Frequency Of Enuresis Research Articles

Prevalence of Nocturnal Enuresis among Schoolchildren in Sana’a City, Yemen

Objective: To estimate the prevalence, frequency and time of nocturnal enuresis (NE) among primary schoolchildren in Sana’a city, Yemen.
 Methods: This was a cross-sectional study was conducted among 2689 schoolchildren in the primary schools of four randomly selected districts in Sana’a city in the period from September 2012 to December 2013. Data about sociodemographic characteristics, frequency, time, psycho-social effects and the factors possibly associated with NE among children were collected using a pre-designed questionnaire and analyzed using appropriate statistical tests.
 Results: The overall prevalence of NE was 11.2%, which was significantly higher among males than females (13.0% vs. 10.0%, respectively; P = 0.044) and decreased significantly with increasing age (P <0.001). More than half of children (55.3%) in Sana’a city had the habits of drinking excess fluids and tea at night and/or deep sleeping. Of physical and health disorders, difficulty in breathing and urinary tract infections were the two most frequent conditions among children with NE, being observed among 29.6% and 23.9% of cases, respectively. However, urogenital anomalies and mental retardation were the least frequent conditions in children with NE, being observed among 5.8% and 1.3% of cases, respectively. On the other hand, marital problems (24.8%) and arrival of a new baby (17.9%) were the most frequently observed social conditions among children with NE, while death in the family (8.5%) and parental separation (6.0%) were the least frequently observed conditions.
 Conclusions: NE is prevalent among 11.2% of schoolchildren in Sana’a city with a significantly higher, though slight, rate among males. This rate is lower than the rates reported from Aden and Mukalla cities in the country and from Saudi Arabia and Turkey. However, it is higher than those reported from Iran and Malaysia. About a third of children experience nightly NE, whereas the lowest proportion of children experience NE twice a month. The habits of drinking excess fluid and tea at night and/or deep sleeping, the disorders of difficulty in breathing and urinary tract infections and the social conditions of marital problems and arrival of a new baby are the most frequent observations among children with NE in Sana’a city.

PENGARUH TERAPI PERILAKU (TEKNIK MODELLING DAN TOKEN EKONOMI) TERHADAP FREKUENSI ENURESIS PADA ANAK USIA PRASEKOLAH (4-6 TAHUN)

Enuresisis urinary problem sare often found in childhood and cause concern for patients and their families. The results of preliminary studies that have been carried outin Apri l2014, of 10 children aged 4-6 years who were in the village of Sejati Slabayan District of Camplong Sampang found that 60% of children aged4-6 years experience denuresis and 40% did not experience enuresis.
 This study is an experimental pre-one group pretest-posttest design. Collecting data using pre and post observations. Data was taken on the majority of children who have enuresis of purposive sampling technique. The results were analyzed using descriptive and correlation parametric test paired t-test.
 The frequency of enuresis in children before and after behavior therapy there are significant differences. Analysis of parametric tes twith a variable scale paired t-test shows that there is influence between behavior therapy (modeling techniques and token economy) to decrease the frequency of enuresis(p=0.000).
 To further research the authors suggest that continued follow-up study with some preparation sinclude a clearand practical education to the respondent, the procurement of more stringent environmental controls, manufacture of detector surinate more flexible, so that it can be better.

Use of propranolol in children with primary nocturnal enuresis.

In nocturnal enuresis, motivational therapy, alarm therapy, and drug therapy, such as anticholinergics, imipramine, and sertraline, are the mainstay of treatment. In the present study, we used motivational therapy, oxybutynin, and propranolol in children with primary nocturnal enuresis to determine if propranolol is an effective treatment. Fifty-two children with primary nocturnal enuresis were included in the study. Firstly, motivational therapy was given for 1 month to all patients. Patients who failed the motivational therapy were randomly given oxybutynin or propranolol. The patients were re-evaluated after 1 month of drug therapy. There was not a significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis ( p > 0.05). Of 52 patients, 28 (53.8%) patients improved by motivational therapy. There were 14 patients in the oxybutynin group. One patient was excluded from the study because facial flushing and mouth drying developed in the first week of oxybutynin therapy. In oxybutynin group, 12 of 13 (92.3%) patients improved. There were 10 patients in the propranolol group. In the propranolol group, while nine (90%) patients did not improve, one patient had significant remission (90%, p < 0.001). No significant adverse reaction was noted during propranolol therapy. There was no significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis (p > 0.05). A significant difference was found between the groups for the remission of nocturnal enuresis ( p < 0.001). Our findings showed that motivational therapy is the first line treatment in primary nocturnal enuresis, and oxybutynin but not propranolol is effective in patients who failed with the motivational therapy.

Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients

ObjectiveTo investigate the beneficial effect of adenotonsillectomy (AT) on nocturnal enuresis (NE) in children with adenotonsillar hypertrophy and evaluate the Modified Pediatric Epworth Scale (MPES). MethodsThis was a prospective study comparing preoperative and postoperative evaluation of the frequency of NE and MPES in pediatric obstructive sleep apnea (OSA). A questionnaire on NE history was prepared based on the Turkish Enuresis Guidelines. NE histories were evaluated pre- and postoperatively on the first month and third month, respectively. MPES questions were asked to the parents of all the OSA patients pre- and postoperatively, and scores were noted. ResultsEighty-four (84) pediatric OSA patients were involved in the study. Preoperatively, 19 patients (27%) complained about nocturnal enuresis. After the surgery, 52% of the patients with NE had complete resolution of NE (p < 0.001). Postoperatively, the average Epworth scores of both groups significantly decreased (p < 0.001). ConclusionThere is a strong correlation between OSA and NE. In the present study, enuresis in pediatric OSA patients significantly decreased after surgery. Also, Epworth scores decreased significantly after surgery. In children with nocturnal enuresis, the presence of OSA symptoms should be questioned.

Therapeutic Efficacy of Hydrochlorothiazide in the Primary Monosymptomatic Nocturnal Enuresis of Children

Abstract Background: Nocturnal enuresis is a symptom with probably multiple etiologic factors and a high prevalence. Conventional therapies is expensive and complicated, since the effect of calcium on voiding dysfunction was approved. Therefore, to the current study aimed at evaluating the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis (PMNE). Methods: The current study was conducted based on the interviews with patients. Morning urine test was evaluated in children with PMNE detection and specific gravity < 1010 enrolled to the study (110 children comprised of 57 cases and 53 controls). Children were divided into 2 groups; in the case group, hydrochlorothiazide (tablet 1 mg/kg and maximum 50 mg) was administered in the morning and the control group was only given necessary training about enuresis. For 3 times and with 1 month interval (based on a predetermined questionnaire) the frequency of nocturnal enuresis was checked. Data were transferred into SPSS program and the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis was investigated. Findings: There was a statistically significant difference regarding the frequency of nocturnal enuresis between the 2 groups (P = 0.0001). Also, both groups were matched by age (P = 899) and gender (P = 607). Conclusions: Hydrochlorothiazide can be used as an effective and safe therapeutic option for treatment of primary monosymptomatic nocturnal enuresis.

Frequency of enuresis and related factors among school children in Guilan province; a single center investigation

Introduction: Enuresis is one of the most common diseases in children that has several physical and psychosocial effects on children and their parents. Enuresis is classified in primary and secondary groups which depends on various factors such as genetic predisposition, biological and developmental, psychological, social and economic factors. Objectives: This study aimed to determine the prevalence of enuresis in primary school-aged children and the role of related personal and family factors in Rasht. Patients and Methods: In this cross-sectional study, samples were randomly selected from Rasht’s primary schools. Questionnaires were selected for each student and then completed by a health expert with invitation of a parent. Results: In this study, 1125 questionnaires were completed that 568 (50.5%) were boys and 557 (49.5%) were girls. The study showed that the prevalence of enuresis was 7.5% (n = 43) in boys and 4.1% (n = 23) in girls and overall is 5.9% (n = 66). The gender difference was statistically significant. There was statistically significant relation in two groups about personal factors such as history of urinary tract infections (UTIs), snoring, computer games and eating fast food and family factor such as family history of enuresis and the place of residence. Conclusion: The results showed that the prevalence of this disorder was lower than other studies, which it may be because of ethnic and cultural differences among the communities. Our results with enuresis prevalence and associated factors were comparable to other epidemiological studies from various countries.

The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment.

To investigate the effect of biofeedback therapy on children with desmopressin- resistant primary monosymptomatic enuresis (MsE). The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin- resistantprimary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. The mean age of 29 patients included in the study was 9.14±3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1±5.76 days/month, while after treatment this was calculated as 8.52±10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively). Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails.

Combination treatment of nocturnal enuresis with desmopressin and indomethacin.

We investigated the effect of combining indomethacin and desmopressin in treating children with monosymptomatic nocturnal enuresis (MNE) and desmopressin-resistant nocturnal polyuria. Twenty-three children with MNE, nocturnal polyuria, and partial or no response to desmopressin were recruited from incontinence clinics of our tertiary referral center. We used a randomized single-arm crossover placebo-controlled study design consisting of two 3-week treatment periods with a combination of desmopressin (0.4mg) and indomethacin (50mg) or desmopressin and placebo at bedtime. Home recordings at baseline and for the final 2weeks of each treatment period were performed and included nocturnal urine output measurements. The number of dry nights achieved and reduction in the nocturnal urine output were the main effect parameters. Student's t test and Pearson's correlation coefficient were used for statistical analysis. The addition of indomethacin to desmopressin significantly reduced nocturnal urine output (from 324 ± 14ml to 258 ± 13ml, p < 0.001). This did not lead to more dry nights in all children, and we found no statistically significant reduction in enuresis frequency (from 68% ± 0.1 to 56% ± 0.1, p = 0.24). Addition of indomethacin to desmopressin can further reduce nocturnal urine output in children with MNE and desmopressin-resistant nocturnal polyuria. The combination treatment does not, however, improve outcome in terms of frequency of nights with enuresis. The dissociation of antidiuretic and antienuretic effect may reflect nocturnal bladder reservoir dysfunction in children who present with normal daytime bladder function.

Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: A follow-up study

To understand the remission rates, shifts in treatment methods used by parents, and parents' attitudes towards their children with primary nocturnal enuresis (NE). 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. 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. 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.

Topical use of Matricaria recutita L (Chamomile) Oil in the Treatment of Monosymptomatic Enuresis in Children: A Double-Blind Randomized Controlled Trial.

To evaluate the efficacy of topical use of Matricaria recutita L oil in the treatment of enuresis in children. Eighty patients diagnosed as monosymptomatic nocturnal or daytime enuresis were allocated to receive Matricaria recutita L (chamomile) oil or placebo topically for 6 weeks in a double-blind randomized placebo-controlled trial with a parallel design. Patients were evaluated prior to and following 8 weeks of the intervention in terms of frequency of enuresis and any observed adverse events. The mean frequency of enuresis at the first, second, and third 2 weeks was lower in the intervention group compared with the placebo group, and the differences were statistically significant (P < .001, P = .03, and P < .001, respectively). There was no report of any adverse event in the study groups. The findings of this study showed that the topical use of (chamomile) oil can decrease the frequency of nocturia in children with monosymptomatic nocturnal or daytime enuresis.

Nocturnal Enuresis Frequency in Children and Anxiety-Depression Risks of Parents

Objective: In this study, we aimed to detect the prevalence of the monosymptomatic nocturnal enuresis (MSE) in the children attended to our clinics and to detect the relationship between enuresis and social tendencies, anxiety and de­pression risks of the parents. Methods: Our study was performed with 133 children aged between 5-16 years and with their parents who admitted to Ankara Numune Training and Research Hospital outpatient clinics. The children’s MSE were confirmed with voiding dysfunction scoring system scale. For the parents Hospital Anxiety and Depression Scale and Fatih Social Tendencies Scales (FSTS) were conducted. Results: MSE frequency was found as 37.6% (n=50). Enuresis was observed more frequently in the crowded families with low socioeconomic status and low parent education level. Risk of MSE in children was found to be increased 5.5 times in whom parents have also MSE. High depression score of father was found to be related with MSE in child (p=0.038). Conclusion: Enuresis is a condition that decreases the life quality of the children and their parents and increases the level of anxiety. Family physicians have important mission for prevention of the disease related with their biopsychoso­cial approach.

Association of Sleep Disordered Breathing with Mono-Symptomatic Nocturnal Enuresis: A Study among School Children of Central India.

ObjectiveTo study the prevalence of primary monosymptopomatic nocturnal enuresis (PMNE) in children aged 5–10 year and to find its association with sleep disordered breathing (SDB) by using a 22 item pediatric sleep related breathing disorder (SRBD) scale.MethodsThis was a school based cross sectional epidemiological study from July 2015 to November 2015. A questionnaire seeking information on socio-demographic variables, nocturnal enuresis (NE) frequency, school performance and a validated 22 item pediatric sleep related breathing disorder scale (SRBDs) was distributed to 1820 pupils in three primary schools.ResultsA total of 1528(83.95%) questionnaires were retrieved. Out of 1528 forms, 182(11.9%) forms were incomplete for requested information and hence 1346 (73.9%) questionnaires were finally analyzed. The prevalence of NE was found to be 12.7% (95% CI; 11–14.6), whereas prevalence of primary nocturnal enuresis (PMNE) was 8.2% (95% CI; 7.1–10.1). SRBD scale score >0.33 (adjusted OR: 2.87; 95%CI: 1.67–4.92), paternal history of enuresis in childhood (adjusted OR:4.96; 95% CI: 2.36–10.45), and inappropriate toilet training (adjusted OR: 1.64; 95% CI: 1.01–2.66) were independently associated with PMNE.ConclusionSleep disordered breathing, inappropriate toilet training and a history of childhood NE in father were found to be significant risk factors for PMNE in the present study. Thus, these findings suggest that it is imperative to rule out SDB in PMNE patients as they may require different therapeutic interventions.

Frequency of Enuresis and the Factors Associated with it in School-going Children of Karachi, Pakistan

Objective: This study was designed to spot the elegant of the frequency of enuresis and the factors associated with it in school going children Karachi, Pakistan. Study Design: Cross sectional study. Materials and Methods: Study Setting: Private and Public schools in the different areas of Karachi. School children from age 5 to 15 years. Calculated by using 9.1% prevalence with a maximum error of ±2% and a confidence interval of 99 %, the sample size was found out to be 1371.A total of 3000 questionnaires were distributed, of which only 1236 were returned. Thus, the response rate was 41.2%. Convenient sampling was adopted. Data for the study was collected from school children ages 5-15 years, interviewing their parents through a structured questionnaire regarding child’s height and weight, parents education and occupation, monthly income, presence or absence of enuresis, duration, associated complications, family history management. Results: The study showed frequency of enuresis 13.1%, in which males were 15.9%, while the females were 10.2%. The data collected from public (13.9%) and private (12.5%) sector. A significant relationship was found between the frequency of enuresis and the factors (i.e. age, gender, town, family history, co-morbidities, social behavior, BMI) after using x2 test. The data was entered and analyzed on SPSS 16.0v. Conclusion: This is a common disorder among school going children in Karachi and concern is present in parents and children both. The lack of knowledge and awareness is there, so that to educate the parent and children, awareness programs and campaigns should be organized.

Desmopressin versus Oxybutynin for Nocturnal Enuresis in Children in Bandar Abbas: A Randomized Clinical Trial

BackgroundNocturnal enuresis is among the most common disorders in children. Several pharmacological and non-pharmacological treatments are available for nocturnal enuresis. Studies for reaching the best pharmacological treatment for this disorder are continuing.ObjectiveTo compare the effectiveness and safety of Desmopressin and oxybutynin for treatment of nocturnal enuresis in children from Bandar Abbas in 2014.MethodsThis randomized controlled trial was conducted in 2014 and participants included 66 children with nocturnal enuresis who were more than 5 years old. Patients were randomly assigned into two groups. The first group received 120 microgram Desmopressin daily for 2 months, then 60 microgram daily for 2 months, then 60 microgram every 2 days. The second group received 5 mg oxybutynin twice a day for 6 months. The patients were followed after 1, 3, and 6 months to track treatment response. The study outcomes were frequency of nocturnal enuresis, urinary incontinency, urgency, and frequency. Data were analyzed using SPSS software.ResultsThere were no significant differences between the two groups with respects to sex, age, place of residence, and parents’ education (p<0.05). Nocturnal enuresis, incontinency, urgency, and frequency of nocturnal enuresis was significantly lower with Desmopressin treatment in comparison to the oxybutynin treated group after 1 and 3 months (p<0.05). In addition, constipation and xerostomia were more frequent among the oxybutynin group after 1, 3, and 6 months (p<0.01). Blurred vision was also more frequent among oxybutynin group after 3 months (p<0.01). After 6 months the frequency of nocturnal enuresis and its frequency was higher in oxybutynin group in comparison to the Desmopressin group (p<0.05).ConclusionDesmopressin is more effective and has lower rate of side effects in comparison to oxybutynin for treatment of nocturnal enuresis. We recommend using Desmopressin for treatment of nocturnal enuresis in children. More studies are needed to achieve the best pharmacological treatment option for treatment of nocturnal enuresis.Trial registrationThe trial is registered at ClinicalTrials.gov with a ClinicalTrials.gov Identifier: NCT02538302FundingThe funder of this research is Hormozgan University of Medical Sciences.

Noctural Enuresis as a Risk Factor for Falls in Older Community Dwelling Women with Urinary Incontinence

We determined the association of urinary symptoms with fall risk andphysical limitations in older community dwelling women with urinary incontinence. We performed an in-depth assessment of daytime and nighttime urinary symptoms, fall risk, physical function, physical performance tests and mental function in older community dwelling women with urinary incontinence who had not sought care for urinary symptoms. All assessments were performed in participant homes. We used univariable and multivariable linear regression to examine the relationship of urinary symptoms to fall risk,physical function and physical performance. Of 37 women with a mean ± SD age of 74 ± 8.4 years who had urinary incontinence 48% were at high risk for falls. Nocturnal enuresis was reported by 50% of the women. Increased fall risk was associated with increasing frequency of nocturnal enuresis (p = 0.04), worse lower limb function (p <0.001), worse upper limb function (p <0.0001) and worse performance on a composite physical performance test of strength, gait and balance (p = 0.02). Women with nocturnal enuresis had significantly lower physical performance test scores than women without nocturnal enuresis (median 7, range 0 to 11 vs 9, range 1 to 12, p = 0.04). In a multivariable regression model including age, nocturnal enuresis episodes and physical function only physical function was associated with an increased fall risk (p <0.0001). Nocturnal enuresis is common in older community dwelling women with urinary incontinence. It may serve as a marker of fall risk even in women who do not seek care for urinary symptoms. Interventions targeting upper andlower body physical function could potentially decrease the risk of falls in older women with urinary incontinence.

Commentary on “No effect of basic bladder advice in enuresis: A randomized controlled trial”

Cederblad et al. [1] are the first to report results of a randomized clinical trial (RCT) assessing whether the recommendation to initially treat all children suffering from nocturnal enuresis (NE) with basic bladder advice (BBA) can be supported by evidence. Forty children aged 6 years and older with primary untreated NE and without daytime incontinence were randomized to receive either first BBA during 1 month and then alarm therapy (AT) for 8 weeks, or only AT. Since BBA did not reduce enuresis frequency or the end results after the AT, the authors concluded that the recommendation to treat all children with BBA first cannot be supported and recommend to start with the AT or desmopressin as first-line treatment [1]. The research question was relevant and interesting. However, we feel that the conclusion cannot be supported because of important methodological flaws.

Efficacy of posterior tibial nerve stimulation in the treatment of children with primary mono-symptomatic nocturnal enuresis

Background/Aims: Primary monosymptomatic nocturnal enuresis is the most frequent (85%) type of enuresis in children. However, there is limited research on the effect of posterior tibial nerve stimulation on monosymptomatic nocturnal enuresis in children. This study investigated the effect of posterior tibial nerve stimulation on primary monosymptomatic nocturnal enuresis in children. Methods: This controlled exposure study was conducted using a pretest–posttest design between March and December 2014. Participants (n=80) were randomly distributed to two study groups (control and intervention) using block randomisation. Participants in the control group were given and instructed on how to use a bedwetting alarm in addition to medical treatment for 12 weeks, whereas participants in the intervention group received posterior tibial nerve stimulation in addition to medical treatment for 12 weeks. The frequency of nocturnal enuresis, maximum voided volume and quality of life were evaluated before and after treatment. Results: Comparative analysis between pre- and post-treatment data revealed significant differences in both groups across all measured variables (p&lt;0.05), with significant improvements in all three outcome measures found in the intervention group. Post-treatment, the intervention group demonstrated decreased frequency of nocturnal enuresis and improved maximum voided volume and quality of life. Conclusions: Posterior tibial nerve stimulation is an effective and safe approach for the treatment of primary monosymptomatic nocturnal enuresis and control of bedwetting in children.

A double-blind randomized clinical trial on the efficacy of magnetic sacral root stimulation for the treatment of Monosymptomatic Nocturnal Enuresis.

Purpose: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE). Methods: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions. Results: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group. Conclusion: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.

Rapid maxillary expansion in therapy-resistant enuretic children: An orthodontic perspective.

To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out. Thirty-four subjects, 29 boys and five girls with mean age of 10.7 ± 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the first-line antienuretic treatment and therefore were classified as "therapy resistant." To rule out a placebo effect of the RME appliance, all children were first treated with a passive appliance for 4 weeks. Rhinomanometry (RM), acoustic rhinometry (AR), polysomnographic registration, and study casts were made at different time points. One child experienced severe discomfort from the RME appliance and immediately withdrew from the study. Following RME, the long-term cure rate after 1 year was 60%. The RM and AR measurements at baseline and directly after RME showed a significant increase in nasal volume and nasal airflow, and there was a statistically significant correlation between reduction in enuresis and increase in nasal volume. Six months postretention, a 100% relapse of the dental overexpansion could be noted. RME has a curative effect in some children with NE, which could be connected to the positive influence of RME on the sleep architecture. Normal transverse occlusion does not seem to be a contraindication for moderate maxillary expansion in attempts to cure NE in children.

No effect of basic bladder advice in enuresis: A randomized controlled trial

There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis. To explore whether basic bladder advice has any effect against nocturnal enuresis. The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15. The basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy. This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy. The recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.