediatric Nocturnal Enuresis in Comparison with Sesame Oil, A Randomized Double-Blind Clinical Trial

Nocturnal enuresis is one of the most common chronic problems of childhood. It has a significant effect on health and quality of life of children and their families. Despite pharmacological treatments, enuresis in most children relapses after the medication is discontinued. Also available drugs have many side effects that limited their uses. So, we compared the effect of topical use of Saussurea costus (Falc.) Lipsch. (Qost) oil as a Persian Medicine product on pediatric nocturnal enuresis in a parallel randomized double blinded study. Eighty-two patients aged 5 to 15 years who were diagnosed as monosymptomatic nocturnal enuresis were allocated to receive costus oil or sesame oil topically below the navel twice a day for 4 weeks. Patients were evaluated prior to and following end of the study in terms of frequency of enuresis and any observed adverse events. The results were evaluated with valid PLUTSS questionnaire. For evaluation, Chi-square and Fisher's exact tests, Mann-Whitney and Wilcoxon tests were used. Significant p value was &lt; 0.05. A significant decrease in mean scores of the questionnaires was noted in both groups. The results before and after the intervention were significantly different in both groups, but there was no statistically significant difference between the intervention and control groups. At the end of the 4th week, the frequency and volume of enuresis showed a 46.2 percent reduction in costus oil group and a 25.5 percent reduction in sesame oil group. According to this study, the response rate based on PLUTSS questionnaire in costus oil group is 74.5%; while in the sesame oil group is 69%. No drug side effect was noticed in this study. Based on the results of this study, costus oil is effective in children with monosymptomatic nocturnal enuresis; however, there is no significant difference between costus oil and sesame oil.

Clinical Study on the Treatment of Pediatric Primary Nocturnal Enuresis by Integrated Traditional Chinese and Western Medicine

To investigate the curative effect of integrated traditional Chinese and Western medicine in the treatment of children with primary nocturnal enuresis is the objective of the study. 160 children with primary nocturnal enuresis were randomly divided into four groups and received suoquan capsules, solifenacin combined with suoquan capsules, solifenacin or behavioral intervention for 2 mo. The response rates of each group were evaluated and logistic regression analysis was used to analyze the influencing factors of curative effect. In addition, the patients were followed up after 3 mo to investigate the recurrence rate. The complete remission (complete response) rate in solifenacin combined with suoquan capsules group was higher than that in behavioral intervention group (37.5 % vs. 7.5 %, p=0.007). The complete response rate and non-response rate in the solifenacin group were lower than those in the solifenacin combined with suoquan capsules group (all p<0.05). The recurrence rate in the solifenacin group was significantly higher than that in the solifenacin combined with suoquan capsules group (72.5 % vs. 30.0 %, p=0.027). Multivariate analysis showed that treatment group, enuresis frequency and age were independent predictors of complete response at 2 mo. Integrative traditional Chinese and Western medicine has good effect in the treatment of children with primary nocturnal enuresis and the recurrence rate is low. Enuresis frequency, treatment method and age were important predictors of complete remission after treatment

Immunoterapia orale per arachide, da piccoli è meglio. I risultati di un RCT

Monosymptomatic primary nocturnal enuresis and daily urotherapy: an unnecessary intervention? Although evidence of their effectiveness is lacking, basic bladder function indications (urotherapy, BBA), according to old international guidelines have been the first step in treating nocturnal enuresis in children. Sixty-two children aged 6-11 were randomized into 3 groups (standard urotherapy, enuresis alarm, no treatment) and followed for 8 weeks; response to therapy was measured, defined as a reduction in the number of wet nights during the last 2 weeks of treatment (or no treatment), compared with 2 weeks before the intervention. The difference in reduction in frequency of enuresis between groups was highly significant (p=0.002) in favor of the alarm group, while no difference was found between BBA and controls. The small number of participants, the brevity of follow-up, and the lack of follow-up on compliance, do not allow the results to be generalized. It is reported that urotherapy is no longer planned in the treatment of monosymptomatic nocturnal enuresis according to the 2020 ICCS guideline update. Surprisingly, although the authors cited this update regarding the usefulness of the micturition chart in the initial evaluation of all children with enuresis, they made no mention of urotherapy being surpassed as the first level of treatment in monosymptomatic nocturnal enuresis.