Nocturnal Enuresis In Children Research Articles

BDNF, proBDNF and proBDNF/BDNF ratio with electroencephalographic abnormalities in children with attention deficit hyperactivity disorder: Possible relations to cognition and severity.

Attention deficit hyperactivity disorder (ADHD) with and without subclinical epileptogenic discharges (SED) have been suggested to negatively affect cognitive abilities of children with ADHD. The role of brain-derived neurotrophic factor (BDNF) and its precursor proBDNF in ADHD is in need of being investigated. The aims were to evaluate the levels of serum BDNF, proBDNF and the proBDNF/BDNF ratio in addition to the potential impacts of SED on the children's cognitive abilities and the severity of ADHD. The included participants with ADHD were 30 children with normal electroencephalogram (EEG) (G1) and 30 children with SED (G2), together with 30 healthy children (G3). The cognitive abilities and severity of the disorder were evaluated. The biochemical measures were determined by ELISA. The presence of coexisting SED and nocturnal enuresis has led to a deleterious effect on cognitive processes but not on the severity. The focal epileptogenic discharge was the most common among children in G2. The levels of BDNF in Groups 1 and 2 were less than those in G3. The higher proBDNF/BDNF ratio could be related to the low BDNF levels rather than high proBDNF levels. The findings of this study highlight the importance of investigating the presence of SED and nocturnal enuresis in children with ADHD. Targeting strengthening of cognitive abilities in children with coexisting ADHD and SED is advised. The role of proBDNF in the pathophysiology of ADHD needs further investigation.

Approach to nocturnal enuresis in children

Approach to nocturnal enuresis in children

Laser versus Needle Acupuncture in the Management of Nocturnal Enuresis in Children: A Randomized–Controlled Trial.

Laser versus Needle Acupuncture in the Management of Nocturnal Enuresis in Children: A Randomized–Controlled Trial.

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.

To Study the Role of Homoeopathy in Nocturnal Enuresis in Children

To Study the Role of Homoeopathy in Nocturnal Enuresis in Children

Diurnal rhythm of urinary aquaporin-2 in children with primary monosymptomatic nocturnal enuresis.

Nocturnal enuresis can be frustrating for children and their families as the child ages. Our aim is to evaluate urine aquaporin 2 (AQP-2) as a noninvasive biomarker of water balance in children with primary monosymptomatic nocturnal enuresis (PMNE). The study included 90 children; sixty-eight children suffering from PMNE aged (9.57 ± 2.16) years and 22 healthy children with good toilet control, matched sex and age. All enuretic children were subjected to complete history taking, clinical evaluation, and bed wetting diary. Serum arginine vasopressin (AVP) and urine AQP-2 were tested in the morning (at 9-11 am) and evening (at 9-11 pm). Blood urea, creatinine, Na, glucose, urine osmolality, Ca/Cr, Alb/Cr and specific gravity were tested simultaneously. Serum AVP, urine AQP-2, and urine osmolality were statistically lower in patients than controls. Patients had a significantly lower level of night serum AVP concentrations, urine AQP-2, and urine osmolality than the corresponding morning level. Urine AQP-2 was significantly correlated with urine osmolality (p < 0.05). AQP-2 had a sensitivity of 90% and a specificity of 70%. However, no statistically significant correlation was found between serum AVP and urine AQP-2. Primary monosymptomatic nocturnal enuresis in children could be associated with reduction of urine excretion of AQP-2 at night. Urine AQP-2 is significantly correlated with urine osmolality. Therefore, it may be a noninvasive biomarker of hydration status in children with PMNE, with good sensitivity and specificity.

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.

Study of Prevalence and Risk Factors of Nocturnal Enuresis in Children with Thalassemia Major

Study of Prevalence and Risk Factors of Nocturnal Enuresis in Children with Thalassemia Major

The impact of COVID-19 on mental health and nocturnal enuresis in children

BACKGROUND: The aim of this study was to evaluate the impact of COVID-19 and related restrictive measures on NE and children mental health comparing the prelockdown (T0) and postlockdown period (T1).METHODS: The study was carried out within our pediatric outpatient clinic in Pediatric Unit of Campus Bio-Medico University Hospital of Rome, enrolling 89 children (group 1 or G1), between 5 and 14 years, with NE and 100 children (group 2 or G2), between 3 and 16 years, without NE. Data collection was carried out by completing a questionnaire, KIDSCREEN-27, with the aim of measuring the subjective health-related quality of life in children and adolescents. The questionnaire was filled in by the parents. Data concerning NE were collected through questionnaire and interviews with parents.RESULTS: G1 and G2 are subdivided into two groups. G1 was composed of 89 enuretic children, of which 68/89 (76%) aged between 5 and 9 years (G1a) and 21/89 (24%) aged between 10 and 14 years (G1b). G2 was composed of 100 non-enuretic children, of which 55/100 (55%) aged between 3 and 9 years (G2a) and 45/100 (45%) aged between 10 and 16 years (G2b). Our study showed a worsening of NE symptoms during the postlockdown period. In fact, we observed that in G1a, NE-correlated symptoms worsened in 3/68 (4.4%) (P<0.0001) while in G1b in 2/21 (9.5%) of children (P=0.005). Moreover, comparing the enuretic children in two different time periods for several lifestyle characteristics, statistically significant differences were found in several specific areas. This study was conducted in accordance with the regulatory standards of Good Clinical Practice and the Declaration of Helsinki.CONCLUSIONS: Enuretic children have been more affected by the restrictive measures for the COVID-19 pandemic, with a worsening of quality of life and NE symptoms.

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.

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

CURRENT STATUS OF DIAGNOSTICS OF NOCTURAL ENUREZIS IN CHILDREN AND ADOLESCENTS”

These analyzes of the study on the methodology for diagnosing nocturnal enuresis in children and adolescents are given and the causes and circumstances diagnosed by modern technologies are considered. Nocturnal enuresis, involuntary urination during sleep in a child who is already able to control his physiological needs for it, occurs frequently 5-17% depending on age.[1]

Nocturnal enuresis — a new look at the old problem

Nocturnal enuresis is the most common functional disorder of the urinary system in children, significantly reducing the quality of life of both patients and their parents. There are several hypotheses for the development of this disease, none of which can be taken as dominant. In this regard, Nocturnal enuresis is considered as a polyetiological condition. This review details the main factors that are associated with the development of nocturnal enuresis in children. These include hereditary predisposition, bladder dysfunction, sleep and awakening disorders, delayed maturation of central nervous system structures, disruption of the circadian rhythm of antidiuretic hormone and aquaporin-2 production. Despite many publications on nocturnal enuresis in children, many aspects of the pathogenesis of the disease remain unclear and require further study.

The role of primary nocturnal enuresis in the aetiology of overactive bladder syndrome.

The aim of this study was to investigate the effect of nocturnal enuresis (NE) in childhood on the development and course of overactive bladder (OAB) in adulthood. Between January and September 2021, data from patients who visited the Urology Outpatient Clinic with OAB symptoms were collected. Patients with a history of diabetes mellitus, neurological diseases, bladder outlet obstruction, active urinary system infection, or previous medical treatment for OAB and those who did not agree to join the study were excluded. Patients with a diagnosis of NE in childhood were classified as group 1, and patients without a diagnosis of NE were classified as group 2. Demographic data were recorded. Frequency of incontinence, and the number of daytime voids and nocturia were evaluated according to a three-day voiding diary. In addition, the maximum urinary flow ratio (Qmax), bladder wall thickness, and postvoid residual volume were determined using uroflowmetry and pelvic ultrasound. After applying the inclusion/exclusion criteria, the mean age of the study group of 103 patients, consisting of 34 women and 69 men, was 32.85 ±11.20 years (18-65), and the mean BMI of both groups was 26.62 ±3.34 (19.49-39.18). Sixty-five of 103 patients (63.1%) had a history of childhood NE diagnosis. Patients in the group with a history of NE were younger than those without a history of NE. The earlier onset and more intense course of OAB symptoms in patients diagnosed with NE in childhood suggests that NE may be a triggering factor in the aetiology of OAB.

Adulthood Urge Incontinence: Is Childhood Nocturnal Enuresis A Risk Factor?

Urge incontinence and childhood nocturnal enuresis are two related urinary conditions that significantly affect individuals and their quality of life, varying prevalence between age and obesity. This systematic review examines the literature on the relationship between childhood nocturnal enuresis and urge incontinence in adulthood, including the potential mechanisms linking these conditions. Ten studies met the inclusion criteria and were included in the review. The results showed a consistent association between childhood nocturnal enuresis and urge incontinence in adulthood. The pooled analysis demonstrated that childhood nocturnal enuresis was a risk factor for adult urge incontinence, with odds ratios ranging from 1.75 to 2.7. This relationship’s potential mechanisms include nocturnal polyuria, detrusor overactivity, and arousal thresholds. However, the exact mechanisms still need to be fully understood and further investigated. Clinical implications of these findings suggest the importance of early identification and intervention for childhood nocturnal enuresis to potentially reduce the risk of developing urge incontinence in adulthood. Future research should focus on longitudinal studies to better understand the association between these conditions and explore potential risk factors and preventive strategies. Overall, this review highlights the need for increased awareness and management of childhood nocturnal enuresis to minimize the socioeconomic burden and improve the outcomes for individuals with urge incontinence.

Bark of the Rhus aromatica and nocturnal enuresis in children

Bark of the Rhus aromatica and nocturnal enuresis in children

Safety and Efficacy of Mirabegron in Treatment of Nocturnal Enuresis in Children

Safety and Efficacy of Mirabegron in Treatment of Nocturnal Enuresis in Children

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

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

Clinical Effect of Pressing Needle on Nocturnal Enuresis in Children

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

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

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