Treatment Of Primary Nocturnal Enuresis Research Articles

A Comparative Study of Imipramine and Tolterodine for the Treatment of Children with Primary Nocturnal Enuresis

Background: Nocturnal enuresis (NE), or bed-wetting, affects children aged ≥5 years after ruling out organic causes. The ICCS defines NE as intermittent urinary incontinence during sleep, categorized into monosymptomatic (MNE) and non-monosymptomatic (NMNE) forms. NE is also classified by onset: primary (no dry period) and secondary (bed-wetting after a dry period). Contributing factors include sleep disorders, stress, hereditary predisposition, and delayed bladder development. Management involves behavioral and pharmacological treatments, with desmopressin and anticholinergic drugs being common options. Aim of the study: This study aims to find out an alternate effective and safe drug for the treatment of primary nocturnal enuresis. Methods: This study was conducted at the Department of Urology(outdoor), Shahid Sk. Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2020 to December 2021. After excluding 12 patient’s pre-randomizations for non-cooperation, 60 patients were split into two groups: Group A received 25mg of imipramine before bedtime, while Group B took 1mg of tolterodine tartrate twice daily evaluated efficacy over 6 months, including a 2-week behavioral modification baseline and follow-ups at 3 and 6 months. Data were analyzed using SPSS 26, employing various statistical tests with significance set at p <0.05. Result: The study involved 60 children (mean age 10.0±3.1 years, 55% male), assessing bed-wetting patterns and treatment outcomes. The majority (80%) had unsatisfactory behavioral modifications, with 35% having a family history of enuresis. Both groups (A and B) showed no significant difference in bed-wetting episodes at baseline or after 3 months of treatment. Complications were more common in Group A, including dry mouth, nausea, and insomnia. Imipramine led to a higher proportion of patients with fewer than 50 dry nights after drug withdrawal, while Tolterodine showed better results at month 3 but a higher decrease in dry ...

A0649 - Mirabegron and Solifenacin in treatment of primary nocturnal enuresis with reduced nocturnal bladder capacity: A randomized double blind placebo controlled study

A0649 - Mirabegron and Solifenacin in treatment of primary nocturnal enuresis with reduced nocturnal bladder capacity: A randomized double blind placebo controlled study

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

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

Development and evaluation of a composite dosage form containing desmopressin acetate for buccal administration

Desmopressin acetate (DDAVP) is an oligopeptide indicated for the treatment of primary nocturnal enuresis, for example. The poor oral bioavailability of DDAVP accelerated a shift to alternative routes of administration like nasal and oromucosal, whereby nasal administration results in high fluctuations increasing the risk of undesirable side effects. Aim of the study was to use a new composite dosage form (solid matrix attached to a bilayer mucoadhesive film) to make DDAVP available via oromucosal route, reducing the risk of undesirable side effects through precise dosing. DDAVP was incorporated into a solid matrix in the form of a minitablet, and both direct tableting (AV > 30) and granulation followed by tableting (AV = 17.86) were compared. Minitablets with content uniformity could only be obtained by granulation and loss supplementation (AV = 11.27) with immediate drug release (>80% after 7–8 min) and rapid disintegration (<49 s). Permeation studies were performed with a clinically relevant dose (200 μg) in a time interval of up to one hour, resulting in apparent permeation coefficients of 4.90 × 10−6 cm/s (minitablet) and 2.04 × 10−6 cm/s (composite). Comparable fluctuations showed no inferiority of composite and minitablet regarding dosing accuracy. Thus, a step towards controlled and dose-accurate transmucosal delivery of systemically active DDAVP could be achieved.

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

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

Use of propranolol in children with primary nocturnal enuresis.

In nocturnal enuresis, motivational therapy, alarm therapy, and drug therapy, such as anticholinergics, imipramine, and sertraline, are the mainstay of treatment. In the present study, we used motivational therapy, oxybutynin, and propranolol in children with primary nocturnal enuresis to determine if propranolol is an effective treatment. Fifty-two children with primary nocturnal enuresis were included in the study. Firstly, motivational therapy was given for 1 month to all patients. Patients who failed the motivational therapy were randomly given oxybutynin or propranolol. The patients were re-evaluated after 1 month of drug therapy. There was not a significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis ( p > 0.05). Of 52 patients, 28 (53.8%) patients improved by motivational therapy. There were 14 patients in the oxybutynin group. One patient was excluded from the study because facial flushing and mouth drying developed in the first week of oxybutynin therapy. In oxybutynin group, 12 of 13 (92.3%) patients improved. There were 10 patients in the propranolol group. In the propranolol group, while nine (90%) patients did not improve, one patient had significant remission (90%, p < 0.001). No significant adverse reaction was noted during propranolol therapy. There was no significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis (p > 0.05). A significant difference was found between the groups for the remission of nocturnal enuresis ( p < 0.001). Our findings showed that motivational therapy is the first line treatment in primary nocturnal enuresis, and oxybutynin but not propranolol is effective in patients who failed with the motivational therapy.

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

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

Nocturnal Enuresis as a Specific Compensatory Syndrome

The pathophysiological nature of the monosymptomatic primary nocturnal enuresis (PNE) in children is still the unresolved problem. The most hypotheses of pathogenesis of nocturnal enuresis are limited within anatomical, biochemical and physiological regulation of the urinary control. Based on our own observations as well as the data reported in the literature, we have concluded that in addition to described biological causes of this disorder, we should focus on the common clinical and developmental features observed in the majority of cases of the monosymptomatic primary nocturnal enuresis that could be united as “enuretic syndrome”. In attempt to move “outside of the box” of the urinary control we have put forward a hypothesis that enuresis is a specific compensatory syndrome which is self-developed by the child’s organism to “offset” the deviated sleep–wake mechanisms. This concept is based on the general “control system theory” and offers the explanations of the majority of symptoms. From the compensatory “offset” concept the treatment of PNE should be focused not on the suppression of the act of enuresis but on the stabilization of circadian sleep-wake mechanisms. Further investigations are needed to evaluate the validity of this concept.

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

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

Desmopressin, Imipramine, and Oxybutynin in the Treatment of Primary Nocturnal Enuresis: A Randomized Clinical Trial.

Background:Nocturnal enuresis is the most common pediatric urologic problem in outpatient clinics.Objectives:To assess the effect of various monotherapies, and comparing the effects of desmopressin, imipramine, and oxybutynin in children with enuresis, as well as the influence of socioeconomic and cultural factors of their families on the response and relapse rates.Patients and Methods:The study was a randomized clinical trial conducted on 92 children aged 5 - 14 years, referred to the pediatric clinic of Semnan University Hospital in Semnan, Iran. Children with primary nocturnal enuresis were randomly allocated to three different treatment groups: desmopressin (n = 30), imipramine (n = 31), and oxybutynin (n = 31) all for 6 weeks. The socioeconomic and demographic characteristics of all participants were recorded. The number of wet nights per week was noted at the end of the 6-week-trial, and children were followed up to three months for relapse.Results:Children in the oxybutynin group showed a slightly higher response rate (71.0% success) and a lower relapse rate (31.8%), while in the desmopressin group the response and relapse rates were 63.3% and 57.9%, respectively, and in the imipramine group 61.3% and 63.2%, respectively. However, the difference between the 3 groups in terms of response (P = 0.701) and relapse rates (P = 0.095) was not statistically significant.Conclusions:There is no significant difference between monotherapy with desmopressin, imipramine or oxybutynin in children with enuresis. However, oxybutynin showed a higher response rate and a lower relapse rate compared to other medications. More clinical trials with a larger sample size are needed to clarify these uncertainties.

Assessment of the Efficacy of Enuresis Alarm in Treatment of Primary Nocturnal Enuresis in Egyptian Children

Assessment of the Efficacy of Enuresis Alarm in Treatment of Primary Nocturnal Enuresis in Egyptian Children

Progress on treatment of primary nocturnal enuresis

Primary nocturnal enuresis is a common childhood disorder.This review discusses the progress on the treatment of primary nocturnal enuresis in children.Alarm interventions for nocturnal enuresis and desmopressin are the first-line therapy of primary nocturnal enuresis.In therapy-resistant cases,anticholinergic treatment combined with desmopressin can be tried.In situations when all other treatments have failed,imipramine treatment is warranted,provided the cardiac risks are taken into account.More research is needed regarding both the above drugs and non-pharmacological therapies on children with therapy-resistant enuresis. Key words: Enuresis; Children; Treatment

Effectiveness of an alarm intervention with overlearning for primary nocturnal enuresis

ObjectiveTo explore the effectiveness of the enuresis alarm with overlearning for treatment of primary nocturnal enuresis (PNE). A key objective was to explore the effect of overlearning on treatment gains, and its impact on relapse. Patients and methodsThe RMIT University Psychology Clinic has been treating PNE in the community for more than 20 years following a standardized treatment protocol. The study analysed archival data of 126 participants, aged ≥5 years, presenting with PNE. A mean wetting frequency of 5.13 wet nights per week was observed at baseline. ResultsTreatment significantly reduced mean wetting from baseline levels during both treatment and overlearning phases, F(1.41, 176.10) = 588.54, p < 0.001, r2 = 0.77, 95% CI (0.74–0.81). Wet nights per week reduced from a mean of 5.13 (SD = 1.77) during baseline to 1.88 (SD = 0.85) during treatment, and 0.64 (SD = 0.60) during overlearning. Alarm treatment with overlearning produced a treatment response of 87%, compared with 59% for alarm treatment only. ConclusionsEvidence of improved treatment response with the addition of overlearning suggests overlearning should be considered as a potentially useful adjunct to alarm treatment for PNE. Overlearning was not unreasonably onerous for participants. Further research is required to explore the impact overlearning has on reducing relapse rates.

What is the best treatment approach to primary nocturnal enuresis in an otherwise healthy adult?

Evidence-Based Answer Desmopressin is effective for the treatment of primary nocturnal enuresis (PNE) in adults (SOR: B, cohort study). While tricyclic antidepressants and enuresis alarms are effective in children (SOR: A, systematic reviews), no information is available on these modalities in adults.

Parent and Physician Perspectives on the Treatment of Primary Nocturnal Enuresis in Korea

PurposeParental decisions about the treatment of nocturnal enuresis (NE) are generally based on silent agreement with a physician's recommendation. However, physicians may have an insufficient understanding about parents' concerns and expectations regarding treatment. The aim of this study was to clarify the discrepancies between the perceptions of parents and physicians and to better understand the attitudes related to NE treatment.Materials and MethodsA survey was conducted in six centers and included 105 parents and 102 physicians. Two questionnaires, one for parents and another for physicians, were prepared. Each contained items on demographic characteristics, concerns, and NE treatment preferences. The parents completed the questionnaire during their child's first clinical visit, and the physicians completed the questionnaire via e-mail or individual interviews.ResultsLow self-esteem was the most common concern among both parents and physicians. Parents showed a more serious concern regarding disease progression and sequelae than did physicians. In the parent group, parents of younger children were mainly concerned about growth, whereas parents of children with daytime symptoms were mainly concerned about disease progression and relationships. Treatment outcome preferences differed significantly between the two groups. Physicians preferred treatments yielding immediate results, whereas parents preferred long-term treatments that would result in low recurrence.ConclusionsThis survey presents the differences between parents and physicians regarding NE concerns and therapeutic preferences. Our study may provide valuable insight for physicians regarding parental attitudes toward NE treatment.

Assessment of Interferential Currents Therapy Efficacy in Management of Primary Nocturnal Enuresis in 5-15 Years Old Children: A Randomized Clinical Trial

Introduction: Nocturnal enuresis affects about 15 percent of 5 years old children and because of its social (psychological) problems, it must be treated. Different treatment modalities such as imipramine, desmopressin, bed alarm have been used but applying of new and effective modalities can be an appropriate view. The aim of this study was to compare efficacy of interferential currents (IFC) with nasal spray of desmopressin in treatment of primary nocturnal enuresis of 5-15 years-old children. Methods: This study was a randomized, clinical trial in which 39 patients with primary nocturnal enuresis received desmopressin (20 μg/day ) for 3weeks and if was responsive, leave off gradually in six months and 36 patients were selected randomly by simple randomization for IFC therapy (5 times /week, 20 minutes / session, up to 15 sessions). Efficacy of treatment was evaluated after accomplishment of therapeutic sessions and recurrence rate was evaluated one month later. Results: In IFC group, complete response was observed in 25%, partial response in 36.1% and 38.9% had no response. In desmopressin group, response was observed in 87.2%, and 12.8% had no response (Risk ratio =2.4, 95% confidence interval (1.32-4.32)). The recurrence rate in IFC and desmopressin were 61% and 87.2%, respectively. Therapeutic side effects were not observed in any of patients (Risk Ratio=0.7, 95%CI (0.53-0.94)). Conclusion: Desmopressin and IFC are effective and safe modalities for treatment of primary nocturnal enuresis of children. Although desmopressin has more efficacy but IFC has less recurrence rate

Desmopressin versus Behavioral Modifications as Initial Treatment of Primary Nocturnal Enuresis

The purpose of this study was to compare the effectiveness of desmopressin to behavioral modifications as the initial treatment of primary monosymptomatic nocturnal enuresis (PMNE). Study results determined that either intervention led to a significant reduction in PMNE episodes. These results suggest that either method is equally effective for treatment of PMNE.

Did the removal of the indication of nocturnal enuresis for intranasal desmopressin change prescribing practice?

The indication for the treatment of primary nocturnal enuresis was removed from all intranasal preparations of desmopressin in May 2007. Objective of this study was to examine whether and how fast this regulatory decision changed prescribing in affected children. We analyzed claims data of the Gmünder ErsatzKasse (GEK) over the years 2004-2008. All children and adolescents aged 0-18 years who received at least one out-patient diagnosis of urinary incontinence in the corresponding years were included. Our outcome of interest was the proportion of oral desmopressin and its change over time. A total of 6308 to 7207 children with a mean age of about 8 years were included annually (62-63% were male) and 14 746 packages of desmopressin were analysed (49.9% intranasal; 50.1% oral; 0.01% parenteral preparations). The proportion of patients using desmopressin decreased slightly from 13.9% in 2004 to 12.6% in 2008 ( p for trend = 0.0131). Between January 2004 (39.1%) and December 2006 (41.3%), the proportion of oral forms was nearly constant and doubled after that within a few months to about 80%. Immediately after the removal of the indication for intranasal desmopressin, an increased prescribing of tablet forms in affected children was found in Germany.

Treatment of primary nocturnal enuresis in children: a review

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

Randomized comparison of long-term desmopressin and alarm treatment for bedwetting

To compare the efficacy of long-term primary nocturnal enuresis (PNE) treatment using desmopressin versus enuresis alarm. A 6-month randomized trial was performed with patients from 29 enuresis clinics: 251 patients ≥ 5 years in age with severe PNE (mean 5.5-5.6 wet nights/week) were randomized to desmopressin (0.2-0.4 mg daily) or alarm. Efficacy was assessed by percentage reduction in mean number of wet nights/week; patients achieving dryness, mean initial duration of sleep and compliance were evaluated. Efficacy analyses were performed using the intent-to-treat population (all patients) and excluding patients who withdrew; 12-month follow-up data were collected. Data could not be evaluated for the 32% of alarm patients and 7% of desmopressin patients who withdrew early. In intent-to-treat analyses, a similar proportion of patients across groups showed a ≥ 50% reduction in wet nights/week (desmopressin: 37.5%, alarm: 32.2%) and achieved dryness (desmopressin: 32%, alarm: 37%). Compliance was higher with desmopressin: 95-98% of patients took >75% of tablets; 50-78% used alarm >75% of nights. Initial sleep duration was 1.02 h longer at the end of treatment with desmopressin (95% CI: 0.045, 1.99). Desmopressin and alarm demonstrated comparable efficacy in the treatment of PNE. Withdrawal from the alarm group was high, indicating the importance of considering family motivation before selecting treatment, for optimal outcome.