RESUMO
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.
RESUMO
PURPOSE: Hypercalciuria has been suggested to be involved in the pathogenesis of nocturnal enuresis associated with polyuria. We have measured the amount of calcium excretion in the urine from children with monosymptomatic nocturnal enuresis and studied the association with enuresis. METHODS: Thirty-six children (20 males and 16 females, age 5 to 15.6 years) presenting with monosymptomatic nocturnal enuresis were recruited for this study. RESULTS: Among 36 patients, 6 patients had hypercalciuria, providing a 16.7% frequency. The mean Ca/Cr ratio of hypercalciuria group showed 0.23+/-0.10 on daytime, and 0.33+/-0.10 on nighttime showing higher values in nighttime, but it was not statistically significant. Average 24 hour calcium excretion was 8.95 mg/kg. Night/day time urine volume ratio in hypercalciuria group was 0.87+/-0.20, and that in normocalciuria group was 0.81+/-0.33, also showing no difference. Daytime Ca/Cr ratio and nighttime Ca/Cr ratio from all enuresis patients showed a significant correlation (P=0.0001). However, Ca/Cr ratio between daytime and nighttime urine volume had no significant correlation, respectively (daytime P=0.08; nighttime P=0.07). Also, daytime and nighttime Na concentration, urea concentration, and osmolality also had no significant correlation with urine Ca/Cr ratio, respectively. CONCLUSION: Hypercalciuria shown in some of enuresis patients is not directly caused by primary monosymptomatic nocturnal enuresis.