Nocturnal Enuresis In Children Research Articles

Traditional Japanese medicine, Yokukansan, for the treatment of nocturnal enuresis in children

The major pathogenic factors involved in nocturnal enuresis are nocturnal polyuria, small bladder capacity and/or detrusor overactivity, and a high arousal threshold. Desmopressin is the first-line therapy for the patients with diuresis-dependent nocturnal enuresis. Yokukansan, a traditional Japanese medicine, has been used in Japan to treat patients with nervousness, insomnia, and children with night terrors and temper tantrums. We experienced the positive effect of Yokukansan in some of the patients who did not respond well to desmopressin therapy. In total, 32 children with monosymptomatic nocturnal enuresis with nocturnal polyuria were treated with oral desmopressin melt tablets, which were approved for clinical use in Japan on 29 May 2012. This treatment was effective for 14 of them. For the rest (n = 18), Yokukansan was introduced in combination with desmopressin. Yokukansan was effective for 12 out of the 18 cases. Yokukansan should be a candidate for the medication of nocturnal enuresis.

Treating nocturnal enuresis in children and young people

Nocturnal enuresis can be a distressing condition for children and young people, and their families. Successful treatment, resulting in children becoming dry at night, can make a real difference to their lives and futures, and may help reduce the incidence of emotional and behavioural problems associated with long-term bedwetting. It is therefore vital that school nurses have a broad knowledge of the subject and are familiar with the treatments and how they work. This article provides a brief overview of the condition, its incidence, and treatment.

Simple behavioural interventions for nocturnal enuresis in children

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into:(a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and(b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including enuresis alarm therapy.This review focuses on simple behavioural interventions.Simple behavioural interventions are often used as a first attempt to improve nocturnal enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and enuresis alarm therapy are considered elsewhere. To determine the effects of simple behavioural interventions in children with nocturnal enuresis.The following comparisons were made:1. simple behavioural interventions versus no active treatment;2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, enuresis alarm therapy or complex behavioural interventions);3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched. All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal enuresis were excluded. Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer. Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus enuresis alarm therapy which included two studies and demonstrated that alarm therapy was superior to bladder training.In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as enuresis alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another. Simple behavioural methods may be superior to no active treatment but appear to be inferior to enuresis alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering enuresis alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.

Nocturnal Enuresis in Adults

Nocturnal enuresis in adults is a clinical entity which has not been studied extensively. Hence data available is limited. Though less common than childhood nocturnal enuresis, it can be distressing and may denote a significant underlying pathology. It can be divided into three subgroups - persistent primary nocturnal enuresis, recurrent nocturnal enuresis and recent onset nocturnal enuresis. Persistent primary and recurrent nocturnal enuresis are commonly due to nocturnal polyuria and nocturnal detrusor overactivity. These can be treated by desmopressin with or without anticholinergic drugs. Recent onset nocturnal enuresis in adults is associated with high pressure chronic urinary retention which could cause renal impairment and even death. Therefore such patients should be evaluated to identify the underlying cause of their bladder outflow obstruction. Most of them require corrective surgery to relieve the obstruction.

AB0678 Enuresis in moroccan children with juvenile idiopathic arthritis

BackgroundEnuresis is a health problem frequently encountered in childhood. This condition is most likely a symptom of psychological stress, although physiological causes, should not be ruled out. In general, the...

Second generation antipsychotics & nocturnal enuresis in children

Nocturnal enuresis, or involuntary wetting during sleep, is an adverse drug reaction that may occur with numerous second generation antipsychotics (SGAs) and currently is underreported. This article reviews SGA-induced enuresis and its management.

Transcutaneous Parasacral Electrical Neural Stimulation in Children with Primary Monosymptomatic Enuresis: A Prospective Randomized Clinical Trial

Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.

Effect of adenotonsillectomy on nocturnal enuresis in children with OSA

BackgroundPediatric obstructive sleep apnea (OSA) is the most severe form of SDB. The most important risk factors for the development of pediatric SDB include adenotonsillar hypertrophy. On the other hand, nocturnal enuresis is common symptom that is associated with (OSA), through influencing the nocturnal secretion of antidiuretic hormone (ADH). ObjectiveWe aimed to study the relation between polysomnography data of children with OSA due to adenotonsillar hypertrophy and levels of ADH, total and night urine volume. Subject and methodThe study included 23 Consecutive non obese children with age above 5years old, complaining of nocturnal enuresis, hypertrophied adenoids and tonsils. A polysomnographic evaluation was done together with serum level of ADH, total and nocturnal urine volume were measured pre and 3months post adenotonsillectomy. ResultsThere was a significant negative correlation between ADH and different polysomnographic data including respiratory events (apnea index, total hypopneas, hypopnea index and RDI), oxygen saturation data and the snoring index. There was also a significant negative correlation between night urine volume and desaturation index. comparison between the data means before and after adenoidectomy were done using the paired t-test; showed a significant improvement of all the polysomnographic data values, and a significant improvement in serum level of ADH, besides the significant decrease in both the 24h urine volume and the night urine volume being. ConclusionChildren with OSA and nocturnal enuresis, should be considered for early adenotonsillectomy or other treatments to approve normal release of ADH, and subsequent improvement of nocturnal enuresis.

Nocturnal Enuresis in Children: Prevalence, Correlates, and Relationship with Obstructive Sleep Apnea

Nocturnal Enuresis in Children: Prevalence, Correlates, and Relationship with Obstructive Sleep Apnea

The effect of adenotonsillectomy on pediatric nocturnal enuresis: a prospective cohort study.

Sleep disorder caused by adenotonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. This study was conducted to investigate the effect of adenotonsillectomy on enuresis in children with adenotonsillar hypertrophy. This prospective cohort study was conducted in Hamadan City in Western Iran, from April 2010 to December 2011. Ninety-seven children aged 3 to 12 years with adenotonsillar hypertrophy who were admitted to Besat Hospital for adenotonsillectomy were evaluated. The primary outcome was the number of incidents of bedwetting (nocturnal enuresis) post-operation compared with pre-operation. Patients were followed-up for 3 months. Data were collected using a questionnaire regarding number of bedwetting incidents, type of enuresis (primary or secondary), and family history of enuresis, as well as results of urine analysis. Of 420 children admitted for adenotonsillectomy, 97 had a positive history of preoperative enuresis, including 42 girls and 55 boys, with mean age of 48 months. The parents of 84 (86.6%) children agreed to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 51 (60.7%) children and had shown relative improvement in 22 (26.2%) children. Enuresis had not improved in the remaining 11 (13.1%) children (P<0.001). The results of this study indicate that adenotonsillectomy can improve enuresis in the majority of children with adenotonsillar hypertrophy. However, further evidence based on large multi-center randomized clinical trials is required to confirm these results.

Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics).

Enuresis (bedwetting) is a socially stigmatising and stressful condition which affects around 15% to 20% of five-year olds and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great. Drugs (including desmopressin, tricyclics and other drugs) have often been tried to treat nocturnal enuresis. To assess the effects of drugs other than desmopressin and tricyclics on nocturnal enuresis in children and to compare them with other interventions. We searched the Cochrane Incontinence Group Specialised Register of trials (searched 15 December 2011), which includes searches of MEDLINE and CENTRAL, to identify published and unpublished randomised and quasi-randomised trials. The reference lists of relevant articles were also searched. All randomised trials of drugs (excluding desmopressin or tricyclics) for treating nocturnal enuresis in children up to the age of 16 years were included in the review. Trials were eligible for inclusion if children were randomised to receive drugs compared with placebo, other drugs or behavioral interventions for nocturnal enuresis. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal enuresis were excluded. Two review authors independently assessed the quality of the eligible trials and extracted data. Differences between review authors were settled by discussion with a third review author. A total of 40 randomised or quasi-randomised controlled trials (10 new in this update) met the inclusion criteria, with a total of 1780 out of 2440 children who enrolled receiving an active drug other than desmopressin or a tricyclic. In all, 31 different drugs or classes of drugs were tested. The trials were generally small or of poor methodological quality. There was an overall paucity of data regarding outcomes after treatment was withdrawn.For drugs versus placebo, when compared to placebo indomethacin (risk ratio [RR] 0.36, 95% CI 0.16 to 0.79), diazepam (RR 0.22, 95% CI 0.11 to 0.46), mestorelone (RR 0.32, 95% CI 0.17 to 0.62) and atomoxetine (RR 0.81, 95% CI 0.70 to 0.94) appeared to reduce the number of children failing to have 14 consecutive dry nights. Although indomethacin and diclofenac were better than placebo during treatment, they were not as effective as desmopressin and there was a higher chance of adverse effects. None of the medications were effective in reducing relapse rates, although this was only reported in five placebo controlled trials.For drugs versus drugs, combination therapy with imipramine and oxybutynin was more effective than imipramine monotherapy (RR 0.68, 95% CI 0.50 to 0.94) and also had significantly lower relapse rates than imipramine monotherapy (RR 0.35, 95% CI 0.16 to 0.77). There was an overall paucity of data regarding outcomes after treatment was withdrawn.For drugs versus behavioural therapy, bedwetting alarms were found to be better than amphetamine (RR 2.2, 95% CI 1.12 to 4.29), oxybutynin (RR 3.25, 95% CI 1.77 to 5.98), and oxybutynin plus holding exercises (RR 3.3, 95% CI 1.84 to 6.18) in reducing the number of children failing to achieve 14 consecutive dry nights.Adverse effects of drugs were seen in 19 trials while 17 trials did not adequately report the occurrence of side effects. There was not enough evidence to judge whether or not the included drugs cured bedwetting when used alone. There was limited evidence to suggest that desmopressin, imipramine and enuresis alarms therapy were better than the included drugs to which they were compared. In other reviews, desmopressin, tricyclics and alarm interventions have been shown to be effective during treatment. There was also evidence to suggest that combination therapy with anticholinergic therapy increased the efficacy of other established therapies such as imipramine, desmopressin and enuresis alarms by reducing the relapse rates, by about 20%, although it was not possible to identify the characteristics of children who would benefit from combination therapy. Future studies should evaluate the role of combination therapy against established treatments in rigorous and adequately powered trials.

Nocturnal enuresis in children

Nocturnal enuresis in children

Nocturnal enuresis in children

Although nocturnal enuresis is common in children and young people, many families have difficulty understanding the condition and accessing appropriate advice and support. Healthcare professionals need to be able to demonstrate knowledge of assessment, causes and management of nocturnal enuresis to provide patients and their families with individualised care. This article discusses the importance of identifying the causes of bedwetting, thorough assessment of the patient and selection of appropriate management strategies.

Role of Posterior Tibial Nerve Stimulation in the Treatment of Refractory Monosymptomatic Nocturnal Enuresis: A Pilot Study

We evaluated the early clinical and urodynamic results of posterior tibial nerve stimulation in patients with refractory monosymptomatic nocturnal enuresis. We randomly assigned 28 patients with refractory monosymptomatic nocturnal enuresis to 2 equal groups. Group 1 received a weekly session of posterior tibial nerve stimulation for 12 weeks and group 2 was the placebo group. Evaluation was performed in each group at baseline and after posterior tibial nerve stimulation to compare clinical and urodynamic findings. Another clinical assessment was done 3 months after the first followup. The 2 groups were comparable in baseline clinical and urodynamic data. Overall, 13 patients (46.4%) had detrusor overactivity and 14 (50%) had decreased bladder capacity. After treatment 11 group 1 patients (78.6%) had a partial or full response to posterior tibial nerve stimulation but only 2 (14.3%) in group 2 had a partial response (p = 0.002). Also, the average number of wet nights in group 1 was significantly lower than at baseline (p = 0.002). All urodynamic parameters significantly improved in group 1. In contrast, the number of wet nights and urodynamic parameters did not change significantly in group 2. At 3-month followup the number of patients with a partial or full response in group 1 had decreased from 11 (78.6%) to 6 (42.9%). No change was evident in group 2. Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis. However, deterioration in some responders with time suggests the need for maintenance protocols.

Self‐esteem in 6‐ to 16‐year‐olds with monosymptomatic nocturnal enuresis

Childhood nocturnal enuresis (NE) and incontinence has been shown to be associated with increased behavioural problems and reduced self-esteem (SE) in Western populations. The impact on Asian children, however, is not known. This study investigates the relationship between SE and monosymptomatic NE in Malaysian children aged 6 to 16 years. Children with wetting frequency of at least 4 out of 14 nights were recruited with controls matched for age, gender and race. SE scores were obtained using the 'I Think I Am' questionnaire for five domains: body image, talents and skills, psychological well-being, relationship with family and relationship with others. A total of 126 children were recruited; 22 enuretics aged 6-9 years and their matched controls (Group1) and 41 enuretics aged 10-16 years and their matched controls (Group 2). SE scores were similar between the enuretic and controls in Group 1, whereas in Group 2, enuretics had significantly lower scores (P < 0.05) in 'body image', 'relationship with others' and total SE scores. This difference was more pronounced among girls, adolescents and those who wet more than 10/14 nights. The SE of Malaysian children with monosymptomatic NE aged 10 years and above is significantly lower than their peers. This effect is seen particularly among girls, adolescents and those with frequent wetting. In the light of these findings, the 'wait and see' approach by the Malaysian medical profession is no longer appropriate. Treatment should begin before the age of 10 years.

Nocturnal enuresis in children in Kinshasa, Democratic Republic of Congo

To determine the prevalence of nocturnal enuresis in children of Kinshasa in Democratic Republic of Congo. In all, 506 questionnaires were sent to parents of children aged 6-12 years randomly selected from four primary schools in Kinshasa, Democratic Republic of Congo. The questionnaire was designed to collect information about prevalence and factors associated with nocturnal enuresis. A total of 415 (82.0%) were correctly completed. In this series, 109 children were identified as nocturnal enuresis in which 50 boys and 56 girls (p > 0.05). Factors associated with nocturnal enuresis were deep sleep, young age and familial history of enuresis (p < 0.05). Only 11% of patients have been consulted by doctors. Twelve children (11.0%) were treated by healers traditional. In the other part, 43 children (39.4%) were frequently punished by their parents. The common self-help strategies were 79 children (72.5%) were submitted to fluid restrictions before going to sleep and 68 (62.4%) were waking the child at night to void. In Kinshasa, the prevalence of nocturnal enuresis was high to those reported in Asian and Western countries. Nocturnal enuresis remains an important clinical problem in children but only a small percentage of parents seek medical help.

The prevalence of probable overactive bladder, associated risk factors and its effect on quality of life among Turkish midwifery students

To evaluate the associated risk factors of probable overactive bladder (OAB) and to determine the effect of OAB on quality of life through validated questionnaires in Turkish midwifery students. 279 midwifery students were invited to participate, and 265 (95.0%) were included in the study, which was approved by the local ethics committees. The relationship between quality of life and probable OAB was evaluated using Turkish language-validated questionnaires (OABq SF, NQOL). Chi-square test, t-test and logistic regression were used for the statistical analysis, and p<0.05 was considered significant. The participants' mean age was 21.74 ± 2.15 years. The prevalence of OAB was 35.4%. There was a significant relationship between the presence of probable OAB and familial urinary incontinence history and childhood nocturnal enuresis. In the logistic regression analysis, family history was associated with an OR of 2.11 (95% CI: 1.08-4.10) for OAB, and nocturia with an OR of 2.69 (95% CI: 1.16-6.21) for OAB. Drinking moderate amounts of tea and carbonated drinks daily did not affect OAB, but extreme consumption of these beverages was associated with an OR of 2.98 (95% CI: 1.26-7.03) for OAB. OAB significantly worsens quality of life according to all the quality of life indices. OAB is not a rare condition among young people. It appears that the quality of life was adversely influenced by OAB among both younger and older people. Familial urinary incontinence and childhood nocturnal enuresis were found to be risk factors for OAB. There is insufficient evidence to restrict tea or carbonated drinks consumption in young people with OAB unless their consumption is extreme.

Selecting the best scale for measuring treatment effect in a network meta-analysis: a case study in childhood nocturnal enuresis.

Dichotomous outcomes in pairwise meta-analysis are typically summarised using the odds ratio (OR), relative risk (RR) or risk difference (RD). The hazard ratio (HR) may also be used where events occur over time. Choice of scale is often determined by ease of interpretation or mathematical properties of a measure, as there is frequently insufficient power to compare goodness-of-fit across different scales. Network meta-analysis (NMA) combines evidence across a network of treatment comparisons. NMA allows the combination of a greater numbers of trials, so there is greater potential to use goodness-of-fit statistics to determine an appropriate scale on which the effects of treatments are additive. In this paper, we explore choice of scale in an NMA of childhood nocturnal enuresis for the outcome 'failure to achieve 14 days consecutive dry nights'. We compare OR, RR of both the harmful (RRH) and the beneficial (RRB) outcomes, RD and HR. Using a Bayesian framework, the posterior mean residual deviance and deviance information criterion are used to evaluate model fit and selection between the different summary effect measures. We use I(2) to examine within-comparison heterogeneity for the pairwise analyses. The results suggest that the HR and RRB provide the best fit. We conclude that choice of scale should be based on physiological and epidemiological understanding of the disease process, together with an empirical assessment of model adequacy. HR should be given greater consideration where there is an underlying time-to-event process. We demonstrate how results can be transformed to an alternative scale to aid interpretability. Copyright © 2012 John Wiley & Sons, Ltd.

The association between sleep‐disordered breathing and enuresis in children

To evaluate the prevalence of nocturnal enuresis in children diagnosed with sleep disordered breathing (SDB) and the effect of adenotonsillectomy (T&A) on nocturnal enuresis. Systematic review of the literature. Systematic review of the literature was performed using PubMed and Ovid. A systematic analysis of the literature was performed from 1980 to 2010 to identify children who had SDB and enuresis. A subset of children with enuresis who underwent T&A for SDB were also studied. A total of 14 studies were reviewed. A total of 3,550 children had SDB, of which one-third (n = 1,113) had a diagnosis of enuresis. Age range was 18 months to 19 years. Seven studies (n =1,360) had data on patients who underwent T&A for SDB with follow-up data on enuresis. The mean sample size was 194, with a median follow-up of 6 months and age range of 2 to 18 years. Preoperative prevalence of enuresis was 31% (426/1,360). A total of 587 children were followed after T&A. The postoperative prevalence of enuresis was 16% (95/587; P < .0002, two-tailed). Most studies did not make a distinction between primary and secondary enuresis. The age range of the subjects (18 months to 19 years) likely included some patients with developmentally acceptable enuresis. SDB in children is associated with nocturnal enuresis. T&A is associated with a significant improvement in enuresis in children with SDB. There is a need for randomized controlled trials to look at the role of T&A in children with SDB and enuresis.

Involvement of urinary bladder Connexin43 and the circadian clock in coordination of diurnal micturition rhythm

SummaryNocturnal enuresis in children and nocturia in the elderly are two highly prevalent clinical conditions characterized by a mismatch between urine production rate in the kidneys and storage in the urinary bladder during the sleep phase. Here we demonstrate, using a novel method for automated recording of mouse micturition, that connexin43 (Cx43), a bladder gap junction protein, is a negative regulator of functional bladder capacity. Bladder Cx43 levels and functional capacity show circadian oscillations in wild-type mice, but such rhythms are completely lost in Cry-null mice having a dysfunctional biological clock. Bladder muscle cells have an internal clock, and show oscillations of Cx43 and gap junction function. A clock regulator, Rev-erbα, upregulates Cx43 transcription as a co-factor of Sp1 using Sp1 cis-elements of the promoter. Therefore, circadianoscillation of Cx43 is associated with the biological clock and contributes to diurnal changes in bladder capacity, which avoids disturbance of sleep by micturition.