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Hypothesis/aims of study Two percent of adolescents and adults suffers from enuresis. In this age group, social problems can arise. We evaluated the effect of a Modulated Dry Bed Training (MDBT) in a previously therapy-resistant group of adolescents and adults with enuresis, provided by a specialized enuresis-centre. Study design, materials and methods Descriptive, retrospective cohort study. Between January 2003 and July 2013, 907 patients were treated by MDBT: a 5-days/4- nights in-hospital training in small groups consisting of enuresis-anamnesis, explanation, alarm treatment, day-time activities with the purpose of increasing self-esteem and group contact. We contacted patients by phone during follow-up. Patient data were retrospectively derived from medical files and put in a database. Success of treatment was determined using International Children's Continence Society (ICCS)-definitions, at 6 weeks, 3 and 6 months. Secondary outcome was the medication use after treatment. Sensitivity analyses were performed to control for missing values, and expressed in a best case and a worst case scenario. Results Patients were aged 11-42 years (median 15, IQR 3.5), 34% female. At baseline, 65% had primary enuresis, 81% nonmonosymptomatic enuresis, and 46% frequent enuresis (≥4 days/week). After 6 weeks, 46% (CI95% 43-50) and 41% of patients had a full or partial response, respectively. After 6 months this was 68% (CI95% 65-72) and 25%. Results from the sensitivity analysis are shown in the table. Interpretation of results The treatment response at six months can be considered to be quite high, as this is a formerly therapy-resistant group of enuresis patients. However, the sensitivity analysis shows that, owing to the large amount of missing values, the real number of patients having a full response after six months will lie between 43% and 80%. Concluding message MDBT was shown to have an adequate short term effect in therapy resistant adolescents and adults with enuresis. (Table Presented).

Contains fulltext : 89031.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To teach children to perform clean intermittent self-catheterization (CISC) at our institution, the nurse practitioner uses a step-by-step approach in combination with an instruction model in an outpatient setting. For a small group of children the procedure remains difficult to learn. For them, we developed a multidisciplinary, group-wise training program. PATIENTS AND METHODS: Small groups of children, aged 7-12 years, and their parents consulted our clinic during six meetings. The group training was provided by a pediatric urology nurse practitioner, physiotherapist and behavioural practitioner. Using a tell/show/do method each intervention was instructed group wise. The actual CISC was performed individually within a private setting. Elements of the training were: sharing of mastery and difficulties with other children/parents, cognitive restructuring to enhance understanding and motivation, handling and trying out of devices, relaxation as a response to physical stress, and supporting parental guidance. RESULTS: The preliminary results of seven children were successful after group-wise intervention. Children were less anxious and more cooperative. Parents could share their difficulties dealing with their child at home and were given suggestions to help their children with CISC. CONCLUSION: Group interactions and a multidisciplinary approach seems to be of great help in learning CISC for selected children. 01 juni 2010