Treatment Of Nocturnal Enuresis Research Articles

Patient Engagement in Medical Device Design: Refining the Essential Attributes of a Wearable, Pre-Void, Ultrasound Alarm for Nocturnal Enuresis.

To date, no pre-void wearable alarm exists to treat nocturnal enuresis (NE)-night-time bedwetting, and children with NE and their families are disappointed in relation to the post-void moisture alarms and medicine currently available. Development of a safe, comfortable and non-invasive wearable pre-void alarm and associated technology, using advanced mechatronics, is underway (the MyPAD device). Each stage of development includes patient and public involvement (PPI), particularly with respect to human factors, in collaboration with physicians, radiologists, psychologists, nurses, engineers and designers. The aim of this study was to help us understand the families' experience of the condition of enuresis, and to provide opinion relating to existing NE alarms, designed to detect moisture, and most importantly, the initial design of the MyPAD wearable technology. A PPI workshop in the form of a focus group, made up of children with enuresis and their parents, was conducted during the early stage of the MyPAD product development. The key research questions (RQs) were: (RQ1) What were the families' experiences of using existing post-void enuresis alarms? (RQ2) What do families like about the MyPAD prototype? and (RQ3) What do families not like about the MyPAD prototype? A nurse specialised in terms of NE treatment, including post-void alarms, from the Lancashire Teaching Hospitals NHS Foundation Trust, and two MyPAD design engineers were also present, to explain the MyPAD design concept. Braun and Clarke's six-phase approach to thematic analysis was implemented, which included familiarisation with the data, initial descriptive coding, identifying themes, reviewing themes, defining and labelling themes and producing a report. Four common themes were identified from the focus group discussions: the importance of sleep; children do not want to feel different; parents feel frustrated and concerned; resilience and perseverance. These themes applied across the research questions; for example, sleep disruption was highlighted as an issue with existing post-void alarms and as an important requirement for the design of MyPAD. The evaluation of the early version of the MyPAD device has prompted the consideration of changes to some existing facets of the device, including providing multiple alarm types, more options for the design of the garment that houses the device, and the need for clear, age-appropriate and informative instructions relating to how the device should be used, in order to maximise its performance/efficiency and acceptance. The qualitative data derived from the focus group discussion was incredibly valuable as it enabled the research and design team to experience the perspectives of the families in terms of the challenges and conflicts of managing the condition and the limited utility of existing post-void alarms. This has improved our understanding of the social and environmental challenges that will need to be considered during the design process.

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy\xae for the treatment of nocturnal enuresis in children

BackgroundNocturnal enuresis (NE), or ‘bedwetting’, is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child’s water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE.MethodsThis study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion.DiscussionThis study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition.Trial registrationAustralian and New Zealand Clinical Trials Registration Number: 12618000288224.Protocol: 23 February 2018, version 1.1.

Experience Of Medical Treatment With Desmopressin And Imipramine In Children With Severe Primary Nocturnal Enuresis In Taiwan.

PurposeThe aim of this study was to compare the efficacy and safety of desmopressin and imipramine in the treatment of severe primary nocturnal enuresis (NE) in Taiwan.Patients and methodsThis study was a retrospective chart review study conducted on children with primary monosymptomatic nocturnal enuresis (PMNE) or non-monosymptomatic nocturnal enuresis (PNMNE), referred to and treated by senior physicians in a Changhua medical center in Taiwan. After being screened, these children were treated with either desmopressin (n = 125) or imipramine (n = 71). All participants were treated for at least 3 months and followed afterward for at least 3 more months. The response and relapse rates were measured. Side effects were monitored. Age, gender, and severity of NE were recorded.ResultsAfter 3 months of treatment, 97 children treated with desmopressin were responsive (77.6%) while 58 children treated with imipramine were responsive (81.7%). Sixty-one children treated with desmopressin (48.8%) and 26 treated with imipramine (36.6%) relapsed during the 3-month post-treatment monitoring. The differences in responsive and relapse rates were not statistically significant. Four children treated with imipramine (5.6%) reported side effects while none was reported for children treated with desmopressin (P < 0.05). Age, gender, and the presence or absence of daytime enuresis did not influence the response rate to either drug (P < 0.05).ConclusionCurrently, desmopressin is preferred over imipramine for treating NE due to the latter’s side effects. Our results demonstrated similar response rates for both drugs, with imipramine demonstrating minimal side effects. While health practitioners should pay attention to its side effects, concerns regarding imipramine toxicity in NE treatment are often overblown. Since imipramine is much cheaper than desmopressin, using imipramine to manage NE can allow health practitioners, especially in Taiwan, to treat the greatest number of children with NE.

The efficacy of electrical stimulation in treating children with nocturnal enuresis: A systematic review and meta-analysis.

We performed a systematic review and meta-analysis to evaluate the efficacy of electrical stimulation (ES) in treating children with nocturnal enuresis (NE). Randomized controlled trials (RCTs) of the use of ES for the treatment of NE in children were searched using EMBASE, MEDLINE, and the Cochrane Controlled Trials Register. The references of related articles were also searched. The systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Four RCTs involving 171 patients were studied. We found that there was statistically significant difference in the wet nights per week (mean difference [MD], -0.70; 95% confidence interval [CI], -0.89 to -0.51; P < .00001), the number of patients with clinical response (MD, 26.88; 95% CI, 11.16 to 64.74; P < .00001), and bladder capacity (MD, -0.70; 95% CI -0.89 to -0.51; P < .00001) in the ES group compared with the placebo group with the exception of maximum voided volume (MVV) (MD, 19.48; 95% CI, -9.18 to 48.14; P = .18). The study provides a significant improvement in statistics in the wet nights per week, the number of patients with clinical response and bladder capacity for children with NE compared with the placebo group with the exception of MVV.

Would the association of different Therapeutic Agents be the Best Solution for the Treatment of Nocturnal Enuresis?

Introduction: We compare the efficacy of urological physiotherapy and parasacral neuromodulation and biofeedback in combination with the use of oxybutynin in the treatment of enuresis. Nocturnal enuresis is defined as the involuntary leak of urine that occurs during sleep. There are three pathogenic mechanisms responsible for the condition: nocturnal polyuria; overactivity of the detrusor; and high arousal threshold; all of which caused by a likely alteration in the control of the pontine micturition reflex center.

Feasibility study of intelligent autonomous determination of the bladder voiding need to treat bedwetting using ultrasound and smartphone ML techniques

Unsatisfactory cure rates for the treatment of nocturnal enuresis (NE), i.e. bed-wetting, have led to the need to explore alternative modalities. New treatment methods that focus on preventing enuretic episodes by means of a pre-void alerting system could improve outcomes for children with NE in many aspects. No such technology exists currently to monitor the bladder to alarm before bed-wetting. The aim of this study is to carry out the feasibility of building, refining and evaluating a new, safe, comfortable and non-invasive wearable autonomous intelligent electronic device to monitor the bladder using a single-element low-powered low-frequency ultrasound with the help of Machine Learning techniques and to treat NE by warning the patient at the pre-void stage, enhancing quality of life for these children starting from the first use. The sensitivity and specificity values are 0.89 and 0.93 respectively for determining imminent voiding need. The results indicate that customised imminent voiding need based on the expansion of the bladder can be determined by applying a single-element transducer on a bladder in intermittent manner. The acquired results can be improved further with a comfortable non-invasive device by adding several more features to the current features employed in this pilot study.Graphical Ultrasound device design: echoed US pulses reflected from the bladder and related tissues around the bladder is detected. These pulses are analysed, and an alarm is triggered when needed to treat nocturnal enuresis.

Nocturnal enuresis and poor sleep quality.

Sleep disorders are strongly associated with childhood nocturnal enuresis (NE). In this study, we examined whether sleep disorders are present in children with NE, and whether NE is caused by sleeping disorders, or is simply comorbid. We examined 14 children with monosymptomatic NE and 15 age-matched controls. Sleep disorders were assessed for ≥5days using contactless biomotion sensors to detect breathing and body movements during at-home sleep. To assess sleep quality, we compared median sleep efficiency and the number of shallow sleep episodes between the groups. We also investigated the change in sleep quality after successful NE treatment in five children. Median sleep efficiency was significantly lower in the NE group (87.3%) than in the control group (93.4%; P < 0.001). The number of shallow sleep episodes per night was significantly higher in the NE group (5.11) than in the control group (1.50; P < 0.001). Neither sleep efficiency nor the number of shallow sleep episodes improved in the five children whose NE was successfully stopped after bedwetting-alarm therapy (P = 0.50 and 0.22, respectively). Sleep disorders are present in children with NE. Although there are insufficient data to conclude that sleep disorders are not the cause of NE, we suggest that they are comorbid because sleep disorders persisted even after NE was halted.

Assessment and treatment of nocturnal enuresis in children and young people.

Nocturnal enuresis - or bed-wetting - is one of the most common chronic conditions of childhood. It has a significant effect on the quality of life of affected children and their families and is associated with several comorbidities, some of which resolve on successful treatment. The causes of this troublesome condition are explored and the principles of assessment and treatment are discussed with reference to National Institute for Health and Care Excellence guidance as well as research. Response to treatment resistance is considered and appropriate onward referral discussed.

The Relationship Between Nocturnal Enuresis and Spina Bifida Occulta: A Prospective Controlled Trial

ObjectiveTo compare the frequency of spina bifida occulta (SBO) detected in patients with nocturnal enuresis (NE) and to investigate its clinical significance. MethodsPatients aged 6 to 15 years who were admitted to the urology clinic with NE were included in this prospective study. The control group consisted of patients who were admitted with a complaint of abdominal or lateral pain. The patients who had lower urinary tract symptoms (LUTS) were classified as nonmonosymptomatic NE (NMNE). Those with monosymptomatic NE were treated with desmopressine. In patients with NMNE, treatment with oxybutynin was added if an overactive bladder or uninhibited contraction was detected by urodynamics. ResultsA total of 184 NE and 180 control patients were included in the study. SBO was detected in 71 (19.5%) patients and LUTS in 100 (27.4%). When the groups with and without NE were compared, the number of patients with SBO (26% vs 17%, P = .044) and those with LUTS (36% vs 17.5%, P < .001) were significantly higher in the NE group. The overall rate of dryness (67.4% vs 83.6%, P = .024) and response to LUTS treatment (65% vs 97%, P < .01) were significantly lower in those with SBO than in those without SBO. ConclusionSBO is more common in NE patients than in non-NE patients. Response to NE treatment is lower in SBO patients with severe LUTS; for this population, advanced treatment options may be considered earlier.

Relationship between sleep patterns, sleep problems, and childhood enuresis

ObjectiveSleep dysfunction has been speculated to be involved in the pathological mechanism of nocturnal enuresis (NE). However, results obtained from previous studies were conflicting. This study evaluated and compared the sleep patterns and problems between children with and without nocturnal enuresis (NE) across different age and gender groups in a large epidemiological study. MethodsA multi-center, cross-sectional, epidemiological study was carried out in which 21,439 primary school children (10,655 boys and 10,784 girls aged 5.1–12.9 years) and their parents participated. Chinese versions of the Children's Sleep Habits Questionnaire and the General Condition Questionnaire were used to identify nocturnal enuresis, sociodemographic characteristics, sleep patterns, and sleep problems in children. The sleep patterns and problems were compared between children with and without NE while controlling for a number of confounding factors in different age and gender groups. ResultsIt was observed that children with NE (especially boys aged 11–12 years with severe NE) slept for a shorter period and were more likely to have sleep problems such as bedtime resistance, sleep duration disorder, night awakening, sleep anxiety, sleep-disordered breathing, and daytime sleepiness than those without NE. Girls with NE were more likely to suffer from other types of parasomnias. ConclusionChildren with NE, especially older boys with severe NE, were more sleep compromised than those without NE. Our findings warrant further research on the mechanism of NE and may have clinical implications for the treatment of childhood sleep problems and NE.

Oral Desmopressin Lyophilisate Formulation (MELT): Efficacy and Safety in Children and Adults

Nocturnal enuresis (NE) is a common disorder in childhood and desmopressin is one of the most widely and well-tolerated medications for NE. The recent oral lyophilisate formulation of desmopressin (MELT) is effective in the treatment of NE in children and nocturia in adults. A MEDLINE literature search MEDLINE (2000-July 2017) was performed using the search terms MELT enuresis, MELT desmopressin, sublingual desmopressin, lyophilisate desmopressin. Twenty articles were analyzed with a number of patients of 3448. In 12 articles were reported 1275 pediatric patients (&lt;18 years old), and in 8 articles 2213 adult patients. In pediatric population the indication was enuresis in 1269 patients and central diabetes insipidus in 6 patients. In adult population the indication was nocturia in 1941 patients, renal colic in 259 patients, healthy volunteers 13 patients. In 17 studies desmopressin was administered alone while in 3 studies in association respectively with Tolterodina, Ketorolac and Tamsulosin. In 7 studies were reported side effects in only 81 patients, 60 in pediatric population and 21 in adult population. The reported side effects in pediatric population were nausea, lethargy, lower limb weakness, headache, diarrhea, viral gastroenteritis. The reported side effects in adult population were asymptomatic hyponatriemia, nausea, diarrhea, dizziness, symptomatic hyponatriemia. Our review confirm that the MELT formulation of desmopressin guarantee the same response of other formulations with a lower doses and a lowest number of side effects. We believe according with the literature that this formulation is actually the first line and safety treatment for nocturnal enuresis and nocturia.

Phytotherapy for children's nocturnal enuresis

In a period of childhood, one of the issues that annoys the parents is their child's nocturnal enuresis. Nocturnal enuresis is annoying not only for the family but for the children themselves. Conventional treatments for nocturnal enuresis lead to certain complications. Medicinal plants have a special status in the treatment of neonatal and pediatric diseases. In phytomedicine, certain medicinal plants and phytotherapies have been suggested to treat nocturnal enuresis. The purpose of this study is to review the most important medicinal plants for children's nocturnal enuresis. To conduct this review, we searched for relevant articles indexed in certain databases such as PubMed, Scopus, Islamic World Science Citation Center, Scientific Information Database, and Magiran and some data sites using the words nocturnal enuresis, children's urination, medicinal plants, and traditional medicine. Results have shown that Zingiber officinale, Valeriana officinalis, Alcea rosea, Elettaria cardamomum, Cinnamomum verum, Ribes uva-crispa, Cornus mas, Juglans regia, Vitis vinifera, Sinapis spp., Olea europaea, and Prunus cerasus are a number of important plants that are effective on nocturnal enuresis in traditional medicine and phytomedicine.Journal of Medical and Biomedical Sciences (2017) 6(3), 23 - 29

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.

Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial.

Nocturnal enuresis (NE) is a common pediatric developmental disorder. Desmopressin is frequently used for NE and is an evidence-based therapy. Suoquan capsule is a Chinese medicine commonly used for treating NE in children but is poorly understood by most scholars. A total of 369 children with NE were randomized to receive either suoquan, desmopressin plus suoquan, desmopressin, or behavioral intervention for 2months, and the response rates evaluated. Subsequently, the viable demographic factors that could lead to success were investigated on logistic regression analysis. Moreover, after 3months of follow up, the relapse rate was investigated. The complete response (CR) rate in the desmopressin plus suoquan group (37.5%) was higher than that in the behavioral intervention group (6.3%, P<0.007). The desmopressin group had a lower CR rate (22.5%) and a higher non-response rate (25.0%) than the desmopressin plus suoquan group (non-response rate, 21.9%; P>0.007). The relapse rate in the desmopressin group was significantly higher than that in the desmopressin plus suoquan group (72.2% vs. 30.6%, P<0.007). On Multivariate analysis, treatment group, NE frequency, and age were independent predictors of CR at 2months (P<0.05). Combined traditional Chinese and Western treatment in children with NE is effective and has a low relapse rate. NE frequency, treatment method, and age are important predictive factors for CR after treatment.

Clinical management of nocturnal enuresis.

Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful.

Desmopressin plus anticholinergic agent in the treatment of nocturnal enuresis: A meta-analysis.

The present study aimed to evaluate the clinical efficacy and safety of combination therapy comprising desmopressin plus anticholinergic agent compared with desmopressin alone for children with nocturnal enuresis (NE). A meta-analysis of 8 eligible studies was performed to analyze the effects of desmopressin plus anticholinergic agent combination therapy and desmopressin monotherapy in the treatment of NE in children. The overall odds ratio (OR) or standardized mean difference (SMD) and 95% confidence interval were calculated for full responders (FR), partial responders (PR), non-responders (NR), the change in the mean number of wet nights and adverse events. Following 1 month of treatment, efficacy analysis yielded an OR of 3.736, which suggested that the proportion of FR for patients treated with the combination therapy was higher than that for patients treated with monotherapy. Analysis of the change in the mean number of wet nights yielded an SMD of 0.719, which indicated that the change in the mean number of wet nights in the patients treated with combination therapy was greater than that in the patients treated with monotherapy. Following 3 months of treatment, the OR calculated for FR plus PR compared with NR was 2.857, indicating that the proportion of FR and PR was elevated by the combination therapy compared with desmopressin alone. The OR for adverse events was 4.074, which suggested that the combination therapy did not lead to more adverse events in the treatment of NE. Therefore, the present meta-analysis suggests that, compared with desmopressin monotherapy, a combination therapy comprising desmopressin and anticholinergic agent is more effective with equivalent safety for children with NE.

Children with nocturnal enuresis and attention deficit hyperactivity disorder: A separate entity?

There is ongoing debate about whether nocturnal enuresis (NE) is affected by the presence of attention deficit hyperactivity disorder (ADHD) in children. Clarifying this relationship could categorize them as a separate entity, potentially requiring a different management from enuretic children without ADHD. To study whether (1) children with ADHD exhibited greater severity of enuresis and associated voiding symptoms compared with children without ADHD, (2) whether there was a difference in enuretic response to treatment between children with/without ADHD, (3) whether previously prescribed medication for ADHD affected severity of enuresis or voiding symptoms, and response to treatment. Data on all consecutive children seen with primary NE and ADHD and age- and gender-matched children with NE without ADHD over the course of 2 years were extracted from our database. Controls were identified using a random number generator to choose patients within each age/gender group. Changes in Dysfunctional Voiding Scoring System (DVSS) and Bristol scores were assessed before and after treatment for NE using repeated measures ANOVAs. Number of weekly wet nights was compared between the groups before and after the treatment of enuresis. Children with more than a 50% decrease in number of wet nights per week were categorized as responding to treatment. Compared with controls, ADHD children (N=95) had significantly more severe voiding symptoms, NE and constipation (Table). No significant differences were found between children on ADHD medication (63.2%) and those who were not on ADHD medication (36.8%) on any of the demographic and pre-treatment clinical parameters. Similar enuretic response rates to behavioral modification alone were seen in both study (13.5%) and control (12.8%) groups (p=0.73). Response to pharmacological treatment was seen in nine patients with ADHD (42.9%) and in six (20.7%) controls, with pharmacological intervention being significantly more effective than behavioral modification for patients with ADHD (p=0.012). Additionally, no difference was found between ADHD patients on and off ADHD medication in terms of response to enuresis treatment. In children with primary NE, the presence of ADHD was associated with more severe NE, voiding symptoms and constipation. The severity of voiding symptoms and/or NE was unrelated to the use of stimulant medication. The response to behavioral modification was comparable in both groups. However, patients with ADHD were significantly more responsive to medication for NE compared with behavioral modification, indicating a possible benefit for earlier pharmacological treatment for enuresis in this population subgroup.

Treatment and Management of Nocturnal Enuresis: A Review

Nocturnal Enuresis (NE) is the involuntary passing of urine whileasleep after the age at which bladder control would normally be prevised. NE has hassled humans for hundreds of years. It has been recognized since the time of Papyrus Ebers, 1550 B.C. Various potions were prepared by using different plants, animals or organs in some of the early treatment modalities. A number of medications have been used to treat nocturnal enuresis where, Imipramine and Desmopressin acetate were found to be efficacious. Besides, some credit has also been given to Oxybutynin. Because of the high relapse rates recited after short-term therapy with pharmacotherapeutic agents, pharmacological treatment for NE is best considered as management therapy rather than a cure. In this review article, we have mainly focused on the treatment and management of nocturnal enuresis by reviewing various treatment modalities along with behavioural modifications, bladder retention training, hypnotherapy, psychotherapy and combination therapy.

Clonidine may have a beneficial effect on refractory nocturnal enuresis

Although the evidence-based treatment for nocturnal enuresis is established, nearly one-third of patients are still enuretic with desmopressin, anti-cholinergic treatment and alarm. The fourth option, imipramine, is limited because of the risk of cardiotoxicity on overdose. Clonidine, an α2 -adrenoceptor agonist that also has noradrenergic effects like imipramine, is a new option for refractory enuresis. A total of 148 patients (6-14 years of age; mean, 9.1 years) with refractory enuresis under desmopressin, anti-cholinergic treatment and alarm were enrolled. The patients consisted of 100 boys and 48 girls, of whom 23 had monosymptomatic nocturnal enuresis and 125 had non-monosymptomatic nocturnal enuresis. Clonidine 4 μg/kg/day (maximum, 75 μg/day) orally 30 min before bedtime was added and its effects were evaluated after 4 weeks of treatment. A total of 83 patients (56.1%) achieved partial or complete response with the additional clonidine. No significant adverse reactions were noted. Clonidine could be an aid for refractory enuresis, although further randomized controlled trials are needed.

Comorbid Psychiatric Disorders in Children and Adolescents with Nocturnal Enuresis.

The present study was conducted with the aim of identifying the frequency of comorbid psychiatricdisorders in children and adolescents with nocturnal enuresis (NE). In this descriptive-analytical study, 183 children and adolescents aged 5-18 years withNE referred to psychiatric clinics at Tabriz University of Medical Sciences were selected in 2015. A structuredclinical diagnostic interview, the kiddie-schedule for affective disorders and schizophrenia (K-SADS), was employedbased on the diagnostic and statistical manual of mental disorders (DSM-IV-TR) for the diagnosis of NEand comorbid psychiatric disorders. In this study, 39 participants (21.3%) were female and 144 (78.7%) were male. The mean age of participantswas 8.69 &plusmn; 2.34 years. The lifelong incidence of mental disorders among enuretic children and adolescentswas 79.23%. The highest incidence belonged to attention deficit/hyperactivity disorder (ADHD) with 74.9%, oppositional-defiant disorder (ODD) with 53%, and tic disorders with 12% (motor tics together with a single caseof vocal tic). The lowest incidence was for conduct disorder, bipolar affective disorder, and post-traumatic stressdisorder (PTSD) with 5%. Based on the Fisher exact test, there was no significant difference between girls andboys in terms of psychiatric disorders incidence (P &gt; .05). Comorbid psychiatric disorders with NE are common among children and adolescents. Therefore,in-depth examination of other psychiatric disorders needs to be carried out in enuretic children and adolescents,which will affect the treatment and prognosis of NE.