Treatment Of Childhood Nocturnal Enuresis Research Articles

The Effect of Family Assistance to Wake Children with Monosymptomatic Enuresis in Alarm Therapy: A Pilot Study

Alarm therapy is widely used as first line treatment for nocturnal enuresis. However, some children do not wake when nocturnal urination activates the alarm. It is currently unclear whether waking the child when the alarm is activated improves the efficacy of alarm therapy. In this study we investigated the efficacy of alarm therapy for nocturnal enuresis when children do not wake in response to the sound and their parents do not wake them. Detailed information regarding incontinence was retrospectively obtained from 78 of 112 patients who underwent alarm therapy between 2006 and 2016, and completed a questionnaire and a 14-day bladder diary. The enrolled patients were divided into 2 groups. In the family assisted group (44) the children were awakened by family members when the alarm sounded. In the alarm control group (34) the children were self-responsible for waking to the alarm. The groups were compared to investigate differences at 16 weeks after alarm therapy began. The efficacy rate was calculated using the International Children's Continence Society criteria. The efficacy was similar between the groups. Full response and partial response were observed in 36.4% and 20.5% of patients in the family assisted group, and 26.5% and 29.4% of patients in the alarm control group (p = 1.00), respectively. There was no significant difference in the percentage of children who woke spontaneously to the alarm in the 2 groups (56.7% and 64.0%, respectively). Family assisted alarm therapy and self-responsible alarm therapy are equally efficacious in the treatment of childhood nocturnal enuresis.

Exploring potential mechanisms in alarm treatment for primary nocturnal enuresis

In the treatment of childhood nocturnal enuresis the enuresis alarm has consistently proved effective. However, the various proposals advanced to explain its therapeutic mechanism generally lack empirical support. In this clinical trial we investigated the hypothesis that the alarm promotes reduced nocturnal urine production through increased urine concentration (enabling the child to sleep through the night). Measurements of urinary vasopressin and osmolality were made pre- and post-alarm treatment in a group (n=12) of outpatient children (aged 7-12 years) with severe (more than four times a week) nocturnal enuresis. Of the study group, 75% achieved the success criteria, with 89% predominantly sleeping through the night on dry nights, confirming that arousability is unlikely to be the principal mode of action. All those becoming dry showed an increase in urine concentration post-treatment. For half this was associated with an increase in post-treatment vasopressin whilst for the rest, although increases in osmolality were observed, there was no associated increase in vasopressin. Although based on a small sample this study offers an insight into possible therapeutic mechanisms of an enuresis alarm. It suggests that most children who become dry sleep through the night and that increased nocturnal urine concentration (and thus reduced urine volume) is likely to be the means whereby this is achieved. Furthermore, the study suggests two possible mechanisms whereby nocturnal urine concentration is achieved: either increased production of vasopressin or enhanced water transport across the urothelium.

Acupuncture for nocturnal enuresis in children: A systematic review and exploration of rationale

This review identified reports of acupuncture for childhood nocturnal enuresis, with the aim of ascertaining whether acupuncture is efficacious and or better than standard therapy for treating enuresis. Studies of children of either gender <18 years of age who received acupuncture treatment for nocturnal enuresis, were considered. The primary outcome measure was change in the mean number of wet episodes following treatment. Electronic searching was supplemented by hand searching of western medicine and traditional Chinese medicine (TCM) journals along with English language alternative medicine journals. Trials were assessed for quality and sources of bias. Meta-analysis was performed and the overall weighted odds ratio (OR) and associated 95% confidence interval (CI) were computed using the fixed effect model; the Forest plot was used to demonstrate results. Two hundred six abstracts were identified, of which 11 studies were eligible for data extraction. All the trials were of low methodological quality. There was some evidence that acupuncture is useful for nocturnal enuresis when used in conjunction with other treatment that may also include a different form of acupuncture (OR 3.98, CI: 2.2-7.2). When one form of acupuncture is compared with another there was marked heterogeneity, implying that some forms of acupuncture are effective. This review provides tentative evidence for the efficacy of acupuncture for the treatment of childhood nocturnal enuresis. Due to the low methodological quality of studies, evidence to identify, which parameters of acupuncture work best, is lacking. More rigorous trials are clearly warranted.

Alarm treatment for childhood nocturnal enuresis: an investigation of within-treatment variables.

The enuresis alarm has been widely advocated as an effective intervention in the treatment of childhood nocturnal enuresis. Although there is a body of evidence concerning which pretreatment variables are related to outcome, there is little evidence relating to influential within-treatment variables. This study sought to examine a series of treatment variables against outcome. A total of 66 children with severe primary nocturnal enuresis but with no day-time wetting were treated with a body-worn enuresis alarm. Pre- and within-treatment variables were collected. Success was considered to be 14 consecutive dry nights during a 16-week period. A total of 54.5% of children achieved the success criterion, with 12.1% being classed as partial successes. Of the pretreatment variables, only low functional bladder capacity was significantly associated with failure. Inability to be woken by the alarm emerged as the most important within-treatment predictor of failure. The success of alarm treatment is dependent on the child's ability to be aroused by the alarm. Interestingly, of those who successfully became dry, 72.2% slept throughout the night for >80% of nights that they were dry, suggesting that the mode of action of the enuresis alarm is more complex than was previously thought.

EXAMINATION OF THE STRUCTURED WITHDRAWAL PROGRAM TO PREVENT RELAPSE OF NOCTURNAL ENURESIS

A variety of treatment options are available for children with nocturnal enuresis. The success of any intervention depends on if the child remains dry once the treatment is withdrawn. All interventions for children with nocturnal enuresis are vulnerable to some degree of relapse. Pharmacological interventions, involving either desmopressin or imipramine, seem particularly susceptible to relapse occurring rapidly once medication is withdrawn. The usual practice is to taper the dose gradually although this is time-consuming and of questionable effectiveness. An alternative approach is to use a time-limited structured withdrawal program, the success of which has been recently documented. We investigated the effectiveness of the structured withdrawal program to understand the variables related to success. A total of 51 patients 7 to 16 years old were included in the 8-week structured withdrawal program. Patients were 90% dry with medication taken for 4 to 24 months before the program and had experienced 2 unsuccessful withdrawal attempts. Patients were offered the choice of using an enuresis alarm on medication-free nights. Progress was monitored at 2, 5 and 8 weeks, and long-term success was defined as no relapse 6 months after cessation of treatment. At weeks 9 and 10 with complete cessation of medication 74.5% of children remained dry, and success was not related to use of an enuresis alarm. The structured withdrawal program significantly reduces relapse rates, and offers an alternative and rapid means of successfully withdrawing medication. It is argued that the influential variable concerns the ability of the child to shift attribution for success from an external source (that is medication) to an internal focus (that is changes in themselves).

Treatment of childhood nocturnal enuresis: an examination of clinically relevant principles.

BJU InternationalVolume 88, Issue 6 p. 563-571 Treatment of childhood nocturnal enuresis: an examination of clinically relevant principles R. Butler, R. Butler Department of Clinical Psychology, High Royds Hospital, West Yorkshire, UK, andSearch for more papers by this authorA. Stenberg, A. Stenberg Uppsala University Children's Hospital, Section of Urology, Uppsala, SwedenSearch for more papers by this author R. Butler, R. Butler Department of Clinical Psychology, High Royds Hospital, West Yorkshire, UK, andSearch for more papers by this authorA. Stenberg, A. Stenberg Uppsala University Children's Hospital, Section of Urology, Uppsala, SwedenSearch for more papers by this author First published: 07 July 2008 https://doi.org/10.1046/j.1464-410X.2001.02373.xCitations: 22Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume88, Issue6October 2001Pages 563-571 RelatedInformation

The effectiveness of desmopressin in the treatment of childhood nocturnal enuresis: predicting response using pretreatment variables.

To determine the factors that predict the effectiveness of desmopressin in the treatment of childhood nocturnal enuresis. Sixty-six children with monosymptomatic nocturnal enuresis were treated with intranasal or oral desmopressin for a 4-week period. starting with a standard dose of 20 microg (0.2 mg oral) and increasing after 2 weeks where no progress was apparent to 40 microg (0.4 mg oral). Before treatment a range of variables (demographic, situational, enuretic history, physiological, parental attitude and child) were recorded. Three parameters of success acted as dependent variables, with stepwise linear regression models used to determine pretreatment predictors of success with desmopressin. Each outcome variable produced a very similar model of predictors. Success, as assessed by the most dry nights over a 14-night period, was associated with less severe enuresis before treatment, a parental belief that the child's enuresis was unstable and higher birthweight. From the analysis, a model of arginine vasopressin release is proposed and the clinical implications of the findings addressed.

The American Experience With Desmopressin

Conclusive evidence of a polyuric etiology from a failure of vasopressin elevation led to a new pharmacologic approach to the treatment of childhood nocturnal enuresis. Desmopressin acetate, a vasopressin analogue, has been used successfully since 1978 to treat this condition. Desmopressin's efficacy at doses of 5 to 40 micrograms has been demonstrated in Europe and the United States. Similarly, its safety has been established, and it is a first-line choice for physicians worldwide.

The treatment of childhood nocturnal enuresis in the community

The nature of childhood nocturnal enuresis and its psychological treatment are briefly reviewed and the major features relevant to providing a community service are identified. A treatment system is outlined, based on criteria for inclusion, particular treatment packages, specifiable number of contacts and predetermined definitions of success. The operation of this treatment system by a small multidisciplinary team in a community clinic setting is described and data to demonstrate the running and efficacy of the service are presented.

The body‐worn alarm in the treatment of childhood enuresis

SummaryTwo studies examined the effectiveness of the body‐worn alarm in out‐patient treatment of childhood nocturnal enuresis. The first involved 40 children, previously untreated by conditioning methods, treated with either the body‐worn alarm or the traditional pad and bell alarm. The second study compared the body‐worn alarm with modified dry‐bed training with 48 children previously resistant to treatment.Results of both studies indicated the body‐worn alarm was as effective as other methods in terms of the proportion of children successfully treated and was superior with respect to rapidity of response and consumer appeal. Such findings indicate that the body‐worn alarm could become the treatment of choice for nocturnal enuresis.

The Behavioral Treatment of Childhood Nocturnal Enuresis

Nocturnal enuresis is a relatively common childhood disorder. Although many treatments have been attempted, the most popular methods have been pharmacotherapy, individual psychotherapy, and behavioral conditioning. Of these, the most effective is behavioral conditioning with a urine alarm. The author reviews the enuresis literature and provides recommendations for use of the urine alarm approach.

A comparison of dry-bed training and standard urine-alarm conditioning treatment of childhood bedwetting

Two experiments examined the significance of patient-therapist contact in the treatment of childhood nocturnal enuresis by behavioural methods. The first involving 45 enuretic children compared the effectiveness of the standard urine-alarm conditioning procedure when it is closely supervised as opposed to not supervised after the initial description of training. Results showed that adequate patient-therapist contact is necessary for the effective use of the standard conditioning treatment. One hundred and twenty children took part in the second experiment which compared standard conditioning with Dry-Bed Training (DBT) (Azrin et al, 1974) administered under four different conditions—by the child's parents at home, by a professional trainer at home, by a professional trainer in hospital and by the child's parents without the adjunct of a conventional bed-buzzer device. DBT was superior to standard conditioning in terms of the proportion of bedwetters successfully treated and in terms of the speed of treatment. DBT was equally effective under all conditions of administration except where it did not have the adjunct of a machine, in which case it was only marginally better than no treatment at all.

The use of self-hypnosis in the treatment of childhood nocturnal enuresis. A report on forty patients.

The use of self-hypnosis in the treatment of childhood nocturnal enuresis. A report on forty patients.