Urodynamic evaluation of functional urinary incontinence in children / 现代泌尿外科杂志

Pediatric urinary incontinence (PUI) is common in clinical practice and seriously affects the quality of life as well as physical and mental health of patients. PUI is a multi-factorial related abnormality, very complex in etiology and types. The occurrence of PUI is mostly associated with abnormal vesicourethral function. Urodynamic examination (UDS) is the golden standard to assess voiding function and diagnose the type of bladder and urethral function in children with PUI. UDS of PUI is of great clinical value in determining the cause, making treatment protocol as well as evaluating the therapeutic response. However, UDS in children has not been popularized in China, which seriously affects the diagnosis and treatment of PUI. This article reviews the research progress in the clinical application of UDS in the evaluation of PUI, in order to provide reference for improving the diagnosis and treatment of this disease.

Analysis of current situation and risk factors of primary nocturnal enuresis in adolescents / 现代泌尿外科杂志

【Objective】 To investigate the prevalence and risk factors of primary nocturnal enuresis (PNE) in adolescents, and to explore its psychological effects. 【Methods】 During Sep.2020 and Dec.2020, an epidemiological survey was conducted among 6 408 junior and senior high school students in a region of Henan Province by stratified and cluster random sampling. The survey included general information questionnaire, urinary frequency, urgency, incontinence, recurrent urinary tract infection (RUTI), Enuresis Questionnaire, Self-esteem Scale (SES) and the Pittsburgh Sleep Quality Index (PSQI). 【Results】 A total of 7, 000 questionnaires were distributed and 6 408 (91.54%) were valid. The survey showed that the total prevalence of PNE among adolescents was 2.98%. The prevalence was 4.67% in those aged 12 years and 1.37% in those aged 18 years. The results of Logistic regression analysis showed that male (OR=1.677, P<0.05), overweight (OR=1.842, P<0.05), urgency (OR=1.676, P<0.05), frequency (OR=1.919, P<0.05), incontinence (OR=3.493, P<0.001), RUTI (OR=2.535, P<0.001) and family history (OR=3.005, P<0.001) were related to the risk of PNE. The SES score of PNE patients was lower than that of non-PNE group (z=-3.097, P<0.05), and the PSQI was higher (z=-5.456, P<0.05). 【Conclusion】 The prevalence of PNE is high in adolescents and decreases gradually with age. Male, overweight, frequency, urgency, incontinence, RUTI and family history are risk factors. PNE has a negative impact on self-esteem and sleep quality in adolescents.

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

ABSTRACT Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p<0.01). Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Validación de un algoritmo hipnoterapéutico para niños con enuresis nocturna monosintomática / Validation of a hypnotherapeutic algorithm for children with monosymptomatic nocturnal enuresis i: en

Introducción: La enuresis nocturna monosintomática es la micción involuntaria intermitente durante la noche. Esta se presenta en 15 % de los niños de 5 años, en 5 % de los de 10 años y 12 % de los adultos jóvenes sin defectos congénitos o adquiridos. Objetivo: Validar un algoritmo hipnoterapéutico diseñado para pacientes con enuresis nocturna. Métodos: Se realizó un estudio complejo en la Clínica de Hipnosis Terapéutica de la Universidad de Ciencias Médicas en Santiago de Cuba, de febrero del 2021 a julio del 2022, el cual estuvo estructurado en dos etapas metodológicas; en la primera se diseñó el algoritmo terapéutico y en la segunda se validó el contenido de este. A tal efecto, se aplicaron un cuestionario del tipo Likert, el índice de validez de contenido, el coeficiente de concordancia de Kendall, así como el coeficiente alfa de Cronbach y el análisis de conglomerados. Resultados: La validación del contenido realizada por los expertos mostró una excelente consistencia interna, con un coeficiente alfa de Cronbach de 0,9221, que se interpreta como una altísima fiabilidad del instrumento. Asimismo, el índice de validez del contenido de los ítems fue superior a 0,89, lo que también denotó una validez elevada. Conclusiones: La validación del algoritmo hipnoterapéutico diseñado y sometido al criterio de expertos demostró ser adecuado, con elevada coherencia y concordancia evaluativas.

Introduction: Monosymptomatic nocturnal enuresis is the involuntary urine loss during sleep which affects 15 % of 5-years-old children, 5 % of 10-years-olds and 12 % of young teens without congenital or acquired defects. Objective: To validate a hypnotherapeutic algorithm designed for patients with nocturnal enuresis. Methods: A complex study was carried out at the Therapeutic Hypnosis Clinic of the University of Medical Sciences in Santiago de Cuba, from February 2021 to July 2022. It was structured in two methodological stages; in the first one the therapeutic algorithm was designed and in the second one the content of this algorithm was validated. For this purpose, a Likert scale questions, the content validity index, Kendall's coefficient of concordance, as well as Cronbach's alpha and cluster analysis were applied. Results: The content validation executed by the experts showed excellent internal consistency, with a Cronbach's alpha of 0.9221, which meant a very high reliability of the instrument. Likewise, the content validity index of the items was higher than 0.89 that also indicated high validity. Conclusions: The validation of the hypnotherapeutic algorithm designed and subjected to experts' criteria proved to be adequate, with high evaluative coherence and concordance.

Association between winter season and desmopressin treatment efficiency in children with monosymptomatic nocturnal enuresis: a pilot study

ABSTRACT Objectives: The purpose of our study was to assess the association between the winter season and desmopressin treatment failure in South Chinese children with monosymptomatic nocturnal enuresis (MNE). Materials and Methods: A retrospective study was conducted to analyze the clinical data of children with monosymptomatic nocturnal enuresis who have visited our urology clinic from January to December 2019. All patients received desmopressin treatment. Final treatment outcomes were categorized as successful (complete response) or failed (absent and partial response). The relationship between winter season and treatment response to desmopressin was evaluated. Additionally, associated risk factors were investigated with both univariate and multivariate regression analysis. Results: In total, 393 patients diagnosed with MNE were included in the present study. There were no statistically significant differences in pretreatment variables at first visit between patients who visited the clinic in winter and those who did so in other seasons. However, the treatment failure rate of MNE in the winter season was higher than that of other seasons (77.50% vs. 52.74%). Multivariate logistic regression analysis demonstrated that the severity of symptoms and an initial clinic visit in the winter season were significantly related to desmopressin treatment failure in MNE patients. Conclusion: Winter season and severity of symptoms are two risk factors associated with desmopressin treatment failure in MNE patients.

Quality of life in enuretic children

ABSTRACT Introduction: Nocturnal enuresis is a highly incident chronic disorder that generates countless problems to the child and their parents. Bed-wetting has significant negative impacts on self-esteem and the performance of children. The aim of the current study is to assess the quality of life of enuretic children, as well as its association to sex and age. Patients and Methods: Thirty-nine enuretic children (23 boys) and 49 healthy children (27 boys) without any history of previous treatment for enuresis or voiding dysfunction were included. Age ranged between 6 and 11 years old. The "AUQEI" questionnaire was applied in a private environment to all children by the same researcher (psychologist) to evaluate quality of life. Results: Enuretic children displayed loss in quality of life when compared to non-enuretic (35.9% of enuretic x 16.3% of non-enuretic, p=0.035). They were mostly affected in their daily activities (p=0.02). No significant differences were found in the association of sex and gender with quality of life. These results suggest that, children with nocturnal enuresis have 2.87 times more chances of having loss in quality of life compared to non-enuretic. Conclusions: Enuresis has a great impact in quality of life of children. This impact is not related to the age or sex of the child.

A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with Solifenacin Plus Desmopressin, Tolterodine Plus Desmopressin, and Desmopressin alone: a randomized controlled clinical trial

ABSTRACT Introduction: Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. Objectives: In this study, we compared therapeutic efficacy and tolerability of treating primary nocturnal enuresis (PNE) with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone. Because we don't have enough information about this comparison especially about solifenacin plus desmopressin. Patients and Methods: This clinical trial study was performed on 62 patients with enuresis aged 5-15 years who referred to the urology clinic of Imam Khomeini Hospital in Ahwaz in 2017-2018. Patients were randomly assigned to one of the three different therapeutic protocols and any participants were given a specific code. After that, we compared the therapeutic response and the level of satisfaction of each therapeutic group in different months. Data were analyzed using SPSS 22 software and descriptive and analytical statistics. Results: The mean age of patients was 8.70±66 years. In the therapeutic group with desmopressin and solifenacin, 19 of 20 patients (95%) achieved complete remission (1) after a 3-month treatment in comparison with monotherapy group in which 14 of 22 patients (63.63%) achieved complete remission; and in the combination therapy group of desmopressin and tolterodine, in the study and the evaluation of the consequences of 3-month treatment of this group, it was found that 17 of 20 patients (85%) had complete remission. Overall, the therapeutic response in combination therapy groups of desmopressin plus anticholinergic was higher than the monotherapy group of desmopressin alone. Conclusion: Our results demonstrate that the combination of desmopressin and an anticholinergic agent is highly effective in treatment of children with PMNE. Although desmopressin has long been a first - line treatment for PMNE, desmopressin monotherapy often fails to achieve a successful response in patients with PMNE.

The clinical features of nocturnal enuresis in adult men and women / 中华泌尿外科杂志

Objective:To discover the clinical features of nocturnal enuresis (NE) in adults and to detect factors that correlated with the symptom severity.Methods:This cross-sectional study recruited NE subjects from September 2017 through December 2020. All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer. Followed by documentation of history and medical records, three-day bladder diary was adopted to assess their voiding pattern, and urodynamic parameters were obtained to evaluate lower urinary tract function.Results:A total of 106 NE patients (43 male and 63 female) were identified. There is no statistical difference regarding the average age (men: 57.8±15.6 vs. women: 56.1±14.0, P>0.05) and BMI (men: 23.9±3.4 vs. women: 23.3±4.3, P>0.05) between men and women. Comorbidities are extremely common in NE patients (n=85, 80.2%), with the incidence rate higher in men compared to women [88.4% (38/43)vs. 74.6% (47/63), P<0.05]. Hypertension (n=58, 54.7%), hyperlipemia (n=41, 38.7%), diabetes mellitus (n=38, 35.8%), coronary heart disease (n=22, 20.8%) were the most frequently reported conditions. On bladder diaries, subjects were frequently manifested nocturnal polyuria (NP, 47/106, 44.3%), reduced nocturnal bladder capacity (NBC, 74/106, 69.8%), or combination of both(33/106, 31.3%). Urodynamic studies suggested that the incidence of reduce bladder compliance, detrusor overactivity (DO), stress incontinence, bladder outlet obstruction(BOO), detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106), 39.6%(42/106), 17.9%(19/106), 9.4%(10/106), 25.5%(27/106)and 15.1%(16/106), respectively. Women were more likely to suffer from stress urinary incontinence [2.3%(1/43) men vs. 28.6% (18/63) women, P<0.01], while men were prone to have bladder outlet obstruction [ 23.3%(10/43) men vs. 0 women, P<0.01]. Correlation analysis demonstrated that obesity( r=0.63, P<0.01), systemic comorbidities( r=0.40, P<0.01), presence of NP( r=0.50, P<0.01) and NP+ NBC( r=0.47, P<0.01), post-void residual( r=0.53, P<0.01), reduced compliance( r=0.21, P=0.04), DU( r=0.28, P<0.01), stress incontinence( r=0.42, P<0.01)and DHIC ( r=0.35, P<0.01)are positively correlated with NE severity. Whereas, reduced Q max( r=-0.35, P<0.01), low capacity( r=0.21, P=0.03), and reduced bladder sensation( r=-0.21, P=0.03) correlate negatively with NE severity. Conclusions:The presence of NE is not only a sign of bladder dysfunction, but also an implication of obesity, systematic chronic diseases, urine production malfunctioning. Therefore, a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully, so that, an integrated and personalized treatment can be carried out.

Prevalence and factors affecting nocturnal enuresis among primary school children in Baddi, Himachal Pradesh, India

Background: Enuresis is defined as involuntary urination beyond the age of 5 years. The present study was done to determine the prevalence of nocturnal enuresis and its associated risk factors in children in Baddi, Himachal Pradesh.Methods: This was a prospective observational cross-sectional study done in children in the age group of 5-11 years over a period of 18 months. Nocturnal enuresis was defined using the DSM IV criteria. Data analysis was done using chi square test.Results: The total sample size was 2144 and the prevalence of nocturnal enuresis was found to be 22.0% (n=472). There was statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (p=0.0018), history of deep sleep (p<0.05), history of perianal itching (p<0.05), history of urinary tract infection (p<0.05), poor academic performance (p<0.05).Conclusions: Nocturnal enuresis is a result of complex interplay of multiple physiological and psychological factors. Parents need to be sensitised and educated regarding these causation factors for better prevention and treatment of nocturnal enuresis.

Clinical profile and risk factors of enuresis in children

Background: Enuresis is a common problem in children and its incidence is multifactorial in nature. The aim of this study is to assess the etiological risk-factors in enuresis in the study population and also to compare the risk factors in enuresis subgroups.Methods: A total of 51 patients with enuresis presenting to the department of paediatrics, Institute of Social Paediatrics, Govt. Stanley Hospital, Chennai were included in the study. All children were sub classified as primary/secondary and the primary enuretics were sub classified into monosymptomatic/non monosymptomatic depending on the symptoms. The data was analyzed and the results presented.Results: Enuresis was common in boys. Statistically significant difference in the incidence of disorder between primary and secondary enuretic children was seen in relation to presence of storage symptoms (p=0.04), cystitis (p=0.013) sleep disordered breathing (p=0.0001) and low-income status (p=0.04). No statistically significant difference between into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE) children was observed in terms of gender, difficulty in arousal, specific gravity, spina bifida, low bladder capacity and family history (p>0.05).Conclusions: The findings of the study reported that risk factors related to the incidence is similar in both primary and secondary enuresis. MNE and NMNE have no differences in the presentation and probably represent the spectrum of a same disorder.

Association between enuresis and obesity in children with primary monosymptomatic nocturnal enuresis

ABSTRACT Objective The purpose of this study was to determine whether the presence of obesity was related with symptoms of nocturnal enuresis (NE) and the efficacy of behavioral intervention in the treatment of NE. Materials and Method The patients diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) were studied retrospectively. NE severity was classified as mild, moderate, and severe according to the frequency of enuresis. The children were divided into three groups, namely normal weight (5th-84th percentile), overweight (85th-94th percentile), and obesity (≥95th percentile), according to their Body Mass Index (BMI) percentage. The relationship between obesity level and enuresis severity was analyzed. After three months of behavioral therapy, the efficacy of treatment among normal, overweight, and obese groups were evaluated. Moreover, the predictive risk factors for treatment failure were investigated. Results The rates of severe enuresis in patients with normal weight, overweight, and obesity were 63.9%, 77.5%, and 78.6%, respectively. Obese children depicted higher odds of having severe enuresis compared with normal-weight children (OR: 1.571; 95% confidence interval [CI]: 1.196-2.065; P=0.001). The odds of presenting with severe enuresis were 1.99 times higher in children who are obese or overweight compared to children with normal weight (OR: 1.994; 95% CI: 1.349-2.946; P=0.001). The complete response of the normal group was higher than those of the overweight and obese groups (26.8% vs. 14.0%, P=0.010; 26.8% vs. 0.0%, P=0.000). Overweight children showed higher complete response than obese ones (14.0% vs. 0.0%, P=0.009). Logistic regression analysis revealed that obesity level and enuresis frequency were significantly related to the treatment failure of behavioral intervention. Conclusions Obesity is associated with severe enuresis and low efficacy of behavioral therapy in children with nocturnal enuresis.

Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis / Estudo do perfil dos problemas de comportamento e dos índices de qualidade de vida numa coorte pediátrica de enurese monossintomática

Abstract Objective: To evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. Method: After the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6-16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. Results: Of the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. Conclusions: Only the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.

Resumo Objetivo: Avaliar e relacionar, pré e pós-intervenção terapêutica, em pacientes com enurese noturna monossintomática, os escores de problemas de comportamento, avaliados pelo questionário CBCL/6-18, e os índices de qualidade de vida, avaliados pelo PedsQL™ 4.0. Método: Após avaliação inicial e preenchimento CBCL6/18, procedeu-se avaliação multidisciplinar e preenchimento do PedsQL™ 4.0. Das 140 crianças e adolescentes de 6 a 16 anos inicialmente avaliados, 58 foram excluídos por enurese não monossintomática ou comorbidades associadas. Dos 82 pacientes inicialmente incluídos e randomizados em três grupos de tratamento, 59 preencheram o CBCL/6-18 e PedsQL™ 4.0 no fim do tratamento e puderam ser incluídos neste trabalho. O erro alfa foi estabelecido em 5% para descarte da hipótese de nulidade. Resultados: Dos 59 participantes 45,8% responderam com sucesso total, 23,7% tiveram sucesso parcial, 23,7% não atingiram critério de melhoria e 6,8% desistiram do tratamento. Verificou-se aumento significativo dos índices de qualidade de vida e redução dos escores de problemas de comportamento pós-intervenção, nas três modalidades propostas, nos pacientes que obtiveram resposta total ou parcial ao tratamento. Não se demonstrou correlação entre maiores escores de problemas de comportamento pré-tratamento e insucesso terapêutico. Conclusões: Apenas os participantes que responderam com sucesso às intervenções melhoraram em sua qualidade de vida e problemas comportamentais, o que indica que a enurese é um problema primário que impacta negativamente esses parâmetros. Sugere-se que é viável obter sucesso no tratamento da enurese monossintomática, mesmo em pacientes com altos escores de problemas de comportamento pré-intervenção.

Prevalence and determinants of nocturnal enuresis in school going children in Southern Maharashtra, India

Background: Nocturnal enuresis or bedwetting is a common health problem in children in the age group of 5 to 15 years. In India the prevalence of nocturnal enuresis ranges from approximately 7% to 12.6%. The prevalence from other parts of the world ranges from 6% to 42%. This study was planned to find the prevalence and determinants of nocturnal enuresis in school going children.Methods: This cross-sectional study was conducted in four primary and secondary schools in Solapur. A predefined questionnaire, prepared in English and translated to local languages, Marathi and Kannada, was handed over to all the children attending the selected schools. Children were asked to hand over the questionnaire to their parents and return with the filled questionnaire. The questionnaire was prepared to obtain the information related to the socio-demographic factors of the family and child, frequency of enuresis and information related the risk factors. Nocturnal enuresis was defined if the frequency of enuresis was more than twice per week.Results: The overall prevalence of nocturnal enuresis was 11.4 %. The maximum prevalence was found in the age group of 8 -9 years (22.96 %). The prevalence of nocturnal enuresis in boys (14.34 %) was significantly more than the prevalence in girls (8.31 %). The study showed that nocturnal enuresis was significantly associated with stress, poor school performance, sleep pattern (hard to awaken), family history, burning micturition etc. But it was not associated with maternal or paternal education, birth order, type of family.Conclusions: The prevalence of nocturnal enuresis is 11.40 % in school going children and it is associated with age, sex, stress, family history, burning micturition, hyperactive child, poor school performance, sleep pattern (hard to awake) avoidance of going to micturate before sleep etc.

Congenital B-cell Acute Lymphoblastic Leukemia with Congenital Rubella Infection

Background: Congenital B-cell Acute lymphoblastic leukemia (ALL) is a rare malignancy.Case Characteristics: A newborn infant presented with purpuric spots and ecchymoticpatches, blueberry muffin rash, depressed neonatal reflexes, respiratory distress andhepatosplenomegaly. Peripheral smear revealed atypical blast cells. Serum ELISA waspositive for Rubella IgM and IgG antibodies. Flow cytometry suggested congenital B-cellALL. Outcome: The baby died after 3 days due to suspected intracranial hemorrhage.Message: Congenital leukemia may be rarely associated with congenital rubella infection.

Enuresis alarm therapy for preschool children with primary monosymptomatic nocturnal enuresis: A report of 95 cases / 中国实用儿科杂志

OBJECTIVE: To explore the effectiveness of enuresis alarm therapy on preschool children with primary monosymptomaticnocturnal enuresis(PMNE). METHODS: Totally 95 PMNE preschool children aged 3.5 to 6 years admitted between January 2017 and July 2018 to Department of Nephrology,Affiliated Children's Hospital of Capital Institute of Pediatrics,were randomly divided into two groups:alarm group(53 cases)and control group(42 cases). The alarm group was managed by enuresis alarm therapy,while the control group received basic treatment. Treatment ceased after 12 weeks of training or when the cases achieved 14 consecutive dry nights(meaning successful treatment). The relapse cases were recorded 1 month after stopping treatment. The alarmtherapy was performed again in the relapse cases for another course. RESULTS: Seven cases(13.2%)discontinued intervention in the alarm group. The response of the alarm therapy in the remaining 46 patients was as follows:full response(FR)in 29 cases(63.0%),partial response(PR)in 7 cases(15.2%),no response(NR)in 10 cases(21.7%). A total of 25 patients achieved 14 consecutive dry nights in FR cases. Successful treatment requires a minimum course of treatment for 42 days. Relapse occurred in 11 cases within the first 1 month after stopping treatment,and 8 relapse patients responded to another course of alarm therapy. Three cases(7.1%)lost to follow-up in the control group. The response of the control group in the remaining 39 patients was as follows:FR in 0 case,PR in 17 cases(43.6%)and NR in 22 cases(56.4%). No cases achieved successful treatment in the control group. The full response rate was significantly different between two groups(Fisher's exact test χ~2=55.10,P=0.00). Half(5 cases)of NR patients were less than 4 years old,while in the FR+PR patients,the percentage of children under 4 years old was only 8.3%(3 cases)in alarm therapy group(Pearson chi-square test,χ~2=9.457,P=0.007). No severe adverse events occurred in all cases. CONCLUSION: Enuresis alarm therapy is a safe and effective way to treat PMNE preschool children. The enuresis alarm provided gradual effects and require more than 1 month in achieving successful effect. The appropriate age for alarm treatment is over four years old.

Effect of bladder overdistention on uroflowmetry and post-void residual urine in children with enuresis / 中华实用儿科临床杂志

Objective@#To explore the effect of bladder overdistention on uroflowmetry and post-void residual urine(PVR)in children with primary nocturnal enuresis (PNE).@*Methods@#A total of 136 children with PNE from March 2015 to June 2018 at Department of Pediatric Urodynamic Center, the First Affiliated Hospital of Zhengzhou University were enrolled, aged 5-14 years, with mean age of (7.96±2.48) years old.Uroflowmetry and PVR measurement were performed in the condition of over and no urinary distention, respectively.According to the initial urinary voided volume (VV), the children were divided into 3 groups, 25 mL≤ VV<50 mL(group 1), 50 mL≤VV<100 mL(group 2), and VV≥100 mL(group 3). The VV, maximum flow rate (Qmax), average flow rate (Qave), urine flow time, and PVR were compared interms of condition between the groups.Different types of flow curve were analyzed simultaneously.@*Results@#In the condition of bladder over distention, the VV, Qmax, Qave, urinary flow time and PVR of children were higher than those with no overdistention[group 1: (168.25±103.23) mL vs.(34.04±7.03) mL, (17.76±11.13)mL/s vs.(8.23±2.72) mL/s, (9.56±4.13) mL/s vs.(4.30±1.55) mL/s, (20.24±15.13) s vs.(8.64±4.27) s, (3.90±3.55) mL vs.(1.50±2.55) mL; group 2: (168.65±80.66) mL vs.(68.04±15.13) mL, (16.41±5.18) mL/s vs.(14.61±5.29) mL/s, (9.86±3.56) mL/s vs.(8.14±2.29) mL/s, (18.75±10.73) s vs.(9.41±3.47) s, (5.98±8.59) mL vs.(2.77±6.41) mL; group 3: (280.24±102.00) mL vs.(181.50±66.22) mL, (22.73±8.21) mL/s vs.(20.42±6.25) mL/s, (12.57±3.68) mL/s vs.(11.00±3.22) mL/s, (23.46±10.65) s vs.(17.01±6.90) s, (3.78±6.26) mL vs.(2.09±3.21) mL], and the differences were all significant(all P<0.05). Excluding physiological pseudomorphism, urinary flow curves of 114 children with initial urinary intention and excessive voiding were obtained.The incidence of Staccato urinary flow curve was significantly higher than that with no distention [6.14%(7/114 cases) vs.21.93%(25/114 cases), χ2=14.45, P<0.05].@*Conclusions@#Bladder overdistention induced significant influence on the uroflowmetry and PVR.

A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children / 临床儿科杂志

Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95％ CI :1.5～5.4; success rate: OR=3.5, 95％ CI :1.7～7.5) and alarm (complete response rate: OR=2.7, 95％ CI :1.1～6.6; success rate: OR=3.8, 95％ CI: 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI: 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI: 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.

Pelvic floor muscle training alone or in combination with oxybutynin in treatment of nonmonosymptomatic enuresis. A randomized controlled trial with 2-year follow up / Exercícios dos músculos do assoalho pélvico exclusivos ou em combinação com oxibutinina no tratamento da enurese não monossintomática. Um estudo randomizado controlado com 2 anos de seguimento

Abstract Objective To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis. Methods A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire. Results The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them. Conclusion All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups.

Resumo Objetivo Comparar os resultados da uroterapia padrão isolada e associada ao treinamento dos músculos do assoalho pélvico isoladamente e em combinação com a oxibutinina no tratamento da enurese noturna não monossintomática. Métodos Trinta e oito crianças entre 5 e 10 anos de idade foram randomizadas em três grupos: Grupo I (n=12) realizou uroterapia padrão; Grupo II (n=15) realizou uroterapia padrão associada ao treinamento muscular do assoalho pélvico; e Grupo III (n=11) realizou uroterapia padrão associada ao treinamento muscular do assoalho pélvico e oxibutinina. O tratamento teve duração de 12 semanas. Os instrumentos de avaliação foram diário miccional lúdico e diário miccional de 48 horas, antes e depois do tratamento. Após 2 anos, os pacientes foram avaliados por telefone, usando um questionário padronizado. Resultados Os dados das crianças dos três grupos eram homogêneos no início do estudo. Após 12 semanas de tratamento, todas as crianças apresentaram melhora em relação aos sinais e sintomas de enurese noturna não monossintomática, mas as diferenças não foram significativas entre os grupos. Depois de 2 anos, os resultados do tratamento se mantiveram nos três grupos, mas não houve diferenças entre os grupos. Conclusão As três modalidades de tratamento foram eficazes na melhora da enurese e dos sintomas do trato urinário inferior, mas o tamanho da amostra não foi grande o suficiente para mostrar diferenças entre os grupos.

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

PURPOSE: To 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). METHODS: Ninety 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. RESULTS: After 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. CONCLUSIONS: Both 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.

The experiences and feelings of major caregivers of children with nocturnal enuresis:a qualitative research / 中国实用护理杂志

Objective To understand the experiences and feelings of major caregivers of children with nocturnal enuresis. Methods A semi-structured interview was conducted with major caregivers of children with nocturnal enuresis. Data were analyzed based on Colaizzi phenomenological research method. Results The major caregivers′experiences and feelings were classified into 4 themes, including overload care tasks, worry about the children with nocturnal enuresis,uncertain feeling of the prognosis, lack of family and medical support system. Conclusions Understanding the experiences and feelings of major caregivers of children with nocturnal enuresis can help medical workers realize their attending demands, provide professional services and promote the recovery of children.