Voiding Disorders Research Articles

Corticotropin-Releasing Hormone Expressing Neurons of the Pontine Micturition Center Inhibit Volitional Micturition

Lower urinary tract or voiding disorders are prevalent across all ages and affect over 40% of adults over 40 years old leading to decreased quality of life and high healthcare costs. The pontine micturition center (PMC) contains a large population of neurons that co-localize the stress-related neuropeptide, corticotropin-releasing hormone (CRH) and project to neurons in the spinal cord to regulate micturition. How the PMC and CRH-expressing neurons in the PMC control volitional micturition is of critical importance for human voiding disorders. To investigate the specific role of these CRH-expressing PMC neurons, these neurons were optogenetically stimulated during in vivo cystometry in unanesthetized mice. Optogenetic activation of CRH-PMC neurons led to increased intermicturition interval and voided volume, similar to the altered voiding phenotype produced by social stress. These effects were eliminated by CRH-receptor 1 antagonist pretreatment. In a cyclophosphamide cystitis model of bladder overactivity, optogenetic stimulation of CRH-PMC neurons returned the voiding pattern to normal. Collectively, our findings demonstrate that CRH in PMC spinal projections has an inhibitory function on micturition and may be a potential therapeutic target for human disease states such as voiding postponement, urinary retention, and under- or over-active bladder.

Psychiatric comorbidities of children with elimination disorders

Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4–17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.

Efficacy of transcutaneous posterior tibial nerve stimulation in children with functional voiding disorders.

To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor-beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow-up. A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups. QoL scores, overalland day-time DVISS scores were significantly decreased in both sham and test groups (p < 0.05). In addition to these findings, the frequency of incontinence and urgency episodes were also significantly reduced (p < 0.05) in the TPTNS treatment group. This effect in the test group was still valid 2 years after intervention. There was no significant difference in UBs measurements between treatment and nonsymptomatic groups and between pretreatment and posttreatment measurements of test and sham groups. TPTNS is an efficient minimally invasive treatment in children with FVD who do not respond to medical treatment. TPTNS provides a significant improvement on episodes of frequency, episodes of incontinence, overall and day-time DVISS scores, and QoL scores. The effectiveness of treatment continues even at the end of the second year of intervention. UBs were not found to be predictive in terms of diagnosis and evaluating the treatment response.

Psychological differences between toilet trained and non-toilet trained 4-year-old children.

Late to complete toilet training has been associated with many psychological factors including behavior and mood problems. Unfortunately, the majority of the research is specific to children with elimination disorders or children identified as incontinent after the age of 7 years. The current study addressed gaps in the literature by comparing the psychological functioning of children not toilet trained by their 4-year-old well child care visit with their toilet trained peers. Parent reports of internalizing and externalizing behavior using the Child Behavior Checklist (CBCL) were compared across groups, non-toilet trained and toilet trained, for 150 children recruited during their 4-year-old well child health care visit. Independent samples t tests of group means and χ2 analyses were performed on all CBCL scales. Results found no clinically or statistically significant differences between groups on parents' reports of internalizing and externalizing behavior. The current study provides no evidence that delays in successfully completing toilet training by 4 years of age were related to psychological problems for this sample of children. Nursing professionals in primary care settings are positioned to provide anticipatory guidance to parents of children not yet toilet trained. Findings from the current study offer evidence that delays in toilet training might not be related to psychopathology, and these children are not likely to require intervention outside the pediatric setting and could be effectively managed by primary care health providers employing evidence-based toilet training protocols.

Çocukluk Dönemi İşeme Bozuklukları İle Erişkin Dönemdeki Aşırı Aktif Mesane İlişkisi

Objective : Overactive bladder (OAB) and childhood voiding disorders are important and common health problems. In the literature, childhood voiding disorders have been shown to be an important risk factor for OAB in adulthood. We aimed to reveal the factors that facilitate the emergence of AAM in adulthood in patients with childhood voiding disorders. Material and Methods : 144 patients with voiding disorders in childhood were included in the study. The patients were divided into two groups as those with OAB (Group 1) and those without OAB (Group 2). Demographic data and eating habits of all patients were determined with a questionnaire. Results : In the group 1, 44 women (59.5%) and 30 men (39.5%), in the second group, 31 women (44.3%) and 39 men (55.7%) were included.. The mean body mass index of the group 1 (26.0±5.2) was higher than the group 2 (24.4±3.4) (p=0.034). There was no difference between eating habits between daily water, tea and coffee consumption. Hot chilli consumption was significantly higher in Group 1 than Group 2 (p=0.003). There was no significant difference in cigarette consumption between the groups (p=0.796). Alcohol consumption was higher in Group 1 but there was no statistically significant difference (p=0.591). Conclusion : We found that obesity and hot chilli consumption may be risk factors for OAB in adulthood in patients with voiding disorders in childhood.

Comparison of holmium laser enucleation prostatectomy and open transvesical prostatectomy in large prostate more than 80 g in Egyptian men: a randomized controlled trial

Objective The aim was to assess the safety and efficacy of holmium laser enucleation prostatectomy (HoLEP) vs open prostatectomy (OP) for prostate of more than 80 g owing to benign prostatic hyperplasia in Egyptian men regarding micturition parameters and complications. Patients and methods A total of 110 patients were randomly divided into HoLEP (55 patients) and OP (55 patients). The inclusion criteria were American Urological Association-Symptom Score (AUA-SS) of eight or higher, maximum urinary flow rate (Qmax) of 10 ml/s or less, postvoiding residual urine (PVUR) of 50 ml or more, and a total prostate volume of 80 ml or more in transrectal ultrasound. The exclusion criteria included previous prostate or urethral surgery and non-benign prostatic hyperplasia related voiding disorders. Follow-up was done at first week, second week, first month, third month, sixth month, and 12th month postoperatively. Perioperative parameters were operative time, enucleation specimen weight, postoperative hemoglobin, length of hospital stay, and the duration of indwelling catheter. The assessment was done in the form of AUA-SS, Qmax, PVUR, and reported complications. Results Operative time was statistically significantly shorter in HoLEP compared with OP (102.45 vs 170.45 min, respectively). Drop-in hemoglobin concentration was statistically significantly higher in OP compared with HoLEP. Moreover, the duration of catheterization and hospital stay were statistically significantly shorter in HoLEP compared with OP. On the contrary, AUA-SS, PVUR, and Qmax did not reveal statistically significant differences between the two groups. Conclusion Both modalities have similar efficacy; however, HoLEP was superior to OP regarding hospital stay, the duration of catheterization, and the rate of hemoglobin concentration drop.

Dermoscopic features of acquired perforating dermatosis: a retrospective analysis of 19 cases

Acquired perforating dermatosis (APD) comprise a group of trans-epidermal elimination disorders. The clinical picture is characterized by the presence of multiple pruritic, keratotic, follicular/non-follicular papules, and nodules commonly over the extremities and trunk. 1 Dermoscopic features of APD are sparsely reported in the literature. 2, 3 We aimed to study the various dermoscopic features of APD. This retrospective descriptive study was conducted in a tertiary care Hospital of South India, after approval from the institutional ethical committee. Only the biopsy-proven cases of APD, from January 2014 to December 2016, were included in the study. The clinicodemographic data and clinical and dermoscopic images were retrieved for all the patients. The dermoscopic images were taken using a nonpolarized contact dermoscope and attached Nikon SLR camera.

Elimination disorders - ICD-11 classification and definitions

Elimination disorders - ICD-11 classification and definitions Abstract. Elimination disorders are common in children and are can be divided into three main groups: nocturnal enuresis, daytime urinary incontinence, and encopresis or fecal incontinence. There are also many subgroups that can be diagnosed exactly. This review critically presents the definitions and the classification suggestions of the ICD-11. It compares the definitions of enuresis according to ICD-11 with those of nocturnal enuresis and daytime urinary incontinence of the ICCS. It also contrasts encopresis according to ICD-11 with functional constipation and nonretentive fecal incontinence by the Rome-IV criteria. It becomes apparent that the ICD-11 does not reflect current research findings; that it does not render specific diagnoses, which are prerequisites for effective treatment; and that it is not exact enough for research. In conclusion, the ICCS and Rome-IV definitions are the preferred classification systems in clinical practice and research.

Factors Related to Nurse's Compliance in Implementation of Standard Operating Procedures for Urethral Catheter Insertion

ABSTRACT The act of catheterization in patients with urinary elimination disorders must be based on science and carried out in accordance with the installation sequence or fixed procedure. The purpose of this study was to determine the factors related to nurses' compliance in the implementation of standard operating procedures for urethral catheter placement in Ambon Living Resources Hospital. The analytical descriptive design with cross sectional study was used. The population is all nurses who provide nursing services in the Emergency Room and inpatient rooms of Ambon Life Sources Hospital, which number a population of 40 nurses. Sampling using total sampling technique. The sample in this study amounted to 40 people. There is a correlation between knowledge with nurses 'compliance in the implementation of fixed catheter installation procedures with values (p = 0.013), there is a relationship between attitudes and nurses' compliance in the implementation of fixed catheter installation procedures with a value (p = 0.000), there is a long working relationship with compliance nurses in the implementation of fixed catheter installation procedures with a value (p = 0,000). It is expected that nurses can apply and run in nursing practice regarding compliance with running a Standard Operating Procedure (SOP) for catheter insertion. Keywords: Knowledge, Attitude, Length of Work, SOP Catheter

Place des alphabloquants chez la femme : revue de la littérature

Marketing authorization of alphablockers is limited principally to men with benign hypertrophy of prostate. The objective of this review is to evaluate clinical and urodynamic improvement of alphablockers in women. A review of the literature was carried out on all prospective studies about the use of alphablockers in women with urination disorders. Seventeen articles have been included. The selected articles were classified according to the studied population: lower urinary tract disorders, bladder emptying disorders without details on mechanism, bladder outlet obstruction, detrusor hypoactivity overactive bladder. Four studies were randomized against placebo. There was an improvement in the IPSS in 8 studies going as far as a decrease of 11,7 points (4.6 vs. 16.3 P<0.05). The voiding IPSS subscore was improved overall in 8 studies with a decrease of up to 6,2 points (9.6±5.5 vs. 14.8±4 P<0.01). Two trials showed an improvement of clinical scores versus placebo with an improvement of IPSS from -11.7 vs -9.5 (P<0.05) and -5.6 vs -2.6 (P<0.05). Urodynamic parameters were also often improved with a decrase of Qmax going to+5.8mL/s (P<0.05). Alphablocker also appear to improve non obstructive voiding disorders. The benefit in overactive bladder seems limited. Alphablockers may be indicated in voiding disorders of women. Their exact role must be established.

Prevalence of Psychiatric Disorders in Children with Chronic Kidney Disease in Zagazig University Hospitals

Background: Psychiatric manifestations as depression, periods of adjustment, low self-Esteem, cognitive dysfunction, anxiety, and attention deficit disorders occur with chronic kidney disease (CKD). Objective: The aim of the work was to assess the association between psychiatric disorders and chronic kidney disease in Pediatric Nephrology Unit, Zagazig University Children's Hospital. Patients and Methods: This cross-sectional study included a total of 156 patients with Chronic Kidney Disease, attending at Pediatric Nephrology Unit, Zagazig University Children's Hospital. All patients were subjected to complete history taking and psychiatric assessment of children that was based on the Semi Structured Clinical Interview for Children and Adolescents AGES 6-18 PROTOCOL FORM (SCICA) and the diagnostic and statistical manual of mental disorders 5th edition (DSM-5). Results: Among CKD children the prevalence of anxiety was 37.2%, prevalence of eating disorder was 15.4%, prevalence of elimination disorder was 19.2% and prevalence of attention deficit was 43.6%. Prevalence of depression among CKD children was 30.8%. CKD patients on dialysis were more likely to be depressed than the pre-dialysis patients. Prevalence of psychiatric disorders among CKD children was 64.7 %. This study showed that, CKD patients on dialysis were more likely to had psychiatric disorders than the pre-dialysis patients. Conclusion: Psychiatric disorders were significantly higher in CKD patients. The most common psychiatric comorbidity in CKD patients was attention deficit (43.6%), followed by disruptive disorder (40.4%) and depression (30.8%). Patients with dialysis are significantly more prone to develop psychiatric disorders.

Micção inapropriada em um gato doméstico: tratamento bem sucedido com fluoxetina

Inappropriate urination in feline medicine embraces the behavior of domestic cats to urinate for no specific reason in undesirable places for their guardians. Cats with behavioral problems are two to six times more likely to be abandoned and many animals are euthanized. The aim of this paper is to report a case of inappropriate urination in a domestic cat, from which a satisfactory response was observed in pharmacological treatment with fluoxetine hydrochlorid. A male domestic breed, male, sterilized at six months of age, four years old, was taken for clinical care. The tutor's complaint focused on the elimination of urine in undesirable places, such as dog’s bed, sofa. Through history and anamnesis, it was found that the feline at the time of the consultation had a strictly domiciled habit of living and that such behavior of Inappropriate urination had started after moving to a new apartment. The owner used to live in a larger home where cats had peridomiciliated habits. Clinical examination, laboratory tests (blood count and serum biochemistry), blood glucose, feline leukemia virus (FeLV) antigen and feline immunodeficiency virus (FIV) antibody testing and feline abdominal ultrasound did not result in changes. Noteworthy. Thus, through the diagnosis of elimination related to primary environmental / social factors, environmental enrichment measures were adopted that did not result in a satisfactory response. Consequently, the pharmacological therapy was prescribed with fluoxetine hydrochloride at a dose of 0.5 mg / kg orally every 24 hours until further recommendations. The animal presented improvement during the first 10 days after the start of drug treatment and 12 months after it remained without signs of periuria. There was no side effect associated with the therapy adopted. The factors that trigger the inappropriate elimination disorder are not necessarily those that maintain them, therefore justifying the non-response only to the environmental management adopted. Such a report may contribute to a better understanding and adoption of treatment techniques for inadvertent urination disorder in cats, which may help to reduce the tutor's dissatisfaction with felines that exhibit such behavior and consequently reduce the number of animals abandoned and euthanized because of this disorder.

Interactive Effects of Perinatal BPA or DES and Adult Testosterone and Estradiol Exposure on Adult Urethral Obstruction and Bladder, Kidney, and Prostate Pathology in Male Mice.

Obstructive voiding disorder (OVD) occurs during aging in men and is often, but not always, associated with increased prostate size, due to benign prostatic hyperplasia (BPH), prostatitis, or prostate cancer. Estrogens are known to impact the development of both OVD and prostate diseases, either during early urogenital tract development in fetal–neonatal life or later in adulthood. To examine the potential interaction between developmental and adult estrogen exposure on the adult urogenital tract, male CD-1 mice were perinatally exposed to bisphenol A (BPA), diethylstilbestrol (DES) as a positive control, or vehicle negative control, and in adulthood were treated for 4 months with Silastic capsules containing testosterone and estradiol (T+E2) or empty capsules. Animals exposed to BPA or DES during perinatal development were more likely than negative controls to have urine flow/kidney problems and enlarged bladders, as well as enlarged prostates. OVD in adult T+E2-treated perinatal BPA and DES animals was associated with dorsal prostate hyperplasia and prostatitis. The results demonstrate a relationship between elevated exogenous estrogen levels during urogenital system development and elevated estradiol in adulthood and OVD in male mice. These findings support the two-hit hypothesis for the development of OVD and prostate diseases.

Efficacy of Vibroacoustic Stimulation Treatment of Enuresis in Children

Background and Aim: Functional voiding disorders (FVDs) are common problems in children. The effect of vibroacoustic therapy has not been examined in children with FVDs. The aim of this study was to investigate the efficacy of vibroacoustic therapy for treatment of FVDs in children.Methods: Seventy-eight children were included in this prospective study. Dysfunctional voiding score (DVS) and nocturnal enuresis (NE) score were measured before and after vibroacoustic treatment. The success of vibroacoustic therapy use was evaluated according to the percentage of decrease in DVS and NE scores relative to the pre-treatment values. Descriptive and analytic statistical methods were applied for data analysis using SPSS software version 22.0.Results: The mean age of the participants was 8.65±3.11 years, and half of them were boys. Of 78 patients, 60 were school-aged and 18 were preschool-aged children. A significant difference was noticed between DVS score (p < 0.01) and NE score (p < 0.01) before and after vibroacoustic therapy in school-aged children. No significant correlation was observed between the success of vibroacoustic therapy and factors such as enuresis type (primary/secondary), applied form of pharmacologic therapy, baseline DVS and NE score, and the presence of a positive family history and expressed through percentage of decrease in DVS and NE scores in school-aged children.Conclusion: The results of the present study showed the positive effect of the vibroacoustic therapy in school-aged children with functional voiding disorders. It is, however, necessary to conduct further prospective studies in order to confirm its effectiveness and determine its long-term results. Keywords: Child; Enuresis; Urinary bladder.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents.

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

A survey of Psychiatric Disorders and Their Comorbidities in Children and Adolescents.

Background: This community-based study aimed to investigate the psychiatric disorders and their comorbidities according to the kind of psychiatric disorders. Frequency of demographic factors and the prevalence of total psychiatric disorders in term of demographic charactheristics were obtained too. Materials and Methods: The present study focused on 1028 children and adolescent aged 6 to 18 years old across the Razavi Khorasan province by random sampling. The subjects included 496 boys and 532 girls from three age groups (6-9 years, 10-14 years and 15-18 years). Eight clinical psychologists trained to complete the Persian version of K-SADS-PL (Kiddie-SADS present and life time version). This scale measures five diagnostic appendixes of psychiatric disorders. Demographic data of participants were collected too. The data were recorded into the SPSS version 16. The relationship between psychiatric disorders and demographic factors deliberate by descriptive analysis and 95% confidence interval. Results: The total rate of psychiatric disorders among children and adolescent was estimated as 20.5%, elimination disorders with a rate of 12.9% was the most prevalent disorder in the subjects. The lowest prevalence belongs to psychotic disorder and bulimia nervosa (0.1%). Of participants with mood disorders about 71.4% have behavioral disorders too. Anxiety disorders also commonly occurred in person with mood disorders. The comparison of ORs and their 95% confidence interval revealed that there is a significant difference for total psychiatric disorder among boys and girls (OR=0.6 for girls; 95% CI: 0.44-0.82). The rate of total psychiatric disorders in rural and urban areas was 14.9% and 21.1% respectively. Conclusion: With attention to the high prevalence of psychiatric disorders among children and adolescents, it’s necessary that healthcare officials pay more attention to reinforcement of mental health care.

Voiding Disorders in Pediatrician's Practice.

Voiding disorders result usually from functional disturbance. However, relevant organic diseases must be excluded prior to diagnosis of functional disorders. Additional tests, such as urinalysis or abdominal ultrasound are required. Further diagnostics is necessary in the presence of alarm symptoms, such as secondary nocturnal enuresis, weak or intermittent urine flow, systemic symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in the lumbar region, altered sensations in the perineum. Functional micturition disorders were thoroughly described in 2006, and revised in 2015 by ICCS (International Children’s Continence Society) and are divided into storage symptoms (increased and decreased voiding frequency, incontinence, urgency, nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency, dysuria), and symptoms that cannot be assigned to any of the above groups (voiding postponement, holding maneuvers, feeling of incomplete emptying, urinary retention, post micturition dribble, spraying of the urinary stream). Functional voiding disorders are frequently associated with constipation. Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract symptoms are accompanied by problems with defecation. Monosymptomatic enuresis is the most common voiding disorder encountered by pediatricians. It is diagnosed in children older than 5 years without any other lower urinary tract symptoms. Other types of voiding disorders such as: non-monosymptomatic enuresis, overactive and underactive bladder, voiding postponement, bladder outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually require specialized diagnostics and therapy. Treatment of all types of functional voiding disorders is based on non-pharmacological recommendations (urotherapy), and such education should be implemented by primary care pediatricians.

Practical tips for paediatricians: Assessment and management of bladder and bowel dysfunction in the office

Bladder and bowel dysfunction (BBD) is a term used to describe a spectrum of lower urinary tract symptoms (LUTS) and associated bowel complaints (constipation and/or encopresis) (1). It is a common, but under-recognized problem encountered by general paediatricians. Most cases are due to functional voiding disorders and constipation, rather than secondary or organic causes (1). BBD symptoms can negatively impact a child’s quality of life; thus, timely diagnosis and management are essential. Begin by obtaining a detailed clinical history of voiding routines, LUTS (i.e., frequency, dysuria, and enuresis), and prior urinary tract infections (UTI). Recognize overactive bladder symptoms including incontinence, urinary urgency, and holding manoeuvres (i.e., crossing of legs) (1). Requesting and reviewing voiding and bowel diaries (48 to 72 hours duration), a Bristol Stool Scale, and fluid/dietary intake can help to objectively identify patterns of BBD symptoms (1). Be aware of red flags that may suggest an underlying organic cause (Table 1). As there is a known association between BBD and neuropsychiatric disorders (i.e., anxiety, hyperactivity) (2), it is important to inquire about behaviour difficulties. Social history of recent life stressors and screening for sexual abuse should be considered.

Systemic Lupus Erythematosus and DNA Degradation and Elimination Defects.

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that is characterized by the production of autoantibodies specific for components of the cell nucleus and that causes damage to body tissues and organs. The pathogenesis of SLE remains unclear, with numerous studies pointing to a combination of genetic and environmental factors. A critical stage in SLE development is cell necrosis, in which undegraded chromatin and nucleoproteins are released into the blood, resulting in circulating cell-free DNA and serum nucleoproteins that trigger anti-dsDNA autoantibody production. This systematic literature review aimed to examine whether SLE stems from a DNA degradation and elimination defect.Materials and Methods: An advanced literature search was conducted in PubMed using the following keywords: [(“SLE” OR “Systemic Lupus Erythematosus” OR “Lupus”)] AND [(“DNA” OR “DNA Degradation”)] AND [(“Defect Elimination”)]. More articles were obtained from the references of the identified articles and basic Google searches. Twenty-five peer-reviewed articles published within the past 10 years (2007–2018) were included for review.Results: The findings of each study are summarized in Tables 1, 2.Discussion and Conclusion: The etiopathogenesis of SLE remains controversial, which limits therapeutic inventions for this disease. However, SLE is a DNA degradation and elimination disorder caused by uncleared histones and nuclear material that leak into the extracellular space and form cell-free DNA, triggering an immune response that destroys tissues and organs. Under normal conditions, apoptosis allows DNA and other nuclear material to be efficiently cleared through degradation and additional complex mechanisms such that this material does not trigger the immune system to produce nuclear autoantibodies.

The Diagnosis and Treatment of Enuresis and Functional Daytime Urinary Incontinence.

Elimination disorders in childhood are common and treatable. Approximately 10% of 7-year-olds wet the bed at night, and 6% are affected by incontinence during the daytime. Two main types of disturbance are distinguished: nocturnal enuresis and functional (i.e., non-organic) daytime urinary incontinence. Each type contains a wide variety of subtypes. Effective treatment requires precise identification of the subtype of elimination disorder. This review is based on a selection of current publications, including principally the German S2k-AWMF guideline and the recommendations of the International Children's Continence Society (ICCS). Diagnostic assessment focuses on the clinical picture, is non-invasive, and can be carried out in most health care settings. If the child is suffering from multiple types of elimination disorder at once, then fecal incontinence or constipation is treated first, daytime urinary incontinence next, and enuresis last. 20-50% of children with elimination disorders have a comorbid mental disorder that also needs to be treated. With standard urotherapy, 56% of patients with daytime urinary incontinence become dry within a year. This conservative, symptom-oriented approach consists of educating the patient and his or her parents to promote behavior changes with respect to drinking and micturition. Elements of specific urotherapy are provided only if indicated. For enuresis, the treatment of first choice is alarm therapy, with which 50-70% of the affected children become dry. Pharmacotherapy, e.g., with desmopressin, can be a helpful adjunctive treatment. In intractable cases, training techniques have been found useful. Childhood elimination disorders can be treated effectively after targeted diagnostic evaluation and the establishment of specific indications for treatment. In view of the emotional distress these disorders cause, the associated physical and mental disturbances, and their potential persistence into adolescence, they should be evaluated and treated in affected children from the age of five years onward.