Periaqueductal gray subregions connectivity and its association with micturition desire-awakening function.

Existing literature strongly supports the idea that children with primary nocturnal enuresis (PNE) have brainstem abnormalities. However, the connection between pre-micturition arousal responses and brain functional connectivities is still not clearly defined. Our study investigated the correlation between the gradations of micturition desire-awakening (MDA) functionality and the functional connectivity of the midbrain periaqueductal gray (PAG), a pivotal brainstem hub implicated in the neural regulation of micturition in humans. Neuroimaging and behavioral data from 133 patients with PNE and 40 healthy children were acquired from functional magnetic resonance imaging (fMRI) and precise clinical observations, respectively. The whole-brain correlation analyses were undertaken to elucidate the complex connectivity patterns between the subregions of PAG and the cerebral cortex, with a focus on their correlation to the spectrum of MDA functionality. A positive correlation was identified between MDA dysfunction and the resting-state functional connectivity (RSFC) between the left ventrolateral periaqueductal gray (vlPAG) and the right temporal pole of the superior temporal gyrus. Conversely, a negative correlation was observed between MDA dysfunction and the RSFC of the right vlPAG with the right superior parietal lobule. Additionally, MDA dysfunction exhibited a negative association with the RSFC between the dorsomedial PAG (dmPAG) and the right inferior parietal lobule. These findings may indicate that the specific signal from a distended bladder is blocked in the PAG and its functional connectivity with the executive function, attention, and default mode networks, ultimately leading to impaired arousal and bladder control. This revelation underscores potential neural targets for future therapeutic interventions.

Abnormal microstructure of corpus callosum in children with primary nocturnal enuresis: a DTI study.

Primary nocturnal enuresis (PNE) is a common childhood disorder with abnormal sleep or arousal. The corpus callosum (CC) continues to develop into adulthood and plays an important role in sleep arousal. This study aimed to evaluate the microstructure of the CC in children with PNE. Diffusion tensor imaging (DTI) indices were extracted throughout the CC and its seven subregions were compared between the children with PNE and healthy children (HC). The correlation between abnormal DTI indices of the CC and cognitive condition was also tested. Compared to HC, decreased fiber number (NF) (F = 8.492, PFDR = 0.032) and fractional anisotropy (FA) value (F = 8.442, PFDR = 0.040) were found in the posterior midbody of the CC, increased RD was found in the posterior midbody (F = 6.888, PFDR = 0.040) and isthmus (F = 7.967, PFDR = 0.040) in children with PNE. The reduction of FA value was more obvious in boys than girls with PNE. In children with PNE, there was a significant positive correlation between the NF of the posterior midbody and full IQ (r = 0.322, P = 0.025) and between the FA value and the general knowledge memory (r = 0.293, P = 0.043). This study provides imaging evidence for abnormalities in the microstructure of the CC in children with PNE, especially in male PNE, which might affect the children's cognitive performance.

The role of primary nocturnal enuresis in the aetiology of overactive bladder syndrome.

Introduction: The aim of this study was to investigate the effect of nocturnal enuresis (NE) in childhood on the development and course of overactive bladder (OAB) in adulthood. Material and methods: Between January and September 2021, data from patients who visited the Urology Outpatient Clinic with OAB symptoms were collected. Patients with a history of diabetes mellitus, neurological diseases, bladder outlet obstruction, active urinary system infection, or previous medical treatment for OAB and those who did not agree to join the study were excluded. Patients with a diagnosis of NE in childhood were classified as group 1, and patients without a diagnosis of NE were classified as group 2. Demographic data were recorded. Frequency of incontinence, and the number of daytime voids and nocturia were evaluated according to a three-day voiding diary. In addition, the maximum urinary flow ratio (Qmax), bladder wall thickness, and postvoid residual volume were determined using uroflowmetry and pelvic ultrasound. Results: After applying the inclusion/exclusion criteria, the mean age of the study group of 103 patients, consisting of 34 women and 69 men, was 32.85 ±11.20 years (18-65), and the mean BMI of both groups was 26.62 ±3.34 (19.49-39.18). Sixty-five of 103 patients (63.1%) had a history of childhood NE diagnosis. Patients in the group with a history of NE were younger than those without a history of NE. Conclusions: The earlier onset and more intense course of OAB symptoms in patients diagnosed with NE in childhood suggests that NE may be a triggering factor in the aetiology of OAB.

Analysis of current situation and risk factors of primary nocturnal enuresis in adolescents / 现代泌尿外科杂志

【Objective】 To investigate the prevalence and risk factors of primary nocturnal enuresis (PNE) in adolescents, and to explore its psychological effects. 【Methods】 During Sep.2020 and Dec.2020, an epidemiological survey was conducted among 6 408 junior and senior high school students in a region of Henan Province by stratified and cluster random sampling. The survey included general information questionnaire, urinary frequency, urgency, incontinence, recurrent urinary tract infection (RUTI), Enuresis Questionnaire, Self-esteem Scale (SES) and the Pittsburgh Sleep Quality Index (PSQI). 【Results】 A total of 7, 000 questionnaires were distributed and 6 408 (91.54%) were valid. The survey showed that the total prevalence of PNE among adolescents was 2.98%. The prevalence was 4.67% in those aged 12 years and 1.37% in those aged 18 years. The results of Logistic regression analysis showed that male (OR=1.677, P<0.05), overweight (OR=1.842, P<0.05), urgency (OR=1.676, P<0.05), frequency (OR=1.919, P<0.05), incontinence (OR=3.493, P<0.001), RUTI (OR=2.535, P<0.001) and family history (OR=3.005, P<0.001) were related to the risk of PNE. The SES score of PNE patients was lower than that of non-PNE group (z=-3.097, P<0.05), and the PSQI was higher (z=-5.456, P<0.05). 【Conclusion】 The prevalence of PNE is high in adolescents and decreases gradually with age. Male, overweight, frequency, urgency, incontinence, RUTI and family history are risk factors. PNE has a negative impact on self-esteem and sleep quality in adolescents.

Urodynamic evaluation of functional urinary incontinence in children / 现代泌尿外科杂志

Pediatric urinary incontinence (PUI) is common in clinical practice and seriously affects the quality of life as well as physical and mental health of patients. PUI is a multi-factorial related abnormality, very complex in etiology and types. The occurrence of PUI is mostly associated with abnormal vesicourethral function. Urodynamic examination (UDS) is the golden standard to assess voiding function and diagnose the type of bladder and urethral function in children with PUI. UDS of PUI is of great clinical value in determining the cause, making treatment protocol as well as evaluating the therapeutic response. However, UDS in children has not been popularized in China, which seriously affects the diagnosis and treatment of PUI. This article reviews the research progress in the clinical application of UDS in the evaluation of PUI, in order to provide reference for improving the diagnosis and treatment of this disease.

Abdomino-Pelvic Ultrasound Evaluation in Monosymptomatic Primary Nocturnal Enuresis.

BACKGROUND: Enuresis is one of the most common childhood problems. Our study aimed to evaluate children with enuresis by renal bladder ultrasound (RBUS) to detect urological abnormalities and to compare the sonographic findings with control group. METHODS: Our study included 30 children with primary monosymptomatic nocturnal enuresis (PMNE). Another 30 matched children with normal continence to urine were assigned as controls. The 2 groups were subjected to urine analysis, serum creatinine, and RBUS. RESULTS: Ultrasound showed abnormality in 10% of case group, which was not significantly different from controls (p = 1.000). CONCLUSION: Abnormalities discovered by ultrasonography in PMNE are more than in control group but without statistical significance and do not require invasive diagnostic tests. Children with sonographic abnormalities appear to be more resistant to treatment. We concluded that ultrasound is not necessary in MPNE and should be done in patients resistant to treatment.

Abnormal resting-state functional connectivity of hippocampal subregions in children with primary nocturnal enuresis.

Objective: Previous neuroimaging studies have shown abnormal brain-bladder control network in children with primary nocturnal enuresis (PNE). The hippocampus, which has long been considered to be an important nerve center for memory and emotion, has also been confirmed to be activating during micturition in several human imaging studies. However, few studies have explored hippocampus-related functional networks of PNE in children. In this study, the whole resting-state functional connectivity (RSFC) of hippocampus was investigated in children with PNE. Methods: Functional magnetic resonance imaging data of 30 children with PNE and 29 matched healthy controls (HCs) were analyzed in our study. We used the seed-based RSFC method to evaluate the functional connectivity of hippocampal subregions defined according to the Human Brainnetome Atlas. Correlation analyses were also processed to investigate their relationship with disease duration time, bed-wetting frequency, and bladder volume. Results: Compared with HCs, children with PNE showed abnormal RSFC of the left rostral hippocampus (rHipp) with right fusiform gyrus, right Rolandic operculum, left inferior parietal lobule, and right precentral gyrus, respectively. Moreover, decreased RSFC of the left caudal hippocampus (cHipp) with right fusiform gyrus and right supplementary motor area was discovered in the PNE group. There were no significant results in the right rHipp and cHipp seeds after multiple comparison corrections. In addition, disease duration time was negatively correlated with RSFC of the left rHipp with right Rolandic operculum (r = -0.386, p = 0.035, uncorrected) and the left cHipp with right fusiform gyrus (r = -0.483, p = 0.007, uncorrected) in the PNE group, respectively. In the Receiver Operating Characteristic (ROC) analysis, all the above results of RSFC achieved significant performance. Conclusions: To our knowledge, this is the first attempt to examine the RSFC patterns of hippocampal subregions in children with PNE. These findings indicated that children with PNE have potential dysfunctions in the limbic network, sensorimotor network, default mode network, and frontoparietal network. These networks may become less efficient with disease duration time, inducing impairments in brain-bladder control, cognition, memory, and emotion. Further prospective research with dynamic observation of brain imaging, bladder function, cognition, memory, and emotion is warranted.

Altered resting-state functional connectivity of insula in children with primary nocturnal enuresis.

Objective: Primary nocturnal enuresis (PNE) is a common developmental condition in school-aged children. The objective is to better understand the pathophysiology of PNE by using insula-centered resting-state functional connectivity (rsFC). Methods: We recruited 66 right-handed participants in our analysis, 33 with PNE and 33 healthy control (HC) children without enuresis matched for gender and age. Functional and structural MRI data were obtained from all the children. Seed-based rsFC was used to examine differences in insular functional connectivity between the PNE and HC groups. Correlation analyses were carried out to explore the relationship between abnormal insula-centered functional connectivity and clinical characteristics in the PNE group. Results: Compared with HC children, the children with PNE demonstrated decreased left and right insular rsFC with the right medial superior frontal gyrus (SFG). In addition, the bilateral dorsal anterior insula (dAI) seeds also indicated the reduced rsFC with right medial SFG. Furthermore, the right posterior insula (PI) seed showed the weaker rsFC with the right medial SFG, while the left PI seed displayed the weaker rsFC with the right SFG. No statistically significant correlations were detected between aberrant insular rsFC and clinical variables (e.g., micturition desire awakening, bed-wetting frequency, and bladder volume) in results without global signal regression (GSR) in the PNE group. However, before and after setting age as a covariate, significant and positive correlations between bladder volume and the rsFC of the left dAI with right medial SFG and the rsFC of the right PI with right medial SFG were found in results with GSR in the PNE group. Conclusion: To the best of our knowledge, this study explored the rsFC patterns of the insula in children with PNE for the first time. These results uncovered the abnormal rsFC of the insula with the medial prefrontal cortex without and with GSR in the PNE group, suggesting that dysconnectivity of the salience network (SN)-default mode network (DMN) may involve in the underlying pathophysiology of children with PNE. However, the inconsistent associations between bladder volume and dysconnectivity of the SN-DMN in results without and with GSR need further studies.

Prevalence, Risk Factors, and Psychological Effects of Primary Nocturnal Enuresis in Chinese Young Adults.

PURPOSE: This study aimed to investigate the prevalence, risk factors, and effects of primary nocturnal enuresis (PNE) on physical and mental health in young adults in mainland China. METHODS: An anonymous questionnaire was used to collect information including the sociodemographic characteristics, history of PNE, family history, daytime voiding symptoms, Pittsburgh Sleep Quality Index (PSQI) scores, Self-Esteem Scale (SES), and Self-Rating Depression Scale (SDS). A total of 22,500 university students from 23 provinces and 368 cities in mainland China were included. RESULTS: In total, 21,082 questionnaires were collected, and 20,345 of them qualified for statistical analysis. The PNE prevalence was 1.17%, and the distribution of monosymptomatic nocturnal enuresis (MNE) and nonmonosymptomatic nocturnal enuresis (NMNE) was 66.1% and 33.9%, respectively. In total, 28% of respondents with PNE reported bedwetting daily, 31.6% between 1 and 7 times weekly, and 40.4% between 1 and 4 times monthly; 80% of PNE cases had no history of treatment. The prevalence of PNE in patients with a family history, frequency, urgency, urinary incontinence, and recurrent urinary tract infections was significantly higher than in those without these conditions (P<0.001). PNE was significantly correlated with the PSQI total score (sleep quality) (P=0.011). The SES score was lower and the SDS was higher (P<0.001) in the PNE group than in those without PNE. CONCLUSION: In mainland China, the PNE prevalence among young adults was found to be high, and PNE had significant effects on physical and mental health. Risk factors included a family history, daytime voiding symptoms, and lack of treatment.

An Outcome Of Conservative Management Of Primary Nocturnal Enuresis In Children.

BACKGROUND: Primary nocturnal enuresis is one of the common problems in children. Mostly parents are concern for this condition in children and also children are depressive from this condition. The main stay of treatment is the training of child. The objective of this study was to look for the outcome of conservative management of primary nocturnal enuresis. METHODS: This study was done in OPD of paediatrics department. Patients aged five year or more were included in the study. Patient age, weight, sex, blood pressure, family history in siblings and parents, number of wet days/week, recorded on specific proforma along with renal function tests. Patients were advised fluid restriction after evening and micturition before sleep and after 2-3 hours of sleep. Follow up was done after six months to observe for the impact of habit change. Data has been analysed by SPSS 20 and results are taken significant with p-value <0.05. RESULTS: Out of 81 patients, 41 were male and 40 females. Age ranged from 5 to 14 years and mean age was 8.2±2.35 years. There were 11.1% parents who had primary nocturnal enuresis during childhood and in 29.6% siblings, history was positive. Follow up at 6 months, 58% patients improved while 42% showed no improvement. There was significant relationship between evening fluid restriction, micturition before and after sleep with improvement at 6 months with p-value of 0.010, <0.001 and 0.002 respectively. CONCLUSIONS: Conservative management is the effective intervention in children as parents should be emphasized for habit change.

Functional connectivity of thalamus in children with primary nocturnal enuresis: results from a resting-state fMRI study.

Primary nocturnal enuresis (PNE) is characterized by a low cure rate and a high reoccurrence rate, since its underlying mechanism remains unclear. Based on the recent studies that thalamus plays an important role in waking up a sleeping person, here we further investigate the functional connectivity (FC) information between thalamus and other brain regions, in order to make better understanding of the PNE's pathogenesis. In this study, we enrolled 30 children diagnosed with PNE and 30 typically developing children that are age and sex matched, the thalamus-based FC estimates were extracted at the resting-state. Experiments showed that for children with PNE, there were four brain regions found with a reduced connection efficiency with thalamus, that were cerebellum posterior lobe, frontal lobe, parietal lobe and precentral gyrus. It can be concluded that these relevant regions might induce an arousal disorder, and therefore further lead to PNE. This finding also provides a new insight in the pathophysiology of PNE.

Abnormal neurite orientation dispersion and density imaging of white matter in children with primary nocturnal enuresis.

Several lines of evidence indicate that multiple abnormalities of gray matter are related to the pathogenesis of primary nocturnal enuresis (PNE); however, few studies have been conducted with respect to abnormalities in white matter (WM) of children with PNE. The present work investigated the microstructure of WM in children with PNE using a neurite orientation dispersion and density imaging (NODDI) method. NODDI data were obtained from 29 children with PNE (age = 9.8 ± 1.2 years, 59% males) and 34 healthy controls (age = 10.3 ± 1.6 years, 56% males) in this study. Multi-b-value diffusion-weighted imaging data were acquired with a 3 T MR system, and the orientation dispersion index (ODI) and neurite density index (NDI) maps were calculated. Tract-Based Spatial Statistics analyses of WM tracts were performed with ODI and NDI maps in children with PNE and controls. Children with PNE had lower ODIs in WM fiber tracts of the bilateral superior longitudinal fasciculus (SLF) and higher ODIs in the bilateral internal capsule (IC) and right anterior thalamic radiation (ATR) than controls. PNE children also had lower NDIs in the bilateral IC and the cingulum and higher NDIs in the bilateral SLF. These changes in NODDI indices, which indicated abnormal neural maturation of the WM microstructures, may be related to abnormal sleep and enuresis in children with PNE.

Increased potassium excretion in children with monosymptomatic nocturnal enuresis: could it be related to Kir 4.1- KCNJ10 gene polymorphism?

BACKGROUND AND OBJECTIVES: There are controversial results in the literature regarding urinary electrolytes, especially potassium, in enuretic children. KCNJ10 channel protein, a member of the Kir 4.1 family is expressed in renal distal tubules and has an important function in renal ion transport. We investigated whether KCNJ10 gene polymorphisms are associated with clinical and laboratory findings of a group of Turkish children with monosymptomatic primary nocturnal enuresis (MNE). METHOD: Ninety-seven MNE children and 100 healthy controls were tested for three single nucleotide polymorphisms (SNPs) in the KCNJ10 gene. The transversions in SNPs were G to A for intron 1(SNP1), G to A for exon 2 (SNP2), and T to C transition for promoter (SNP3). All SNPs were genotyped by PCR-restriction fragment length polymorphism. RESULTS: SNP3 in promoter of KCNJ10 gene showed strong association with MNE children for distribution of genotype and allele frequency, while SNP1 in intron 1 and SNP2 in exon 2 were noninformative. The distribution of TT, TC, and CC genotypes for SNP3 was 66%, 26.8% and 7.2% respectively in MNE compared with 38%, 59% and 3% respectively in controls (p < 0.0001). In enuretic children, TT genotype was higher and there was an increased potassium excretion in children with TT genotype (P < 0.05). CONCLUSION: We conclude that KCNJ10 gene promoter polymorphism may have a role on potassium excretion in Turkish MNE children. This is the first study in literature evaluating KCNJ10 gene polymorphism in this patient population. Future studies investigating the other SNPs, mutations or altered regulation of Kir4.1 in larger samples would help clarify the role (s) of KCNJ10 gene in enuresis.

A comparative study of transcutaneous interferential electrical stimulation and transcutaneous electrical nerve stimulation on children with primary nocturnal enuresis: a randomized clinical trial.

INTRODUCTION: Nocturnal enuresis is an infrequent uncontrolled voiding during sleep in a child aged 5 years or more without any congenital or acquired disorders of the central nervous system. OBJECTIVE: To compare immediate and short-term effects of interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) in the treatment of children with primary nocturnal enuresis (PNE) in numbers of wet nights and quality of life (QoL). STUDY DESIGN: 52 children aged 7-14 (10.6 ± 1.9) having PNE, were assigned randomly into two groups (26 children for each group). Both IFC and TENS groups continued treatment session for 20 min, 3 sessions per week for 6 weeks. The outcome measures were the number of wet nights, and QoL through pediatric incontinence questionnaire (PinQ).The measurements were evaluated before treatment (Pre-), after the last session (Post-1), and 6 months later (Post-2). RESULTS: By comparing the Pre- and Post-1 mean values, the number of wet nights, reduced significantly (P < 0.05) in both groups, in favor of IFC group. Post-1 showed many children with full and good responses and few numbers with partial or no responses to IFC than TENS. Post-1 revealed that PinQ was significantly reduced in both groups in favor of the IFC group (P < 0.05). The values were slightly improved in both groups in Post-2, they were significantly different between Pre- and post-measurements in each group (P < 0.05). Comparison between both groups showed significant differences in the mean values between Post-1 and Post-2 in favor of IFC group (P < 0.05). CONCLUSIONS: IFC and TENS had immediate and short-term improvements in children with PNE by reducing numbers of wet nights and enhancing QoL in favor of the IFC group.

Abnormal Thalamic Functional Connectivity During Light Non-Rapid Eye Movement Sleep in Children With Primary Nocturnal Enuresis.

OBJECTIVE: To investigate abnormalities of thalamocortical and intrathalamic functional connectivity (FC) in children with primary nocturnal enuresis (PNE) during light non-rapid eye movement (NREM) sleep using a simultaneous electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) method. METHOD: Polysomnographic and EEG-fMRI data were obtained during sleep from 61 children with PNE (age 10.2 ± 1.7 years, 59% boys) and 61 age-matched controls (age 10.1 ± 1.4 years, 54% boys). All subjects first participated in one overnight video-polysomnographic study. Total sleep time, percentage of total sleep time in each sleep stage, arousal index, and awakening index were calculated. Simultaneous EEG-fMRI studies were then performed using a 3T MRI system with a 32-channel MRI-compatible EEG system. Visual scoring of EEG data permitted sleep staging. Thalamocortical and intrathalamic FCs in the waking state and at different stages of light sleep were calculated and compared. RESULTS: Children with PNE had a higher percentage of total sleep time in light sleep and a higher arousal index compared with controls. Abnormal thalamocortical FCs were detected in the lateral prefrontal cortex, medial prefrontal cortex, and inferior parietal lobule during light NREM sleep. Abnormal intrathalamic FCs were also detected during light NREM sleep among the motor, occipital, prefrontal, and temporal subdivisions of the thalamus. CONCLUSION: Abnormal prefrontal and parietal thalamocortical FCs, accompanied by abnormal intrathalamic FCs among the motor, occipital, prefrontal, and temporal subdivision of thalamus during light NREM sleep, may be related to abnormal sleep and enuresis in children with PNE.

Degree centrality of key brain regions of attention networks in children with primary nocturnal enuresis: A resting-state functional magnetic resonance imaging study.

Primary nocturnal enuresis (PNE) is always associated with attention impairment, some of which even could develop to attention deficit hyperactivity disorder. The mechanism of attention impairment is not clear, especially lacking of objective indicators of neuroimaging. The aim of this study is to explore the possible functional imaging mechanism of impaired attention in PNE children. A total of 26 PNE children and 26 age-matched normal controls were recruited. Resting-state functional magnetic resonance imaging (rs-fMRI) was performed on these children. Degree centrality (DC) of key brain regions of DAN (lFEF, rFEF, lIFG, rIFG, lIPS, rIPS), VAN (TPJ, VFC) and DMN (PCC, aMPFC, lAG, rAG) were calculated and compared between PNE and normal children. And the correlations between DC values and attention behavioral results were measured. Compared with normal controls, PNE children exhibited lower DC value in the right frontal eye field (rFEF), left inferior parietal sulcus (lIPS), right inferior parietal sulcus (rIPS), temporal parietal junction (TPJ) and left angular gyrus (lAG). The correct number of continuous performance test (CPT) in the PNE group was significantly lower than the normal controls and there was no significant difference in the reaction time between the two groups. The correlation between DC values and attention behavioral results in PNE showed that the DC values of PCC and lAG were negatively correlated with the correct number. This work indicates that the damage of the key brain regions of DAN, VAN and DMN might be the possible functional imaging mechanism of impaired attention in children with PNE.

Use of propranolol in children with primary nocturnal enuresis.

In nocturnal enuresis, motivational therapy, alarm therapy, and drug therapy, such as anticholinergics, imipramine, and sertraline, are the mainstay of treatment. In the present study, we used motivational therapy, oxybutynin, and propranolol in children with primary nocturnal enuresis to determine if propranolol is an effective treatment. Fifty-two children with primary nocturnal enuresis were included in the study. Firstly, motivational therapy was given for 1 month to all patients. Patients who failed the motivational therapy were randomly given oxybutynin or propranolol. The patients were re-evaluated after 1 month of drug therapy. There was not a significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis ( p > 0.05). Of 52 patients, 28 (53.8%) patients improved by motivational therapy. There were 14 patients in the oxybutynin group. One patient was excluded from the study because facial flushing and mouth drying developed in the first week of oxybutynin therapy. In oxybutynin group, 12 of 13 (92.3%) patients improved. There were 10 patients in the propranolol group. In the propranolol group, while nine (90%) patients did not improve, one patient had significant remission (90%, p < 0.001). No significant adverse reaction was noted during propranolol therapy. There was no significant difference between oxybutynin and propranolol groups for initial frequency of nocturnal enuresis (p > 0.05). A significant difference was found between the groups for the remission of nocturnal enuresis ( p < 0.001). Our findings showed that motivational therapy is the first line treatment in primary nocturnal enuresis, and oxybutynin but not propranolol is effective in patients who failed with the motivational therapy.

Parental perception and factors associated with treatment strategies for primary nocturnal enuresis.

OBJECTIVE: The aim was to investigate the factors influencing parents seeking reasonable managements for their child and their overall outlook toward primary nocturnal enuresis (PNE). STUDY DESIGN: We recruited 93 children with PNE from enuresis clinics and requested their parents to complete questionnaires regarding their child's medical history and behavior, their methods for coping with PNE, and their perception of enuresis. Logistic regression models were applied to investigate factors influencing the parents to adopt a positive approach toward enuresis and to subsequently seek a medical consultation. RESULTS: One-third of the parents had an encouraging attitude toward children with PNE, whereas slightly less than half reacted with anger. The more educated the father or the younger the child with NE, the larger the possibility of the parents utilizing a positive approach, such as encouragement, for coping with NE. Factors that influenced parents to seek medical consultation for NE were socioeconomic status, maternal educational level, and the age and birth order of their child. DISCUSSION: From our results, angry and frustrated parents (43.0%) were significantly more likely to punish their child for bedwetting than were parents who approached NE positively (comfort and encouragement; 33.3%). A lack of encouragement may negatively affect the self-esteem of children with NE. Moreover, an individual's self-esteem or confidence, both of which can help them eliminate NE, determines the person's behavioral response to bedwetting. In our study, approximately 50% of the parents who approached NE positively (comfort and encouragement) or inconsistently (ambivalence) reported that they comforted their child after bedwetting. CONCLUSIONS: Nearly half the parents reacted angrily to children with NE, and some parents even punished their child. The parents' socioeconomic background, education, and the age and birth order of the child were the factors associated with their seeking active treatment for NE. A father's education and young age of the child were factors that influenced parents who preferred positive approaches, such as encouragement, for coping with NE.

Noninvasive imaging of brain oxygen metabolism in children with primary nocturnal enuresis during natural sleep.

A series of studies have revealed that nocturnal enuresis is closely related to hypoxia in children with primary nocturnal enuresis (PNE). However, brain oxygen metabolism of PNE children has not been investigated before. The purpose of this study was to investigate changes in whole-brain cerebral metabolic rate of oxygen (CMRO2 ), cerebral blood flow (CBF), and oxygen extraction fraction (OEF) in children suffering from PNE. We used the newly developed T2-relaxation-under-spin-tagging (TRUST) magnetic resonance imaging technique. Neurological evaluation, structural imaging, phase-contrast, and the TRUST imaging method were applied in children with PNE (n = 37) and healthy age- and sex-matched control volunteers (n = 39) during natural sleep to assess whole-brain CMRO2 , CBF, OEF, and arousal from sleep scores. Results showed that whole-brain CMRO2 and OEF values of PNE children were higher in controls, while there was no significant difference in CBF. Consequently, OEF levels of PNE children were increased to maintain oxygen supply. The elevation of OEF was positively correlated with the difficulty of arousal. Our results provide the first evidence that high oxygen consumption and high OEF values could make PNE children more susceptible to hypoxia, which may induce cumulative arousal deficits and make them more prone to nocturnal enuresis. Hum Brain Mapp 38:2532-2539, 2017. © 2017 Wiley Periodicals, Inc.

Attention impairment in children with primary nocturnal enuresis:an event-related potentials study / 中华行为医学与脑科学杂志

ObjectiveTo explore the neural mechanism of attention impairment in children with primary nocturnal enuresis.MethodsERPs elicited by performing the continuous operation test(CPT) were assessed in 20 children with primary nocturnal enuresis and 20 normal children.The Go/Nogo measurements of enuretic group at central scalp(Cz) were compared with the normal children and analyzed.Results1.Behavior results: there was no significant difference in the reaction time,the correct number and the false number between primary nocturnal enuresis and control group(P>0.05).2.ERP:(1)Go stimulate:the latency of Go-N2 and P3 of the children with primary nocturnal enuresis were longer than the normal control group(Go-N2:(326.80±46.40)ms vs (295.90±38.27)ms,P3:(438.80±62.60)ms vs (402.60±39.74)ms),and the difference had statistic significance(P0.05).②Latency: the latency of Nogo-P2 of the children with primary nocturnal enuresis was longer than that of the normal control group((214.10±27.85)ms vs (198.30±19.16)ms),and the difference had statistic significance(P0.05).ConclusionAttention impairment in children with primary nocturnal enuresis might be caused by the information processing speed and conflict monitoring function obstacle,but it is not because the reactive inhibition dysfunction,thus result in the lack of arousal function and bedwetting.