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.

Enuresis infantil, formar y educar / Children enuresis: training and educating

Introducción: La enuresis se define como la eliminación nocturna, involuntaria y funcionalmente normal de orina que ocurre a una edad en la que cabe esperarse en el niño un control voluntario de la micción. Es un motivo frecuente de consulta en pediatría, posiblemente, infradiagnosticado y, por lo tanto, infratratado que puede llegar a ser un problema de salud importante en niños y adolescentes. Objetivo: Examinar y analizar datos epidemiológicos sobre enuresis en una muestra de población infantil e importancia de su diagnóstico tempano. Métodos: estudio transversal, descriptivo a través de encuestas rellenadas en un período de 6 meses, por pacientes de edad pediátrica de 5-15 años de edad, en consultas externas del Hospital Lluís Alcanyís de Xàtiva (Valencia) Resultados: 321 pacientes incluidos, 50,5 por ciento mujeres. Rango de edad de los incluidos entre 5-15 años, con media de 11 años. 2,8 por ciento incontinencia diurna, 8,4 por ciento enuresis nocturna, de los que el 77,8 por ciento fueron enuresis monosintomática primaria, 77,8 por ciento de los participantes habían comunicado a su pediatra su situación de salud y 22,2 por ciento, no lo notificaron. Conclusiones: Es importante diagnosticar a tiempo la enuresis, educar a las familias en los conocimientos de este problema y ayudar a dar soluciones y un tratamiento adecuado e individualizado. Un alto porcentaje no despreciable, no informa a su pediatra, actitud que puede retrasar su tratamiento. El diagnóstico precoz y atención de este problema de salud, pueden ayudar a los niños a mejorar su calidad de vida(AU)

Introduction: Enuresis is defined as the nighttime, involuntary and functionally normal removal of urine that occurs at an age at which voluntary urination control can be expected in the child. It is a common cause of consultation in pediatrics, possibly rarely diagnosed and treated, which can become a major health problem in children and adolescents. Objective: Examine epidemiological data on enuresis in a sample of children population and the importance of its early diagnosis. Methods: Cross-sectional study, descriptive through surveys filled in over a period of 6 months, by pediatric patients aged 5-15 years, in external consultations of Lluís Alcanyís de Xativa Hospital (Valencia) Results: 321 patients included in the study, 50.5 percent female ones. The age range of those included was of 5 to 15 years, with an average of 11 years. There was 2.8 percent of daytime incontinence, 8.4 percent of nocturnal enuresis, of which 77.8 percent were primary monosymptomatic enuresis; 77.8 percent of participants had reported their health status to their pediatrician and 22.2 percent did not report it. Conclusions: It is important to diagnose enuresis early, educate families in their knowledge of this problem, and help providing adequate and individualized solutions and treatment. A high and not negligible percentage of families does not inform their pediatrician, and this attitude can delay the treatment. Early diagnosis and care of this health problem can help children improve their quality of life(AU)

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.

Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort / Transtornos psiquiátricos em crianças com enurese aos 6 e 11 anos numa coorte de nascimentos

Abstract Objective: Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age. Method: 3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis. Results: The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p = 0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis. Conclusion: There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.

Resumo Objetivo: A enurese pode ter grande impacto negativo na autoimagem na infância e adolescência. O objetivo deste estudo foi avaliar a associação entre enurese e transtornos psiquiátricos aos 6 e 11 anos de idade. Métodos: Foram avaliadas 3.356 crianças de uma coorte de nascimentos. Foi usado questionário padronizado sobre hábitos urinários e saúde mental (Development and Well-Being Assesment - DAWBA). Foi descrita a prevalência de transtornos psiquiátricos conforme a presença de enurese e seus subtipos (monossintomática e não monossintomática), estratificados por sexo. Para análise ajustada usou-se regressão logística. Resultados: A prevalência de enurese aos 6 anos foi 10,2% (9% não monossintomática) e aos 11 anos, 5,4% (4,5% não monossintomática). Aos 6 anos, meninos com enurese não monossintomática apresentaram mais transtornos de hiperatividade, em comparação com os não enuréticos (6,2% x 2,7%, p = 0,017). Aos 11 anos, após ajuste, entre os meninos com enurese não monossintomática, a prevalência de transtornos psiquiátricos, de hiperatividade e de oposição foi, respectivamente, 3,2, 3,4 e 2,6 vezes maior do que nos meninos não enuréticos; e entre as meninas com enurese não monossintomática, a prevalência de transtornos psiquiátricos e de oposição foi, respectivamente, 4 e 5,5 vezes maior do que entre meninas não enuréticas. Conclusões: Há uma forte associação entre enurese não-monossintomática e transtornos psiquiátricos aos 6 e 11 anos de idade.

Experiências vividas por famílias e crianças com sintomas urinários e intestinais: revisão sistemática de métodos mistos / Experiencias vividas por familias y niños con síntomas urinarios e intestinales: revisión sistemática de métodos mixtos / Lived experiences by families and children with urinary and intestinal symptoms: systematic review of mixed methods

RESUMO Objetivo Mapear e descrever a ocorrência de sintomas urinários e intestinais durante a infância e investigar o impacto de tais sintomas nas experiências vividas por crianças e suas famílias. Método Revisão sistemática de métodos mistos realizada nas bases eletrônicas MEDLINE/PUBMED, CINAHL, LILACS, PSYCINFO e EMBASE em julho de 2019, as quais geraram 3.020 referências. Após remoção das duplicatas, 2.521 títulos e resumos foram triados com filtro de tempo, e aplicado critérios de inclusão. Desses, 31 artigos foram lidos na íntegra e avaliados quanto à qualidade metodológica pelo Mixed Methods Appraisal Tool, resultando em 15 artigos como amostra final. Resultados Foram encontrados: sentimento de inferioridade, agressividade, culpa e vergonha. A revisão evidenciou, ainda, o impacto negativo dos sintomas urinários e/ou intestinais no contexto social da criança e de sua família, em especial, no ambiente escolar. Conclusão e implicações para a prática Essa revisão sistemática de métodos mistos evidencia a importância de trabalhar os impactos emocionais e sociais da criança, em especial os eventos no ambiente escolar. Se faz necessário subsidiar o profissional de saúde na assistência às famílias e crianças com sintomas urinários e/ou intestinais, no sentido de prover um cuidado ampliado, valorizando as necessidades biopsicoemocionais da díade criança-família.

RESUMEN Objetivo Mapear y describir la ocurrencia de síntomas urinarios e intestinales durante la infancia e investigar su impacto en las experiencias de los niños y sus familias. Método Revisión sistemática de métodos mixtos, realizada en las bases de datos electrónicas MEDLINE/PUBMED, CINAHL, LILACS, PSYCINFO, EMBASE en julio de 2019, las cuales generaron 3,020 referencias. Después de eliminar los duplicados, se seleccionaron 2.521 títulos y resúmenes con filtro de tiempo, y se aplicaron criterios de inclusión. De esos, 31 artículos fueron totalmente leídos y evaluados en cuanto a la calidad metodológica por Mixed Methods Appraisal Tool, resultando en 15 artículos como muestra final. Resultados Fueron encontrados: sentimiento de inferioridad, agresividad, culpa y vergüenza. También se notó el impacto negativo de los síntomas urinarios y/o intestinales en el contexto social de los niños y sus familias, especialmente en el escolar. Conclusión e implicaciones para la práctica Esta revisión sistemática resalta la importancia de abordar los impactos emocionales y sociales de los niños, especialmente en la escuela. Se necesita subsidiar el profesional de salud en la atención a las familias y niños con síntomas urinarios y/o intestinales, a fin de proporcionar un cuidado ampliado, valorando las necesidades biopsicosociales de la díada niño-familia.

ABSTRACT Objective To map and describe the occurrence of urinary and intestinal symptoms during childhood and to investigate the impact of such symptoms on the experiences of children and their families. Method Systematic review of mixed methods, performed in the electronic databases MEDLINE/PUBMED, CINAHL, LILACS, PSYCINFO and EMBASE in July 2019, which generated 3,020 references. After removal of duplicates, 2,521 titles and abstracts were screened with time filter, and application of inclusion criteria. Among these, 31 articles were read in full and evaluated as for methodological quality by the Mixed Methods Appraisal Tool, resulting in 15 articles as the final sample. Results The following results were found: feeling of inferiority, aggressiveness, guilt and shame. The review also showed the negative impact of urinary and/or intestinal symptoms in the social context of children and their families, especially in the school environment. Conclusion and Implications for practice: This systematic review of mixed methods highlights the importance of addressing children's emotional and social impacts, especially events in the school environment. It is necessary to subsidize the health professional in assisting families and children with urinary and/or intestinal symptoms, in order to provide expanded care, valuing the biopsychosocial needs of the child-family dyad.

Perfil clínico-epidemiológico, pacientes pediátricos con enuresis nocturna. Centros escolares, San Pedro Sula / Clinical-epidemiological profile, pediatric patients with nocturnal enuresis. schools, San Pedro Sula

Antecedentes: La Enuresis nocturna, es una enfermedad prevalente aproximadamente en 18% de los pacientes pediátricos, se ha asociado a diferentes patologías, como el transtorno por déficit de atención e hiperactividad (TDAH), la constipación y trastornos del sueño, el diagnóstico oportuno es importante. Objetivo: Describir el perfil clínico, epidemiológico y sociocultural de los niños que presentan enuresis nocturna, evaluados en centros educativos Fidelina Cerros en Barrio Chamelecón y Miguel Paz Barahona en Cofradía Departamento de Cortés. Pacientes y métodos: Estudio no experimental, Cuantitativo, Descriptivo, de agosto 2018 a mayo 2019, con una muestra de 200 niños, Resultados: La prevalencia encontrada fue de 16.7% y la edad promedio de 7.72 años, 61% hombres, 100% residentes del casco urbano. El 80% presento buena adaptación escolar, 33% no tenían fácil acceso a servicios de salud y solo el 47.5% llevaba controles periódicos de salud, 67% presento enuresis diurna y 45% pesadillas. Conclusiones: Los pacientes con enuresis nocturna de escuelas metropolitanas de san pedro sula se caracterizan así: edad 7 u 8 años, sexo masculino, viven en casas con servicios básicos sin patio, pero con adecuado material de construcción, que comparten habitación e inclusive viven en hacinamiento, con pocos controles de salud periódicos y con acceso a centros de atención de salud del área metropolitana...(AU)

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.

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.

Are uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACT Objectives: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE). Material and methods: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response. Results: In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response. Conclusions: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

Evidências de revisões sistemáticas Cochrane sobre tratamento da enurese em crianças / Evidence from Cochrane systematic reviews on treatment of enuresis in children

Contexto: Apesar de a enurese acometer mais de 15% das crianças e ter impacto importante na sua qualidade de vida, existem muitas incertezas sobre a efetividade e a segurança das intervenções disponíveis para o seu tratamento. Objetivo: Avaliar evidências de revisões sistemáticas Cochrane sobre efetividade e segurança de intervenções para o tratamento da enurese em crianças. Métodos: Revisão de revisões sistemáticas com busca sistematizada na Biblioteca Cochrane. Dois autores avaliaram a adequação das revisões encontradas aos critérios de inclusão e apresentaram uma síntese qualitativa de seus resultados. Resultados: Foram incluídas sete revisões que avaliaram o uso de intervenções farmacológicas (n = 3), comportamentais e educacionais (n = 4) em crianças com enurese. Conclusão: Desmopressina, indometacina, diclofenaco, diazepam e ibuprofeno/pseudoefedrina, intervenções com dispositivos de alarme e intervenções educacionais e comportamentais parecem ter algum benefício nos desfechos clínicos. No entanto, esses achados precisam ser confirmados em futuras atualizações das revisões sistemáticas existentes e por ensaios clínicos adicionais com melhor qualidade metodológica.

Event-related potentials of working memory impairment in children with primary nocturnal enuresis / 中国当代儿科杂志

OBJECTIVE@#To study the cognitive neural mechanism of working memory impairment in children with primary nocturnal enuresis using event-related potential (ERP).@*METHODS@#A total of 14 children with primary nocturnal enuresis were enrolled as enuresis group, and 14 normal children were enrolled as control group. The learning-recognition task test was applied, and the ERP components (P2, N2, and P3) at Fz lead while identifying old pictures (learned) and new ones (unlearned) were measured and compared between the two groups.@*RESULTS@#While identifying the old pictures, the enuresis group had a lower amplitude of P2 and N2 than the control group (P<0.05). There were no significant differences between the two groups in the latency of P2, N2, and P3 and the amplitude of P3. While identifying the new pictures, the enuresis group had a longer latency of P2 and a significantly lower amplitude of N2 than the control group (P<0.05). There were no significant differences between the two groups in the amplitude of P2 and P3 and the latency of N2 and P3.@*CONCLUSIONS@#Compared with normal children, the children with primary nocturnal enuresis have reduced abilities of classified information extraction, a prolonged reaction time, and reductions in memory capacity, memory consolidation, and conflict monitoring, which causes working memory impairment.

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.

Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática / Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis

La enuresis primaria monosintomática es un problema clínico común que afecta del 5 al 10% de los niños en edad escolar. La etiología exacta no se conoce, pero se ha propuesto una capacidad vesical funcional disminuida como factor predisponente. Existen pocos reportes en la literatura del uso de ultrasonido para su evaluación. Objetivo: Determinar si la capacidad vesical funcional medida por ultrasonido está disminuida en enuresis primaria monosintomática comparada con población sana. Pacientes y Método: Estudio trasversal analítico de febrero de 2014 a mayo de 2015 incluyendo 40 pacientes con enuresis y 40 sin enuresis, 5 a 15 años de edad, midiendo la capacidad vesical funcional mediante ecógrafo Siemens Acuson S2000TM con transductor 3,5 y 5 MHz por un solo operador cegado. Se realizó estadística descriptiva y analítica mediante el programa IBM SPSS 20 TM. Resultados: Los pacientes con enuresis presentaron menor capacidad vesical funcional 171,7 ml vs controles 225,5 ml (p = 0,025). Resultó factor de riesgo OR = 2,81 (IC 95%: 1,06-7,42) tener un familiar de primera línea con antecedente de enuresis y OR = 4,0 (IC 95%: 1,48-10,78) para segunda línea. La capacidad vesical funcional presentó correlación débil con la capacidad vesical normal estimada mediante la fórmula de Kaefer. Conclusión: La capacidad vesical funcional es menor en quien padece enuresis que en los que no la padecen y existe poca correlación con las fórmulas que determinan la capacidad vesical normal esperada como la de Kaefer. Se reafirmó que el antecedente hereditario de enuresis juega un papel importante como factor de riesgo.

Nocturnal enuresis is a common clinical problem affecting 5% to 10% of school-age children. Etiology is not known but a diminished functional bladder capacity it has been proposed as a predisposing factor. There exist only a few studies evaluating it by ultrasound. Objective: To identify if there is a difference of the functional bladder capacity measured by ultrasound between nocturnal enuresis group and healthy children. Patients and Method: A cross-sectional study from February 2014 to May 2015 including two groups, nocturnal enuresis and a control group of 40 patients each, 5 to 15 years old. A single blinded operator measured the functional bladder capacity by ultrasound with an Acuson S2000 SiemensTM 3.5 and 5 MHz transducer. Analytics and descriptive statistics were performed using IBM SPSS 20TM software. Results: Patients with enuresis showed a decreased functional bladder capacity vs. controls (171.7 ml vs 225.5 ml; p = 0.025). A history of first-degree relative with enuresis increased the risk of having enuresis OR = 2.81 (95% CI: 1.06-7.42), a second-degree relative presented OR = 4.0 (95% CI: 1.48-10.78). Functional bladder capacity presented a weak correlation with the bladder capacity estimated by Kaefer’s formula. Conclusion: The functional bladder capacity is lower in the patients with nocturnal enuresis when compared to control group. There is little correlation between functional bladder capacity and Kaefer’s formula to determine the normal bladder capacity. We reaffirmed that the family history with enuresis strongly increases the risk of developing nocturnal enuresis.

Efeitos do tratamento com alarme para enurese no autoconceito de crianças / Effects of alarm treatment for enuresis on children's self-concept / Efectos del tratamiento con alarma para enuresis en el autoconcepto de niños

O objetivo do estudo foi avaliar a eficácia do tratamento comportamental para enurese com uso de alarme, realizado à distância, e avaliar efeitos da intervenção no autoconceito dos participantes. Trata-se de um ensaio clínico com delineamento quase-experimental de grupos. Trinta e uma crianças com enurese primária monossintomática participaram (M(idade)=8,3; DP=1,3), 15 meninos (48,3%). Para avaliar a enurese, foi utilizado o Formulário de Avaliação da Enurese; para o autoconceito, a Escala de Autoconceito Infantojuvenil; para instruções sobre o tratamento, o Guia de Pais. A taxa de sucesso no tratamento foi de 71%. Houve diferença estatisticamente detectável na variação do autoconceito pessoal pré e pós-intervenção (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01), independentemente do desfecho, e diferenças no autoconceito social entre as médias de crianças que tiveram sucesso no tratamento (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). A proposta de tratamento da enurese apresentada é viável e eficaz e impactou positivamente o autoconceito das crianças avaliadas. (AU)

The objective of the study was to evaluate the efficacy of enuresis alarm therapy, performed at a distance, and to evaluate the effects of the intervention on the participants' self-concept. This is a clinical trial with a quasi-experimental group design. Thirty-one children with mono-symptomatic primary enuresis participated (M(age)=8.3, SD=1.3), 15 boys (48.3%). Assessments were made using the Enuresis Evaluation Form; Child-Juvenile Self-Concept Scale; and the Parents' Guide, for treatment instructions. Treatment success rate was 71%. There was a statistically significant difference in the variation of the personal self-concept before and after intervention (M=4.8, SD=1.9; vs M=6.1, SD=1.9; p=0.01), regardless of the outcome (M=9.8, SD=1.9 vs M=0.5, SD=1.5; p=0.03), and differences in the social self-concept among the means of children who had successful treatment (M=9.8, SD=1.9 vs M=0.5, DP=1.5; p=0.03). The proposed enuresis treatment is feasible and effective, and positively impacted the self-concept of the children evaluated. (AU)

El objetivo del estudio fue evaluar la eficacia del tratamiento comportamental para Enuresis, con uso de alarma, realizado a distancia, y evaluar también los efectos de la intervención en el autoconcepto de los participantes.Se trata de un ensayo clínico con delineamiento casi experimental de grupos. Participaron 31 niños con enuresis primaria monosintomático (M(edad)=8,3; DP=1,3), 15 varones (48,3%). Para evaluar la enuresis fue utilizado el Formulario de Evaluación de Enuresis, para el autoconcepto; Escala de Autoconcepto Infanto Juvenil, para instrucciones sobre el tratamiento; Guía de Padres. La tasa de éxito del tratamiento fue de 71%. Hubo diferencia estadísticamente detectable en la variación del autoconcepto personal antes y después de la intervención (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01) independiente de los resultados, y diferencias en el autoconcepto social entre el promedio de los niños que tuvieron un tratamiento exitoso (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). La propuesta del tratamiento de enuresis presentada es viable y eficaz e impactó positivamente en el autoconcepto de los niños evaluados. (AU)