Monosymptomatic Nocturnal Enuresis Research Articles

Discontinuing absorbent pants in children with bedwetting: a randomized controlled trial

The objective of this study is to examine the effect of discontinuing wearing protective garments (absorbent pyjama pants — APP) in children with severe childhood nocturnal enuresis (NE). The study employs a multicenter, parallel, randomized controlled trial. Following a 4-week run-in period, participants were randomly allocated in a 2:1 group allocation to discontinue or continue using APP. The research was conducted across seven European pediatric incontinence centers. The study included treatment-naïve children aged 4–8 years with severe (7/7 wet nights per week) mono-symptomatic NE, who had used nighttime protection for at least 6 months prior to the study. The study consisted of a 4-week run-in period (± 7 days), where all children slept wearing APP (DryNites®). At week 4 (± 7 days), if meeting randomization criteria (7/7 wet nights during the last week of run-in), participants were randomized to continue to sleep in APP or to discontinue their use for a further 4 weeks, with the option of another 4 weeks in the extension period. The primary outcome was the difference between groups of wet nights during the last week of intervention. Quality of life (QoL) and sleep were secondary endpoints. In total, 105 children (43 girls and 62 boys, mean age 5.6 years [SD 1.13]) were randomized (no-pants group n = 70, pants group n = 35). Fifteen children (21%) in the no-pants group discontinued early due to stress related to the intervention. Children in the no-pants group experienced fewer wet nights compared to the pants group during the last week (difference 2.3 nights, 95% CI 1.54–3.08; p < 0.0001). In the no-pants group, 20% responded to the intervention, of whom 13% had a full response. Clinical improvement was detected within 2 weeks. Sleep and QoL were reported as negatively affected by APP discontinuation in the extension period but not in the core period.    Conclusion: A ~ 10% complete resolution rate was associated with discontinuing APP. While statistically significant, the clinical relevance is debatable, and the intervention should be tried only if the family is motivated. Response was detectable within 2 weeks. Discontinuing APP for 4–8 weeks was reported to negatively affect QoL and sleep quality. No severe side effects were seen.Trial registration: Clinicaltrials.gov Identifier: NCT04620356; date registered: September 23, 2020. Registered under the name: “Effect of Use of DryNites Absorbent Pyjama Pants on the Rate of Spontaneous Resolution of Paediatric Nocturnal Enuresis (NE).”What is Known?• APP has been hypothesized to delay time until spontaneous resolution of bedwetting, but no prospective randomized evidence is available regarding if APP use sustains symptoms.• No evidence whether discontinuation of APP can lead to dryness or impact sleep quality and QoL.What is New?• Thirteen percent became dry after removing APP for up to 8 weeks and initial response was detectable within 2 weeks.• Even though  prolonged discontinuation was reported to lead to sleep disturbances and rediced QoL, still our results suggest trying 2 weeks of the intervention if the family is motivated, prior to engaging established treatments for nocturnal enuresis.

Association of Overweight and Obesity with Monosymptomatic Nocturnal Enuresis in 5-15 Years Old Children

Background: Monosymptomatic nocturnal enuresis (MNE) has increasingly been reported as a challenging issue for families and children due to its impact on the psychological aspects of children and on reducing their concentration at school the next day. Obesity might serve as a risk factor for voiding dysfunction in children. Our study aimed to evaluate the relationship between excess body mass index (BMI) in children and MNE. Methods and Results: This case-control study included 60 children diagnosed with MNE (the main group [MG]) and 60 children without MNE (the control group [CG]) aged 5-15 years. Proper matching between the two groups concerning age and sex was adopted. Age, weight, family history, and complete medical history were recorded for each participant. In the MG, 18(30%) children had excess BMI, and 42(70%) had normal BMI. In contrast, 9(15%) children in the CG had excess BMI, and 51(85%) children had normal BMI, indicating a statistically significant association between increased BMI and MNE (P=0.049). The frequency of positive family history was significantly higher among the MG than the CG (P=0.0001). The findings of this study showed no significant relationship between gender and a family history of enuresis with excess BMI in children with MNE (P=0.679 and P=0.234, respectively). Conclusion: Obesity and overweight in children have an influence on the development of MNE.

Bed Wetter: An Upset 9 Y Old Boy with Primary Mono symptomatic Nocturnal Enuresis

Background: Bed wetting or nocturnal enuresis is seen in 15% of children over 5 Yr. it is primary in 75-90% of cases and the monosymptomatic enuresis is more common and should be estimated after ruling out other symptoms. In here we report a case of a 9-year-old boy who referred with a permanent primary monosymptomatic nocturnal enuresis and he was quite upset and had a tired and unhappy family. Case Presentation: This is a clinical combined therapy case study. A 9-year-old boy was referred with a chief complaint of bed wetting, which was primary and monosymptomatic, but because of experiencing of wrong incomplete period of treatments, they were disappointed. He had tried one or two drugs each time. In this approach I put him under simultaneous given multifaceted treatment, include education and advises, motivational therapies, conditional therapy, and pharmacotherapies. And this situation revealed a faster and also more persistent result and this motivated the child and his family to complete the treatment course (for 4 months) without any relapse after completion this period. Conclusion: Our study shows that nocturnal enuresis, even primary monosymptomatic types, which are most common types of enuresis may need multi-faceted treatment to make child calm and his family comfort.

Alarm therapy for nocturnal enuresis in children: A literature review

AbstractNocturnal enuresis is a common childhood problem impacting the quality of life of children and families. Treatment with an enuresis alarm is recommended for 8–12 weeks by the International Children's Continence Society as first line management of monosymptomatic nocturnal enuresis. However, the effectiveness of alarm therapy varies between 80% and 45.9%. There is minimal evidence within the literature exploring the factors impacting this varying response to alarm therapy. Therefore, this literature review aims to explore factors that impact the effectiveness of the enuresis alarm as a treatment for nocturnal enuresis, in children aged 5–17 years. Literature searches were conducted on MEDLINE (Ovid), SCOPUS and CINAHL Databases. The PRISMA tool was used to report the data in the search strategy. The inclusion criteria of children aged 5 to 17 years was chosen based on International Children's Continence Society Guidelines. English language, academic journals and studies in the past 10 years were selected as additional inclusion criterion to identify the most recent, robust literature for the review. All 13 primary research articles were critiqued using the Caldwell Framework. Data were extracted and presented in table format highlighting study methodology, sample, duration of treatment, relevance to review topic and key findings. The findings highlight factors influencing the effectiveness of alarm therapy related to the impact on the child and family, heighten arousal to the alarm, the duration of therapy, age of child and the impact of overlearning. This review provides health professionals with an insight into strategies that may help children and their family to respond successfully to enuresis alarm treatment.

Allergy as a potential aetiology of micturition disorders in children

Introduction: In the paediatric population, the co-occurrence of micturition disorders with allergic diseases is often observed. The aim of this study was to demonstrate whether allergic aetiology may be a potential cause of micturition disorders in children. Materials and methods: The study included 69 children who were divided into two main cohorts: patients with and without voiding disorders. Among them, subgroups of children with allergies and children without allergic reactions were distinguished. In all patients, the absolute and percentage content of eosinophils in the blood and selected immune parameters were assessed. The usefulness of minimally invasive diagnostic methods in the diagnosis of allergic aetiology of micturition disorders in children was also evaluated. Results: It was shown that in the cohort of patients with voiding disorders, monosymptomatic nocturnal enuresis occurred statistically more commonly in the group of children with atopy compared to the children without atopy. There were no statistically significant differences between the groups in terms of the percentage values of immune parameters. It was found that urine cytology and urethral swab were not helpful tools in assessing allergic reactions in the bladder. Conclusions: The results of the study indicate that monosymptomatic nocturnal enuresis co-occurs with allergy significantly more often than with other types of voiding disorders. The importance of urine cytology and urethral smear for the presence of eosinophils in demonstrating the allergic aetiology of micturition disorders in children was not confirmed.

Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center.

To identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis. A total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5-18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non-MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients. Detrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2-75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively). There was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.

Examination of posture and balance in children with primary monosymptomatic nocturnal enuresis.

This study aimed to examine symptom severity, posture, and balance of children with primary monosymptomatic nocturnal enuresis (PMNE) and compare to a healthy control group. Thirty-five children with PMNE and 34 healthy children were included in this study. Physical and sociodemographic characteristics of the children were recorded. Symptom severity was assessed with a Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES), a four-day bladder diary and a seven-day bowel diary. Standing postural alignment was assessed with the Spinal Mouse device, and the sensory integration of static balance and dynamic standing balance was assessed with the Biodex Balance System SD. Compared to healthy controls, children with PMNE demonstrated increased symptom severity (p = 0.001), increased upright lumbar lordosis (p = 0.018) and sacral-hip angles (p = 0.029), decreased static balance in the sensory condition of unstable surface with eyes closed (p = 0.001), and decreased mediolateral dynamic balance (p = 0.049). Children with PMNE demonstrate altered postural alignment, static and dynamic postural instability, and greater symptom severity on the Vancouver NLUTD/DES than age-matched controls.

Nocturnal Bladder Function and Sleep in the Children with Refractory Nocturnal Enuresis: A Prospective Study

To prospectively investigate the nocturnal bladder function and sleep in children with refractory primary monosymptomatic nocturnal enuresis (RPMNE). Fifty-three children diagnosed with RPMNE and 30 controls who had upper urinary tract abnormality but without any voiding problems were included in the study. RPMNE patients underwent a standardized investigation protocol, including the Pittsburgh Sleep Quality Index (PSQI) questionnaire, a 7-day bladder diary, and the simultaneous ambulatory urodynamic monitoring and polysomnography (PSG); controls were evaluated using the PSQI questionnaire and PSG. The children with RPMNE were subdivided into the nocturnal detrusor overactivity (NDO) case group and the non-NDO case group. The children in the NDO case group had a higher percentage of total sleep time in light sleep and a lower percentage in the N3 sleep stage than those in the non-NDO case group and control group (P<.05). The cortical arousal index and PSQI scores of both RPMNE subgroups were higher compared to the control group (P<.05). The incidences of reduced nocturnal bladder capacity (NBC) in the NDO case group were higher than in the non-NDO case group (P<.05). The frequency of involuntary detrusor contractions during sleep was positively correlated with cortical arousal index in the NDO case group (r=0.811, P<.0001). In addition to the reduced NBC, the RPMNE is related to abnormal NDO, increased light sleep period, and cortical arousal dysfunction. Moreover, there is a certain correlation between the abnormal degrees of NDO and cortical arousal dysfunction.

Effect of Multidisciplinary Assessment on Paediatric Patients with Monosymptomatic Nocturnal Enuresis.

This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE.

Comparison between Levels of Vitamin D in Primary Mono-Symptomatic Nocturnal Enuresis and Non-Enuretic Children

Background Enuresis (synonymous with intermittent nocturnal incontinence) refers to discrete episodes of urinary incontinence during sleep in children 25 years of age. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. The pathogenesis of PE is similar to that of SE. Aim of the Study To compare between the levels of Vitamin D - as an important factor in growth and development - in primary monosymptomatic enuretic and non-enuretic children. Patients and Methods This is a case control study was performed in Ain Shams University Hospitals, Damanhour National Medical Institute. The study started on February 2020. The study included 60 children with primary mono-symptomatic nocturnal enuresis selected randomly and 60 healthy children age and sex matched children as a control group. Results We found that 61.7% of cases in the NE group had low Vit.D level (&amp;lt;20ng/ml) compared with 40% in the control group and this difference is statistically significant Conclusion Our study indicates that there • is a significant relationship between primary monosymptomatic nocturnal enuresis and serum vitamin D deficiency.

At-home use of parasacral transcutaneous electrical nerve stimulation for pediatric voiding dysfunction: a randomized controlled trial to assess its safety and feasibility.

Treating pediatric voiding dysfunction involves behavioral changes that require significant time or medications that are often avoided or discontinued due to side effects. Using parasacral transcutaneous electrical nerve stimulation (PTENS) has shown to have reasonable efficacy, but the safety and feasibility of its off-label use for pediatric voiding dysfunction are not well-established. Concerns have also been raised over treatment adherence. In-home therapy might improve adherence compared with office-based therapy; however, no studies have evaluated in-home feasibility to date. This study aims to assess the safety and feasibility of off-label use of PTENS for pediatric voiding dysfunction. A single-institution prospective, randomized controlled study was conducted from March 2019 to March 2020. Participants aged 6-18 years diagnosed with voiding dysfunction, overactive bladder, or urinary incontinence were eligible for the study. Those with known neurologic disorders, implanted electrical devices, anatomic lower urinary tract abnormality, and recurrent urinary tract infections and those taking bladder medications were excluded. Children with primary monosymptomatic nocturnal enuresis were also excluded due to previous work suggesting a lack of efficacy. Participants were randomly assigned to receive 12 weeks of urotherapy alone (control) or urotherapy plus at-home PTENS treatment. Families were contacted weekly to assess for adverse events (AEs) and treatment adherence. The primary and secondary outcomes were safety, defined as the absence of AEs and treatment adherence, respectively. A total of 30 eligible participants were divided into two groups, with 15 participants in each arm. The median age was 9.4 years (interquartile range: 7.7-10.6). In total, 60% were male. Baseline demographics and urotherapy compliance were similar between the two groups. With PTENS use, two AEs were reported, including mild pruritus at the pad site and discomfort when removing pads, while no AEs were noted in the control group. In total, 60% of patients completed three 30-min sessions per week, and all participants were able to complete treatment sessions for at least 10 weeks, involving 30 min of PTENS treatment each time. This randomized controlled study confirms that at-home use of PTENS is feasible with reasonable treatment adherence and minimal AEs. Future collaborative, multi-institutional studies may better determine the efficacy of this treatment modality.

Self-guided Online Medical Hypnosis Program Improves Dry Nights in Children With Nocturnal Enuresis in a Prospective Single-Center Pilot Study.

Bedwetting is a common condition in children. We evaluated the effectiveness of medical hypnosis as a first-line therapy in children with primary monosymptomatic nocturnal enuresis (PMNE). The study enrolled children in a prospective single-center pilot clinical trial consisting of 1 month diary of dry nights prior to using the commercially available hypnosis intervention (www.keepingthebeddry.com), followed by 3 consecutive months diary following intervention. Seventeen children aged 8 to 15 years old were enrolled and 12 recorded at least 1 month data after the hypnosis intervention. The median dry nights prior to intervention was 8 (0-17) days and improved to 15.5 (7-28) days by the third month post-intervention (P = .0033). All patients who completed the study showed an improvement. Self-guided medical hypnosis therapy showed significant improvement in dry nights without any side effects and any identifiable risk to patients. It should be considered for use in children as first-line therapy for PMNE.

AN INVESTIGATION OF THE RELATIONSHIP BETWEEN THE QUALITY OF LIFE OF THE CHILD PATIENT AND THE PARENT AFTER DESMOPRESSIN TREATMENT IN CHILDREN WITH PRIMARY NOCTURNAL ENURESIS

Our study aimed to assess the quality of life of both children with monosymptomatic enuresis and their parents during the enuresis period and through the process of cessation with desmopressin treatment. Materials and methods: The study assessed 78 children aged 6-18 with Monosymptomatic Nocturnal Enuresis (MEN) treated with desmopressin. Comprehensive evaluations, including physical exams and lab tests, were conducted. The surveys on the impact of enuresis on daily life and emotional well-being were evaluated. Results: The study observed 78 patients, averaging 10.6 years old, primarily treated for urinary incontinence with desmopressin. Patient demographics indicated 68% had education below high school, 74% were Turkish, and 26% Syrian. Familial data revealed an average of 3.87 siblings per patient. Key findings included a significant reduction in the number of incontinence days per week post-treatment (from 5.09 days to 2.59 days). Quality of Life (QOL) scores for both patients and parents showed significant improvement after treatment. The mean QOL for patients increased from 20 to 26.8, while for parents, it rose from 13 to 24.6. Overall, desmopressin demonstrated a positive impact on urinary incontinence and the associated quality of life. Conclusions: With treatment, there is a noticeable improvement in psychological, social, and emotional aspects among children with MEN and their parents. Therefore, it is essential to treat children experiencing MEN.

Parasacral transcutaneous electrical neural stimulation versusurotherapy in primary monosymptomatic enuresis: A prospective randomized clinical trial.

To evaluate the clinical response of parasacral transcutaneous electrical neural stimulation (parasacral TENS) associated with urotherapy in children with primary monosymptomatic nocturnal enuresis(PMNE) compared to urotherapy alone. This prospective controlled clinical trial enrolled 72 children over 5 years of age with PMNE. Children were randomly divided into twogroups, control group (CG), treated with urotherapy and scapular stimulation, and experimental group (EG), treated with urotherapy and parasacral TENS. In both groups, 20 sessions were performed, 3 times weekly, for 20 min each, with 10 Hz frequency, 700 μS pulse width and intesity determinated by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4), and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for threeconsecutive months. Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 36%, at T1 49%, at T2 54%, at T3 54%, at T4 54%, and 57% at T5; while in CG, these percentages were 28%, 39%, 37%, 35%, 36%, and 36%, respectively. Parasacral TENS associated with urotherapy improves the percentage of dry nights in children with PMNE, although no patient had complete resolution of symptoms in this study.

Differences in the urinary metabolome and proteome between wet and dry nights in children with monosymptomatic nocturnal enuresis and nocturnal polyuria.

Nocturnal enuresis (NE) is a common disease with multiple pathogenic mechanisms. This study aimed to compare levels of metabolites and proteins between wet and dry nights in urine samples from children with monosymptomatic NE (MNE). Ten boys with MNE and nocturnal polyuria (age: 7.6 ± 1.3 years) collected their total nighttime urine production during a wet and a dry night. Untargeted metabolomics and proteomics were performed on the urine samples by liquid chromatography coupled with high-mass accuracy tandem mass spectrometry (LC-MS/MS). On wet nights, we found reduced urine osmolality (P = 0.025) and increased excretion of urinary potassium and sodium by a factor of, respectively, 2.1 (P = 0.038) and 1.9 (P = 0.19) compared with dry nights. LC-MS identified 59 metabolites and 84 proteins with significantly different levels between wet and dry nights (fold change (FC) < 0.67 or > 1.5, P < 0.05). Some compounds were validated by different methodologies. During wet nights, levels of compounds related to oxidative stress and blood pressure, including adrenalin, were increased. We found reduced levels of aquaporin-2 on wet nights. The FCs in the 59 metabolites were positively correlated to the FCs in the same metabolites identified in urine samples obtained during the evening preceding wet and dry nights. Oxidative stress, which in the literature has been associated with nocturia and disturbances in sleep, might be increased during wet nights in children with MNE. We further found evidence of increased sympathetic activity. The mechanisms related to having wet nights in children with MNE seem complex, and both free water and solute handling appear to be important. A higher resolution version of the Graphical abstract is available as Supplementary information.

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 &lt; 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 &lt; 0.001). After adjusting for confounders, vitamin D was significantly associated with enuresis (&lt; 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 &lt; 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.

The Relationship Between Copeptin Level and Enuresis in Children Aged 5 - 15 Years

Background: Enuresis is bedwetting that occurs during sleep in children over five years old. If left untreated, it can lead to social and psychological problems for children and their parents. The role of copeptin in patients with primary monosymptomatic nocturnal enuresis (PMNE) has been reported in several studies. Due to the favorable structural properties of copeptin and the reflection of arginine vasopressin (AVP) concentration, it can be used as an alternative marker for AVP secretion. Objectives: This study aims to compare the levels of copeptin in healthy and enuresis children aged 5 - 15 years. Methods: This case-control study was performed on 42 children with primary monosymptomatic enuresis and 42 children without enuresis who were referred to the clinic of Taleghani hospital in Gorgan in 2020. Copeptin levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Results: Out of 84 patients, an equal proportion of girls (21 patients) and boys (21 patients) participated in both the case and control groups. The age of the children was 8.05 ± 2.46 years, and there was no statistically significant difference between the two groups (P = 0.16). The mean level of copeptin in the case and control groups were 6.7 ± 4.27 and 6.87 ± 8.52 pg/mL, respectively, significantly lower in the case group (P = 0.03). There was a statistically significant difference in the level of copeptin between the boys in the two groups (P = 0.03). Although the mean level of copeptin in the girls in the patient group was lower than that in the control group, this difference was not statistically significant (P = 0.35). Conclusions: In this study, the mean level of copeptin in PMNE was significantly lower than that in the control group, which suggests it may be considered as a probable biomarker for the prediction of response to treatment with desmopressin, but further study is required to confirm this hypothesis.

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 ...

Limited caffeine consumption as first-line treatment in managing primary monosymptomatic enuresis in children: how effective is it? A randomised clinical trial

ObjectiveEvidence about the negative caffeine effect on enuresis in children remains understudied or poorly understood. The study aimed to investigate the effect of caffeine restriction on the improvement and severity...

Evaluation of the association between asthma and non-neurogenic urinary incontinence in children; a case-control study

BackgroundAsthma is the most common chronic disease in children. Asthma can lead to sleep disorders and psychiatric issues, which are often accompanied by urinary incontinence in children. Furthermore, several studies have shown a relationship between allergic diseases and urinary incontinence. This study aims to examine the association between asthma and non-neurogenic urinary incontinence.Materials and methodsThis case-control study included 314 children over three years old referred to Amir Kabir Hospital; 157 with asthma and 157 without asthma. After explaining each urinary disorder in accordace with the International Children’s Continence Society’s definitions, parents and children were asked about their presence. The disorders included monosymptomatic nocturnal enuresis(MNE), nonmonosymptomatic nocturnal enuresis (NMNE), vaginal reflux (VR), pollakiuria, infrequent voiding, giggle incontinence (GI), and overactive bladder (OAB). The analysis was performed using Stata 16.ResultsThe average age of the children was 8.19 ± 3.15 years. Patients with asthma (p = 0.0001) and GI (p = 0.027) had a considerably lower average age than patients without these disorders. Asthma and urinary incontinence, including NMNE, Infrequent voiding, and OAB, were significantly correlated (p = 0.017, 0.013, and 0.0001, respectively). Moreover, the association between MNE and asthma was significant in males (p = 0.047).ConclusionDue to the relationship between asthma and urinary incontinence, children with asthma must be evaluated for the presence of urinary disorders and, if present, receive the proper treatment in order to improve their quality of life.