Primary Monosymptomatic Nocturnal Enuresis Research Articles

Study on resting-state cerebral functional magnetic resonance imaging and ambulatory urodynamics monitoring in children with primary monosympt-omatic nocturnal enuresis

Objective To investigate the significance of blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and ambulatory urodynamics monitoring (AUM) to find the cause of primary monosymptomatic nocturnal enuresis (PMNE) in children. Methods Thirty-seven children with PMNE (20 males and 17 females) were selected, with a mean age of (11.3±4.1) years old.A clinical management tool, 3-day urination record, daytime BOLD-fMRI scan, conventional urodynamics (CUD) and AUM were performed respectively.Thirty-seven gender-age matched children(19 males, 18 females) who would receive surgery treatment because of upper urinary tract disease and were confirmed to have no lower urinary tract dysfunction by CUD were enrolled as controls, with a mean age of (11.1±2.9) years old, and 13 cases underwent BOLD-fMRI scanning. Results It was found that the ALFF value of the left middle frontal gyrus of PMNE was decreased and the ReHo value of the left superior occipital gyrus was increased compared with the control group by the resting BOLD-fMRI.The maximum voiding volume of PNME children was (303.11±87.48) mL, the total urine volume at night was (568.65±208.48) mL, and the nighttime bladder volume was (217.43±81.53) mL.The incidence of maximum voiding volume reduction, nocturnal polyuria and decreased nocturnal bladder volume were 24.32% and 56.76%, and 64.86%, respectively.However, AUM results showed that maximum detrusor pressure in the PMNE group was (39.22±7.78) cmH2O(1 cmH2O=0.098 kPa), which was statistically significantly higher than that in CUD (32.22±9.00) cmH2O, and the difference was statistically significant (P 0.05). Conclusions The abnormal functions of the left middle frontal gyrus and left superior occipital gyrus, nighttime DO and the decrease of bladder capacity at night are considered to be key causes of enuresis in children with PMNE.AUM and resting state BOLD-fMRI evaluations are helpful in differentiating the pathogenesis of PMNE. Key words: Enuresis; Ambulatory urodynamics monitoring; Functional magnetic resonance imaging; Resting state

BDNF and NGF gene polymorphisms and urine BDNF–NGF levels in children with primary monosymptomatic nocturnal enuresis

The pathophysiology and genetic influences in nocturnal enuresis have not been fully elucidated. Delayed neuronal maturation has been suggested as a pathogenetic mechanism in primary monosymptomatic nocturnal enuresis (PMNE). Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are neurotrophins affecting maturation of the nervous system. The aim of this preliminary study was to investigate BDNF and NGF gene polymorphisms and urine levels of BDNF and NGF in children with PMNE as a first time. The single-nucleotide polymorphisms of BDNF (rs6265:G>A:Val66Met; rs8192466:C>T:Thr2Ile) and NGF (rs6330:C>T:Ala35Val, rs11466112:C>T:Arg221Trp) were investigated by comparing 104 children with PMNE and 140 healthy control subjects. Children with non-PMNE were excluded. DNA isolation and detection of polymorphisms were performed by real-time polymerase chain reaction. In addition, urine BDNF and NGF levels of 47 PMNE and 29 healthy children were measured by enzyme-linked immunosorbent assay method and normalized to urine creatinine (Cr) concentration for comparisons. There were no differences in genotype and allele frequencies of BDNF rs6265 and NGF rs6330 polymorphisms between patients with PMNE and the control group (P>0.05). No mutant alleles were found in BDNF rs8192466 and NGF rs11466112 polymorphisms in either group. Children with PMNE had higher urine BDNF/Cr (0.020±0.010 vs 0.010±0.002; P=0.008) and NGF/Cr ratio (3.01±1.87 pg/mg vs 1.77±0.26 pg/mg; P=0.002) compared with the control subjects. However, no significant differences were found in BDNF/Cr and NGF/Cr values between GG, GA, and AA genotypes of BDNF rs6265 polymorphismand CC and CT genotypes of NGF rs6330 polymorphism (P>0.05). In this study, no association of BDNF and NGF gene polymorphisms with PMNE was found, and urine neurotrophin concentrations were not directly influenced by investigated polymorphisms. Although, previously increased urine neurotrophin secretion has been found in detrusor overactivity, bladder inflammation, and dysfunctional voiding, this preliminary results also showed an increase in neurotrophins in PMNE.Higher urine neurotrophin levels may be related to delayed and continued neuronal maturation or increased production of neurotrophins in the bladder. The increased urine neurotrophins in PMNE may be an indicator of increased sensory nerve excitability of the bladder, contributing to the development of enuresis. This study showed that investigated neurotrophin gene polymorphisms did not make a significant contribution to the development of PMNE, but urine levels of neurotrophin gene products were higher in PMNE. Owing to the complexity and heterogeneity of genotype-phenotype relationships in enuresis, further studies are needed in PMNE.

Night-time diuresis pattern in children with and without primary monosymptomatic nocturnal enuresis

Night-time polyuria as the dominating pathophysiological mechanism for primary monosymptomatic nocturnal enuresis (PMNE) has been put in question with nocturnal detrusor overactivity and high arousal thresholds as alternatives. An earlier finding of night-time polyuria in 12% of healthy non-enuretic schoolchildren underscores that excessive night-time diuresis per se is unlikely the major cause of PMNE. The objective of this study was to compare the night-time diuresis pattern in children with and without PMNE and to evaluate the role of night-time polyuria in provoking enuretic episodes in children with PMNE. Night-time diuresis pattern was recorded in 27 children with PMNE, aged 6-15 years, and 29 non-enuretic children, aged 6-13 years. Using a portable ultrasound recorder, the bladder volume was estimated at 15-min intervals for at least three nights with the child sleeping in its own bed at home. The volume of enuretic episodes was controlled using preweighed diapers. All voids were registered by time and volume. Diuresis during night time was estimated from the slope of regression lines fitted to ultrasound recording points. Mean night-time diuresis was calculated from total urine production during the night and time interval from the last void before bedtime to the first morning void. Night-time bladder filling pattern was recorded from 189 nights, giving 149 interpretable patterns for analysis (77 children with PMNE and 72 dry children). The night-time diuresis pattern was similar for children with or without PMNE, showing large variability between different nights of the same child. Most nights displayed a smooth bladder filling at constant low rate, whereas other nights showed an early phase with high diuresis followed by a longer period of low diuresis with no difference between the two groups. Night-time diuresis has been non-invasively monitored in children while asleep in their own beds at home. The pattern of night-time diuresis varies considerably between different nights of the same child, with no obvious differences in any diuresis parameters between children with or without PMNE. Non-enuretic children have similar diuresis pattern and maximal night-time diuresis values as children with PMNE, making it unlikely that PMNE is caused by night-time polyuria per se (Summary figure). Delayed maturation of sleep mechanisms such as decreased arousability or sleep inhibition of the micturition reflex is more likely to be the main etiology for enuresis.

Is copeptin a reliable biomarker of primary monosymptomatic nocturnal enuresis?

IntroductionThe position of copeptin (C-terminal fragment of antidiuretin propeptide) as a marker of primary monosymptomatic nocturnal enuresis (PMNE) is under debate, and there are no data on the relation between copeptin and clinical and biochemical parameters in these patients. Aim of the study was to assess the level of serum copeptin in children with PMNE and to look for a relation between copeptin and selected clinical and biochemical parameters in these children.Material and methodsTwenty-five children recruited for the trial fulfilled the following criteria: clinical diagnosis of PMNE, age 5-15 years, normal creatinine level, normal ultrasonographic image of kidneys and urinary tract. The following parameters were evaluated: serum copeptin, creatinine, sodium, potassium, hematocrit and urine specific gravity. Twenty healthy children were included in the control group.ResultsChildren from study and control groups did not differ in serum copeptin, sex, age creatinine, sodium, hematocrit and specific gravity. Serum potassium level remained normal in subjects but was significantly higher in the study group. In children with PMNE we found no relation between serum copeptin level and sex, kidney function, sodium, and urinary specific gravity. We found a negative correlation between copeptin and bladder capacity and trends towards positive relations between copeptin and age, as well as hemoglobin. In the subgroup of children with normal bladder capacity a trend towards a positive correlation between copeptin and potassium was found.ConclusionsCopeptin may be a marker of hydration status in children with PMNE. The relation between potassium and copeptin levels and the clinical significance of the relation require further studies.

Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial.

PurposeTo compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE).MethodsNinety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment.ResultsAfter training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups.ConclusionsBoth intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.

Abnormal neural responses to emotional stimuli in children with primary monosymptomatic nocturnal enuresis.

Nocturnal enuresis (NE) is a common disorder in school-aged children that has been reported to affect nearly 10% of 7-year-old children and affects both the children and their families. Previous studies have shown that the risk of psychosocial difficulties in children with enuresis is elevated. Thus, children with NE may experience negative effects on psychosocial health or emotion processing. Therefore, the aim of this study was to investigate the potential disturbance in emotional processing in children with NE using functional magnetic resonance imaging (fMRI). In this work, we used fMRI and an affective picture task to evaluate brain response changes in children with NE. Two groups, one consisting of 22 children with primary monosymptomatic NE and one with 23 healthy controls, were scanned using fMRI. Compared to the healthy subjects, children with NE mainly showed increased activation when viewing negative vs. neutral pictures in the bilateral medial superior frontal gyrus that extended to the anterior cingulate cortex. Our results demonstrated that children with primary monosymptomatic NE showed abnormal neural responses to emotional stimuli and overactivation in the medial prefrontal and anterior cingulate cortices suggested that children with primary monosymptomatic NE may be hypersensitive in their sensory perception of negative pictures.

Is Renal Bladder Ultrasound Necessary in Monosymptomatic Primary Nocturnal Enuresis? A Case Control Study

Background: Primary nocturnal enuresis is the most common type of enuresis and has profound detrimental effects on quality-of-life and sleep patterns, and increased morbidity. The purpose of this study was to determine the frequency of urinary tract abnormalities found in ultrasound of children with monosymptomatic primary nocturnal enuresis (MPNE) and to compare with ultrasound findings of children without MPNE to determine whether performing ultrasound in these children is necessary. Methods: One hundred and two children aged three to 13 years with MPNE at Golestan Hospital affiliated to the Military University of Medical Sciences of Tehran, Iran from 2016 to 2017, were enrolled in this case-control study. The control group included 59 children with no history of voiding dysfunction, who had abdominal ultrasoud for other than urinary system-related causes. The ultrasound findings were compared between the MPNE and control group. Results: Urinary tract abnormality, detected by ultrasound, was found in 15 children (14.7%) in the MPNE group and one child (1.69%) of the control group, with a statistically significant difference (P < 0.05). Findings of the nocturnal enuresis group were mild unilateral or bilateral kidney fullness in three children (20%), kidney simple cysts in one child (6.66%), hydrocele in three children (20 %), increased thickness or irregularity in the bladder wall of eight children (53.33%), and increased bladder wall thickness in one child of the control group. Conclusions: Urinary abnormalities discovered by ultrasonography in MPNE were not clinically significant and did not require any other diagnostic tests. It may only be of concern to parents and cause unnecessary diagnostic procedures by the physician. This study showed that ultrasound should be done for patients with resistant or inappropriate clinical response during treatments.

A new checklist method enhances treatment compliance and response of behavioural therapy for primary monosymptomatic nocturnal enuresis: a prospective randomised controlled trial.

The aim of the study was to demonstrate the benefits of a newly-established written checklist of behavioural instructions for monosymptomatic nocturnal enuresis. From a total of 96 parents with children who complain of bedwetting three or more nights per week for at least 14days, 79 were randomly divided into three groups. Group I (n = 27) were instructed to apply only behavioural therapy as a written guideline, Group II (n = 26) were instructed to apply behavioural therapy with a written checklist for parents to fully complete and Group III (n = 26) received desmopressin treatment plus verbal behavioural therapy. All participants were analysed in respect of compliance and the response rate to treatment over a time period of 8 weeks. A total of 63 participants completed the study period. The participants in all three groups were similar in terms of the age of the child and the parents, number of siblings, and the educational and economic status of the parents (p > 0.05). High rates of treatment compliance were determined for the participants with the checklist compared to those with written guideline. No statistically significant difference was determined between Group II and III in respect of compliance rates (p = 0.12). The treatment response rates of the participants in Group I were significantly lower compared to those of Group II and III (p = 0.001) with no statistical difference determined between Groups II and III (p = 0.15). The success rate of behavioural therapy for MNE can be increased with the newly-designed method of a written checklist form of behavioural instructions.

Comparison of the efficacy of long-term treatment of primary monosymptomatic nocturnal enuresis of varying severity using traditional methods

Background: Primary monosymptomatic nocturnal enuresis (PMNE) is a pathological state where the patient has no problem with bladder control in the waking state but does not awake from the urge to urinate. Very little is known about the prognostic factors regarding effective treatment of PMNE using methods recommended by the International Children's Continence Society. Objective: To compare the efficacy of long term treatment of PMNE using alarm intervention (AI) and desmopressin in children and adolescents and also to study the impact on it of the severity of disease, age and socio-economic factors. Method: Study was conducted from 15 th January to 30 th October, 2016 in the Far Eastern Federal University (Vladivostok) in children 7 to 14 years old having PMNE. At the preliminary stage, the clinical, socio-economic and demographic characteristics of the children were noted. All patients had blood and urine tests done and the level of antidiuretic hormone was determined. To exclude a hyperactive bladder, uroflowmetry and a questionnaire survey of OABq-SF were used. Monitoring of changes in the number of episodes of enuresis (EE) and independent awakenings was carried out using a voiding diary. In the active phase of the study, patients from group A underwent treatment by AI and patients from group B received desmopressin 0.4 mg per day. Results: There were 339 children aged 7 to 14 years with PMNE during the study period. Group A comprised 162 children treated with AI. At the end of the 4-month course, absence of PMNE was noted in 82.7% patients and after 6 months in 74.7% children. Group В comprised 177 children treated with desmopressin 0.4 mg/day. In group В the absence of PMNE was noted 4 months after the start of the experiment in 72.9% of children and after six months in 67.2% of children. Construction of a two-stage regression model and carrying out partial F-tests established that in group A, the EE level was significantly associated with age (p In addition, it was found that the effectiveness of AI was significantly higher in children who had a greater number of independent awakenings before treatment (p≤0.01). Conclusions: Use of AI in the treatment of PMNE is significantly associated with the number of independent awakenings. Use of both AI and desmopressin are significantly associated with age and severity of symptoms of PMNE. Socio-economic and demographic factors have no significant influence on treatment outcomes of PMNE. Sri Lanka Journal of Child Health, 2018; 47 : 249-256

Primary monosymptomatic nocturnal enuresis: an etiological study

BackgroundNocturnal enuresis (NE) is a very common chronic pediatric problem with bad psychological consequences.MethodsForty primary monosymptomatic nocturnal enuresis (MNE) children and 20 healthy controls were recruited in the study and subjected to history taking, neurological and urological examinations, and psychological assessment using the Arabic-translated and validated version of child behavior checklist, sleep architecture studying through one-night polysomnography (PSG), and vasopressin levels determination both diurnal and nocturnal.ResultsEnuretic children had positive family history of NE in 42.5%, inverted vasopressin circadian rhythm in 52.5% and PSG changes in the form of increased N3 deep sleep % of total sleep time (TST), sleep stage transition index (SSTI), periodic limb movement index (PLMI), and snore index. Enuretic children PSG showed decreased deep sleep latency, N1% of TST, N2% of TST, and REM % of TST. The child behavior checklist showed higher anxious depressed symptoms, social problem, attention problems, and internalizing problems in enuretic children than control subjects.ConclusionsMNE is a heterogeneous disorder with multiple factors interplay in its pathogenesis. So, the management must be tailored patient by patient according to the dominating etiology.

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

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

The optimal duration of alarm therapy use in children with primary monosymptomatic nocturnal enuresis

The prevalence of primary monosymptomatic nocturnal enuresis (PMNE) has a range of 1.6-5.3% in adolescents and 7.5-12.4% in children of 5-10 years. Alarm intervention has been well known for more than 30 years. This method is a reliable and safe means of treating primary monosymptomatic nocturnal enuresis, being effective in 60-80% of cases. The objective of this study was to determine the efficacy of alarm intervention prolongation after the cure in order to reduce the risk of disease recurrence. Two hundred ninety-four boys and 161 girls (455 persons in total) of age 9-14 years (average 11.4 years) took part in the prospective randomized study. After preselection and establishing diagnosis, all patients were randomly divided in three groups. In group А (n=139) alarm system treatment was carried out within 12 weeks, in group В (n=136) 16 weeks, and in group С (n=139) 20 weeks. The percentage of patients who no longer wet the bed (for 2 weeks or more) immediately after treatment in groups B (80.7%) and C (85.5%) was higher than in group A (67.4%) if the probability of error is pB/A<0.05; pC/A<0.05. There was no statistically significant difference in treatment success between groups B and C immediately after treatment. The percentage of patients who no longer wet the bed 3 months after the end of treatment in groups B (71.2%) and C (77.1%) was higher than in the group A (45.9%) if the probability of error is pB/A<0.05; pC/A<0.05. There was no statistically significant difference in treatment success between groups B and C 3 months after treatment. During the year this ratio did not change. These data suggest that the effective duration of alarm intervention is found in the range 16-20 weeks and involves an uninterrupted course of treatment. Perhaps this range of time is optimal for the formation of a neuroreflexive mechanism that creates a habit for independent awakening in children with primary monosymptomatic nocturnal enuresis. The effective duration of alarm intervention is likely to be 16-20 weeks of an uninterrupted course of treatment. This time interval ensures the maximum effectiveness of treatment and the stability of long-term results.

Morphometric Magnetic Resonance Imaging Study in Children With Primary Monosymptomatic Nocturnal Enuresis.

Primary monosymptomatic nocturnal enuresis (PMNE) refers to bed-wetting in children who have no other lower urinary tract symptoms and are never dry for more than 6 months. Our previous studies demonstrated that children with PMNE exhibited brain functional abnormalities compared with healthy controls; however, researches on the abnormalities in gray matter were limited. This study aimed to investigate brain structural changes in gray matter of children with PMNE using magnetic resonance imaging (MRI). Gray matter volumes (GMVs) and gyrification indices (GIs) were calculated using voxel-based and surface-based morphometry analyses of structural MRI data acquired from 26 children with PMNE and 28 healthy children. To identify between-group differences in gray matter, two-sample t-tests were conducted on GMV and GI images separately. Compared with the controls, children with PMNE showed significantly increased GMVs in the supplementary motor area and medial prefrontal cortex regions (mean GMV in PMNE: 0.54 ± 0.07 l; mean GMV in controls: 0.50 ± 0.06 l) and reduced GIs in the right precuneus (mean GI in PMNE: 25.74° ± 2.34°; mean GI in controls: 27.97° ± 1.79°). Children with PMNE showed abnormal GMVs in frontal lobe and GIs in precuneus, and these changes might be involved in the pathological mechanism of PMNE.

Evaluation of the Frequency of Obesity and Demographic Characteristics of Children with Primary Monosymptomatic Nocturnal Enuresis

Evaluation of the Frequency of Obesity and Demographic Characteristics of Children with Primary Monosymptomatic Nocturnal Enuresis

Kalciurija kod dece sa primarnom monosimptomatskom noćnom enurezom

Introduction: The prevalence of idiopathic hypercalciuria (IH) in healthy pediatric population ranges from 3.0% to 7.0%. There is insufficient data about IH in children with mono-symptomatic enuresis. The aim of this study was to examine calcium excretion in urine (UCa) in patients with primary mono-symptomatic nocturnal enuresis (PMNE). Methods: In patients with PMNE, aged 5 to 17 years, IH was determined in 24-h urine and from second morning spot urine. The completeness of the 24-h urine collections was estimated via measuring 24h-urine creatinine excretion (UCr) of 0.1-0.2 mmol/kg/24h. Results: Sixty patients with PMNE, 32 males and 28 girls, median age of 9 years were enrolled in the study. Only 41.7% patients successfully completed 24 h urine collection. IH, defined as 24-h UCa &gt; 0.1 mmol/kg body weight, was diagnosed in 12% of the patients, while when defined as UCa/UCr &gt; 0.8 mmol/mmol in children 5-7 years and &gt; 0.6 mmol/mmol in those &gt; 7 years, IH was 8.3% and 6.7% from 24hurine and spot urine, respectively. Conclusion: Children and adolescents with PMNE are in risk of hypercalciuria. Therefore, it is useful to examine 24 hours of urine calcium excretion in these patients.

Brain networking in primary monosymptomatic nocturnal enuresis: News from Brain-Bladder-Control matrix

Brain networking in primary monosymptomatic nocturnal enuresis: News from Brain-Bladder-Control matrix

Alarm therapy and desmopressin in the treatment of patients with nocturnal enuresis.

Purpose:The purpose of this study was to compare the rates of success, relapse, and compliance to treatment in patients undergoing alarm therapy or receiving desmopressin for primary monosymptomatic nocturnal enuresis (PMNE).Materials and Methods:This retrospective study was performed by reviewing the medical files of patients undergoing alarm therapy (Group 1) or receiving desmopressin (Group 2) for PMNE, between January 2010 and July 2014. Patients undergoing treatment in the 3rd and 6th month as well as 1st year follow-up data were analyzed. Two groups were compared with regard to treatment success, relapse rate, and compliance to treatment.Results:Group 1 included 64 and Group 2 included 70 children. Relapse rates at the 3rd month, 6th month, and 1st year were 67.2%, 71.9%, and 17.0% for Group 1 and 74.3%, 80.0%, and 21.4% for Group 2, respectively. There was no statistically significant difference between relapse rates at any point of follow-up.Conclusions:Alarm therapy and desmopressin have the same success rate and relapse rates for PMNE. Compliance with alarm therapy is higher and we recommend it as the first-line treatment. On the other hand, desmopressin has low side effects and can also be used.

Children with monosymptomatic primary nocturnal enuresis – the clinical profile of patients during the first nephrological consultation

Children with monosymptomatic primary nocturnal enuresis – the clinical profile of patients during the first nephrological consultation

EFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS

EFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS Murtadha M Almusafer@ & Aymen Adel* @FICMS, Professor of Urology, University of Basrah, College of Medicine, Department of Surgery. *FICMS, Urology Specialist, Basrah General Hospital, Basrah, IRAQ. Abstract Primary monosymptomatic nocturnal enuresis (PMNE) is still a common bothersome complaint that makes the children and their families looking for help. Primary MNE is defined as abnormal urination that occurs involuntarily during sleep. Its incidence varies with age, with 15%-20% at 5 year old and fades with increasing age to reach 1-2% at 15 year old. Owing to its complicated pathophysiology and sharing of different body systems, multiple lines of treatment were attempted. This study aimed is to explore the efficacy of different treatment modalities for PMNE in the study patients. Ninety two patients were enrolled in this prospective randomized trial and divided into 4 groups; group A instructed to use the behavioral measures, group B given intranasal Desmopressin, group C given Oxybutynin and group D given combination of the 3 treatments. Fourteen participants were excluded because they were lost during followup and the remaining 78 patients' data were analyzed. Patients were reassessed at 4th and 12th weeks. Wet nights/week significantly reduced in all treatment groups as compared to baseline. Percentage reduction of wet nights/week for behavioral group was 38.9%, Desmopressin was 83%, Oxybutynin was 78% and for Combination was 87.8% at 12th week. According to the ICCS definitions of success there is no full response in behavioral group with partial response of 42.1%, for Desmopressin group the full response was 57.1% and partial response 28.6%, for Oxybutynin group was 50%, and 33%, for combination group 60%, 30% at 12th week of treatment. In conclusion, although behavioral therapy reduces wet nights but not reaching to a full improvement and its use is preferably combined with other treatment modalities. Desmopressin, Oxybutynin, and Combination treatment significantly decreases wet nights with high full response rate.

Therapeutic Efficacy of Hydrochlorothiazide in the Primary Monosymptomatic Nocturnal Enuresis of Children

Abstract Background: Nocturnal enuresis is a symptom with probably multiple etiologic factors and a high prevalence. Conventional therapies is expensive and complicated, since the effect of calcium on voiding dysfunction was approved. Therefore, to the current study aimed at evaluating the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis (PMNE). Methods: The current study was conducted based on the interviews with patients. Morning urine test was evaluated in children with PMNE detection and specific gravity < 1010 enrolled to the study (110 children comprised of 57 cases and 53 controls). Children were divided into 2 groups; in the case group, hydrochlorothiazide (tablet 1 mg/kg and maximum 50 mg) was administered in the morning and the control group was only given necessary training about enuresis. For 3 times and with 1 month interval (based on a predetermined questionnaire) the frequency of nocturnal enuresis was checked. Data were transferred into SPSS program and the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis was investigated. Findings: There was a statistically significant difference regarding the frequency of nocturnal enuresis between the 2 groups (P = 0.0001). Also, both groups were matched by age (P = 899) and gender (P = 607). Conclusions: Hydrochlorothiazide can be used as an effective and safe therapeutic option for treatment of primary monosymptomatic nocturnal enuresis.