Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Enuresis en niños: frecuencia y antecedentes familiares / Enuresis in children: frequency and family history

La enuresis es una patología frecuente en pediatría, con potencial impacto en la calidad de vida del niño y sus padres. En Chile no existe literatura respecto al potencial efecto de esta patología en la dinámica familiar. El objetivo de este trabajo fue estimar la frecuencia de enuresis en una población de nivel socioeconómico medio-alto y describir los factores de riesgo familiares asociados y grado de preocupación de los padres respecto al tema. Método. Entre 2010 y 2011 se aplicó una encuesta voluntaria a los padres de pacientes atendidos ambulatoriamente en Clínica Las Condes. Se registraron los antecedentes de enuresis de los padres, número y edad de los hijos, número de hijos con enuresis, preocupación de los padres al respecto. Resultados. Se analizaron 334 familiares, que correspondieron a 499 niños mayores de cinco años, de los cuales 91 (18,2%) presentaron enuresis. El 57% de los pacientes con enuresis tenía antecedentes familiares, 58% correspondía al padre, 36% a la madre y 6% a ambos padres. El 51% de los padres reveló preocupación por este hecho. El grupo etario más afectado correspondió a niños de entre cinco y nueve años con un 38,8% de frecuencia, porcentaje bastante mayor al señalado por la literatura. Respecto a la herencia, un 57% tenía antecedentes familiares de padre y/o madre con enuresis.

Enuresis is a common condition in children, with potential impact on quality of life of children and their parents. In our country there is no literature on the potential impact of this disease on family dynamics. The aim of this study was to estimate the frequency of bedwetting in a population of middle-high socioeconomic level and describe the risk factors associated, family and degree of parental concern regarding the issue. Method: between 2010 and 2011 were surveyed parents of voluntary outpatients seen at Clinica Las Condes. We recorded the history of bedwetting parents, number and age of children, number of children with enuresis, parental concern about it. Results: We analyzed 334 families, which corresponded to 499 children over five years old., Ninety one (18.2%) had enuresis. 57% of patients with enuresis had a family history, 58% belonged to the father, the mother 36% and 6% both parents. 51% of parents showed concern about this. The most affected age group accounted for children between 5 and 9 years with a 38.8% rate, far higher percentage than that reported by the literature. Regarding inheritance, 57% had a family history of father and/or mother with enuresis.

Eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes / Effectiveness of the hypnotherapy against the nocturnal enuresis in children and adolescents

Se realizó un ensayo terapéutico en fase III para evaluar la eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes remitidos con ese diagnóstico a la Clínica de Hipnosis de Santiago de Cuba durante el período comprendido de enero a octubre del 2006, previa valoración de la causa del trastorno (no orgánica) por pediatras, urólogos, psiquiatras, neurólogos y psicólogos. El tratamiento basado en la hipnosis fue tan eficaz para eliminar esa molestia como el medicamentoso con imipramina, pero en el primer caso no se produjeron efectos adversos.

A therapeutic trial in phase III was carried out to evaluate the effectiveness of hypnotherapy against nocturnal enuresis in children and adolescents referred with that diagnosis to the Hypnosis Clinic from Santiago de Cuba during the period from January to October, 2006, with a previous evaluation of the cause of the dysfunction (not organic) by pediatricians, urologists, psychiatrists, neurologists and psychologists. The treatment based on hypnosis was as effective to eliminate that disorder as the drug therapy with imipramine, but in the first case adverse effects did not take place.

Stressful life event presenting as enuresis, dissociative disorder and worsening school performance.

Stressful life events are associated with various psychiatric problems. Secondary enuresis and dissociative disorders both may appear in context of traumatic life events. These problems following a trauma may further increase the risk of stress in the family and may in turn result into a vicious cycle of difficulties. We present a case report of stressful life events presenting as enuresis, dissociative disorder and worsening school performance and careful appreciation of situations and rigorous interventions improved the clinical status.

Tratamiento de la enuresis con moxa en niños. Cárdenas 2003-2004 / The enuresis treatment with moxa in children. Cárdenas 2003-2004

La enuresis es uno de los problemas más desconcertantes en la consulta del pediatra y el médico general integral. La bibliografía revisada plantea que ésta resuelve, en algunos casos, con la terapia occidental, aunque esta última ha perdido valor, porque un por ciento no soluciona el problema. Se ha aplicado la Medicina Natural y Tradicional (MNT) en diferentes formas y ha resultado eficaz en la eliminación de la enuresis. Se realizó un estudio prospectivo, longitudinal, con los pacientes que presentaron enuresis del policlínico José Antonio Echeverría, de Cárdenas, durante el año 2003. Hicimos un estudio para comparar los resultados obtenidos con los dos tipos de tratamiento; precisar el umbral de sensibilidad a la exposición de la moxa y determinar el tiempo más efectivo de tratamiento para la eliminación de la enuresis. Se escogieron 25 niños de 5 a 14 años de forma aleatoria como muestra, se dividieron en tres grupos, por condiciones del local, y se aplicó moxa indirecta. Todos estos niños fueron tratados previamente con terapia occidental. Los resultados obtenidos con ambos tratamientos, recogidos de las historias clínicas, fueron procesados en una Pentium 4 utilizando frecuencia absoluta y frecuencia porcentual. Encontramos que los niños de piel más oscura resisten más tiempo el calor, mayor frecuencia de la enuresis en el sexo masculino, una buena respuesta al tratamiento, con desaparición o mejoría de la misma al aplicar la moxibustión, en un período más corto que cuando se usa la terapia occidental en todos los casos estudiados.

The enuresis is one of the most disconcerting problems at the paediatric and integral general doctor's consult. The reviewed bibliography states that this is solved, in some cases, with the western therapy, although this therapy has lost value, because it does not solve the problem in some percentage of cases. Natural and traditional medicine has being applied in different ways, and it has being efficacious in the enuresis elimination. We made a longitudinal, prospective study of the patients presenting enuresis at the policlinic “José Antonio Echeverría”, of Cárdenas, during 2003. We made a study to compare the obtained results with both kinds of treatment; to precise the sensibility threshold to the moxa exposition and to determine the most effective treatment time for the enuresis elimination. As sample we chose 25 5-to-14-years-old children, divided in three groups, in dependence of the treatment place. Indirect moxa was applied. All of these children were previously treated with western therapy. The obtained results with both treatments, registered in the clinical records, were processed in a Pentium 4, using absolute and percentage frequency. We found that darker skin children resist heat more time; enuresis is more frequently in male sex; a good answer to the treatment, with enuresis disappearing or bettering when applying moxibustion, in a shorter period than when the western therapy is used in all the studied cases.

Diagnóstico e manejo das disfunções miccionais em crianças sem anormalidades neurológicas ou anatômicas / Diagnostic and management of mictional dysfunctions in children without neurological or anatomical abnormalities

As disfunções miccionais incluem a enurese, a urgência miccional, alterações funcionais do detrusor. Existem fatores comportamentais afetando o treinamento no uso de banheiro e há também inibição da maturação do controle urinário normal. O objetivo deste trabalho foi revisar o manehjo terapêutico de disfunções urinárias em crianças sem desordens neurológicas ou comprometimento anatõmico associados. Revisou-se a literatura médica atual, enfatizando metanalises, estudos randomizados e controlados, documentos da biblioteca digital Cochrane. Entre os tratamentos encontram-se medidas dietéticas, registro das micções, biofeedback, urofluxometria, eletromiografia, medicamentos, entre outros. Existem poucos estudos controlados, além de dificuldades metodológicas. Os resultados são muito próximos entre si quando comparados, sendo que alguns autores questionam a existência de evidências científicas para estes tratamentos.

Prevalence and associated factors of enuresis in turkish children

OBJECTIVE: Enuresis, which is frequently diagnosed amongst schoolchildren, is an important psychosocial problem for both parents and children. In the present study we aimed to determine the prevalence and associated factors of enuresis in Turkish children and to identify common methods for its management. MATERIALS AND METHODS: A cross sectional epidemiological study was performed among primary school children living in Ankara, Turkey. A self-administered questionnaire was prepared for this study and distributed to the parents of 1,500 schoolchildren whom aged 6-12 years. RESULTS: Of the 1,500 questionnaires distributed, 1,339 (89 percent) were completed. The overall prevalence of nocturnal and diurnal enuresis were 17.5 percent (n = 234) and 1.9 percent (n = 25), respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased number of people sleeping in the child's room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2 percent. The most preferred treatment option for enuresis was medications (59.5 percent), whereas alarm treatment was the least preferred (2.4 percent). CONCLUSIONS: Our results with enuresis prevalence and associated factors were comparable to other epidemiologic studies from various countries. Furthermore we demonstrated that families in Turkey do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.

A enurese em criancas e seus significados para suas famílias: abordagem qualitativa sobre uma intervencão profissional em saúde / Child enuresis and parental meanings: a qualitative perspective for healthcare professionals

OBJETIVOS: discutir as percepcões e significados atribuídos pelas famílias acerca da enurese vivida por seus filhos, através de uma perspectiva socio-antropológica que problematiza as mesmas no contexto das questões identificadas no interior do campo dos modelos explicativos da doenca. MÉTODOS: relato de experiência, baseado em entrevistas semi-estruturadas, realizadas junto a 24 (vinte e quatro) familiares/cuidadores de criancas com quadros de enurese. RESULTADOS: as famílias de pacientes com enurese demonstram a necessidade de definir a doenca de maneira subjetiva, entendendo-a através dos sentimentos que a mesma desencadeia, das mudancas comportamentais e das diferencas encontradas no relacionamento com as outras pessoas devido à mesma. Observa-se que os significados da enurese se organizam em dois campos que se cruzam: a responsabilizacão da própria crianca por sua enurese e os fatores externos, como o ambiente familiar e a situacão econômica e social. CONCLUSÕES: recomenda-se que profissionais de saúde estejam atentos aos perigos da normatividade biomédica de seu discurso, já que o mesmo dificulta a compreensão e elaboracão dos tratamentos necessários. Profissionais de saúde devem estar informados sobre o risco de maustratos relacionados à enurese, o que justifica a discussão acerca de possíveis estratégias de enfretamento dessa realidade na acão profissional junto a essa clientela.

Enuresis in childhood a hospital study

Enuresis remains a society-unresolved problem despite avoluminous literature. The cause is not clearly understood and treatment remains controversial To study the prevalence of Nocturnal enuresis in children among different age groups attending Central Teaching Hospital. This study was carried out at Central teaching hospital for children - Baghdad, A total number of 500 children were included in this study, 220 female and 280 male aged 5-13 years who attending the out patient clinic between the first of June and the thirty of September 2003, the parents of these children were asked about the presence and frequency of enuresis. Fifty [22.3%] of female children included in the study were enuretic and 60 [21.4%] of male included in the study] were enuretic, so the total enuretic children was 110 [22%] and non - enuretic number was 390 [78%] taking a minimum frequency of one wet per month. Positive family history was found in [60] 54% of enuretic children, urinary tract infection was fond in [10] 9% of enuretic children mostly females. Spina bifida occulta was detected in 22 [20%] of enuretic children, worm infestation was present in 61 [55%] of enuretic children. Twenty-two [20%] of the families have asked about medical treatment for their children and 11 [50%] of them received short term medical treatment without great benefit. The prevalence of enuresis in the studied children was higher than that reported previously in Iraq

Actualización en el estudio y tratamiento de la enuresis primaria noctura / Update in the study and treatment of the nocturnal primary enuresis

La enuresis primaria nocturna no es una entidad nosológica sino un signo que está presente en un grupo heterogéneo de enfermedades. Constituye un problema de salud de amplia distribución, ya que está presente en todas las civilizaciones y áreas geográficas; afecta a todas las razas y estratos sociales con discreta predominancia en las clases menos favorecidas económicamente. A los 5 años de edad afecta al 15 por ciento de niños de ambos sexos con un predominio de 3:1 a favor del sexo masculino y es ligeramente más frecuente en zurdos. En Estados Unidos se calcula que hay de 5 a 7 millones de niños que padecen de enuresis nocturna primaria. En México no se cuenta con cifras exactas, pero considerando los datos proporcionados en el XII Censo de población realizado por el Instituto Nacional de Estadística, Geografía e Informática en el 2000, en México hay 2.250.886 niños de 5 años de edad, de ellos el 15 por ciento , es decir 337.633 padecen enuresis y considerando la población total de niños de 5 a 16 años de edad (26.031.931), es muy posible que en nuestro país haya aproximadamente de 4 a 5 millones de jóvenes que padecen de este problema médico el cual no solo afecta la salud física y emocional del paciente sino también a su propia familia y a la sociedad que le rodea

Childhood enuresis epidemiology, pathophysiology and management

The goal of this article is to review childhood enuresis, which is a common behavioral condition reported in millions of children worldwide. An online computer search was made, and the literature up to 1997 was screened in order to include relevant data for this review. The prevalence of childhood enuresis varies across reviewed studies. This was attributed to a variety of sociodemographic and cultural dynamics of societies. Similarly, the pathophysiology of this ubiquitous symptom is determined by multiple risk factors including biological, psychological, social, and cultural, but the developmental/maturational delay influenced by genetics remains the most plausible explanation. Although a variety of pharmacological and non-pharmacological treatment modalities are traced in the literature, there is yet no agreement on a single strategy. A general agreement about behavioral therapy as the first choice of treatment of this minor malady began to emerge. Additionally, tricyclic antidepressants are the most frequently prescribed drugs for the treatment of childhood enuresis. Enuresis is a pediatric public health problem and concerted efforts at all levels, ie, professional, promotional, educational and public should be made to address its multiple domains such as preventive, etiological and curative

Avaliaçäo da terapia motivacional na enurese noturna em crianças / Evaluation of the motivational therapy in nocturnal enuresis on children

Objetivo: A enurese noturna na infância é um importante problema social e uma das mais comuns e importunas condiçöes da infância. O presente trabalho avalia a terapia motivacional como forma isolada de tratamento da enurese noturna. Métodos: Foram avaliadas 3.996 crianças, de 0 a 12 anos de idade, no ambulatório de periferia da FCMMG, entre 1988 e 1994, quando investigou-se a presença de enurese noturna e se propôs a terapia motivacional. O tratamento proposto baseou-se no fato de a criança passar a participar dos cuidados com suas roupas íntimas e de cama, nos dias em que urinava durante o sono. Além disso, recebiam um "quadro" no qual eram anotados os "dias secos". Resultados: Oitenta e nove crianças eram enuréticas, sendo 37 (41,6 por cento) do sexo masculino e 52 (58,4 por cento) do sexo feminino, com idade variando de 4 a 12 anos (M=7,3 ñ 2,2). Obteve-se sucesso terapêutico (ausência de micçöes noturnas) 80 (90 por cento) das crianças (p<0.05), num período que variou de 15 a 150 (M=60) dias. Conclusäo: A terapia motivacional teve bons resultados e, apesar de relativamente longa, a relaçäo custo-benefício é satisfatória. Quando comparada com outras possibilidades terapêuticas descritas na literatura, como o uso de medicamentos e de aparelhos tipo alarme, parece-nos menos agressiva

Enuresis funcional. Manejo psicomotor de los esfínteres vesicales / Functional enuresis

La enuresis es un problema cotidiano de salud en un número importante de niños mayores de 3 años de edad, aunque su frecuencia y prevalencia reales se desconozcan en nuestro país. Su importancia se incrementa debido a la gran vinculación que tiene con los padres de familia y, además, porque su manejo es aún tema de controversia. En la presente revisión bibliográfica se describen los principales aspectos clínicos de esta anomalía; se incluye un cuadro de facíl manejo sobre el criterio diagnóstico en la enuresis funcional, y se hace énfasis en la vigilancia que debe ejercer el médico cuando instituye tratamiento farmacológico. En especial, se destaca la trascendencia que ofrece educar al paciente y a sus padres o cuidadores, a través de instituir, a la brevedad posible, la práctica cotidiana del manejo de los esfínteres vesicales al aportador al niño cantidades generosas de líquidos durante el día. Insistiéndole en la necesidad imperiosa que existe en su caso, de que concientice las sensaciones de la necesidad de miccionar y la conveniencia de controlar los esfinteres mencionados