Monosymptomatic Nocturnal Enuresis In Children Research Articles

Are Vitamin D Levels Linked to Primary Monosymptomatic Nocturnal Enuresis in Children? Six Years of Experience about a Controversy in Medicine: A Case-control Study

Background: The relationship between vitamin D and primary monosymptomatic nocturnal enuresis (PMNE) is still controversial. Objectives: This study aimed to investigate the relationship between different vitamin D levels with the development and severity of PMNE. Methods: A case-control study of 534 children (267 children with PMNE as the case group and 267 healthy children without enuresis as the control group), aged 6 - 15 years old, was conducted in two tertiary primary care hospitals, Tehran, Iran, from 2015 to 2021. The participants' demographic characteristics and vitamin D status were evaluated in both groups. The relationship between vitamin D levels with enuresis and its severity was studied as the main outcome measures. Multiple logistic regression models were utilized for statistical analyses to assay the odds ratio at a confidence interval of 95%. In this study, P < 0.05 were set as the significance level. Results: Vitamin D levels significantly differed between the two groups (18.58 ± 9.83 ng/mL and 30.23 ± 10.62 ng/mL, respectively; P < 0.001). After adjusting for confounders, vitamin D was significantly associated with enuresis (< 20 ng/mL, OR 3.07, 95% CI 1.9 - 4.95, P = 0.0001; 20 - 30 ng/mL, OR 2.72, 95% CI 1.47 - 3.67, P = 0.0001). Adjusted OR with 95% CI concerning the history of parental enuresis was 15.03 (95% CI 1.88 - 19.6, P = 0.01). The prevalence of vitamin D deficiency and insufficiency in the PMNE subjects were 107 cases (40.1%) and 109 cases (40.8%), respectively, and the prevalence values in the control group were 57 cases (21.3%) and 71 cases (26.6%), respectively (P < 0.05). Furthermore, the participants with higher frequencies of bedwetting represented lower vitamin D levels (severe, 10.6 ± 1.23 ng/ mL; moderate, 19.46 ± 1.21 ng/mL; mild, 26.8 ± 2.61 ng/mL, P = 0.0001). Conclusions: According to the finding of this study, parental history, and the participants’ vitamin D status were significant risk factors for the PMNE development. Vitamin D levels were significantly lower in the PMNE children. The prevalence of vitamin D deficiency and insufficiency was significantly higher in the enuretic subjects. Children with higher frequencies of bedwetting represented lower vitamin D levels.

Further experience with fluoxetine for refractory primary monosymptomatic nocturnal enuresis in children: A prospective study

Further experience with fluoxetine for refractory primary monosymptomatic nocturnal enuresis in children: A prospective study

The Safety and Efficacy of Fluoxetine for the Treatment of Refractory Primary Monosymptomatic Nocturnal Enuresis in Children: A Randomized Placebo-Controlled Trial.

We investigated the efficacy and safety of fluoxetine, a selective serotonin reuptake inhibitor, for treating refractory primary monosymptomatic nocturnal enuresis in children. Children 8-18 years old with severe primary monosymptomatic nocturnal enuresis unresponsive to alarm therapy, desmopressin, and anticholinergics were screened for eligibility. After excluding children with daytime urinary symptoms, constipation, underlying urological, neuropsychiatric, endocrinological, or cardiac conditions, patients were randomly and equally assigned to 10 mg fluoxetine once daily or placebo for 12 weeks. The primary outcome was treatment response according to the International Children's Continence Society terminology. Treatment-related adverse effects and nighttime arousal were secondary outcomes. A total of 150 children were enrolled, of whom 110 (56 in fluoxetine group and 54 in placebo group) with a mean age of 11.8 (SD 2.46) years were finally analyzed. After 4 weeks, 7.1% and 66.1% of the fluoxetine group achieved complete response and partial response (defined as 50%-99% reduction of the number of wet nights), respectively, versus 0% and 16.7% of the placebo group (P < .001). At 12 weeks, complete and partial responses were achieved in 10.7% and 21.4% of the fluoxetine group, respectively (vs 0% and 14.8% of the placebo group, P = .023). Fluoxetine-treated patients had fewer wet nights (4.7 [SD 4.2] fortnightly vs 9.7 [SD 3.5] at 4 weeks, P < .001; 5.7 [SD 4.4] vs 9.9 [SD 3.4] at 8 weeks, P < .001; 7.5 [SD 4.6] vs 9.9 [SD 3.4] at 12 weeks, P = .003). Fluoxetine was associated with improved nighttime arousal (P = .017), and minor and rapidly reversible adverse effects in 5 (8.9%) patients. Fluoxetine is safe treatment for refractory primary monosymptomatic nocturnal enuresis in children with good initial response that declines at 12 weeks.

PD48-01 SAFETY AND EFFICACY OF FLUOXETINE, SELECTIVE SEROTONIN REUPTAKE INHIBITOR, FOR THE TREATMENT OF REFRACTORY PRIMARY MONOSYMPTOMATIC NOCTURNAL ENURESIS IN CHILDREN: A RANDOMIZED PLACEBO-CONTROLLED STUDY

You have accessJournal of UrologyCME1 May 2022PD48-01 SAFETY AND EFFICACY OF FLUOXETINE, SELECTIVE SEROTONIN REUPTAKE INHIBITOR, FOR THE TREATMENT OF REFRACTORY PRIMARY MONOSYMPTOMATIC NOCTURNAL ENURESIS IN CHILDREN: A RANDOMIZED PLACEBO-CONTROLLED STUDY Mohamed Hussiny, Ahmed Abdelhalim, Abdelwahab Hashem, Mohamed A. Soltan, Mahmoud R. El-Kenawy, and Tamer Helmy Mohamed HussinyMohamed Hussiny More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , Abdelwahab HashemAbdelwahab Hashem More articles by this author , Mohamed A. SoltanMohamed A. Soltan More articles by this author , Mahmoud R. El-KenawyMahmoud R. El-Kenawy More articles by this author , and Tamer HelmyTamer Helmy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nocturnal Enuresis (NE) is a common medical condition in children. It affects millions of children throughout the world and is associated with a significant negative impact on self-esteem and health-related Quality of life. Behavioral therapy, alarm treatment and desmopressin are first-line treatments. Treatment options for refractory NE are limited. This study aimed at investigating the efficacy and safety of fluoxetine for treatment of refractory primary monosymptomatic NE in children. METHODS: Children aged 8-18 years with primary monosymptomatic NE refractory to desmopressin treatment were screened for eligibility. Patients with daytime symptoms, constipation, underlying urologic, neurological, endocrinological, cardiac or psychiatric conditions were excluded. After sample size calculation, patients were randomly assigned to the fluoxetine (study) or placebo groups in a 1:1 ratio. Patients in the study group were maintained on 10 mg of fluoxetine once daily for 12 weeks. The primary study outcome was reduction in the number of wet nights at 4, 8 and 12 weeks of therapy. Patients with <50% reduction of wet nights were considered non-responders. Patients with 50-99% reduction of wet nights were considered partial responders (PR) and those with complete nighttime dryness were considered complete responders (CR). Treatment adverse effects were secondary outcomes. RESULTS: Between July 2020 and March 2021, a total of 120 children with a mean age of 11.8 +2.46 years were enrolled. Those who continued the follow up duration were 110 patients. a total of 56 children were assigned to the fluoxetine and 54 to the placebo groups. Baseline enuresis severity was similar between both study groups. After 4 weeks of therapy, 7.1% of fluoxetine group achieved CR and 66.1% achieved PR (versus 0% and 16.7% of placebo, respectively; p <0.001). The response rate declined at 12 weeks of therapy with CR achieved in 10.7% and PR in 21.4% of the fluoxetine group (versus 0% and 14.8% of the placebo, respectively; p=0.023). Fluoxetine treatment was discontinued before the planned study duration in 4 patients of the fluoxetine group due to treatment-related adverse effects (dizziness in two patients, mood changes in one and hypersensitivity in another). CONCLUSIONS: Fluoxetine achieves good initial response in patients with primary refractory monosymptomatic nocturnal enuresis. However, the response rate declines significantly at 12 weeks of therapy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e799 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Hussiny More articles by this author Ahmed Abdelhalim More articles by this author Abdelwahab Hashem More articles by this author Mohamed A. Soltan More articles by this author Mahmoud R. El-Kenawy More articles by this author Tamer Helmy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Primary Monosymptomatic Nocturnal Enuresis in Children and Correlation with Sleep Disorders in Arak, Iran

Background: Nocturnal enuresis is a symptom defined as enuresis in children with higher than 5 years of age that might have mutual connection to sleep disturbances. This condition might be a stressful factor for children and their families. Objectives: This study aimed to find the correlation between primary monosymptomatic nocturnal enuresis (PMNE), as a stressful factor and sleep disorders. Methods: This case-control study was conducted on 132 children, including 66 children with nocturnal enuresis as the case group and 66 healthy children as the control group. The two groups were homogenous in age, gender, and other demographic characteristics. The organized sleep disorder questionnaire based on sleep disorder diagnostic criteria (using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) was used in this study. The correlation between PMNE and sleep disorders was investigated based on the chi-square test on SPSS software (version 23). Results: The mean scores of the subjects with sleep disorders in the control and case groups were 0.38 ± 0.78 and 2.24 ± 1.73, respectively. Therefore, there were significant differences between the two groups in sleep disorders (P = 0.001). In addition, primary insomnia, hypersomnia, circadian sleep rhythm, and sleep terror disorders in the case group were higher than the control group (P = 0.001). Conclusions: The PMNE has been defined as a risk factor for sleep disorders.

Body-Worn Versus Bell-and-Pad Alarm Device for the Management of Monosymptomatic Nocturnal Enuresis in Children: A Randomized Controlled Trial.

The purpose of this study was to compare the effectiveness of bell-and-pad alarm therapy to body-worn alarm therapy for the management of monosymptomatic enuresis in children 6 to 16 years of age. A prospective, randomized, adaptive clinical control trial. The sample comprised 86 children who attended a continence clinic for treatment of monosymptomatic enuresis and met the criteria for enuresis alarm therapy as per International Children's Continence Society (ICCS) guidelines. Subjects were randomly allocated to an experimental group (body-worn alarm, n = 41) or a control group (bell-and-pad alarm, n = 45). The study setting was a single-site specialist continence service in regional Victoria, Australia. Treatment was administered in the child's home. Alarm therapy was administered by the child and/or parent for an initial period of 8 weeks at which time the child underwent a review with the continence nurse specialist. If the child had achieved 14 consecutive dry nights, the therapy was deemed successful and ceased. Children who had not become dry continued therapy for a further 8 weeks up to a maximum of 16 weeks, with a final review was instituted. Each child kept a diary for the duration of alarm therapy to report on frequency of wet/dry nights, times of alarm, response to alarm, and response to sensation to void (without alarm). The 2 types of alarm devices were compared with respect to categorical variables using dichotomous cross-tabulations and χ tests of independence based on the most positive outcome versus the other outcomes. Dryness in accordance with the criteria outlined by the ICCS guidelines was achieved in 18 children (43.9%) in the body-worn alarm group versus 29 children (64.4%) in the routine (bell-and-pad) group (P = .056). The bell-and-pad alarm performed better on 7 out of the 9 indicators, including the primary outcome measure of the child attained dryness for 14 nights or more, nightly alarm use, alarm woke child, alarm woke parent (P = .022), false (positive) alarms (P = .039), child turned alarm off and went back to sleep (P = .003), and child was compliant with alarm use. The body-worn device produced higher proportions of the most positive outcomes for 2 of the 9 indicators: relapse (P = .076) and false (negative) nonalarms (P = .066). Study findings suggests that the bell-and-pad alarm is preferable to the body-worn alarm. Additional research is recommended using other body-worn alarm devices across a larger population in order to establish the more definitive findings needed for clinical decision-making.

Re: Efficacy of the novel selective β3‐adrenoreceptor agonist vibegron for treatment‐resistant monosymptomatic nocturnal enuresis in children

Re: Efficacy of the novel selective β3‐adrenoreceptor agonist vibegron for treatment‐resistant monosymptomatic nocturnal enuresis in children

Efficacy of the novel selective β3-adrenoreceptor agonist vibegron for treatment-resistant monosymptomatic nocturnal enuresis in children.

Efficacy of the novel selective β3-adrenoreceptor agonist vibegron for treatment-resistant monosymptomatic nocturnal enuresis in children.

Study on neuropathological mechanisms of primary monosymptomatic nocturnal enuresis in children using cerebral resting-state functional magnetic resonance imaging

Primary monosymptomatic nocturnal enuresis (PMNE) is a heterogeneous disorder, which remains a difficult condition to manage due to lack of knowledge on the underlying pathophysiological mechanisms. Here we investigated the underlying neuropathological mechanisms of PMNE with functional MRI (fMRI), combining the amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and seed-based functional connectivity (seed-based FC) analyses. Compared to the control group, PMNE group showed decreased ALFF value in the left medial orbital superior frontal gyrus (Frontal_Med_Orb_L), and increased ReHo value in the left superior occipital gyrus (Occipital_Sup_L). With left thalamus as the seed, PMNE group showed significantly decreased functional connectivity to the left medial superior frontal gyrus (Frontal_Sup_Medial_L). We conclude that these abnormal brain activities are probably important neuropathological mechanisms of PMNE in children. Furthermore, this study facilitated the understanding of underlying pathogenesis of PMNE and may provide an objective basis for the effective treatment.

Analyzing the Relationship Between Addiction to Video Gaming and Primary Monosymptomatic Nocturnal Enuresis in Children

Background: Nocturnal enuresis is defined as urinary incontinence in children more than five years of age, who are adequately mature to achieve continence of urination. Objectives: Aim of this was to study children with primary mono-symptomatic nocturnal enuresis in regards to video gaming addiction. Methods: In total, 200 children, 100 healthy children as the control group and 100 children with primary mono-symptomatic nocturnal enuresis as the case group, were evaluated. Epidemiologic, video gaming, and nocturnal enuresis information were collected and analyzed by the SPSS software, and significant differences (P < 0.05) were considered. Results: Children with primary monosymptomatic nocturnal enuresis were more prone to video gaming addiction compared with healthy children (P < 0.0001). Conclusions: Video gaming addiction has a significant impact on primary monosymptomatic nocturnal, thus control of stressful factors, instead of pharmacotherapy, can reduce this condition as a symptom.

Can Seasons be an Etiologic Factor for Monosymptomatic Nocturnal Enuresis?

IntroductionPrimary nocturnal enuresis is the most frequent urinary system complaint among pediatric patients. Material and MethodsData compiled from 5,500 children, aged between five to 16 years, diagnosed with enuresis during the period from January 2010 to December 2015 were analyzed. The inclusion criteria were having a diagnosis of monosymptomatic nocturnal enuresis, a birth date known for certain, and complete family history taken. A total of 3,547 children met the inclusion criteria and were included in the study. The study was performed by retrospective analyses. ResultsAnalysis of the results revealed a statistically significant difference among the rates of enuresis with respect to months and seasons (p < 0.001). In our study, we retrospectively reevaluated 3,500 patients for their birth dates and determined a statistically significant difference in the rates of nocturnal enuresis with respect to seasons (p < 0.001). ConclusionAs a result of this study, we determined that monosymptomatic nocturnal enuresis in children is more frequent, particularly in those born during the summer months.

The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children.

This study evaluated the necessity of examining the upper airway in children with nocturnal enuresis. 225 children (aged 5-16years), who were referred from the urology outpatient clinic between May 2015 and May 2016 and who had completed toilet training, were included in this study. Participants were separated into monosymptomatic nocturnal enuresis (MNE) (group 1) and without MNE (group 2) groups. Tonsil hypertrophy, adenoid vegetation, septal deviation, turbinate hypertrophy, allergic rhinitis, upper airway obstruction, and snoring etiology were assessed. In total, 112 children with MNE (group 1) participated in addition to 113 children selected randomly without MNE (group 2). Adenoid score (p=0.016), septal deviation (p=0.017), and snoring (p=0.007) were significantly different between the groups. No differences in tonsil score (p=0.618), turbinate hypertrophy (p=0.424), and allergic rhinitis (p=0.544) were detected between the groups. Possible causes of upper airway obstruction and snoring which is a symptom of obstructive sleep-disordered breathing in the pediatric population, including adenoid hypertrophy and septal deviation, should be considered as possible etiological factors in children with MNE.

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.

Evaluation of bladder capacity in children with lower urinary tract symptoms: Comparison of 48-hour frequency/volume charts and uroflowmetry measurements

Objective evaluation of bladder capacity (BC) in children with lower urinary tract symptoms (LUTS) is important for recognizing types of bladder dysfunction. Bladder capacity is evaluated from 48-hour frequency/volume (48-h F/V) charts or by uroflowmetry with ultrasound post-void assessment. There are limited data on the reliability of both methods of assessment in children. The aim of the study was to compare two modalities of assessment, (F/V chart and uroflowmetry) in cohorts of children with bladder dysfunctions. Maximum bladder capacity (MBC) obtained from 48-h F/V charts was compared with volumes calculated from uroflowmetry in a cohort of 86 children with different bladder dysfunctions. The BC obtained by the two modalities was compared for the three most frequent subtypes of bladder dysfunction: monosymptomatic nocturnal enuresis (MNE), overactive bladder (OAB), and dysfunctional voiding (DV). Considering a 48-h F/V chart as standard, the sensitivity, specificity, negative and positive predictive values of uroflowmetry measurements were calculated for detecting low bladder capacity. The mean maximal bladder capacity (188±99.42ml) obtained from home 48-h F/V chart measurement was 17ml lower than the mean value obtained from uroflowmetry (205±112.11ml) (P=0.58). The differences between bladder capacities estimated by 48-h F/V chart and uroflowmetry for subjects were not significant (Figure). Concordance between 48-h F/V chart and uroflowmetry categorization of BC was present in 64 (74%) subjects. The sensitivity and specificity of uroflowmetry, in comparison with 48-h F/V chart evaluation, for recognizing low bladder capacity were 75.5% and 73.17%. The sensitivity and specificity for the different types of LUTS achieved 68.42% and 58.83% for OAB, 80% and 83% for MNE, and 50% and 83.3% for DV. According to the International Children's Continence Society, the management of MNE in children can be made without uroflowmetry. History and MBC evaluation by 48-h F/V charts yields sufficient information. Nevertheless, in situations where F/V charts are unreliable or unavailable, uroflowmetry can be used as an alternative method. The highest discrepancy between both methods of BC evaluation was found in DV; this was mainly due to the mean PVR of 31ml. For children with MNE, both 48-hour frequency/volume charts and triplicate urine flow measurement with PVR evaluation are reliable methods of maximum bladder capacity evaluation. For children with OAB or DV, both methods may be necessary for accurate evaluation of decreased BC, as F/V chart and uroflow results may not be comparable.

Advances in the management of primary monosymptomatic nocturnal enuresis in children

Advances in the management of primary monosymptomatic nocturnal enuresis in children

Advances in the management of primary monosymptomatic nocturnal enuresis in children

Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.

Efficacy of alarm intervention in primary monosymptomatic nocturnal enuresis in children

Background: Enuresis affects about 15 to 20% of five year old children, and even up to 2% of young adults. The various treatment modalities used are behavioural therapy, alarm intervention and pharmacological therapy. Current evidences suggest that alarm intervention is preferable to other modalities of treatment. So a study was done to assess the efficacy of alarm interventions in primary monosymptomatic nocturnal enuresis in children. Methods: A prospective study was done on children aged between 5-18 years with primary monosymptomatic nocturnal enuresis on a total of 62 children. An enuresis diary was maintained by parents. All children received alarm intervention for 12 weeks. A child remaining dry for two consecutive weeks was taken as a success. The subjects were followed up for 12 weeks, two or more wet night in 2 weeks period were taken as relapse. If child failed to become dry after 12 weeks of alarm intervention, intervention was continued for maximum of 6 months or till he became dry. Results: Out of 62 children, majority were males and in the age group of 5-7 years. Family history of enuresis was present in 30.65% of children. A total of 74.19 % of subjects achieved dryness while failures were 25.8% and relapse was seen in 23.91 % during follow up. Significant improvement was noticed as early as 2 months after alarm intervention (p 0.00499) but maximum improvement was seen after 5 months (20 week). On follow up 23.91 % children had relapsed but the frequency of wet nights among these also was significantly low (mean wet nights 0.08/week). Even among failures there was a significant decrease in mean number of wet nights (from 4.24 wet nights/week to 1.85 wet nights/week). Conclusions: Alarm treatment was an effective intervention for management of primary monosymptomatic nocturnal enuresis with high success and low relapse rate.

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.

Comparison between imipramine and imipramine combined with pseudoephedrine in 5–12-year-old children with uncomplicated enuresis: A double-blind clinical trial

Monosymptomatic nocturnal enuresis is a common entity, with a prevalence of 10% at the age of 7 years. For its primary treatment, we compared the effect of combination medical therapy (imipramine with pseudoephedrine) with imipramine alone. In this one-center prospective double-blind clinical trial, 100 school-age children (age range 5-12 years) were enrolled. They were divided into two groups, comparable in terms of age and other demographic factors: (A) adjusted doses of a combination of imipramine with pseudoephedrine, and (B) imipramine with placebo were administered. Improvement was defined as less than 2 wet nights per week. Four weeks after drug withdrawal, the response rate was 74% in group A in comparison to 52% in group B, this difference being statistically significant. There was a recurrence of enuresis in both groups during the 4 weeks after treatment was discontinued (10% increase in group A and 8% increase in group B). The additive pharmacologic effects of imipramine with pseudoephedrine for the treatment of monosymptomatic nocturnal enuresis in children were well tolerated, and gave significantly faster results than single drug therapy using imipramine. The moderate-to-high recurrence rate following discontinuation of medical treatment indicates the need for a longer term study involving more cases.

Primary monosymptomatic nocturnal enuresis in children and adolescents

Nocturnal enuresis (NE) is one of the most frequent paediatric pathologies. The prevalence of primary nocturnal enuresis (PNE) is around 9% in children between 5 and 10 years of age and about 40% of them have one or more episodes per week. Still for too long, PNE has not been recognised as a pathological condition, particularly by the medical community; as a consequence, there was no specific education at medical school, and a poor involvement by the practitioners. Enuretic children have a sense of social difference and isolation; some of them do express a low self-esteem. Also, self-esteem is improved by the management NE even if this management fails to cure the condition. Primary monosymptomatic nocturnal enuresis (PMNE) is an heterogeneous condition for which various causative factors have been identified such as: nocturnal polyuria, sleep disturbances, reduced bladder capacity or bladder dysfunction, upper airway obstruction. The positive diagnosis of PMNE is based on a complete questionnaire and a careful physical examination. A drinking and voiding chart is an essential non-invasive tool: first, to collect information about the initial drinking and voiding habits of the child, then to reassess the accuracy of the diagnosis. Only motivated patients should receive a specific treatment for their NE and the treatment should be proposed based on the type of PMNE. PMNE associated with nocturnal polyuria should be treated with desmopressin, which reduces nighttime urine production. For PMNE with a reduced bladder capacity alarms should be the first-line treatment. Oxybutinin, a drug with anticholinergic properties, is not theoretically indicated for the treatment of PMNE except for a very small subgroup of patients who have an overactive bladder only during sleep. In cases refractory to monotherapy, NE is probably the result of an association of different physiopathological factors (e.g. both a nocturnal polyuria together with a small bladder capacity) some of them are still unknown. In these patients, a combination of treatments may be more effective than monotherapy. Various combination therapies can be proposed to improve the cure rates.