Primary Nocturnal Enuresis In Children Research Articles

Functional connectivity density of brain in children with primary nocturnal enuresis: results from a resting-state fMRI study.

Primary nocturnal enuresis (PNE) is a disease characterized by involuntary urination during sleep after the age of five, causing inconvenience and psychological burden to children and their families. The onset of PNE is related to many factors, and in recent years, delayed central nervous system maturation has been considered one of the important causes of PNE. Previous studies have demonstrated functional changes in multiple brain regions in children with PNE. However, these studies either focused on changes in local brain regions or the functional connection (FC) between specific brain regions, and there is currently a lack of research on the whole brain FC in children with PNE. This study analyzed functional connectivity density (FCD) across the entire brain based on voxels and comprehensively evaluated the global FCD (gFCD), local FCD (lFCD), and long-range FCD (lrFCD). Decreased gFCD and lFCD were found in the left temporal lobe and the right posterior cerebellum in the children with PNE compared with the HC. The FCD values in these regions were negatively correlated with the scores of hyperactivity/impulsivity in the children with PNE. This study may help to reveal the neural mechanisms underlying the onset of PNE in children from a new perspective.

Abnormal resting-state functional connectivity of hippocampal subregions in children with primary nocturnal enuresis.

ObjectivePrevious neuroimaging studies have shown abnormal brain-bladder control network in children with primary nocturnal enuresis (PNE). The hippocampus, which has long been considered to be an important nerve center for memory and emotion, has also been confirmed to be activating during micturition in several human imaging studies. However, few studies have explored hippocampus-related functional networks of PNE in children. In this study, the whole resting-state functional connectivity (RSFC) of hippocampus was investigated in children with PNE.MethodsFunctional magnetic resonance imaging data of 30 children with PNE and 29 matched healthy controls (HCs) were analyzed in our study. We used the seed-based RSFC method to evaluate the functional connectivity of hippocampal subregions defined according to the Human Brainnetome Atlas. Correlation analyses were also processed to investigate their relationship with disease duration time, bed-wetting frequency, and bladder volume.ResultsCompared with HCs, children with PNE showed abnormal RSFC of the left rostral hippocampus (rHipp) with right fusiform gyrus, right Rolandic operculum, left inferior parietal lobule, and right precentral gyrus, respectively. Moreover, decreased RSFC of the left caudal hippocampus (cHipp) with right fusiform gyrus and right supplementary motor area was discovered in the PNE group. There were no significant results in the right rHipp and cHipp seeds after multiple comparison corrections. In addition, disease duration time was negatively correlated with RSFC of the left rHipp with right Rolandic operculum (r = −0.386, p = 0.035, uncorrected) and the left cHipp with right fusiform gyrus (r = −0.483, p = 0.007, uncorrected) in the PNE group, respectively. In the Receiver Operating Characteristic (ROC) analysis, all the above results of RSFC achieved significant performance.ConclusionsTo our knowledge, this is the first attempt to examine the RSFC patterns of hippocampal subregions in children with PNE. These findings indicated that children with PNE have potential dysfunctions in the limbic network, sensorimotor network, default mode network, and frontoparietal network. These networks may become less efficient with disease duration time, inducing impairments in brain-bladder control, cognition, memory, and emotion. Further prospective research with dynamic observation of brain imaging, bladder function, cognition, memory, and emotion is warranted.

Sacral nerve magnetic stimulation combined with rehabilitation training in the treatment of primary nocturnal enuresis in children

Objective: To explore the clinical value of sacral magnetic stimulation (SMS) combined with rehabilitation training in the treatment of primary nocturnal enuresis (PNE) in children. Methods: The clinical data of 57 children with PNE admitted to the Department of Rehabilitation Xuzhou Rehabilitation Hospital, Xuzhou Central Hospital and Xuzhou Children's Hospital from October 2019 to September 2020 were collected and analyzed. The children were divided prospectively into observation group and control group by using random number table method. Bladder function training, awakening training and life and psychological intervention were performed in both groups, while the observation group was treated with SMS based on the above treatment methods. Before and after treatment, the degree and the frequency of enuresis (normal, mild, moderate, severe), therapeutic evaluation and bladder volume were compared. Chi-square test and T test were used for comparison between the two groups. Results: Finally, 28 cases in the observation group and 29 cases in the control group were included. There was no significant difference in age, sex, degree and of frequency enuresis of children between the two groups (all P>0.05).The degree of enuresis in the observation group after 1 month of treatment was better than that in the control group (12 vs. 7 cases, 8 vs. 8 cases, 5 vs. 9 cases, 3 vs. 5 cases, χ2=-2.269, P=0.030). Enuresis times in observation group was lower than that in the control group [(4.2±1.8) vs. (8.1±2.0), t=4.475, P<0.01). The total effective rate and bladder capacity of efficacy evaluation were higher than those of control group [82%(23/28) vs. 48%(14/29), (225±25) vs. (199±21) ml, Z=11.238, t=-2.249, both P<0.05]. Conclusions: SMS is an effective method for the treatment of PNE in children, which can reduce the degree and frequency of enuresis in children, increase the bladder volume and improve the total effective rate of treatment. It is worthy of clinical promotion and application.

The impact of adenotonsillectomy on monosymptomatic primary nocturnal enuresis in children with obstructive sleep apnea syndrome

Objectives: To analyze the outcome of monosymptomatic primary nocturnal enuresis (MPNE) after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Methods: The study included 74 MPNE children with OSAS qualified for an adenotonsillectomy procedure. MPNE was assessed prior to surgical procedure as well as 3 and 6 months after surgery. In addition to polysomnographic parameters, serum antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) levels were measured preoperatively and 3 months postoperatively. Results: The mean age was 9.8 years and the mean number of nocturnal wetting weekly was 4.1. Thirty-eight percent of patients had family history of MPNE. All the patients underwent a successful adenotonsillectomy. Nocturnal enuresis was still reported in 18% of children 6 months after adenotonsillectomy. An increased risk of MPNE was significantly demonstrated in children with high obstructive apnea-hypopnea index (O-AHI), high oxygen desaturation index (ODI), high frequent nocturnal enuresis and family history. After surgery, ADH levels were significantly lower, whereas BNP levels were significantly higher in non-resolution children. Univariate analysis showed that higher O-AHI, higher ODI, severe enuresis, low serum ADH and higher serum BNP levels were indicative of persistent nocturnal enuresis. Multivariate analysis showed that higher ODI and higher BNP levels are independent prognostic markers for MPNE. Conclusions: Adenotonsillectomy in MPNE children with OSAS is an effective treatment for resolution of MPNE. Also, higher ODI caused by apnea and elevated serum BNP levels are the most important factors affecting the outcome of MPNE patients. Level of evidence: Not applicable for this multicentre audit.

Re: The Role of Adenotonsillectomy in the Treatment of Primary Nocturnal Enuresis in Children: A Systematic Review.

Re: The Role of Adenotonsillectomy in the Treatment of Primary Nocturnal Enuresis in Children: A Systematic Review.

The influence of delay elimination communication on the prevalence of primary nocturnal enuresis-a survey from Mainland China.

A pilot survey shows that primary nocturnal enuresis (PNE) prevalence has increased significantly during the past decade in Mainland China. Whether it is related to the delay of elimination communication (EC) is unclear. This study retrospectively investigated the influence of delayed EC on the PNE prevalence in children and adolescents in mainland China. A cross-sectional study of PNE prevalence was performed by distributing 19 500 anonymous self-administered questionnaires to parents in five provinces of mainland China from July 2017 to October 2017. The questionnaires included sociodemographic data, family caregivers' information, and details about the disposable diapers (DD) usage, EC commencement date, psychological disorders, lower urinary tract symptoms, and family history of PNE in children and adolescents. The 2017 PNE prevalence was compared with that of 2006 in Mainland China. The total response rate was 97.04% (18 631 of 19 500) and 92.39% (18 016 of 19 500) qualified for statistical analysis. The PNE prevalence in 2017 has increased significantly compared to that of 2006 (7.30% vs 4.07%, P < 0.001). The PNE prevalence in children with EC starting before 6 months of age was significantly lower than those who start after 12 months of age. The longer DD were used and the later the beginning of EC, the higher the PNE prevalence was found. The PNE prevalence in Mainland China has increased significantly during the past 10 years. A longer use of DD and later onset of EC may be risk factors for PNE.

Population Pharmacokinetic Modeling of a Desmopressin Oral Lyophilisate in Growing Piglets as a Model for the Pediatric Population.

Desmopressin is used to treat primary nocturnal enuresis in children. Over the years, various formulations of desmopressin were commercialized of which the sublingual melt tablet is preferred in the pediatric population, despite the lack of full PK studies in this population. A full PK study was performed in growing conventional piglets to evaluate if this juvenile animal model can provide supplementary information to complement the information gap in the pediatric population. A desmopressin sublingual melt tablet (120 μg) was administered to 32 male piglets aged 8 days, 4 weeks, 7 weeks, and 6 months (each group n = 8). Population PK (pop-PK) analysis was performed to derive the PK parameters, the between- and within-subject variabilities and the effects of covariates. Desmopressin demonstrated two-compartmental PK, with a dual, sequential absorption process, and linear elimination. Body weight was the only significant covariate on clearance and on apparent volume of distribution of the central compartment. In human pediatric trials, no double peak in the absorption phase was observed in the plasma concentration-time curves, possibly due to the sparse sampling strategy applied in those pediatric studies. Therefore, it is recommended to perform additional studies, based on the sampling protocol applied in the current study.

The role of adenotonsillectomy in the treatment of primary nocturnal enuresis in children: A systematic review

Primary nocturnal enuresis (PNE) is a challenging condition for physicians, patients and families. Although the etiology remains unclear, sleep-disordered breathing (SDB) and sleep apnea have been suggested to play an important role. Recent research has suggested a potential therapeutic benefit of adenotonsillectomy (T&A) and surgical management of upper airway obstruction in the treatment of PNE. The aim was to conduct a systematic review of relevant literature to determine the effectiveness of T&A in treating children aged 2-19 years with PNE. This was a systematic review using a comprehensive electronic search strategy that included PubMed, Embase, CINAHL, Cochrane Library, conference proceedings, and the gray literature up to July 2015. We included all studies of children aged 2-19 years with PNE and SDB who underwent T&A. The primary outcome was resolution of PNE following surgery. Observational studies and randomized trials were reviewed. Risk of bias assessment and meta-analyses of included studies were performed. We screened 3254 citations; following title and abstract screening, 42 studies were selected for full-text screening by two independent reviewers. We included 18 studies (890 patients) in our final analysis. All studies were observational and only one included a control group. Meta-analysis of proportions of all (18) studies revealed a pooled complete resolution rate of 51% (43-60%), with significant heterogeneity among studies (I2=82.2%). Partial resolution was seen in 20% (14-27%), with similar heterogeneity to the complete resolution group. Sensitivity analysis including only studies with a low risk of bias and with patients ≥5 years (n=244 patients) yielded a complete resolution rate of 43% (36-49%) with minimal heterogeneity (I2=0%; figure). In our systematic review, T&A resulted in improvement of nocturnal enuresis in more than 60% of patients, with complete resolution rates in excess of 50%. Findings were persistent on meta-analysis focused only on studies including older patients (≥5 years) and those with short follow-up after surgery (≤3 months), which imply a higher cure rate than would be expected based on natural history alone. The limitations of this review include the lack of controlled trials, the overall quality of the evidence reviewed and the heterogeneity between included studies. The role for systematic investigation and treatment of sleep disorders in patients with PNE should be scrutinized further, since a near 50% complete resolution rate for PNE may be expected with T&A in some settings.

Association between Asthma and Primary Nocturnal Enuresis in Children

Enuresis, sleep respiratory disorders and asthma compromise the quality of sleep in children and may occur in association with each other. An association between sleep respiratory disorders and enuresis has already been demonstrated. According to united airways disease abnormalities of the upper and lower airways may coexist. A child who wheezes has a greater chance of snoring and having obstructive sleep apnea. Since asthma and sleep respiratory disorders may be associated, and sleep respiratory disorders are associated with enuresis, we determined the possibility of an association between asthma and enuresis. Between August 20 and March 2015 parents/guardians of children 6 to 14 years old from 16 elementary schools in our area were randomly chosen for study. Children with nonmonosymptomatic enuresis and urological or neurological disease were excluded. The Tucson and ISAAC (International Study of Asthma and Allergies in Childhood) questionnaires wereused to assess sleep respiratory disorders and asthma, respectively. A total of 523 children (283 males and 240 females) with a mean ± SD age of 9.42 ± 2.46 years were included in analysis. The overall prevalence of enuresis was 15.87% (95% CI 12.98-19.26). Asthmatic children with wheezing in the last 12 months were 2.33 times more likely to have had enuresis at some point in life (OR 2.33, 95% CI 1.37-3.95, p = 0.0017). If enuresis was present, the chance increased to 2.78 (95% CI 1.38-5.61, p = 0.0041). Enuretic children were 5.34 times more prone to have apnea reported by parents (95% CI 2.19-13.03, p= 0.0002). These findings demonstrate that asthma as well as sleep respiratory disorders is associated with primary nocturnal enuresis.

Meta analysis of the alarm treatment and desmopressin in the treatment of primary nocturnal enuresis in children

Objective To explore the therapy efficacy for children with primary nocturnal enuresis by meta-analysis on the efficiency of alarm treatment versus desmopressin. Methods PubMed, Central, Elesvier, CNKI and some other databases were browsed to obtain all randomized controlled trails(RCT) and to compare the therapy between alarm treatment and desmopressin.Data extraction and quality evaluation were done by methods recommended by Cochrane center.The results of short-term and long-term efficacy and compliance were analyzed by Review Manager 5.0. Results Fifty-four RCT were retrieved and 11 RCT were included in the study.There was no statistical difference between alarm treatment and desmopressin when analyzing by no wetting episode, wetting no more than 1 night per month, wetting nights' decrease over 90% or wetting nights decrease over 50%.By 3-month follow-up after treatment stopped, alarm treatment significantly reduced the wetting nights to over 50% or less than 1 night per month than desmopressin.By 6-month follow-ups after treatment stopped, there was no difference between alarm treatment and desmopressin when analyzed by wetting no more than 1 night.The relapse rate of desmopressin was higher than that of alarm treatment(P=0.007). However, the withdrawal and abandonment rate of alarm treatment was higher than that of desmopressin(P<0.000 01). Severe adverse effects were not found in both of the treatment groups. Conclusions There is no statistical difference between alarm and desmopressin therapy in short-term treatment.The efficiency of alarm device is better than that of desmopressin in long-term treatment.The follow-up of alarm treatment lost more than that of desmopressin.Desmopressin is better than the alarm treatment in compliance but has higher recurrence rate. Key words: Primary nocturnal enuresis; Alarm treatment; Desmopressin; Meta analysis; Child

Prevalence and Quality of Life of Slovenian Children with Primary Nocturnal Enuresis

Aim. To get epidemiologic data about primary nocturnal enuresis (PNE) and its influence on the quality of life of Slovenian children and adolescents and to find out the knowledge about the disorder among school population. Methods. Prospective epidemiologic study was performed in Slovenia in 2011 and supported with two questionnaires. The first questionnaire was distributed among primary school population that included 1248 children. The second questionnaire included 44 children, who have been treated for PNE in Nephrology Unit of our Department of Paediatrics. Results. PNE was diagnosed in 12.4% of children, in 11.8% of girls and in 13.0% of boys. There was evident linkage between the appearance of PNE in children and their relatives. The study showed that PNE influences the quality of life in less than half of the investigated children. Disorder restricts them mostly in relations with coevals. Knowledge about PNE among children in elementary schools was found to be insufficient. Conclusion. We found out that the prevalence of PNE in Slovenia is comparable to prevalence in other countries. More than half of children questioned in a survey think that PNE does not affect their lives significantly. General lack of knowledge about PNE is still a problem.

Impact of sleep-disordered breathing and its treatment on children with primary nocturnal enuresis

To determine the prevalence of primary nocturnal enuresis in children, to define the possible role of sleep-disordered breathing (SDB) related to adenotonsillar hypertrophy in enuresis, to explore the role of brain natriuretic peptide (BNP) levels in measuring the severity of SDB in enuretic children, and to evaluate the response to surgical interventions (adenotonsillectomy) in indicated enuretic patients. Parental surveys of 5-10 year-old children were reviewed for SDB and enuresis. Children with SDB were clinically and radiologically examined. Plasma BNP levels were determined in 33 children with SDB and enuresis and in 30 otherwise healthy children of whom 15 had enuresis. A total of 15.3% of the studied children had primary nocturnal enuresis, and 47 children with enuresis (30.7%) had SDB. There was a downward trend of enuresis and SDB as age increased. There appeared to be an association between the frequency of enuresis, snoring and adenotonsillar enlargement. Plasma BNP concentrations were significantly higher among enuretic children. All enuretic children with SDB underwent surgical intervention (33 patients), and an improvement was observed in 29 children (87.8%). Among them, 15 were cured completely, and 12 made a significant improvement in the initial 3 months, but two made just a partial improvement over one year, and four did not show any improvement over one year follow up. All enuretic children with SDB who underwent surgery exhibited a significant reduction in daytime enuresis. The data suggests an association between nocturnal enuresis and adenotonsillar related SDB in children. Enuresis may add to the indications for surgical intervention in this group. Increased BNP levels may account for the increased prevalence of enuresis in context of SDB.

Treatment of primary nocturnal enuresis in children: a review

Primary nocturnal enuresis is a common childhood disorder. Treatment approaches bridge the psychological and medical fields. A substantial body of literature addresses the various ways of treating enuresis, from pharmaceuticals to behavioural interventions. The medical and psychological literatures have proceeded relatively independently from one another and there has been little interconnection between the US and international literatures, resulting in a lack of discourse and integration among researchers investigating treatment outcomes for enuresis. This review examined the evidence base for treatments of primary nocturnal enuresis in children. Psychological, pharmaceutical and multi-component interventions are discussed. This review sought to provide an integrated interdisciplinary and international perspective on treatment efficacy for nocturnal enuresis by expressly gathering publications from psychological and medical fields, as well as US and international sources. The literature supported the urine alarm as the most effective intervention for nocturnal enuresis and demonstrated the benefit of combining the urine alarm with other components, both behavioural and pharmaceutical. In particular, recent literature showed that the urine alarm, when used in conjunction with antidiuretic medication (i.e. desmopressin), leads to more dry nights earlier in the conditioning process. Disparities between the different literatures were discussed.

Self‐monitoring of blood glucose in type 2 diabetes mellitus: a systematic review of economic evidence; Identification and nursing management of dysphagia in individuals with acute neurological impairment; Best practice in the management of primary nocturnal enuresis in children: a systematic review; A systematic review of nurses’ inter‐shift handover reports in acute care hospitals

Self‐monitoring of blood glucose in type 2 diabetes mellitus: a systematic review of economic evidence; Identification and nursing management of dysphagia in individuals with acute neurological impairment; Best practice in the management of primary nocturnal enuresis in children: a systematic review; A systematic review of nurses’ inter‐shift handover reports in acute care hospitals

Facial patterns and primary nocturnal enuresis in children

Aims of our study are evaluating: (1) the prevalence of dolicofacial pattern among enuretic and control-group children, (2) the prevalence of an abnormal head posture in bedwetters, and (3) the correlation with sleep-related breathing disorders (SRBD) identified by polysomnography (PSG) recording. Nocturnal enuresis is a multifactorial disease, but has been related also to obstructive sleep-disordered breathing in both adults and children. Anatomical factors recognized to predispose to SRBD include adenotonsillar hypertrophy, neuromuscular disorders, craniofacial abnormalities associated with macroglossia, retrognathia or maxillary hypoplasia, and obesity. Two hundred seventy enuretic children aged 7-12years (mean 9.62 ± 2.31) were compared with a control-matched group of 274 children. To screen nocturnal sleep habits, all subjects' mothers filled out the Sleep Disturbance Scale for Children. Among these scales, only SBD scale was taken into account. Sleep breathing disorders (SBD) scale is composed of three items: sleep breathing difficulties, sleep apnea, and snoring. Cephalic index was calculated for each patient in order to identify facial patterns. An overnight PSG was performed in 28 (15 males, 13 females), randomly chosen, enuretic children and in 38 healthy volunteer controls (18 males, 20 females) matched for age (8.73 ± 0.79 vs. 9.12 ± 1.23; p = 0.147) and sex distribution (chi-square = 0.062; p = 0.803). Bedwetters show different sleep habits, higher prevalence of dolicofacial pattern, and abnormal head posture more than controls. Our preliminary study support further investigation of usage of the cephalic index as a predictor of SRBD.

Best practice in the management of primary nocturnal enuresis in children: a systematic review.

Nocturnal enuresis is the involuntary loss of urine at night in a child of an age and physical health where they would be expected to be dry. The prevalence of this condition in Australia has been estimated at 18.9% in children 5 to 12 years of age, with up to 19% of boys and 16% of girls aged 5 years wetting the bed at least once per month. Up to the age of 13 years bedwetting is more common in boys and more common in girls after this age. Nocturnal enuresis has a spontaneous cure rate of approximately 14% however up to 3% of children remain enuretic as adults. Although this condition is pathologically benign, it can have serious social and psychological repercussions for the sufferer including affects on self esteem, school success, parental disapproval and even sexual activity in later life. Despite the volume of information available for the management of enuresis, the majority of research has been conducted outside Australia. Therefore, the purpose of this work was to produce management guidelines for nocturnal enuresis in children specific to Australian clinical practice. This review considered systematic reviews or concurrently controlled trials (randomised controlled trials (RCT), pseudo-randomised controlled trials, controlled clinical trials (CCT), interrupted time series (ITS) and controlled before and after trials (CBA)), for examining effectiveness of interventions to manage nocturnal enuresis in children up to the age of 16 years. A systematic search of the literature was performed to identify all available evidence. Cochrane and other health technology assessment websites were searched for existing systematic reviews. For recent randomised controlled trials and controlled trials (1990 to 2007) Pubmed, Embase, and CINAHL databases were searched. Reference lists of all retrieved articles were searched for relevant trials. These reviews and guidelines were summarised and presented to an advisory panel of nurse continence advisors and clinicians to ensure relevance to Australian clinical practice. Methodological quality of all studies was assessed by two reviewers using the JBI critical appraisal forms for experimental studies located within the JBI-MAStARI software. This tool was used to identify all sources of bias. Where disagreement existed between the two reviewers a third reviewer adjudicated. Seven systematic reviews, eight new trials and two guidelines were used in the development of these guidelines.Briefly management recommendations include: CONCLUSIONS: Despite the high prevalence of nocturnal enuresis and the negative psychosocial sequelae that can arise from this condition, management is both readily available and effective. The practice of managing nocturnal enuresis in children should start with addressing both daytime wetting and any evidence of constipation. Following this, less invasive behavioural therapies should be attempted. If these measures fail then the use of alarms with or without short-term administration of desmopressin could be attempted. Other interventions have yet to be proven to be definitively effective and should be considered with caution.It should be emphasized however, that the vast majority of children will become continent at some future time point, with or without the benefit of interventions. While it is clear that some behavioural methods, alarms and desmopressin can be effective interventions, the evidence for other treatments is not so definitive. The observation however that even alarms and/or desmopressin do not work for all children suggests that research to establish the effectiveness of other interventions (especially behavioural and complementary treatments) should be performed in the form of large, carefully designed RCTs.

BEST PRACTICE IN THE MANAGEMENT OF PRIMARY NOCTURNAL ENURESIS IN CHILDREN.

Review Questions/Objectives: This review seeks to answer the following question(s): How effective are: 1. simple behavioural interventions such as reward systems 2. complex behavioural interventions 3. alarms 4. pharmaceuticals such as desmopressin and tricyclics 5. and complementary interventions such as acupuncture and hypnosis in managing primary nocturnal enuresis in children The inclusion criteria for this review: Types of participants: Studies that examined children (as defined in the trial) aged up to and including the age of 16 years, who suffered from a primary diagnosis of NE will be included. Types of interventions: The Cochrane reviews that form the basis of this review have divided interventions for management of NE in children into seven categories. These categories will also be used in this review: 1) alarms 2) simple behavioural and physical interventions (such as fluid restriction, lifting and reward systems) 3) complex behavioural and educational interventions (use a number of different behavioural and educational interventions in combination such as dry bed training) 4) complementary and miscellaneous interventions 5) desmopressin 6) tricyclic and related drugs 7) drugs other than desmopressin and tricyclics Types of outcome measures: Outcomes of interest to this review have been specified by the identified Cochrane reviews and include: 1) change in the number of wet nights per week 2) number of participants failing to attain 14 consecutive dry nights (the accepted criterion for continence) 3) mean number of wet nights at follow-up 4) relapse (as defined by each trial)

Best practice in the management of primary nocturnal enuresis in children: a systematic review

Best practice in the management of primary nocturnal enuresis in children: a systematic review

A Randomized, Placebo-Controlled, Exploratory Trial of Ibuprofen and Pseudoephedrine in the Treatment of Primary Nocturnal Enuresis in Children

This exploratory randomized, double-blind, double-dummy, placebo-controlled trial of 14 days duration conducted in 22 primary care practices in the United States was used to compare the efficacy of ibuprofen and pseudoephedrine, administered alone or in combination, to placebo for the treatment of primary nocturnal enuresis (PNE) in children aged 6 to 11 years. Ibuprofen (IBU) and pseudoephedrine (PSE) are not approved for the treatment of PNE. Three hundred eighteen children with PNE were enrolled. Eligible children had >or= 8 wet nights during a 14-day baseline. Each child was randomly assigned to 1 of 4 treatment groups: IBU 12.5 mg/kg and PSE HCl 15 or 30 mg (depending on weight) (n = 82), IBU 12.5 mg/kg (n = 78), PSE HCl 15 or 30 mg (n = 76), or placebo (n = 82). Treatment was administered orally at bedtime for 14 days. Caregivers recorded whether the child was wet or dry each night in a daily diary. Children in the IBU alone and IBU and PSE combined groups had greater mean reductions from baseline in the number of wet nights (primary end point) compared to children receiving placebo (-2.9, -2.9, and -1.4, respectively, P < .005); PSE alone (-1.8) was not significantly different from placebo. Children in these groups also had greater mean percentage reductions in the number of wet nights compared to placebo-treated children (26%, 28%, and 12%, respectively). Although not always statistically significant, secondary end points improved in the IBU alone and IBU and PSE combined treatment groups, which included decreases in mean number of wet nights and decreases in the number and percentage of children with >or= 50%, 40%, 30%, or 25% reductions in number of wet nights. Children responding to treatment had larger mean bladder capacities and larger mean percentage of predicted bladder capacities than children who did not respond in each treatment group. No significant differences in adverse events were found among treatment groups. In conclusion, in this exploratory study in children aged 6 through 11 years, IBU provided a beneficial effect in the treatment of PNE compared to placebo, whereas PSE did not. The addition of PSE to IBU did not enhance or diminish the efficacy of IBU. All treatments were well tolerated.

Location of spina bifida occulta and ultrasonographic bladder abnormalities predict the outcome of treatment for primary nocturnal enuresis in children

We examined whether the existence of spina bifida occulta or ultrasonographic bladder abnormalities was related to the outcome of treatment for primary nocturnal enuresis in children. Between April 1996 and September 2005, a total of 77 subjects (53 boys and 24 girls, aged 5-18 years; mean age, 9.9 years) with primary nocturnal enuresis were studied. Plain X-ray films of the spine and ultrasonographic bladder measurements (bladder wall thickness, bladder neck descent and bladder neck opening) were obtained and the correlations with the outcome of treatment using imipramine hydrochloride were assessed. On plain X-ray films of the spine, spina bifida occulta (lumbar vertebrae in three, lumbosacral vertebrae in 19 and sacral vertebrae in 31) was recognized in 53 children (69%). Ultrasonographic bladder abnormalities were recognized in 40 children (52%). Children with lumbar and lumbosacral spina bifida occulta showed a higher rate of concomitant ultrasonographic bladder abnormalities (P = 0.006) and had a poorer response to treatment (P = 0.041) compared with the children who had sacral spina bifida occulta. Children with ultrasonographic bladder abnormalities had a worse response to treatment (P = 0.005) compared to the children without bladder abnormalities. The presence of lumbar spina bifida occulta and ultrasonographic bladder abnormalities was related to the outcome of treatment for primary nocturnal enuresis in children, suggesting that spinal radiography and vesical ultrasonography may be useful predictive tests.