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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.
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【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.
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ObjectiveTo explore the neural mechanism of attention impairment in children with primary nocturnal enuresis.MethodsERPs elicited by performing the continuous operation test(CPT) were assessed in 20 children with primary nocturnal enuresis and 20 normal children.The Go/Nogo measurements of enuretic group at central scalp(Cz) were compared with the normal children and analyzed.Results1.Behavior results: there was no significant difference in the reaction time,the correct number and the false number between primary nocturnal enuresis and control group(P>0.05).2.ERP:(1)Go stimulate:the latency of Go-N2 and P3 of the children with primary nocturnal enuresis were longer than the normal control group(Go-N2:(326.80±46.40)ms vs (295.90±38.27)ms,P3:(438.80±62.60)ms vs (402.60±39.74)ms),and the difference had statistic significance(P0.05).②Latency: the latency of Nogo-P2 of the children with primary nocturnal enuresis was longer than that of the normal control group((214.10±27.85)ms vs (198.30±19.16)ms),and the difference had statistic significance(P0.05).ConclusionAttention impairment in children with primary nocturnal enuresis might be caused by the information processing speed and conflict monitoring function obstacle,but it is not because the reactive inhibition dysfunction,thus result in the lack of arousal function and bedwetting.
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OBJECTIVE:To observe the efficacy and safety of Xingpi yang'er granule in the treatment of primary nocturnal en-uresis in children. METHODS:97 children with primary nocturnal enuresis were randomly divided into control group (46 cases) and observation group(51 cases). Control group received Racemic anisodamine tablet 0.5 mg/(kg.d),orally,once a day+Vitamin B1 tablet 10 mg,orally,3 times a day+Oryzanol tablet 10 mg,orally,3 times a day + Meclofenac hydrochloride capsule 0.1 g 30 min before going to bed,orally,once a day. Observation group was additionally received Xingpi yang'er granule 0.4 g for 5-6 years old and 0.6 g for 7-14 years old,3 times a day. They were treated for 4 weeks. Clinical efficacy,kidney Yang deficiency score,wake-up threshold,bladder capacity,bladder volume,BVWI,enuresis frequency,AVP,cAMP,cGMP,cAMP/cGMP be-fore and after treatment,recurrence rate and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total ef-fective rate in observation group was significantly higher than control group(P0.05);after 6 months,the total effective rate recur-rence rate in observation group was significantly lower than control group(P0.05). CONCLUSIONS:Based on conventional treatment,Xingpi yang'er granule shows good efficacy and safety in the treatment of primary nocturnal enuresis in children,which can improve children's kidney Yang deficiency score,wake-up threshold and bladder capacity and serum AVP.
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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.
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Primary nocturnal enuresis is a common childhood disorder,increasingly seen as part of a heterogeneous phenomenon.Nocturnal polyuria,overactive bladder,high arousal thresholds and genetics are in various combinations,central to enuresis pathogenesis.Psychiatric problems also play important roles in the pathogenesis of primary nocturnal enuresis.There are still underlying pathophysiological mechanisms to be discussed and researched.
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PURPOSE : Treatment of primary nocturnal enuresis (PNE) includs folk remedies and various treatments based on pathogenesis. We assessed the therapeutic effect of nocturnal water restriction as the primary treatment of PNE. MATERIALS AND METHODS : From October 1998 to June 1999, 41 children with PNE (>3 wet nights per week) who visited Ewha Womans University Mokdong hospital and who had good compliances to nocturnal water restriction for 2 months were included. Before and during nocturnal water restriction, daily fluid intake and urine volume were recorded for 2 days every 2 weeks. Responses to nocturnal water restriction were classified according to the decrease of wet nights as complete (>90%), partial (50-90%) and no (<50%) response. Predictors such as age, sex, daytime voiding dysfunction, fluid intake, urine volume, maximum urine volume per void and fasting urine osmolality were evaluated. RESULTS : The response rate to nocturnal water restriction for 2 month was 82.9% (34/41) [complete response : 39.0% (16/41), partial response : 43.9% (18/41)]. The response rate to nocturnal water restriction was significantly higher in monosymptomatic PNE than polysymptomatic PNE and more effective in PNE with er nocturnal fluid intake, nocturnal urine volume, and maximum urine volume than lower nocturnal fluid intake, nocturnal urine volume and maximum urine volume per void (p<0.05). Nocturnal urine volume, maximum urine volume per void and fasting urine osmolality after nocturnal water restriction has significantly increased higher in complete response and partial response group than in no response group (p<0.05). CONCLUSION : The nocturnal water restriction was effective in monosymptomatic PNE with nocturnal polydypsia, nocturnal polyuria and high bladder capacity.
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Child , Female , Humans , Fasting , Medicine, Traditional , Nocturnal Enuresis , Osmolar Concentration , Polyuria , Urinary Bladder , WaterABSTRACT
Objective To observe the curative effect and recurrence rate of desmopressin acetate(DDAVP) combined with bladder training therapy on primary nocturnal enuresis(PNE) in chlidren.Methods One hundred children with PNE were randomly divided into control group and observation group(50 cases in each group).Children in control group were treated with simple DDAVP,and patients in observation group were treated with bladder training while DDAVP was using.The course of treatment were 3 months.The therapeutic effect between the 2 groups when the treatment was finished was compared and then followed up all the cases for 3 months to compare the near-term and long-term recurrence rate between the 2 groups.SPSS 13.0 software was used to analyze the data.Results The total effective rate in control group was 72.9%,and the near-term recurrence rate and the long-term recurrence rate were 22.9% and 54.3%,respectively.The total effective rate in observation group was 91.3%,and the near-term recurrence rate and the long-term recurrence rate were 11.9% and 28.6%,respectively.The total effective rate was significantly higher in observation group than that in control group(Z=-1.972,P=0.049).The near-term recurrence rate in 2 groups had no significant difference(?2=1.632,P=0.201).The long-term recurrence rate was extremely lower in observation group than that in control group(?2=5.249,P=0.022).Conclusions There is significant curative effect that DDAVP combined with bladder training therapy on PNE in children,and it can lower the long-term recurrence rate.
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Since MacLean's observation of the possibility of imipramine hydrochloride usefulness in 1960, it has been widely used in the therapy of childhood enuresis. The authors observed 25 cases receiving imipramine therapy and urethral dilatation for primary nocturnal enuresis. Of the 25 patients, 18 boys and 7 girls 4 to 18 years old, in this study, 8 received urethral dilatation because of lower urinary tract stricture. 2 of 8 were no more bed-wetting during sleep. But the other 6were persistent enuretic. 23 cases, 17 without urinary tract disorder and the above 6, were taken imipramine hydrochloride 50mg or 75rag according to the body weight of patients for 28 days one hour before bedtime. During the therapy with imipramine, the effect was excellent in 11 cases, fair in 10 and no effect in 2. After the cessation of the drug, follow-up observation was done at least 1 month. The response was as followed; Complete response in 4 cases, good response in 10, transient response in 7 and no response in 2. Over-all results of complete and good response to the enuretic children through both the administration of imipramine and instrumental dilatation of urethral stricture were 16 case(64%), transient response in 7 cases(28%) and no effect in 2 cases(8%).