Treatment Of Primary Monosymptomatic Nocturnal Enuresis Research Articles

Comparative Analysis of Solifenacin Plus Desmopressin Versus Desmopressin Alone in the Treatment of Primary Mono Symptomatic Nocturnal Enuresis

ObjectivesTo compare the efficacy and tolerability of Solifenacin plus Desmopressin and Desmopressin alone in the treatment of primary monosymptomatic nocturnal enuresis (PMNE). MethodsA total of 88 children, 5–14 years old, diagnosed with PMNE were enrolled in this randomized control trial (RCT) from June 2017 to June 2020. After informed written consent patients were randomized to one of the two therapeutic groups. Group 1 received one puff of desmopressin nasal spray 1 h before bedtime every night. Group 2 received one pill of solifenacin 5 mg plus one puff of desmopressin nasal spray 1 h before bedtime every night. All patients were evaluated after three months for their response to treatment and drug side effects. ResultsThe mean age in desmopressin alone group and solifenacin plus desmopressin group was 8.1 ± 2.2 (5–14) and 7.9 ± 2.2 (5–14) years respectively (p-value >0.05). In group 2, 37/44 (84.09%) patients achieved complete response after three months of treatment in comparison to group 1 in which 27/44 (61.36%) patients showed complete response (p-value <0.05). In group 1, 8/44 (18.18%) patients developed treatment related side effects whereas in group 2, 12/44 (27.27%) patients developed side effects (p-value >0.05). No case of discontinuation of treatment due to side effects was observed in any of the two groups. The recurrence rate was also significantly lower in group 2 in comparison to group 1 (8.1% vs 33.3%, p-value <0.05). ConclusionOur study demonstrated that the combination of Solifenacin plus Desmopressin is more effective than desmopressin monotherapy in the treatment of PMNE with an acceptable tolerability profile. Level of EvidenceLevel I.

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

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

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

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

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

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

Advances in the management of primary monosymptomatic nocturnal enuresis in children

Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.

Therapeutic Efficacy of Hydrochlorothiazide in Primary Monosymptomatic Nocturnal Enuresis in Boys With Idiopathic Hypercalciuria.

Background:Idiopathic hypercalciuria (IHC) can be one of the causes of nocturnal enuresis (NE) and hydrochlorothiazide (HCT) ameliorates hypercalciuria.Objectives:The aim of this study was to assess the therapeutic efficacy of HCT in boys with primary monosymptomatic NE (PMNE).Patients and Methods:This study was a randomized double-blind placebo-controlled clinical trial. A hundred boys with PMNE and IHC were randomly assigned into two groups of experimental (treated with HCT 1 mg/kg/day) and control and all patients were followed for 4 months for the number of wet-night episodes.Results:The mean numbers of wet-night episodes in the first (intervention: 8.34 ± 8.54, control: 9.1 ± 9.3, P = 0.3), second (7.1 ± 7.3, 7.9 ± 8.1, P = 0.4), third (7.8 ± 8, 7.9 ± 8.1, P = 0.1) and fourth (4.9 ± 5.1, 5.9 ± 6, P = 0.3) months were not significantly different between the two groups. However, the decrease in the average wet-night episodes during the 4 months of treatment in the intervention group (P = 0.019) unlike the control group. Not more significant compared to control group (P = 0.191). All patients who were treated by HCT became normocalciuric. However, in 21 patients the dose was increased to 2 mg/kg/day.Conclusions:Single daily dose of HCT is a safe and effective therapeutic option in the treatment of PMNE in children with IHC.

Night diuresis stimulation increases efficiency of alarm intervention

The prevalence of primary monosymptomatic nocturnal enuresis (PMNE) varies from 1.6% to 15%. Although treatment with enuretic alarms has been used for a long period of time, there are many disadvantages, including the necessity for long-term use and the high percentage of children who are resistant to such therapy. We hypothesized that more intense use of the alarm system would accelerate the process of forming the conditioned response to awakening, caused by the desire to urinate and, probably, increase the percentage of patients with positive results. Increased fluid intake will cause more frequent awakenings, so the use of alarm system will be more intense (Figure). To study the effect of increased fluid intake, prior to going to bed, on the efficacy of alarm therapy. The treatment group consisted of 294 children (178 boys) average age: 11.3 (9.1-11.9) years. All participants completed an overactive bladder questionnaire (OAB-q) and a bladder diary, and underwent uroflowmetry, blood and urine testing. Group A (n = 141, mean age 10.9 (9.1-11.6) years), used the alarm system traditionally (Wet Stop/BYE-WET, USA). Group В (n = 153, mean age 11.5 (9.3-11.9) years) drank either water or any other transparent non-colored fluid (any table mineral water with mineralization of less than 1 g per dm³) once immediately prior to sleep at a volume of 4-5 ml/kg of body weight. The effectiveness of therapy was assessed by the change in frequency of urination episodes during sleep per week, episodes of spontaneous awakenings, caused by the desire to urinate per week. Data were analyzed using JMP SAS Statistical Discovery 8.0.2. Wilcoxon criterion was used for comparison of results between groups; correlation of changes in groups was analyzed using the Spearman coefficient. Complete resolution of NE, 2 weeks after the end of alarm therapy, was found in 34 patients (24%) in Group A and 59 (39%) in Group B. This difference was statistically significant with a confidence level of 95%. Having searched the publication databases, including PubMed and Scopus, we failed to find any publication presenting evidence or recommendations on the ideal management of fluid intake in patients with PMNE. Although a limitation of fluid intake is commonly recommended, there is no evidence showing an increase in dry night frequency when such fluid restriction is used as monotherapy. In contrast, our study has shown an improvement in outcome when an increased fluid intake is used in combination with enuretic alarm therapy. We were able to prove that increased fluid intake improved the efficiency of alarm therapy intervention during the treatment of PMNE in children.

Nocturnal enuresis: an approach to assessment and treatment.

On the basis of strong evidence, although primary monosymptomatic nocturnal enuresis (PMNE) is common and most children will outgrow the condition spontaneously, the psychological effect to the child can be significant and represents the main reason for treatment of these children. On the basis of international consensus panels, treatment of PMNE should be targeted toward the specific type of bedwetting patterns the child has, using bladder diary, sleep history, and daytime elimination concerns as a guide (Table 3). On the basis of international consensus panels, it is important for the primary care physician to be able to differentiate children with PMNE from children with nonmonosymptomatic nocturnal enuresis (NMNE) and secondary nocturnal enuresis. On the basis of international consensus panels, children with NMNE should have their underlying voiding or stool problem addressed before initiation of therapy for the nocturnal enuresis. On the basis of strong evidence, both the bedwetting alarm and desmopressin are considered first-line therapy for children with PMNE.

Efficacy and safety during long‐term treatment f primary monosymptomatic nocturnal enuresis with desmopressin

The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long‐term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4‐wk observation period, a 6‐wk dose titration period (with 20‐40 μg desmopressin) and a 1‐y, long‐term treatment period. A treatment‐free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6‐12 y with PMNE were recruited. Of these, 245 patients (61%) experienced ≥ 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long‐term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3‐7.0) during the observation period to a median of 0.8 (range 0.0‐5.0) during the last 3‐mo period. Seventy‐seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6‐7‐y‐olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug‐related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long‐term treatment of PMNE, with a significant therapeutic effect also in children of 6–7 y of age.