A systematic review and meta-analysis assessing the efficacy of Tuina for nocturnal enuresis in children.

Background: Desmopressin acetate (DDAVP) and behavioral interventions (BI) are cornerstone treatments for nocturnal enuresis (NE), a common pediatric urinary disorder. Despite the growing body of clinical studies on massage therapy for NE, comprehensive evaluations comparing the effectiveness of Tuina with DDAVP or BI are scarce. This study aims to explore the efficacy of Tuina in the management of NE. Methods: A systematic search of international databases was conducted using keywords pertinent to Tuina and NE. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated NE treatments utilizing Tuina against DDAVP or BI. This meta-analysis included nine RCTs, comprising a total of 685 children, to assess both complete and partial response rates. Results: Tuina, used as a combination therapy, showed enhanced clinical efficacy and improved long-term outcomes relative to the control group. The therapeutic efficacy of Tuina was not directly associated with the number of acupoints used. Instead, employing between 11 and 20 acupoints appeared to have the most significant effect. Conclusion: The findings of this meta-analysis support the potential of Tuina as an adjunct therapy to enhance the sustained clinical efficacy of traditional treatments for NE. However, Tuina cannot completely replace DDAVP or BI in the management of NE. While this study illuminates some aspects of the effective acupoint combinations, further research is crucial to fully understand how Tuina acupoints contribute to the treatment of NE in children. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442644, identifier CRD42023442644.

Development of a Novel Prediction Tool for Response to First-Line Treatments of Monosymptomatic Nocturnal Enuresis-A Randomized, Controlled International Multicenter Study (DRYCHILD).

PURPOSE: Nocturnal urine volume and bladder reservoir function are key pathogenic factors behind monosymptomatic nocturnal enuresis (MNE). We investigated the predictive value of these together with other demographic and clinical variables for response to first-line treatments in children with MNE. MATERIALS AND METHODS: A randomized, controlled, international multicenter study was conducted in 324 treatment-naïve children (6-14 years) with primary MNE. The children were randomized to treatment with or without prior consideration of voiding diaries. In the group where treatment choice was based on voiding diaries, children with nocturnal polyuria and normal maximum voided volume (MVV) received desmopressin (dDAVP) treatment and children with reduced MVV and no nocturnal polyuria received an enuresis alarm. In the other group, treatment with dDAVP or alarm was randomly allocated. RESULTS: A total of 281 children (72% males) were qualified for statistical analysis. The change of responding to treatment was 21% higher in children where treatment was individualized compared to children where treatment was randomly selected (RR = 1.21 (1.02-1.45), P = .032). In children with reduced MVV and no nocturnal polyuria (35% of all children), individualized treatment was associated with a 46% improvement in response compared to random treatment selection (RR = 1.46 (1.14-1.87), P = .003). Furthermore, we developed a clinically relevant prediction model for response to dDAVP treatment (ROC 0.85). CONCLUSIONS: The present study demonstrates that treatment selection based on voiding diaries improve response to first line treatment, particularly in specific subtypes. Information from voiding diaries together with clinical and demographic information provides the basis for predicting response.

Wearable-Based Integrated System for In-Home Monitoring and Analysis of Nocturnal Enuresis.

Nocturnal enuresis (NE) is involuntary bedwetting during sleep, typically appearing in young children. Despite the potential benefits of the long-term home monitoring of NE patients for research and treatment enhancement, this area remains underexplored. To address this, we propose NEcare, an in-home monitoring system that utilizes wearable devices and machine learning techniques. NEcare collects sensor data from an electrocardiogram, body impedance (BI), a three-axis accelerometer, and a three-axis gyroscope to examine bladder volume (BV), heart rate (HR), and periodic limb movements in sleep (PLMS). Additionally, it analyzes the collected NE patient data and supports NE moment estimation using heuristic rules and deep learning techniques. To demonstrate the feasibility of in-home monitoring for NE patients using our wearable system, we used our datasets from 30 in-hospital patients and 4 in-home patients. The results show that NEcare captures expected trends associated with NE occurrences, including BV increase, HR increase, and PLMS appearance. In addition, we studied the machine learning-based NE moment estimation, which could help relieve the burdens of NE patients and their families. Finally, we address the limitations and outline future research directions for the development of wearable systems for NE patients.

Vitamin D and vitamin B12 profiles in children with primary nocturnal enuresis, an analytical cross-sectional study.

PURPOSE: To outline the prevalence of vitamin D and vitamin B12 deficiencies in enuretic children. METHODS: An analytical descriptive study was conducted on enuretic children who were followed up at the outpatient clinic for nocturnal enuresis at the Children's Hospital, Cairo University. Sociodemographic and clinical data were recorded. The levels of vitamin D and vitamin B12 were assessed and correlated with the severity of enuresis. RESULTS: Two hundred and eighty-eight children were enrolled. Insufficiency of Vitamin D predominated (n = 139; 48.3%). Vitamin D deficiency was present in 31.3%, n = 90 and it was normal in 20.5%, n = 59). Vitamin B12 deficiency was observed in 25% of the studied children, n = 72). The one-sample Wilcoxon signed-rank test was significant for both vitamins (P value =0.001). Vitamin D showed a stronger inverse correlation with the number of enuresis episodes per day than vitamin B12 (-0.680 vs. -0.219 respectively). A cut-off of 13.7 ng/ml for vitamin D was detected, below which the child was predicted to have failed dry nights. Using multivariate logistic regression, higher vitamin D levels and behavioural treatment coexistence were significant protective factors for the absence of dry nights. CONCLUSION: Low levels of vitamin D and B12 were detected in children with primary nocturnal enuresis, which could be considered a burden on the clinical severity of enuresis.

What is already known on this topic?Children with Primary Nocturnal Enuresis may have vitamin D and vitamin B₁₂ abnormalities as deficienciesWhat does this study add?Vitamin D insufficiency may be the most prevalent vitamin D abnormality in children with primary nocturnal enuresis. Vitamin D insufficiency may be more common in children with severe enuresis than vitamin B₁₂ deficiency.How might this study affect research, practice, or policy?This study may invite further research to examine the possible use of vitamin D and vitamin B12 as potential adjuvant therapies for children with Primary Nocturnal Enuresis.

Effects of sex, toilet training, stress, and caffeine on nocturnal enuresis among school children in Gondar Town, the metropolitan city of Ethiopia: a community-based study in 2023.

Background: Nocturnal enuresis is associated with severe social and psychological problems that affect one's self-esteem, later in life, harmed adolescent and adult life, emotional stress on the family, and poor school performance. Moreover, enuresis children may cause panic attacks, mood disorders, and depression. This study aims to assess the prevalence and associated factors of nocturnal enuresis among children aged 5-14 years in Gondar city, Northwest Ethiopia, 2023. Methods: A community-based, cross-sectional study was conducted from April 1, 2023, to May 30, 2023. A stratified multistage sampling technique was used to select study subject from kebeles in Gondar city. The data were collected by using a structured, interviewer-administer Questionnaire. The data were entered using EPI DATA version 4.6.02 software, and processed,and analyzed using the statistical package for the social sciences (SPSS) version 25. All variables with P ≤ 0.25 in the bivariate analysis were included in the final model of multivariate analysis. The multivariate binary logistic regression was used to assess the association between the independent and outcome variable. The direction and strength of statistical association were measured with an adjusted odds ratio along with 95% CI and a P-value <0.05 was considered statistically significant. Result: The overall prevalence of nocturnal enuresis among children aged 5-14 years was 162 (22.2%). The findings showed that being boys [AOR = 0.54; 95% CI (0.31, 0.93)], child and no toilet training practices [AOR = 2.50; 95% CI (1.02, 6.15)], Having no caffeine [AOR = 0.16; 95% CI (0.09, 0.29)], and exposure to stressful events [AOR = 20; 95% CI (11.12, 33.34)] had a significant association with nocturnal enuresis, p-value <0.05. Conclusion: In this study, the prevalence of nocturnal enuresis children age 5-14 years was higher than that in previous studies. Sex of child, toilet training practices, caffeine c before bed, and presences of stressful event were a significant predictor of nocturnal enuresis.

Knowledge and Awareness of Adults towards Nocturnal Enuresis in Children among the Medina Population.

Background: Nocturnal Enuresis (NE) is a common problem among children that is stressful for both the child and adults. There is a lack of adults' knowledge and awareness of the NE condition. Objective: This study aimed to evaluate the adults' knowledge and awareness of NE in Medina City, Saudi Arabia. Method: A cross-sectional observational study was conducted among adults in Medina through September and October 2023, using a questionnaire composed of socio-demographic characteristics and adults' knowledge and awareness of NE. A statistical analysis was performed using SPSS software. Results: The study was conducted among 553 adults in Medina, with a mean (standard deviation [SD]) age of 37.69 (10.775). Most participants (94.8%) were Saudi nationals, of which 84.4% were females, 76.3% were married, and 97.1% were urban residents with university degrees (80.3%). The mean (SD) total score of knowledge and awareness was 4.69 (1.783) out of 9 and 6.49 (2.167) out of 12, respectively. Being female (p < 0.001), with a university degree (p = 0.002), and knowing about enuresis in children (p = 0.011) are significant factors affecting adults' knowledge with higher scores than others. Conclusions: An inadequate knowledge and awareness level of NE in children was revealed among adults living in Medina City, Saudi Arabia. These results emphasize the need for targeted educational campaigns to enhance adults' knowledge and awareness of enuresis.

Autonomic nervous system dysregulation in children with monosymptomatic nocturnal enuresis.

AIM: To investigate the role of autonomic nervous system in subpopulations of children with enuresis. METHODS: We included 35 children with enuresis, divided in children with (17) and without nocturnal polyuria (18) and 43 healthy controls. For all participants hormones and neurotransmitters were measured. Patients and controls wore a sleep tracker device and children with enuresis underwent a 24 h blood pressure monitoring, nocturnal urine output measurement and uroflowmetry. RESULTS: Children with enuresis had lower than controls copeptin and aldosterone, with the latter being more prominent in patients without nocturnal polyuria. Dopamine was lower in patients without nocturnal polyuria compared with patients with nocturnal polyuria. Children without polyuria experienced episodes only during NREM sleep, whereas in children with polyuria episodes occurred in both REM and NREM sleep. Children with enuresis experienced a non-dipping phenomenon during sleep which was more prominent in the group without polyuria. CONCLUSION: In patients with nocturnal polyuria, nocturnal enuresis is associated with sympathetic hyperactivity which results in pressure polyuria and significantly lower systolic dipping during sleep. On the contrary, in children without nocturnal polyuria, it is mostly associated with bladder overactivity due to parasympathetic overstimulation as demonstrated by the NREM-related enuretic episodes and the lower aldosterone and dopamine levels.

Effectiveness of bladder retraining programme on bedwetting frequency and relapse rate of children with nocturnal enuresis.

BACKGROUND OF THE STUDY: Nocturnal enuresis, or bedwetting, is a prevalent and emotionally challenging condition that has a significant impact on the behavior, psychological well-being, and social lives of school-aged children. AIM: This study aimed to assess the effectiveness of bladder retraining programme on bedwetting frequency and relapse rate among children with nocturnal enuresis. METHODS: The study was conducted in two phases. The Phase I included a survey questionnaire to identify the prevalence of nocturnal enuresis among school children studying in Grade I to Grade X of 3 selected schools in Nashik, India. Out of 2150 prevalence questionnaires, 1900 filled in questionnaires were received back. 226 children were found to be positive for monosymptomatic nocturnal enuresis. A total of 160 children were selected from which 80 samples were included in experimental group and 80 were in control group. A three-step bladder retraining program was provided for parents and children in the experimental group. The parents and children from experimental group were called on the 15th day to reinforce the interventions. Posttests were conducted at 1st month (Posttest I), 3rd month (Posttest II), and 6th month (Posttest III/Relapse) for both experimental and control group. RESULTS: The total prevalence of nocturnal enuresis among 1900 school age children aged 6 years-15 years is found to be 11.89%. Out of the 226 enuretic children, majority 101 (44.69%) wet their beds 1-3 times per week while 48 (21.23%) children wet their beds Every night. Comparison of bedwetting frequency in both groups during Pretest, Posttest I, Posttest II and Posttest III using chi-square test showed that: In pretest there was no significant difference between children in experimental and control group as indicated by the non-significant P value 0.43. Whereas in posttest I, II & III, P value 0.001 indicates highly significant difference in bedwetting frequency of children in both the groups. Children in experimental group had a relapse rate of 3.75% and 100% relapse was observed in control group during posttest III (at 6th month). DISCUSSION: The study findings revealed a statistically significant reduction in bedwetting frequency within the experimental group (p = 0.001), contrasting with the control group's non-significant change (p = 0.17). Additionally, the relapse rate was markedly lower in the experimental group (3.75%) compared to the control group (100%). This aligns with Garcia-Fernandez and Petros' (2020) findings, where a squatting-based pelvic floor rehabilitation method demonstrated a significant reduction in bedwetting frequency, curing 86% of children. Van Kampen et al.'s (2009) study also supported the efficacy of pelvic floor muscle training in reducing relapse rates, providing further validation for the current study's findings. CONCLUSION: The 3 step bladder retraining programme was found to be very effective in reducing the bedwetting frequency and relapse rate among children. This study provides evidence supporting effectiveness of such tailored bladder retraining interventions in managing monosymptomatic nocturnal enuresis in school-aged children.

Sleep duration, sleep problems and developmental trajectories of urinary incontinence: a prospective cohort study.

To examine if preschool sleep duration and sleep problems are associated with urinary incontinence (UI) at primary school-age. We used multinomial logistic regression to examine the association of child sleep duration/problems (3½ years) with UI trajectories (4-9 years) in 8751 (4507 boys, 4244 girls) from the Avon Longitudinal Study of Parents and Children. We adjusted for sex, socioeconomic indicators, mothers' emotional/practical/financial support, developmental delay, stressful life events, temperament, and emotional/behaviour problems. Preschool children who slept more than 8½ hours per night had a decreased probability of UI at school-age. There was a 33% reduction in odds of daytime wetting per additional hour of sleep (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.52-0.86). Sleep problems were associated with increased odds of UI e.g., getting up after being put to bed was associated with daytime wetting (OR = 2.20, 95% CI 1.43-3.39); breathing problems whilst sleeping were associated with delayed bladder control (OR = 1.68, 95% CI 1.12-2.52), and night-time waking was associated with persistent (day and night) wetting (OR = 1.53, 95% CI 1.16-2.00). Waking during the night and waking up early in the morning were associated with reduced odds of bedwetting at school-age (OR = 0.76, 95% CI 0.61-0.96 and OR = 0.80, 95% CI 0.64-0.99 respectively). Preschool children who sleep for longer have a lower likelihood of UI at school-age, whilst those with sleep problems are more likely to experience daytime wetting and combined (day and night) wetting, but not bedwetting alone. Short sleep duration and sleep problems in early childhood could be indicators of future problems attaining and maintaining bladder control.

The relationship between lower urinary system symptoms and the level of independence and quality of life in children with Duchenne muscular dystrophy.

BACKGROUND: The purpose was to investigate the frequency of lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in Duchenne muscular dystrophy (DMD) and the relationship between these symptoms and independence and quality of life (QoL). METHODS: The cross-sectional study included children aged 5-18 years and diagnosed with DMD and their families. Data were collected using the Dysfunctional Voiding and Incontinence Scoring System (DVISS), the Barthel Index, and the Pediatric Quality of Life™ 3.0 Neuromuscular Module (PedsQL-NMM). RESULTS: The study was completed with 45 children with DMD. LUTS was found in 86.66% and LUTD was found in 44.44%. The most common symptom was holding maneuvers (62.22%). Other common symptoms were urinary urgency (55.55%), daytime urinary incontinence (46.66%), and enuresis (31.11%). There was a significant correlation of the DVISS with the level of independence and QoL (p < 0.05). Moreover, higher LUTS score was associated with lower Barthel and PedsQL-NMM scores. CONCLUSION: LUTS is a neglected condition, although it is frequently seen in children with DMD. CLINICAL TRIAL REGISTRATION: NCT05464446.

Management of the refractory nocturnal enuresis patient to desmopressin in a pediatric population: Desmopressin + oxybutynin vs. desmopressin + imipramine.

INTRODUCTION AND OBJECTIVE: Desmopressin is well accepted as first-line medical therapy for enuresis. If ineffective, combination therapy of desmopressin + oxybutynin or desmopressin + imipramine has been used. This study assessed the efficacy of adjunct therapy with either imipramine or oxybutynin in the management of enuresis patients who failed desmopressin treatment. STUDY DESIGN: A retrospective chart review of our database for patients with enuresis was performed. Patients who were prescribed desmopressin, oxybutynin, and imipramine over 14 years for enuresis were included. Two cohorts of patients were examined; group OXY was treated with desmopressin and oxybutynin, and group IMP received desmopressin and imipramine. Pretreatment measurement of Vancouver Symptom Scores (VSS) were used to compare groups using the VSS question "I wet my bed at night" where 4: every night, 3: 4-5 nights per week, 2: 1-2 nights per week, 1: 3-4 nights per month, and 0: never. International Children's Continence Society (ICCS) criteria for continence success was utilized to determine outcomes. RESULTS: 2521 patients prescribed one of the 3 medications were identified. Among them, 81 patients (mean age: 10.5 ± 2.8 years) received combination therapy. Of which, 55 were male and 26 female. Specifically, 58 were prescribed both desmopressin and imipramine (group IMP), 23 desmopressin and oxybutynin (group OXY), and 4 transitioned from OXY to IMP. Mean pretreatment VSS showed no difference between groups. Both groups experienced minimal drops in wet nights with desmopressin alone. A comparison revealed that group IMP reduced wet nights significantly more than group OXY (VSS wet night score 0.7 ± 1.2 vs. 2.3 ± 1.1 respectively, p < 0.0001). Non-intent-to-treat complete response rate was 68% vs 5% (OR = 42.5, p < 0.001) (IMP vs. OXY respectively). Intent-to-treat response rates were 58%. DISCUSSION: Although first-line desmopressin treatment for enuresis is effective, it does not work for all patients, and many parents and children desire nighttime dryness. Clinicians have combined desmopressin with oxybutynin or imipramine for improved results, but research comparing these modalities is scarce. Our study suggests that the desmopressin and imipramine combination is superior at reducing nights wet compared to desmopressin and oxybutynin, attributed to imipramine's probable central mechanism rather than its secondary anticholinergic properties. Limitations include a modest sample size, retrospective design, and subjective responses to the Vancouver questionnaire. CONCLUSION: A combination of desmopressin and imipramine was more effective in reducing wet nights and had a complete response rate that was 42.5 times greater than desmopressin and oxybutynin.

Diurnal rhythm of urinary aquaporin-2 in children with primary monosymptomatic nocturnal enuresis.

Background/aim: Nocturnal enuresis can be frustrating for children and their families as the child ages. Our aim is to evaluate urine aquaporin 2 (AQP-2) as a noninvasive biomarker of water balance in children with primary monosymptomatic nocturnal enuresis (PMNE). Material and methods: The study included 90 children; sixty-eight children suffering from PMNE aged (9.57 ± 2.16) years and 22 healthy children with good toilet control, matched sex and age. All enuretic children were subjected to complete history taking, clinical evaluation, and bed wetting diary. Serum arginine vasopressin (AVP) and urine AQP-2 were tested in the morning (at 9-11 am) and evening (at 9-11 pm). Blood urea, creatinine, Na, glucose, urine osmolality, Ca/Cr, Alb/Cr and specific gravity were tested simultaneously. Results: Serum AVP, urine AQP-2, and urine osmolality were statistically lower in patients than controls. Patients had a significantly lower level of night serum AVP concentrations, urine AQP-2, and urine osmolality than the corresponding morning level. Urine AQP-2 was significantly correlated with urine osmolality (p < 0.05). AQP-2 had a sensitivity of 90% and a specificity of 70%. However, no statistically significant correlation was found between serum AVP and urine AQP-2. Conclusion: Primary monosymptomatic nocturnal enuresis in children could be associated with reduction of urine excretion of AQP-2 at night. Urine AQP-2 is significantly correlated with urine osmolality. Therefore, it may be a noninvasive biomarker of hydration status in children with PMNE, with good sensitivity and specificity.

Voiding camp: A successful and unique bladder rehabilitation program for children with urinary incontinence.

INTRODUCTION & BACKGROUND: Standard urotherapy is a well-established treatment for children with incontinence, although it is often challenging for both child and parents, and not always successful. As an alternative, several in- and outpatient bladder training programs have shown positive results on achieving continence. However, the disadvantage is the hospital environment, which can be more stressful for the child, and also quite expensive for society. OBJECTIVE: The aim was to evaluate the outcome on achieving continence following a voiding camp, where standard urotherapy was applied during a one-week stay at a regular summer youth camp, outside the hospital. STUDY DESIGN: Retrospective analysis of 105 children with urinary incontinence, followed in an expert centre for urinary incontinence for at least one year. Data at 7 different time points, before, during and until 6 months after voiding camp were collected. RESULTS: Even though all children had regular follow-up in an expert centre for urinary incontinence for at least one year before participating voiding camp, only 15% of the children reached the recommended amount of daily fluid intake (1.5 L/day). Once minimal daily fluid intake was re-established during the voiding camp, an immediate increase in the maximum voided volume (MVV), and a decrease in the number of wet days and wet nights per week was noted. This effect on a higher MVV remained even 3 months after voiding camp. DISCUSSION: Although sufficient daily fluid intake is a well-established part of standard urotherapy, up until now there was no data that proved the positive impact of sufficient daily fluid intake on bladder volume training and achieving continence in children. CONCLUSION: Voiding camp, as an unique bladder rehabilitation program for children with incontinence, is a successful alternative treatment option. Optimizing the daily fluid intake during voiding camp had a major positive impact on bladder volume training and achieving continence in children.

Short communication: A pilot study to determine safety and feasibility of a commercial enuresis alarm to detect voiding in infants.

Accurate measurement of post-void residual (PVR) volumes requires accurate determination of the timing of voiding, which is challenging in non-verbal patients. As a proof of principle, we sought to test the feasibility, safety and efficacy of using an enuresis alarm to indicate voiding in ten infants. Each infant was observed for 4 h with alarm in the diaper, and diapers checked every 15-30 min to confirm voiding. The alarm activated in 31 of 33 voids (93.9%). No adverse events occurred. Further work will investigate whether this approach may improve accuracy of PVR measurement.

Elimination disorders and associated factors among children and adolescents age 5-14 year-old attending paediatric outpatient clinic at Wolaita Sodo University comprehensive specialized hospital, South Ethiopia.

BACKGROUND: Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5-14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. METHOD: A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value < 0.05 were used to determine the predictors of the outcome variable. RESULT: The overall magnitude of elimination disorder among children and Adolescents age 5-14 in this study was (n 70, 16.8%); in boys (n 47, 17.3%) and girls (n 23, 15.75%). The prevalence of enuresis was (n 64, 15.3%), encopresis (n 15, 3.6%), both enuresis and encopresis, or combined elimination disorder (n 9, 2.2%). Age 9-11 years (AOR = 3.2, 95%CI:1.09, 9.43), family size four and above (AOR = 3.4, 95%CI:1.78, 6.56), family history of elimination disorder (AOR = 3.9, 95%CI:2.12, 7.45), emotional problem (AOR = 2.2, 95%CI:1.18, 4.05), hyperactive problem (AOR = 3.8, 95%CI:1.83, 7.83), low toilet training skills (AOR = 5.9, 95%CI:2.61, 13.33), bad parenting practices, were poor supervision (AOR = 4.4, 95%CI 1.29, 14.69) were significantly associated with elimination disorder. CONCLUSION AND RECOMMENDATION: In this study, approximately one in five children and adolescents had an elimination disorder. Younger age, family size four and above, positive family history of elimination disorder, presence of emotional and hyperactive problems, bad parenting practices, and low toilet training skills were factors associated with elimination disorders. Therefore, preventative, etiological, and therapeutic measure, early toilet training, supportive parenting practices, screening for children's and adolescents' behavioral problems, and elimination disorders need attention to reduce the effect of the problem.

Parental perception of nocturnal enuresis in a local region of Saudi Arabia.

Nocturnal enuresis (NE) has been associated with neurodevelopmental disorders such as autism spectrum disorder, attention deficit or hyperactivity disorder, and intellectual disability. This study aimed to assess parents' perception of NE in children in the eastern region of Saudi Arabia. We conducted a cross-sectional study from May to August 2023, including parents aged ≥18 years living in the area. We administered an online questionnaire to assess parents' knowledge and attitudes toward NE and its treatment. A total of 616 parents completed the questionnaire, 71.4% of which were women, 35% were aged between 25 and 35 years, 75% were married, 65% had a university degree, and 49% had three or more children. In total, 70% demonstrated a good overall knowledge about NE and its treatment, and nearly 60% had a positive attitude toward the condition. Univariate and multivariate ordinal logistic regression analyses revealed that female sex, a higher level of education, and having more than one child were associated with a higher score regarding attitude toward treatment. The level of education and the number of children were predictors of knowledge and a positive attitude toward NE in children.

Transition in enuresis patients: Identifying the gaps and opportunities for the future.

BACKGROUND: Nocturnal enuresis is generally considered a children's condition, yet it may persist 1%-2% in adolescence and early adulthood. Refractory patients often demand follow-up by multidisciplinary teams, which is only restricted to some of the expert tertiary centers. However, there are no standardized transition programs/guidelines when follow-up must be passed from pediatric to adult healthcare providers. AIM, MATERIALS & METHODS: To investigate this issue, we conducted a literature search on enuresis transition, which resulted in no articles. We, therefore, proceeded in a rescue search strategy: we explored papers on transition programs of conditions that may be related and/or complicated by enuresis, nocturia, or other urinary symptoms (chronic diseases, CKD, bladder dysfunction, kidney transplant, neurogenic bladder). RESULTS: These programs emphasize the need for a multidisciplinary approach, a transition coordinator, and the importance of patient and parent participation, practices that could be adopted in enuresis. The lack of continuity in enuresis follow-up was highlighted when we investigated who was conducting research and publishing on enuresis and nocturia. Pediatric disciplines (50%) are mostly involved in children's studies, and urologists in the adult ones (37%). DISCUSSION: We propose a stepwise approach for the transition of children with enuresis from pediatric to adult care, depending on the clinical subtype: from refractory patients who demand more complex, multidisciplinary care and would benefit from a transition coordinator up to children/young adults cured of enuresis but who persist in having or present lower urinary tract symptoms (LUTS)/nocturia later on. In any case, the transition process should be initiated early at the age of 12-14 years, with adequate information to the patient and parents regarding relapses or LUTS/nocturia occurrence and of the future treating general practitioner on the enuresis characteristics and comorbidities of the patient.

An Economic Evaluation of a Web-Based Management Support System for Children With Urinary Incontinence: The eADVICE Trial.

PURPOSE: Children who require specialist outpatient care typically wait substantial periods during which their condition may progress, making treatment more difficult and costly. Timely and effective therapy during this period may reduce the need for lengthy specialist care. This study evaluated the cost-effectiveness of an individualized, evidence-informed, web-based program for children with urinary incontinence awaiting a specialist appointment (Electronic Advice and Diagnosis Via the Internet following Computerized Evaluation [eADVICE]) compared to usual care. eADVICE was supervised by a primary physician and delivered by an embodied conversational agent. MATERIALS AND METHODS: A trial-based cost-effectiveness analysis was performed from the perspective of the health care funder as a substudy of eADVICE, a multicenter, waitlist-controlled, randomized trial. Outcomes measures were incremental cost per incremental change in continence status and quality of life on an intention-to-treat basis. Uncertainty was examined using cost-effectiveness planes, scenarios, and 1-way sensitivity analyses. Costs were valued in 2021 Australian dollars. RESULTS: The use of eADVICE was found to be cost saving and beneficial (dominant) over usual care, with a higher proportion of children dry over 14 days at 6 months (risk difference 0.13; 95%CI 0.02-0.23, P = .03) and mean health care costs reduced by $188 (95%CI $61-$315) per participant. CONCLUSIONS: An individualized, evidence-informed, web-based program delivered by an embodied conversational agent is likely cost saving for children with urinary incontinence awaiting a specialist appointment. The potential economic impact of such a program is favorable and substantial, and may be transferable to outpatient clinic settings for other chronic health conditions.

Enuresis in young offenders - a study on prevalence and mental health comorbidity.

Background: Enuresis is a common disorder in the school-age period, and is often associated with a variety of behavioral, psychological, and social problems. While early studies suggested an association between enuresis and delinquent behavior, there has been no recent research assessing the prevalence of enuresis and its comorbid psychopathology in young offenders. The aim of this study was to therefore assess the prevalence of enuresis and its associated psychiatric comorbidity in incarcerated young offenders. Methods: The prevalence of past and current enuresis and comorbid psychopathology was assessed using a semi-structured psychiatric interview and self-reports from 366 incarcerated male young offenders [age 14 to 19 years (mean age = 16.4)] from Northern Russia. Results: Seventy-three (20.0%) adolescents reported a previous history of enuresis, and in addition almost 10% of the youth reported current enuresis symptoms. Delinquent youth with enuresis did not significantly differ from other youth in the prevalence of comorbid psychiatric diagnoses when assessed by a clinical diagnostic interview, but had significantly higher levels of self-reported mental health problems, and suicidal ideation and attempts. Conclusion: Problems with enuresis are common among delinquent youth and may be associated with increased mental health problems. Given the potentially increased risk for suicidal thoughts and behavior in young offenders with enuresis, comprehensive mental health screening of those who are detected with this condition should be considered in the juvenile justice system.

NITES, a nocturnal bladder score to aid diagnosis during the transition to older age care.

BACKGROUND: As adults transition to older age, bothersome nocturnal lower urinary tract symptoms (LUTS) become common. There is need for a reliable assessment metric to detect and measure specific symptoms. OBJECTIVE: To subject the nocturnal LUTS score for older individuals, Nocturia, Incontinence, Toileting and Enuresis Symptom Score (NITES), to psychometric analysis. MATERIAL AND METHODS: Factor analysis of the metric was conducted with completed questionnaires from 151 older individuals who were either admitted to a tertiary hospital or attending an outpatient continence clinic. Test re-test reliability involved 18 older community dwelling individuals attending a Geriatrician clinic completing the metric at two timepoints separated by at least 1 week. Intra-class correlation coefficients were determined for reliability of each factor and item. RESULTS: The NITES metric was completed by 98 hospitalized older individuals and 53 attending a continence clinic (mean age 83.2 years [SD 7.0]). Factor analysis demonstrated that one item had a floor effect and two items had poor endorsement. After test re-test reliability analysis, a further three items were removed: one due to poor correlation between timepoints and two demonstrating inadequate internal consistency. The final NITES metric is comprised of three factors: Sleep 4-items, Incontinence 4-items, and Personal Bother 2-items. A 4-item short form for symptom screening was extracted from the longer measure. CONCLUSION: The final NITES metric is a 10-item questionnaire with an embedded 4-item short symptom screen. It has utility utilized to detect nocturnal bladder symptoms in both community dwelling and hospitalized older adults.