Relationship between primary monosymptomatic enuresis and process toilet training: a case-control

ABSTRACT Objective: Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. Patients and Methods: A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. Results: The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). Conclusions: The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Relationship between primary monosymptomatic enuresis and process toilet training: a case-control.

OBJECTIVE: Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. PATIENTS AND METHODS: A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. RESULTS: The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). CONCLUSIONS: The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.

Relationship between toilet training process and primary nocturnal enuresis in children and adolescents - A systematic review.

INTRODUCTION: Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents. METHODS: We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies. RESULTS: A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process. CONCLUSION: Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.