Treatment Of Nocturnal Enuresis Research Articles

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

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

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

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

Discontinuing absorbent pants in children with bedwetting: a randomized controlled trial

The objective of this study is to examine the effect of discontinuing wearing protective garments (absorbent pyjama pants — APP) in children with severe childhood nocturnal enuresis (NE). The study employs a multicenter, parallel, randomized controlled trial. Following a 4-week run-in period, participants were randomly allocated in a 2:1 group allocation to discontinue or continue using APP. The research was conducted across seven European pediatric incontinence centers. The study included treatment-naïve children aged 4–8 years with severe (7/7 wet nights per week) mono-symptomatic NE, who had used nighttime protection for at least 6 months prior to the study. The study consisted of a 4-week run-in period (± 7 days), where all children slept wearing APP (DryNites®). At week 4 (± 7 days), if meeting randomization criteria (7/7 wet nights during the last week of run-in), participants were randomized to continue to sleep in APP or to discontinue their use for a further 4 weeks, with the option of another 4 weeks in the extension period. The primary outcome was the difference between groups of wet nights during the last week of intervention. Quality of life (QoL) and sleep were secondary endpoints. In total, 105 children (43 girls and 62 boys, mean age 5.6 years [SD 1.13]) were randomized (no-pants group n = 70, pants group n = 35). Fifteen children (21%) in the no-pants group discontinued early due to stress related to the intervention. Children in the no-pants group experienced fewer wet nights compared to the pants group during the last week (difference 2.3 nights, 95% CI 1.54–3.08; p < 0.0001). In the no-pants group, 20% responded to the intervention, of whom 13% had a full response. Clinical improvement was detected within 2 weeks. Sleep and QoL were reported as negatively affected by APP discontinuation in the extension period but not in the core period. Conclusion: A ~ 10% complete resolution rate was associated with discontinuing APP. While statistically significant, the clinical relevance is debatable, and the intervention should be tried only if the family is motivated. Response was detectable within 2 weeks. Discontinuing APP for 4–8 weeks was reported to negatively affect QoL and sleep quality. No severe side effects were seen.Trial registration: Clinicaltrials.gov Identifier: NCT04620356; date registered: September 23, 2020. Registered under the name: “Effect of Use of DryNites Absorbent Pyjama Pants on the Rate of Spontaneous Resolution of Paediatric Nocturnal Enuresis (NE).”What is Known?• APP has been hypothesized to delay time until spontaneous resolution of bedwetting, but no prospective randomized evidence is available regarding if APP use sustains symptoms.• No evidence whether discontinuation of APP can lead to dryness or impact sleep quality and QoL.What is New?• Thirteen percent became dry after removing APP for up to 8 weeks and initial response was detectable within 2 weeks.• Even though prolonged discontinuation was reported to lead to sleep disturbances and rediced QoL, still our results suggest trying 2 weeks of the intervention if the family is motivated, prior to engaging established treatments for nocturnal enuresis.

Treatment of Nocturnal Enuresis Using Miniaturised Smart Mechatronics With Artificial Intelligence

Treatment of Nocturnal Enuresis Using Miniaturised Smart Mechatronics With Artificial Intelligence

Alarm therapy for nocturnal enuresis in children: A literature review

AbstractNocturnal enuresis is a common childhood problem impacting the quality of life of children and families. Treatment with an enuresis alarm is recommended for 8–12 weeks by the International Children's Continence Society as first line management of monosymptomatic nocturnal enuresis. However, the effectiveness of alarm therapy varies between 80% and 45.9%. There is minimal evidence within the literature exploring the factors impacting this varying response to alarm therapy. Therefore, this literature review aims to explore factors that impact the effectiveness of the enuresis alarm as a treatment for nocturnal enuresis, in children aged 5–17 years. Literature searches were conducted on MEDLINE (Ovid), SCOPUS and CINAHL Databases. The PRISMA tool was used to report the data in the search strategy. The inclusion criteria of children aged 5 to 17 years was chosen based on International Children's Continence Society Guidelines. English language, academic journals and studies in the past 10 years were selected as additional inclusion criterion to identify the most recent, robust literature for the review. All 13 primary research articles were critiqued using the Caldwell Framework. Data were extracted and presented in table format highlighting study methodology, sample, duration of treatment, relevance to review topic and key findings. The findings highlight factors influencing the effectiveness of alarm therapy related to the impact on the child and family, heighten arousal to the alarm, the duration of therapy, age of child and the impact of overlearning. This review provides health professionals with an insight into strategies that may help children and their family to respond successfully to enuresis alarm treatment.

Desmopressin in combination with anticholinergic agents in the treatment of nocturnal enuresis: a systematic review and meta-analysis.

The desmopressin combined with anticholinergic agents for the treatment of nocturnal enuresis (NE) remains controversial. This meta-analysis assesses the efficacy and safety of desmopressin compared with desmopressin plus anticholinergic agents for the treatment of NE. We searched MEDLINE, Embase, and Cochrane Controlled Trials Register databases for RCTs published for the treatment of NE. Systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. This meta-analysis used RevMan v.5.1.0 to analyze data. Eight studies involving 600 patients (293 in the combination group and 307 in the desmopressin group) contained meaningful data. The results were as follows: after one month of treatment, compared with the desmopressin monotherapy group, the combination group was significantly better in treating NE in FR (full responders, P = 0.003), FR + PR (partial responders) (P < 0.0001), and the mean number of wet nights (P = 0.004); also, the combination group had a better effect in FR (P < 0.00001), FR + PR (P = 0.02) and the mean number of wet nights (P = 0.04) after 3 months' treatment. For side effects, combination therapy does not cause more adverse events in treating NE (P = 0.42). This study elucidates that desmopressin combined with the anticholinergic agent was demonstrated to be more effective in treating NE than desmopressin monotherapy, and the anticholinergic agent does not increase the risk of adverse events (AEs).

The pooled analysis evaluates the therapeutic efficacy of desmopressin combined with anticholinergic drugs in the treatment of pediatric nocturnal enuresis.

This pooled analysis aims to demonstrate the clinical efficacy and safety of combined desmopressin and anticholinergic therapy in the treatment of pediatric nocturnal enuresis (NE). A systematic search was conducted through PubMed, MEDLINE, EMBASE, ResearchGate, and Cochrane Library to identify all randomized controlled trials (RCTs) comparing monotherapy with desmopressin versus combined therapy with desmopressin and anticholinergic agents for the treatment of NE. Data analysis was performed using RevMan version 5.4.1. This study included 8 RCTs involving a total of 659 patients. The frequencies of complete response (CR), partial response (PR), and nonresponse (NR) were computed for both short-term treatment (1 month) and long-term treatment (3 months). Additionally, alterations in the mean number of NE episodes, adverse events, and relapse were assessed. Our analysis indicates that, in comparison to the monotherapy group, the combination therapy group plays a pivotal role in augmenting the CR odds and diminishing the NR ratios in both short-term and long-term treatments (1 month CR ratio [risk ratio(RR): 1.84; 95% confidence interval(CI): 1.22-2.76; p = 0.003, I2 = 72%]; 3 months CR ratio [RR: 1.48; 95% CI: 1.25-1.76; p < 0.00001, I2 = 0%]; 1 month NR ratio [RR: 0.67; 95% CI: 0.55-0.82; p = 0.0001, I2 = 0%]; 3 months CR ratio [RR: 0.37; 95% CI: 0.19-0.73; p = 0.004, I2 = 0%]). Furthermore, in both short-term and long-term treatment, the combined therapy group exhibits a greater magnitude of change in the average number of NE episodes compared to patients receiving monotherapy (1 month, mean difference [MD] = -2.97; 95% CI: -4.23 to -1.71, p < 0.0001; 3 months, MD = -4.30; 95% CI: -7.18 to -1.43, p = 0.003). Moreover, the combination therapy group exhibits a significant reduction in the recurrence rate (RR: 0.36; 95% CI: 0.15-0.86; p = 0.02). There is no significant difference in the incidence of adverse events between the two groups (RR: 1.16; 95% CI: 0.58-2.31; p = 0.67). Combining desmopressin with anticholinergic medications is more effective for NE than desmopressin alone, with lower recurrence and minimal adverse effects.

Parental Beliefs About the Causes, Treatments, and Medical Assistance for Children With Nocturnal Enuresis in the Eastern Region of the Kingdom of Saudi Arabia.

To assess parental beliefs about the causes, treatment, and necessity for medical assistance for children with nocturnal enuresis (NE). A self-administered survey questioned parents' beliefs about NE, including causes and at-home behavioral therapy. We evaluated the association between demographic characteristics and the tendency to seek medical advice for NE. The questionnaire received responses from 1232 individuals, 77.1% of whom were female and 82.9% of whom were 30 years of age or older. Psychological issues (53.5%) and laziness to get up (47.6%) were the most often believed causes of NE. Two frequent at-home behavioral therapies chosen by participants were voiding before bedtime and restricting fluid intake at night (73.4% and 70%, respectively). However, only 6.9% of respondents believe that a bedwetting alarm is an effective treatment. The two most frequently reported reasons for not seeking medical attention wereparents' belief that their child will eventually outgrow bedwetting (34.1%) and "parents or children's embarrassment" (21.8%). The chi-squared test was used to evaluate the association between demographic characteristics and seeking medical advice. Participants with a single child were more likely than those with more than three children to take their child to the doctor (61.5% vs. 48.6%, respectively). Also, parents who don't have NE-afflicted children were more open to consider seeking medical advice for NE therapy (if their children developed it in the future) compared to parents who already have children with NE. Parents in the Eastern region of Saudi Arabia hold various misconceptions about the causes and treatment of NE. Only 52.1% of parents would take their child to see a doctor if wetting the bedand only 48.1% of parents were aware of effective treatments for NE. These results emphasize that healthcare practitioners need to provide proper information to raise public awareness of NE.

Treatment of Nocturnal Enuresis using Yoga Prana Vidya Healing Protocols: A Case Study

Introduction: Nocturnal enuresis, is night-time bedwetting in children five years of age or older, and is a common but disturbing condition causing psychological distress in affected children. Though not considered as a serious health problem, several treatment options are available. This paper presents a case of Nocturnal enuresis suffered by a 7-year-old boy who was successfully treated using Yoga Prana Vidya (YPV) Protocols. Method: Case study method is used in the analysis of this case, by collecting data from patient medical records, healer’s records and patient’s parent feedback. Results: Within 14 days of YPV healing by the healer, gradually the frequency of urine pass at night sleep reduced. Also, it was found during follow up that the patient completely recovered and cured of this condition, and because of the holistic healing properties of YPV system and regular self- practices such as rhythmic breathing, forgiveness sadhana and Super-brain Asana, the patient grew up to be a normally healthy teenager without any health issues. Conclusions: Integrated and holistic healing properties of YPV system protocols have been helping thousands of people to overcome physical, mental and emotional issues with sustained results when practiced consistently. Further research on this topic using appropriate methodology and sample size is recommended. It will be highly beneficial for all frontline healthcare workers such as doctors and nurses to acquire a working knowledge of YPV healing practices in combination with their respective specialties to holistically treat patients for sustainable results of cure

Treatment of Nocturnal Enuresis using Yoga Prana Vidya Healing Protocols: A Case Study

Treatment of Nocturnal Enuresis using Yoga Prana Vidya Healing Protocols: A Case Study

Safety and Efficacy of Mirabegron in Treatment of Nocturnal Enuresis in Children

Safety and Efficacy of Mirabegron in Treatment of Nocturnal Enuresis in Children

Effects of short-term treatment with vibegron for refractory nocturnal enuresis.

Long-term nocturnal enuresis treatment leads to stress and lowered self-esteem for children and their parents. This study evaluated the short-term effectiveness and safety of vibegron 50 mg for children with refractory nocturnal enuresis. A retrospective cohort study of children with therapy-resistant enuresis was conducted using data for July 2019 through December 2019. Enuresis frequency was recorded during 30 days before and after additional vibegron administration with prior treatment. We assessed the treatment effectiveness based on enuresis frequencies between before and after treatment with vibegron 50 mg. Statistical evaluation was performed using a paired t-test. Among 29 children receiving vibegron, 14 (48.3%) exhibited partial or complete response to vibegron. Enuresis frequencies were, respectively, 15.8 ± 9.2 (± SD) and 9.5 ± 9.6 (± SD) before and after treatment with vibegron during the observed 30 days. Statistically significant reduction in enuresis frequency was found (p < 0.001). Moreover, maximum morning urine of 200 ± 62.9 mL (± SD) before treatment with vibegron changed to 232 ± 76.6 mL (± SD) after treatment. Significant increase in voiding volume in the early morning was found (p < 0.05). No drug-related severe adverse event was found. Short-term treatment with vibegron is safe and effective for children with refractory enuresis.

Can enuresis alarm therapy be managed by the families without the support of a nurse? A prospective study of a real-world sample.

The alarm is the first-line treatment of nocturnal enuresis. However, the therapy is labour-intensive for both families and healthcare providers. Our aim was to see whether the treatment could be successfully used by the families, without support from healthcare providers. An alarm linked to an application on a parent's smartphone was used. The app recorded enuretic events and gave instructions. Group A were children supported by a nurse. Group B were patients whose families had bought the alarm and downloaded the app independently. There were 196 children in group A and 202 in group B. The percentages of full responders, partial responders, non-responders and dropouts were 18.4%, 20.4%, 22.4% and 38.8% in group A and 13.4%, 11.4%, 14.9% and 60.4% in group B. The risk for dropping out of therapy was higher in group B (p < 0.001), whereas the chance for adherent children to become dry did not differ between the groups (p=0.905). For families who are able to adhere to alarm therapy the chance of success is just as good when managed independently as when supported by a nurse. But the latter children will have a greater chance of adhering to the full treatment.

Transcutaneous electrical nerve stimulation for at-home treatment of nocturnal enuresis in children: Determining optimal pad placement

Introduction:Nocturnal enuresis (NE) is a common problem encountered in children that can be recalcitrant to currently available treatment options. Neuromodulation techniques are used to treat various urologic disorders but can be limited by convenience and compliance. Transcutaneous electrical nerve stimulation (TENS) is a neuromodulator that can be used at home to treat various conditions. The aim of this study was to determine if TENS can be offered as an effective at-home option that shows durability for NE in children, and to determine which pad placement is the most efficacious. Materials & Methods:A randomized clinical trial including 90 patients aged 5–18 years presenting with monosymptomatic NE was performed. After one month of behavioral therapy, they were treated with TENS therapy after randomization to three groups based on pad placement: suprapubic (SP), parasacral (PS), and ankle/posterior tibial (PT). TENS therapy was performed nightly for one month. Voiding diaries recording the number of wet nights, wet scale severity score (0–3), TENS compliance, quality of life (QOL) questionnaires, and any adverse reactions were collected monthly at baseline, during TENS therapy, and after TENS for durability assessment, and statistically analyzed after study completion. Results:No patient was cured of NE, and our study failed to show a statistical difference between the study arms in enuresis frequency during TENS. The only statistically significant improvement was QOL during TENS therapy (2.95 improvement for the PT group versus 1.2 and 1.5 regression for SP and PS groups, respectively, p=0.003). PT TENS therapy also showed improvements for enuresis frequency with 2.7 less episodes/month (versus 4.1 and 8.2 more episodes/month in the SP and PS groups, respectively, p=0.06) and the severity of wetness each night with a 0.17 improvement (versus 0.06 and 0.13 regression in the SP and PS groups, respectively, p=0.06) after TENS therapy was completed, however these did not meet statistical significance. Patients were compliant with using TENS therapy (90% or more in all groups) and there were no adverse events. Discussion:This study found that patients who used the PT pad placement for TENS showed significant improvements in QOL during therapy, however we were unable to show a significant difference in enuresis frequency during TENS between groups. The major limitation of our study was the high number of patients lost to follow-up during the COVID-19 pandemic. Conclusion:TENS therapy when combined with behavioral techniques can be an easy and safe tool that can be used at home to help treat NE, however, further studies are needed to optimize this type of therapy to show a clinically significant benefit.

Принципы подбора терапии энуреза у детей и подростков.

Introduction. The problem of enuresis to this day remains relevant primarily in connection with a decrease in the quality of life of both children, due to psychological discomfort, and their parents. The aim of the study was to select effective algorithms for the diagnosis and treatment of nocturnal enuresis in children and adolescents, taking into account the pathogenesis of the disease. Materials and methods. Children aged 5 to 15 years with a clinically confirmed diagnosis of enuresis were selected for the study. Depending on the clinical form of the disease, the children were divided into three groups. The first group included patients with the primary form of enuresis, the second-with secondary enuresis, and the third-with a mixed form of the disease. After an additional examination, all patients were assigned treatment based on their clinical group. Patients of the first clinical group were prescribed desmopressin as a treatment. In the second clinical group, treatment was carried out taking into account the level of damage to the nervous system. In the case of a suspected lesion of the cervical spine, electrophoresis was performed with a 1% solution of Euphyllini with an electrode applied to the cervical region. Nootropics and group B vitamins were prescribed for suspected cerebral lesions. In hyperexcitability syndrome, patients received Тenoten for children. In the third clinical group, treatment was carried out in two stages. The first stage corresponded to the protocol of treatment of the secondary form of enuresis, was carried out in a hospital setting. Further treatment was carried out on an outpatient basis in accordance with the recommendations for the treatment of the primary form of enuresis. Results. Positive dynamics was observed in all three clinical groups after the treatment. In 2.7% of children, a clinical cure was observed after the first course of therapy. 71.8% have a complete recovery after two courses of therapy. In 17.3% – after three courses of treatment. Conclusion. Principles of therapy selection for enuresis in children and adolescents require a comprehensive diagnosis and careful selection of therapy, depending on the pathogenetic form. The current control of therapy can be carried out by a pediatrician, and the intermediate results of treatment should be evaluated by a neurologist and a urologist. Hospitalization in a hospital is indicated in the case of the development of concomitant complications in the form of urinary tract infection, infectious and urodynamic disorders.

Efficiency of Japanese herbal medicine shokenchuto for nocturnal enuresis: An observational study.

Japanese traditional (Kampo) medicine has been empirically used for nocturnal enuresis (NE). This study aims to investigate the efficacy of one of the most popular formulas, shokenchuto (SKT). We retrospectively analyzed 110 patients with NE who were referred to our department. Following the diagnosis of NE, treatment was started with either alarm or/and desmopressin (DDAVP) therapy. Patient refractory to DDAVP monotherapy or to combination therapy consisting of DDAVP and bedwetting alarm were selected. SKT (Tsumura Co., Tokyo, Japan) extract at a dose of 2.5 g was administered orally to all intractable cases twice daily before meals. The treatment outcomes and safety were assessed. In total, 24 cases were patient refractory to DDAVP monotherapy or to combination therapy consisting of DDAVP and bedwetting alarm. SKT was highly effective in 8, effective in 7, and ineffective in 9. A significant difference was observed between ages 10 and over (P = 0.031). SKT was significantly effective as a treatment for NE in patients aged ≥10 years and could be a good alternative if alarm or DDAVP therapies are ineffective. We proposed evaluating SKT prospectively for NE.

The Effects of Laser Acupuncture Therapy on Nocturnal Enuresis: A Systematic Review and Meta-Analysis.

Introduction:Nocturnal enuresis (NE), often known as bedwetting, is a common condition in children and, as a result, they may have subsequent social impairments. The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in children with NE.Methods:International databases with laser- and NE-related keywords were searched, and only randomized controlled trials (RCTs) that used any type of LLLT to treat NE and compared it with any type of control intervention were included. Eleven studies using laser acupuncture therapy (LAT), involving 927 participants, were included for a systematic review. A meta-analysis was conducted using full and partial response-rate variables. The analysis was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and the Cochrane risk-of-bias tool and Grading of Recommendations Assessment Development and Evaluation recommendations for quality of evidence were used to rate all included publications.Results:The LAT groups showed significant improvement, compared with control groups when full response rates were analyzed. There was no significant difference between the groups treated with LAT and the groups who underwent medication therapy alone when full response rates were analyzed. Red and infrared wavelengths and continuous waves were the most commonly used LAT modalities, and lower abdomen and back acupoints were the most-common sites.Conclusions:LAT seems to be an effective and safe treatment for NE; however, the quality of evidence available in the literature was relatively low. More-rigorous and higher-quality trials are needed to investigate this treatment modality further.

Nocturnal Enuresis

Nocturnal enuresis, or involuntary urination, is a common problem among children. It affects approximately 15% of all children at 5 years old. At our workplace as a primary health care facility, nocturnal enuresis, and incontinence in general, is one of the most common chief complaints presenting to the clinic. Enuresis can be disruptive to normal family life and can generate stress between parents and child. There may be anxiety about events like sleepovers and campouts and there are significant costs in lost time, laundary and bedding, as well as the potential for guilt and loss of self-esteem. Nocturnal enuresis decreases with age, with a spontaneous remission rate of about 15% per year. It can improve with treatment, and improved self-esteem and quality of life have been reported after successful treatment. It is therefore important to offer timely treatment, and to refer children for specialist care when treatments are not effective. In this review we discuss definition, epidemiology, etiology, evaluation and different modalities of treatment for nocturnal enuresis . Key words: Nocturnal enuresis, alarm, desmopressin .

PD48-01 SAFETY AND EFFICACY OF FLUOXETINE, SELECTIVE SEROTONIN REUPTAKE INHIBITOR, FOR THE TREATMENT OF REFRACTORY PRIMARY MONOSYMPTOMATIC NOCTURNAL ENURESIS IN CHILDREN: A RANDOMIZED PLACEBO-CONTROLLED STUDY

You have accessJournal of UrologyCME1 May 2022PD48-01 SAFETY AND EFFICACY OF FLUOXETINE, SELECTIVE SEROTONIN REUPTAKE INHIBITOR, FOR THE TREATMENT OF REFRACTORY PRIMARY MONOSYMPTOMATIC NOCTURNAL ENURESIS IN CHILDREN: A RANDOMIZED PLACEBO-CONTROLLED STUDY Mohamed Hussiny, Ahmed Abdelhalim, Abdelwahab Hashem, Mohamed A. Soltan, Mahmoud R. El-Kenawy, and Tamer Helmy Mohamed HussinyMohamed Hussiny More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , Abdelwahab HashemAbdelwahab Hashem More articles by this author , Mohamed A. SoltanMohamed A. Soltan More articles by this author , Mahmoud R. El-KenawyMahmoud R. El-Kenawy More articles by this author , and Tamer HelmyTamer Helmy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nocturnal Enuresis (NE) is a common medical condition in children. It affects millions of children throughout the world and is associated with a significant negative impact on self-esteem and health-related Quality of life. Behavioral therapy, alarm treatment and desmopressin are first-line treatments. Treatment options for refractory NE are limited. This study aimed at investigating the efficacy and safety of fluoxetine for treatment of refractory primary monosymptomatic NE in children. METHODS: Children aged 8-18 years with primary monosymptomatic NE refractory to desmopressin treatment were screened for eligibility. Patients with daytime symptoms, constipation, underlying urologic, neurological, endocrinological, cardiac or psychiatric conditions were excluded. After sample size calculation, patients were randomly assigned to the fluoxetine (study) or placebo groups in a 1:1 ratio. Patients in the study group were maintained on 10 mg of fluoxetine once daily for 12 weeks. The primary study outcome was reduction in the number of wet nights at 4, 8 and 12 weeks of therapy. Patients with <50% reduction of wet nights were considered non-responders. Patients with 50-99% reduction of wet nights were considered partial responders (PR) and those with complete nighttime dryness were considered complete responders (CR). Treatment adverse effects were secondary outcomes. RESULTS: Between July 2020 and March 2021, a total of 120 children with a mean age of 11.8 +2.46 years were enrolled. Those who continued the follow up duration were 110 patients. a total of 56 children were assigned to the fluoxetine and 54 to the placebo groups. Baseline enuresis severity was similar between both study groups. After 4 weeks of therapy, 7.1% of fluoxetine group achieved CR and 66.1% achieved PR (versus 0% and 16.7% of placebo, respectively; p <0.001). The response rate declined at 12 weeks of therapy with CR achieved in 10.7% and PR in 21.4% of the fluoxetine group (versus 0% and 14.8% of the placebo, respectively; p=0.023). Fluoxetine treatment was discontinued before the planned study duration in 4 patients of the fluoxetine group due to treatment-related adverse effects (dizziness in two patients, mood changes in one and hypersensitivity in another). CONCLUSIONS: Fluoxetine achieves good initial response in patients with primary refractory monosymptomatic nocturnal enuresis. However, the response rate declines significantly at 12 weeks of therapy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e799 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Hussiny More articles by this author Ahmed Abdelhalim More articles by this author Abdelwahab Hashem More articles by this author Mohamed A. Soltan More articles by this author Mahmoud R. El-Kenawy More articles by this author Tamer Helmy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Tuina for Enuresis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

ObjectiveTo evaluate the effects of Tuina (massage) vs. non-Tuina traditional Chinese medicine (TCM) treatments on nocturnal enuresis in children.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reported Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RevMan 5.3 software was used for meta-analysis.ResultsTwelve RCTs recruiting a total of 1,007 children were included. Meta-analysis results showed that, compared with non-Tuina TCM treatments, Tuina could significantly improve the total effective rate of children's enuresis [RR = 1.29, 95%CI (1.22–1.36), P < 0.00001]. The results of subgroup analyses indicated that the total effective rate of Tuina combined with acupuncture in the treatment of nocturnal enuresis was higher than acupuncture alone [RR = 1.24, 95%CI (1.12–1.37), P < 0.0001]. The total effective rate of Tuina in the treatment of enuresis in children was better than that of herbal medicine alone [RR = 1.45, 95%CI (1.31–1.61), P < 0.00001]. The total effective rate of Tuina combined with herbal medicine in the treatment of enuresis in children was better than that of herbal medicine alone [RR = 1.16, 95%CI (1.06–1.26), P = 0.0007]. No adverse reactions of Tuina were reported in all included studies.ConclusionFrom the available evidence, Tuina, or Tuina combined with non-Tuina TCM treatments (acupuncture, or herbal medicine) can improve the clinical outcome of children with enuresis, indicating Tuina is a promising treatment choice for children's enuresis. However, because of the intrinsic limitations of the included studies, more high-quality randomized controlled trials with longer follow-up are still needed to further confirm the efficacy and safety of Tuina in the treatment of nocturnal enuresis in children.