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Aim: To detect effects of desmopressin on sleep in enuretic children and to look for polysomnographical differences between responders and non-responders to desmopressin treatment.Methods: Twenty-one children with primary nocturnal enuresis were examined polysomnographically before treatment. All but one of the children then received treatment with desmopressin in standard dosage, and the response was documented. Seven of the children underwent a second polysomnographic registration while on treatment.Results: The time interval (+/- 1 SD) between sleep onset and the enuretic episode was 92 +/- 67 min without medication and 372 +/- 157 min when desmopressin was given (p = 0.003). Standard polysomnographic variables were not affected by the drug. Ten children were desmopressin responders and 10 were non-responders. The total sleep time was 455 +/- 56 min in the former and 408 +/- 31 min in the latter group (p = 0.04). The responders spent 27.4 +/- 5.5% of their total sleep time in rapid eye movement sleep, compared with 18.2 +/- 6.5% in the non-responder group (p = 0.004).Conclusion: Desmopressin has no major effects on sleep as such but does delay bladder emptying. Enuretic children responding to desmopressin treatment have more rapid eye movement sleep than therapy-resistant children. [ABSTRACT FROM AUTHOR]

This review aims to provide researchers and clinicians involved with the adult lower urinary tract with background knowledge regarding the early development of bladder function and its most common disturbances in childhood. Bladder development begins in weeks 4-6 and the detrusor muscle is formed during weeks 9-12 of gestation. Higher CNS centres are involved in micturition at birth, and the infant usually wakes up, at least briefly, to void. Voiding during the first years of life is often incomplete, owing to detrusor-sphincter dyscoordination, but this disappears when bladder control is attained. Approximately 5-10% of 7-year-old children suffer from daytime incontinence and/or nocturnal enuresis, and a few per cent of them will not outgrow it. Daytime incontinence in childhood is usually attributable to detrusor overactivity, although it is unclear to what extent it is the detrusor or the micturition reflex per se that is overactive. Enuresis - nocturnal incontinence - is caused by either nocturnal polyuria and/or nocturnal detrusor overactivity, in both cases combined with high arousal thresholds. Bladder problems in childhood constitute a risk factor for the development or persistence of bladder problems in adulthood. [ABSTRACT FROM AUTHOR]

Objective To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin. Patients and methods Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long-term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6-week dose-titration period with desmopressin, the children were classified into four groups depending on the response rate. Results The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found. Conclusion Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 µg desmopressin and who do not wet frequently. [ABSTRACT FROM AUTHOR]

Vesico-ureteric reflux and non-neurogenic bladder dysfunction are closely related, although a causal relationship has been established only for severe forms of detrusor-sphincter dyscoordination. There are several urodynamic studies reporting high frequency of bladder instability and/or detrusor-sphincter dyscoordination in children with reflux. The latter includes an element of functional outflow obstruction and is the most serious, since it accompanies kidney damage. When instability is the only urodynamic abnormality damage is absent. There are indications that treatment of bladder dysfunction increases spontaneous resolution of reflux and, furthermore, that bladder dysfunction is a negative prognostic factor following antireflux surgery. Recently also, gross reflux in infant boys was seen to associate with bladder dysfunction in addition to earlier finding of congenital malformation of the ureterovesical junction. However, no comparisons have emerged on the outcome following treatment of bladder dysfunction and following observation only. In conclusion, children with reflux on chemoprophylaxis prior to reimplantation must always be assessed for bladder dysfunction. This is especially important when there are recurrent urinary tract infections. [ABSTRACT FROM AUTHOR]

Objective To study the long-term efficacy and safety of desmopressin treatment in children with primary monosymptomatic nocturnal enuresis. Patients and methods Children (aged 6–12 years) with nocturnal enuresis were recruited into an open multicentre trial. All children underwent an observation period of 4 weeks before starting a 6-week dose-titration period with desmopressin. If the number of wet nights decreased by more than half during medication, they began long-term treatment on 20–40 μg desmopressin. To test for cure and avoid overtreatment, the medication was interrupted for one week every third month. Results Of the 399 children forming the intention-to-treat cohort, 245 halved their number of wet nights and started long-term treatment. During the periods off medication, 77 children were dry and at the end of the study another 73 (still on medication) reduced the number of wet nights to ≤10% of that during the observation period. A further 51 children halved the number of wet nights compared with the observation period. No serious adverse events occurred. Conclusion Long-term treatment with nasal desmopressin at a main dose of 40 μg is an effective and safe treatment for monosymptomatic nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Isometric recordings of mechanical activity in muscle strips from rat and human detrusor were performed and the effect of μ- and δ-opioid receptor stimulation and blockade on detrusor contraction induced by electrical field stimulation was tested. Stimulation of the opioid μ-receptor with morphine (10-13-10-4 M) and DAGO (10-13-10-6 M) had no significant effect on electrical field stimulation except at one concentration of morphine (10-6 M). Naloxone (10-10-10-5 M) caused a significant facilitation of the electrical field stimulation-induced contraction, which was counteracted by morphine (10-8 M) and the δ-agonist DPDPE (10-8 M) in both rat and human detrusor. Addition of atropine (10-6 M) or hexamethonium chloride (10-6 M) or spantide (10-6 M) did not alter the facilitating effect of naloxone in the rat detrusor. Hexamethonium (10-5 M) decreased the facilitating effect of naloxone on electrical field stimulationinduced contractions in the human detrusor, indicating involvement of ganglionic mechanisms. In human detrusor about 15% of the contractile response was found to be atropine-resistant (10-6 M) and one third of this was found to be resistant to tetrodotoxin (1.5 × 10-6 M). The atropine resistant-response in human detrusor was facilitated by naloxone to the same extent as the atropine-sensitive part. Adrenergic blockade per se, achieved with phentolamine mesylate (10-6 M) and propranolol (10-6 M), caused a significant facilitation of the electrical field stimulation-induced contraction in the rat detrusor but did not affect the facilitating effect of naloxone (10-13-10-5 M). Addition of the δ-agonist DPDPE (10-13-10-5 M) did not significantly change the detrusor response to electrical field stimulation in rat detrusor, but the δ-antagonist naltrindole (10-13-10-5 M) caused a significant facilitation at the highest concentration. In human detrusor, DPDPE 10-8 M significantly reduced the response induced by electrical field stimulation. Conclusion: Blockade of the opioid receptors with naloxone facilitates the detrusor contraction elicited by electrical field stimulation. The existence of a tonic, inhibitory action on the detrusor nerve mediated detrusor contraction by opioid μ- and possibly δ-receptors is suggested. [ABSTRACT FROM AUTHOR]

Motility recordings in muscle strips from rat urinary bladder were performed and the effect of the opiate agonist loperamide on motor activity was studied. Loperamide induced a concentration-dependent (10−7-10−3M) inhibition of the contractile response of the detrusor strip of the same order of magnitude after activation of intramural nerves, stimulation of cholinergic receptors with acetylcholine and after direct depolarisation of the cell with potassium. Pretreatment with the opiate-antagonist naloxone (10−5M) did not antagonise the inhibitory action of loperamide on bladder motility regardless of the type of activation. Naloxone per se, however, facilitated the nerve-mediated motor response. The inhibitory action of loperamide on the potassium-induced contraction could partly be counteracted by elevation of the calcium concentration in the medium. It is suggested that the demonstrated inhibitory effect of loperamide on bladder motility is a calcium-dependent direct smooth muscle action, without any significant opiate-receptor-mediated action in the present in vitro preparation. [ABSTRACT FROM AUTHOR]

Objective To study changes in the urodynamic pattern during the first year of life in patients with myelomeningocele (MMC) and to correlate these to deleterious effects on the upper urinary tract. Patients methods Thirty-four infants with MMC were investigated using cystometry, micturating cysto-urethrography and urography at 1, 4 and 10 months of age. Results Detrusor contractility was characterized by an increase in activity, with hyper-reflexia in 45% initially, increasing to 65% at the 4-month investigation. During the same period, the number of infants with areflexia decreased from 25% to 12%. Between 4 and 10 months, there were only minor changes in detrusor contractility. The number of patients with poorly compliant bladders also increased between the first and fourth month. The number of patients with elevated outlet resistance increased only slightly during the first year, from 32% of all infants at the initial investigation to 40% at the 10-month follow-up. Vesico-ureteric reflux was detected in 12 of the patients during the year, with five already diagnosed at the first investigation. Almost all refluxes were cured with clean intermittent catheterization, with additional pharmacological therapy in two patients; one patient required a vesicostomy. Conclusions This study indicates that detrusor activity, and to some extent outlet resistance, change during the first year of life in infants with MMC. The changes were mainly increases in activity and occurred mostly between the first and fourth months of age. There was a strong correlation between the occurrence of reflux and poor compliance, hypercontractility and outlet obstruction. [ABSTRACT FROM AUTHOR]

Aim: During infancy bowel habits change. Most infants with gastrointestinal problems have a functional gastrointestinal disorder (FGID), a major reason for visiting paediatricians. This study aims to provide data on stool frequency and consistency during the first year, prevalence rates for functional constipation (FC) and to establish associations with relevant demographic data. The occurrence of infant colic (IC) and infant dyschezia (ID) was also reported., Methods: This prospective observational birth-cohort study enrolled 122 healthy full-term infants. Questionnaires were completed at 2 weeks and 2, 6 and 12 months., Results: Stool frequency decreased with age and consistency changed, with fewer runny stools. At 2 weeks, 24.3% had at least one of the studied FGID. FC was found in 2.6%-14.3% (up to 12 months), IC was found in 4.9%-3.4% (up to 2 months) and ID in 22.1%-3.9% (up to 6 months). Infants with an FGID had a lower weight and more healthcare visits than infants without. Breastfeeding and a high percentage of runny stools at 2 weeks of age decreased the odds of developing FC., Conclusion: Data on bowel habits and the prevalence of FC, IC and ID are presented. FGID during infancy is common and affects children's well-being, while their families need support and advice., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: In approximately one third of cases, congenital high-grade vesicoureteral reflux (VUR) diagnosed during infancy is seen together with lower urinary tract dysfunction (LUTD), characterised by a high-capacity bladder and incomplete emptying. In an earlier study, 20 of these infants were treated with clean intermittent catheterisation during a 3-year period and with surgical treatment of the VUR before catheterisation was ended. In the present study, bladder function was evaluated in these children at school age., Methods: Bladder function was evaluated in the 20 children at a mean age of 7.3 years using a validated voiding-bowel questionnaire with scores (cut-off score 7) and a urine flow/residual study., Results: Four children (20%) had a normal voiding function at follow-up, whereas 11 (55%) had a clear bladder/bowel dysfunction (scores 7-19) and five (25%) had a mild dysfunction (score 6). Ten (63%) of the children with any dysfunction were recognised as dysfunctional voiding. Recurrent febrile urinary tract infections were correlated with the scores of faecal questions (P = .041), but for total scores P = .058., Conclusion: The follow-up of bladder function in children at 7.3 years, diagnosed with high-grade VUR and LUTD in infancy, revealed bladder/bowel dysfunction of varying severity in the majority of cases., (© 2019 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)