An exploration of outcome criteria in nocturnal enuresis treatment.

This paper is a review of outcome definitions and criteria for nocturnal enuresis treatment. A search of the literature published between 1991 and 2001 highlighted 97 papers. Although the International Children's Continence Society and the World Health Organization have published outcome criteria, different, often idiosyncratic, outcome criteria and/or definitions have been adopted in published research on treatment for nocturnal enuresis in recent years. There remains a debate as to what constitutes successful treatment and how to document improvement. Lack of an agreed definition of outcome reduces confidence in comparing studies, with serious clinical and research implications. This paper reviews aspects of importance in determining outcome, including a suggestion to focus on the establishment of dry nights rather than the reduction of wet nights. A new set of criteria is suggested, consisting of a banding system referred to as a "dryness scale", which focuses on the percentage of dry nights accomplished at a point in time, thus eliminating the need to compare current levels of dryness with a baseline.

Investigating the three systems approach to complex childhood nocturnal enuresis--medical treatment interventions.

OBJECTIVE: Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment. MATERIAL AND METHODS: A total of 66 children were assessed using a schedule for identifying mono- and non-monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5-10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks. RESULTS: Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication. CONCLUSIONS: This study endorses the three systems approach in clinical practice.

Self-construing in children with primary mono-symptomatic nocturnal enuresis--an investigation of three measures.

OBJECTIVE: This study aims to measure different aspects of self-construing in children with primary mono-symptomatic nocturnal enuresis. METHOD: 25 children aged 7-14 years, with nocturnal enuresis were recruited from a paediatric outpatient's unit specialising in enuresis [mean age 10.6 [males], 9.39 [females]] and 25 children acting as controls, were recruited from one primary and one secondary school [mean age 10.08 [males], 9.39 [females]]. MEASURES: The Butler Self Image Profile [SIP], Coopersmith Self Esteem Inventory, Ouvinen-Birgerstam "I think I am" Self Perception Scale were administered. DESIGN: This study was a matched controlled group comparison. RESULTS: The only significant difference was the tendency for children with enuresis to construe themselves more negatively on the SIP. There were no significant differences between children with enuresis and the matched controls on all the other measures. CONCLUSION: Children with nocturnal enuresis generally perceive themselves similar to children without nocturnal enuresis, and are not "psychologically or emotionally disturbed." It is important to assess a child's self-construing in order to identify those children who are more vulnerable to a lower self-esteem. Future research needs to take into account self-construing in different clinical populations, i.e. those children who have non-mono symptomatic nocturnal enuresis.