Nocturnal Enuresis In Children Research Articles

A double-blind, randomized, placebo-controlled trial of individualized homeopathic medicinal products in the treatment of nocturnal enuresis in children

A double-blind, randomized, placebo-controlled trial of individualized homeopathic medicinal products in the treatment of nocturnal enuresis in children

Childhood nocturnal enuresis and clinical course of overactive bladder in women

Background. Overactive bladder (OAB) and nocturnal enuresis are among the most common causes of urinary dysfunction in adults and children, respectively. The pathogenesis factors of OAB and nocturnal enuresis largely coincide. Among adults with OAB, a large proportion of patients have a history of nocturnal enuresis. Aim. To study the features of the clinical course of OAB in women with childhood nocturnal enuresis. Materials and methods. The study included 212 women with OAB (mean age 54.1±0.8 years), who were divided into two groups depending on the presence of the history of childhood nocturnal enuresis. Group 1 included 41 (19.3%) patients with childhood nocturnal enuresis, group 2 included 171 (80.7%) women without a history of childhood nocturnal enuresis. All patients underwent a comprehensive urodynamic study. Results. The severity of clinical symptoms of OAB did not differ between patients of groups 1 and 2. Predictors of a more severe clinical course of OAB and a greater likelihood of developing urge incontinence were the presence of a non-monosymptomatic form of enuresis and an age of cessation of enuresis of 10 years or older. Women from group 1 also showed a higher incidence of detrusor overactivity compared to group 2 (29.3% vs 10.5%). Conclusion. The results of the study indicate a connection between childhood nocturnal enuresis and the clinical course of OAB in adult women.

Upper airway obstruction and nocturnal enuresis in children: Why is it important?

Objectives: Nocturnal enuresis (NE) is a common urological complaint among children. The most common cause of obstructive airway disease in children is enlarged tonsils and adenoids. Although the relationship between the presence of NE and sleep disorders is unclear, some studies show that enuresis improves after airway obstruction is resolved. We aimed to investigate the relationship between upper airway obstruction and NE in children. Methods: Between September 2020 and June 2021, 66 pediatric patients diagnosed with persistent NE were included in the study. A total of 57 healthy patients were included in the control group. The presence of snoring and apnea, the presence of Attention-Deficit/Hyperactivity Disorder (ADHD)/social adjustment disorder, academic achievement, and family members’ history of NE were asked through questionnaires filled out by the families. An upper airway examination was done with a flexible nasopharyngoscope. Results: The mean ages of the study patients and healthy controls were 8.32±2.1 and 8.18±2.3 years. The female/male ratio was (25/41) and (33/24), respectively. Of the case group, 62.1% were male, and 78.8% were under nine years old. The frequency of snoring/apnea in children with enuresis was 27.3%, while it was 19.3% in the control group (p=0.299). It was found that more enuresis developed in children with high BMI (p=0.044). Family history was higher in the NE group than in the control group, but it was not statistically significant (p=0.173). Conclusion: Nocturnal enuresis is commonly associated with obstructive sleep apnea. Upper airway obstruction, obesity, and male gender are important risk factors for NE.

Overview on the management of nocturnal enuresis in children in general pediatrics

Bedwetting, or enuresis, represents a socially stigmatizing and distressing condition that significantly impacts the quality of life for both children and their parents. This article seeks to assess and consolidate the current understanding of traditional and innovative treatments, both pharmacological and non-pharmacological, for children with enuresis. The article discusses the various treatment modalities which have been developed and validated to alleviate symptoms of enuresis, enhance quality of life, and address the social and emotional challenges faced by affected children. Finally the article emphasizes the important primary role of general pediatricians that is to tailor therapy protocols to each individual child, considering their unique needs and circumstances, and working closely with their families to identify the most effective approach.

A systematic review and meta-analysis assessing the efficacy of Tuina for nocturnal enuresis in children.

Background: Desmopressin acetate (DDAVP) and behavioral interventions (BI) are cornerstone treatments for nocturnal enuresis (NE), a common pediatric urinary disorder. Despite the growing body of clinical studies on massage therapy for NE, comprehensive evaluations comparing the effectiveness of Tuina with DDAVP or BI are scarce. This study aims to explore the efficacy of Tuina in the management of NE. Methods: A systematic search of international databases was conducted using keywords pertinent to Tuina and NE. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated NE treatments utilizing Tuina against DDAVP or BI. This meta-analysis included nine RCTs, comprising a total of 685 children, to assess both complete and partial response rates. Results: Tuina, used as a combination therapy, showed enhanced clinical efficacy and improved long-term outcomes relative to the control group. The therapeutic efficacy of Tuina was not directly associated with the number of acupoints used. Instead, employing between 11 and 20 acupoints appeared to have the most significant effect. Conclusion: The findings of this meta-analysis support the potential of Tuina as an adjunct therapy to enhance the sustained clinical efficacy of traditional treatments for NE. However, Tuina cannot completely replace DDAVP or BI in the management of NE. While this study illuminates some aspects of the effective acupoint combinations, further research is crucial to fully understand how Tuina acupoints contribute to the treatment of NE in children. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442644, identifier CRD42023442644.

Knowledge and Awareness of Adults towards Nocturnal Enuresis in Children among the Medina Population.

Background: Nocturnal Enuresis (NE) is a common problem among children that is stressful for both the child and adults. There is a lack of adults' knowledge and awareness of the NE condition. Objective: This study aimed to evaluate the adults' knowledge and awareness of NE in Medina City, Saudi Arabia. Method: A cross-sectional observational study was conducted among adults in Medina through September and October 2023, using a questionnaire composed of socio-demographic characteristics and adults' knowledge and awareness of NE. A statistical analysis was performed using SPSS software. Results: The study was conducted among 553 adults in Medina, with a mean (standard deviation [SD]) age of 37.69 (10.775). Most participants (94.8%) were Saudi nationals, of which 84.4% were females, 76.3% were married, and 97.1% were urban residents with university degrees (80.3%). The mean (SD) total score of knowledge and awareness was 4.69 (1.783) out of 9 and 6.49 (2.167) out of 12, respectively. Being female (p < 0.001), with a university degree (p = 0.002), and knowing about enuresis in children (p = 0.011) are significant factors affecting adults' knowledge with higher scores than others. Conclusions: An inadequate knowledge and awareness level of NE in children was revealed among adults living in Medina City, Saudi Arabia. These results emphasize the need for targeted educational campaigns to enhance adults' knowledge and awareness of enuresis.

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.

Efficacy and safety of combination therapy (desmopressin with tolterodine) in nocturnal enuresis in children: An institutional experience

ABSTRACT Background: Nocturnal enuresis is one of the most common problems of childhood. Desmopressin is started as a first-line treatment along with essential behavioral therapy like fluid restriction before bed and sleep hygiene. Given the high relapse rates seen with using desmopressin alone, the need of the hour is to reinforce its effects using another agent so that the remission is long-lasting. Aim: The aim is to look for efficacy and safety of treatment using combination therapy of desmopressin with tolterodine in nocturnal enuresis and further to look for the relapse rate with a structured withdrawal regimen. Results: A total of 150 patients of nocturnal enuresis were included in the study. Ninety patients (75%) were males, and 30 patients (25%) were females. The median age of patients was 12 years. Evaluation of the consequences at 1 month, 3 months, and 6 months revealed complete remission in 87 patients (72.5%), 105 patients (87.5%), and 105 patients (87.5%), respectively. After 12 months with desmopressin + tolterodine, it was found that 99 patients (82.5%) had complete remission, six patients (5%) had a relapse, and 12.5% of individuals still suffered from enuresis. The relapse rate on follow-up of 6 months after complete cessation of the treatment of 120 patients was 5% in combination therapy. The complication rate with combination therapy is 4.17%. There is no significant effect of gender or age on improvement with combination therapy. Conclusion: Desmopressin given in combination with tolterodine is safe and effective as combination therapy for treating nocturnal enuresis, and in most cases, long-term remissions can be achieved.

Approach to nocturnal enuresis in children

Approach to nocturnal enuresis in children

Role of Homoeopathy in the Treatment of Nocturnal Enuresis in Children Under 16 Year of Age

Role of Homoeopathy in the Treatment of Nocturnal Enuresis in Children Under 16 Year of Age

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.

Nocturnal enuresis in children

Nocturnal enuresis, defined as urinary incontinence during sleep at least twice weekly for three consecutive months in children over 5 years old, is a common childhood condition that significantly impacts both children and their families. This review examines the classification, etiology, pathophysiology, evaluation, and treatment options for nocturnal enuresis. The condition is classified as either monosymptomatic or non-monosymptomatic, and primary or secondary, with primary enuresis accounting for 80% of cases. The pathophysiology involves three main mechanisms: nocturnal polyuria, high arousal threshold, and bladder dysfunction. Genetic factors play a significant role, with a strong familial component following an autosomal dominant pattern. Evaluation includes detailed medical history, voiding diary, physical examination, and basic laboratory tests. Treatment approaches are divided into non-pharmacological (including behavioral modifications, motivational therapy, and alarm therapy) and pharmacological interventions (primarily desmopressin, tricyclic antidepressants, and anticholinergic drugs). While alarm therapy shows the highest long-term success rates (65-75%), combination therapy may be necessary for treatment-resistant cases. This review emphasizes the importance of individualized treatment approaches and family support in managing childhood nocturnal enuresis effectively.

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