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Aims: Primary nocturnal enuresis (PNE) is associated with the maturation of the central nervous system in children. Vitamin B12 and folate are involved in the metabolism, development, and maturation of the nervous system. We examined vitamin B12, folate, and ferritin levels in children with PNE. Methods: This retrospective study included children with and without PNE from a tertiary pediatric nephrology clinic. PNE was defined as nighttime bedwetting (≥2 nights per week) in children aged >5 years. Children with chronic diseases or neurological, psychiatric or urological abnormalities were excluded. Vitamin B12, folate, hemoglobin, hematocrit, and ferritin levels were obtained from medical health records. Results: The study included 86 patients with PNE and 90 age- and sex-matched controls. The PNE group had lower vitamin B12 (229 vs. 264 pg/mL; p=0.001) and folate (7.9 vs. 12.4 ng/mL; p=0.001) levels than the control group. Vitamin B12 deficiency was more common in children with PNE than in controls (40.7% vs. 25.6%; p=0.037). None of the children with PNE or controls had folate deficiency. The hemoglobin, hematocrit, and ferritin levels were similar between the two groups. Conclusions: Compared with controls, children with PNE had lower vitamin B12 and folate levels and a higher prevalence of vitamin B12 deficiency. Further studies are needed to determine whether vitamin B12 and folate supplementation can improve PNE symptoms. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis is a common childhood problem impacting the quality of life of children and families. Treatment with an enuresis alarm is recommended for 8–12 weeks by the International Children's Continence Society as first line management of monosymptomatic nocturnal enuresis. However, the effectiveness of alarm therapy varies between 80% and 45.9%. There is minimal evidence within the literature exploring the factors impacting this varying response to alarm therapy. Therefore, this literature review aims to explore factors that impact the effectiveness of the enuresis alarm as a treatment for nocturnal enuresis, in children aged 5–17 years. Literature searches were conducted on MEDLINE (Ovid), SCOPUS and CINAHL Databases. The PRISMA tool was used to report the data in the search strategy. The inclusion criteria of children aged 5 to 17 years was chosen based on International Children's Continence Society Guidelines. English language, academic journals and studies in the past 10 years were selected as additional inclusion criterion to identify the most recent, robust literature for the review. All 13 primary research articles were critiqued using the Caldwell Framework. Data were extracted and presented in table format highlighting study methodology, sample, duration of treatment, relevance to review topic and key findings. The findings highlight factors influencing the effectiveness of alarm therapy related to the impact on the child and family, heighten arousal to the alarm, the duration of therapy, age of child and the impact of overlearning. This review provides health professionals with an insight into strategies that may help children and their family to respond successfully to enuresis alarm treatment. [ABSTRACT FROM AUTHOR]

Background and aim: Nocturnal enuresis (NE) is prevalent in children and adolescents and affects their social life later. Therefore, the objective of this study was to ascertain laser acupuncture (LA) therapy's effect on NE in adolescent females. Methods: Sixty adolescent females diagnosed with chronic monosymptomatic nocturnal enuresis (MNE) were randomly divided into two equal groups: The intervention group (received LA and desmopressin) and the control group (received desmopressin only) (n = 30 each). Treatment was delivered and LA was used three times a week for 12 successive weeks. Abdominal ultrasonography and voiding calendar were used to assess bladder capacity and maximum voiding volume (MVV), respectively. The frequency of bed wetness was assessed throughout the trial period in a diary. Results: Statistically significant differences were reported in the intervention group. Bladder capacity significantly increased in the intervention group (LA and desmopressin) than in the control group. Conclusions: The results of this study suggest the beneficial influences of LA on MNE, despite the very poor quality of the literature's available evidence. [ABSTRACT FROM AUTHOR]

Objective: Nocturnal enuresis (NE) is one of the most common disorders in pediatric urology, and patients often turn to family physicians (FP) and pediatricians (P) initially. The aim of this study was to understand the awareness, self-confidence and suggestions of physicians regarding the management of NE. Materials and Methods: In this study, 360 FP and family medicine residents (FMR), as well as 280 P and pediatrics residents (PR), were contacted through a cellular phone texting system. A simple multiple-choice questionnaire (Surveymonkey®) consisting of 10 questions was used to gather data. The survey included questions about their experience, training, evaluation, and management of NE. Results: A total of 119 FPs and Ps (18.5%) filled the questionnaire. Thirty (25.21%) of the participants were P, 27 (22.69%) PR, 3 (2.52%) FP and 59 (49.58%) FMR. The rate of physicians who encounter at least 5 children with NE per month is 31.33%. The mean self-confidence in the management of NE was 4.5 out of 10. The self-confidence of pediatricians was significantly higher than that of PR and FMR (p<0.001, p<0.001). Most (n=78, 65.55%) of the participants stated that they received training on EN during medical faculty and 62 (52.10%) during residency. Psychological problems (89.92%), sleep disorders (78.15%), and excessive fluid intake (75.63%) were the most frequently considered factors in etiology. While most responders (75.63%) considered dietary regulation and behavioral interventions as the first-line treatment, 25.21% consult a pediatric urologist and only 1.6% recommend medical treatment. Conclusion: Although FP and P admit they had training on NE, they mostly felt incompetent to manage NE and exclusively avoided pharmacological treatment. [ABSTRACT FROM AUTHOR]

The article focuses on bedwetting (nocturnal enuresis) as a treatable condition that can have a significant impact on children's quality of life and their families. It reports that bedwetting is a common issue affecting seven-year-olds, teenagers, and adults, and it highlights the importance of understanding its impact, causes, and treatment options to provide timely and effective support to affected children.

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background We aimed to investigate if there was any relationship between screen time (ST) and the severity of primary monosymptomatic nocturnal enuresis (PMNE) and treatment success. Methods This study was conducted in urology and child and adolescent phsychiatry clinic in Afyonkarahisar Health Sciences University Hospital. After diagnosis patients were seperated by the ST for exploring causation. Group 1 > 120, Group 2

INTRODUCTION: This meta-analysis aimed to determine the comparative effectiveness of timed alarm device-assisted urotherapy vs. standard urotherapy alone in managing pediatric daytime urinary incontinence (pDUI). METHODS: A systematic literature search was performed in December 2021, with an update search in July 2022. Comparative studies assessing the pDUI treatment effectiveness of timed alarm device-assisted urotherapy vs. urotherapy alone were identified and evaluated according to Cochrane collaboration recommendations. The assessed outcome includes pDUI complete response and adherence rates. Relative risk (RR) with 95% confidence intervals (CI) was extrapolated. A random-effects model was used to pool effect estimates. Heterogeneity was assessed with sensitivity and subgroup analysis performed according to study design and comparative group characteristics. GRADE criteria were used to assess evidence certainty. (PROSPERO CRD42022299173). RESULTS: Four studies (three randomized controlled trials [RCTs] and one retrospective cohort) with 635 cases were included. The pooled effect estimates of pDUI complete response showed no differences between intervention groups (RR 1.20, 95% CI 0.81, 1.76). Pooled effect estimates for treatment adherence were generated from two studies, which showed significantly better adherence for the timed-alarm device group (RR 2.97, 95% CI 1.46, 6.06). Significant interstudy heterogeneity was noted; the source is likely from the study design and comparator device characteristics. The quality of evidence was assessed to be of very low certainty. CONCLUSIONS: Based on very low certainty evidence, timed alarm device-assisted urotherapy does not seem to have the advantage of complete treatment response over standard urotherapy alone in managing pDUI; however, a timed-alarm device is likely able to improve urotherapy treatment adherence. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate if there was any relationship between screen time (ST) and the severity of primary monosymptomatic nocturnal enuresis (PMNE) and treatment success. Methods: This study was conducted in urology and child and adolescent phsychiatry clinic in Afyonkarahisar Health Sciences University Hospital. After diagnosis patients were seperated by the ST for exploring causation. Group 1 > 120, Group 2 < 120 (min/day). For the the treatment response, patients were grouped again. Group 3 patients were administered 120 mcg Desmopressin Melt (DeM) and were requested < 60 min ST. Patients in Group 4 were given 120 mcg DeM solely. Results: The first stage of the study included 71 patients. The ages of the patients ranged from 6 to 13. Group 1 comprised 47 patients, 26 males and 21 females. Group 2 comprised 24 patients,11 males and 13 famales. Median age was 7 years in both groups. The groups were similar in respect of age and gender (p = 0.670, p = 0.449, respectively). A significant relationship was determined between ST and PMNE severity. Severe symptoms were seen at the rate of 42.6% in the Group 1, and at 16.7% in the Group 2 (p = 0.033). 44 patients completed the second stage of the study. Group 3 comprised 21 patients, 11 males and 10 females. Group 4 comprised 23 patients,11 males and 12 famales. Median age was 7 years in both groups. The groups were similar in respect of age and gender (p = 0.708, p = 0.765, respectively). Response to treatment was determined as full response in 70% (14/20) in Group 3 and in 31% (5/16) in Group 4 (p = 0.021). Failure was determined in 5% (1/21) in Group 3 and in 30% (7/23) in Group 4 (p = 0.048). Recurrence was determined at a lower rate in Group 3 where ST was restricted (7% vs. 60%, p = 0.037). Conclusion: High screen exposure may be a factor for PMNE aetiology. And also reducing ST to a normal range can be an easy and beneficial method for treatment of PMNE. Trial Registration ISRCTN15760867(www.isrctn.com). Date of registration: 23/05/2022. This trial was registered retrospectively. [ABSTRACT FROM AUTHOR]

Background: Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. The Aim of study wa s to evaluate the role of UDS in management of refractory Nocturnal Enuresis (MNE). Methods: This Prospective Study was carried out in Urology Department, Zagazig University Hospital that included 24 Patients, 14 boys and 10 girls. The patient ages was ranged from 10-18 years old with mean age (SD) of 11.91± 1.95 years. All patients were treated with mono pharmacotherapy (desmopressin). The duration of treatment before UDS at last six months. Results: bladder sensation was intact in 41.7%, increased in 50.0% and decreased in 8.3% of patients. The value of a single test PVR was ranged from 20-150 ml. 21 of patients were no post voiding volume (87.5%) and 3 cases had post voiding volume (12.5 %). The filling cystometry was normal in 6 patients (25%) and abnormal in 18 patients (75%). Bladder sensation intact in 10 patients (41.7%) and decrease in 2 patients (8.3%) and increase in 12 patients (50%) with p-value (< 0.05). Conclusions: it is recommended to perform urodynamic studies in the form of uroflowmetry and cystometry for those with refractory nocturnal enuresis who failed ADHC (desmopression) for at last 6 months as initial monotherapy. Also a combination therapy of anticholinergics with desmopressin could be applied as treatment for those with refractory monosymptomatic nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis is defined as nighttime urinary incontinence occurring at least twice weekly in children five years and older. Approximately 14% of children have spontaneous resolution each year without treatment. Subtypes of nocturnal enuresis include nonmonosymptomatic enuresis and primary and secondary monosymptomatic nocturnal enuresis. Monosymptomatic enuresis is characterized by nighttime bedwetting without daytime urinary incontinence. Pathophysiology of primary monosymptomatic nocturnal enuresis may be due to sleep arousal disorder, overproduction of urine, small bladder storage capacity, or detrusor overactivity. Children with nonmonosymptomatic enuresis have daytime and nighttime symptoms resulting from a variety of underlying etiologies. An in-depth history is an integral component of the initial evaluation. For all types of enuresis, a comprehensive physical examination and urinalysis should be performed to help identify the cause. It is important to reiterate to the family that bedwetting is not the child's fault. Treatment should begin with behavioral modification, which then progresses to enuresis alarm therapy and oral desmopressin. Enuresis alarm therapy is more likely to produce long-term success; desmopressin yields earlier symptom improvement. Treatment of secondary monosymptomatic nocturnal enuresis and nonmonosymptomatic enuresis should primarily focus on the underlying etiology. Pediatric urology referral should be made for refractory cases in which underlying genitourinary anomalies or neurologic disorders are more likely. . [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract dysfunction or functional urinary incontinence is a common condition with a prevalence up to 21% between 6 and 8 year-old children. It is associated with an impaired quality of life, lower self-esteem, and social stigmatization. Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined.Methods/design: This is a multi-center clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6 and 16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice are eligible. Four centers, two academic hospitals, and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups: urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training, or urotherapy with a SHAM device for 3 weeks. The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control (care as usual) group.Discussion: To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy.Trial Registration: ISRCTN44345202 . Registered on March 2022. [ABSTRACT FROM AUTHOR]

Incontinence disorders are an important group of problems clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, general clinical approach to enuresis, laboratory evaluation, and general principles of management. [ABSTRACT FROM AUTHOR]

Enuresis (bed wetting) is the commonest cause of functional urinary incontinence in children. Enuresis does not lead to damage to the kidneys or long term physical disability but can have a significant effect upon the psychological well-being of the young person and consequences for family life. This article provides an overview of the diagnosis, investigation and treatment of enuresis by addressing the questions most commonly asked by parents or carers looking after a child suffering with enuresis. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis refers to bedwetting at night or during sleep. It may be either primary or have a complex presentation due to secondary etiologies. It is essential to differentiate primary enuresis from secondary enuresis, and monosymptomatic enuresis from polysymptomatic monosymptomatic enuresis, to guide therapy. For primary monosymptomatic enuresis, bladder training, urotherapy, alarm therapy, and desmopressin have been the mainstay of treatment. Choosing a suitable therapy for nocturnal enuresis warrants a thorough review of symptoms and voiding diary. Additionally, certain pretreatment and posttreatment response predictors have been found useful in management. Subclassification of primary monosymptomatic enuresis through bladder diary or ultrasonography helps select suitable candidates for anticholinergic therapy, which was previously reserved for refractory enuresis. The aim of this review is to integrate newer approaches with conventional therapy in diagnosing, classifying, and selecting therapies for nocturnal enuresis. Search Strategy: MeSH analysis was done on NCBI Platform with "enuresis" as MeSH major topic with several subtopics. The input for search builder was: ("Enuresis/classification"[Mesh] OR "Enuresis/diagnosis"[Mesh] OR "Enuresis/diagnostic imaging"[Mesh] OR "Enuresis/diet therapy"[Mesh] OR "Enuresis/prevention and control"[Mesh] OR "Enuresis/therapy"[Mesh])) AND ("Enuresis/etiology"[Mesh] OR). Six hundred and fifty-seven results were found from 75 clinical trials, 28 systematic reviews, and 4 review articles that were used to synthesize this review. [ABSTRACT FROM AUTHOR]

Objective: According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis.Design: Randomised, controlled trial.Setting: Paediatric outpatient ward, regional hospital.Patients: Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence.Interventions: Three groups, each during 8 weeks: (A) basic bladder advice-that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group).Main Outcome Measures: Reduction in enuresis frequency during week 7-8 compared with baseline.Results: The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls.Conclusions: Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin.Trial Registration Number: NCT03812094. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess whether enuretic Japanese patients with nocturnal polyuria (NP) who met Hoashi's criteria (6–9 years: ≥200 mL; 10 years and older: ≥250 mL) met the International Children's Continence Society (ICCS; expected bladder capacity × 130%) and Rittig's criteria for nocturnal polyuria (>[age+9] × 20 mL). We also compared the effectiveness of 1‐desamino‐8‐d‐arginine vasopressin (DDAVP) with the three criteria. Methods: Fifty‐four patients who had NP with normal bladder capacity were enrolled: 36 boys (67%); median age, 8 (interquartile range: 7–9). We compared the diagnostic differences between the Hoashi's criteria and international standards (ICCS and Rittig's) for NP and the short‐term effects of DDAVP. The patients received DDAVP for 8 weeks; we evaluated the association between each evaluation method and the effects of therapy. Results: Only 17% of the patients met both Hoashi's and ICCS criteria, whereas 26% met both Hoashi's and Rittig's criteria. The therapeutic effect of DDAVP did not differ significantly between these two groups: there was an effective rate of 73% (Hoashi's criteria) versus 50% (ICCS criteria), P = 0.19, and an effective rate of 71% (Hoashi's criteria) versus 62% (Rittig's criteria), P = 0.84. Conclusions: Hoashi's criteria are widely used but, according to both the ICCS and Rittig's criteria, approximately 80% of the patients did not fulfill the definition of NP. However, 8 weeks after the DDAVP treatment began, no significant difference was observed in the therapeutic effect of DDAVP according to each set of criteria. The definition of NP should account for the physical disparities between Japanese people and Westerners. [ABSTRACT FROM AUTHOR]

Aim: Enuresis (EN) is a common problem in childhood. Family physicians have an important role in revealing children with EN. The aim of this study was to assess the knowledge and attitude of family medicine (FM) residents regarding the diagnosis and treatment of enuresis in children. Materials and Methods: Family medicine residents of the University of Health Sciences, İzmir Tepecik Training and Research Hospital were invited to complete a questionnaire concerning enuresis in children. Those who had completed their paediatrics rotation training were defined as group 1, and those who had not completed their paediatrics rotation as group 2. The responses were compared between the groups. Results: Sixty (88%) of the FM residents agreed to complete the survey. The mean age of the participants was 28.7 (25-35) years, 38 (63%) had completed their paediatrics rotation (group 1). The question about the age of night-time bedwetting was more often answered correctly in group 1 (19/38) (p=0.025). In the question on the symptoms of non-monosymptomatic enuresis; the constipation option was marked as a symptom by only 15 of the participants (25%), with 13 (87%) being in group 1 (p=0.03). The correct response rates to the questions about other symptoms of non-monosymptomatic enuresis, the causes of secondary enuresis, the need for treatment, treatment options and the follow-up of patients with enuresis were similar between groups 1 and 2. Conclusion: As a result of this study, more correct answers, which revealed adequate knowledge and experience regarding enuresis, were obtained from those who had concluded their paediatrics rotation. [ABSTRACT FROM AUTHOR]

Background: Monosymptomatic enuresis nocturna patients are shown to have disrupted blood‐pressure regulation accompanying polyuria. In our study, we aimed to research the desmopressin response of enuresis patients with blood‐pressure regulation problems. Methods: The study included 175 patients, aged from 6–15 years, with a diagnosis of monosymptomatic enuresis nocturna. Before treatment, 24 h ambulatory blood‐pressure monitoring (ABPM) was used to identify 52 non‐dipper patients and 73 patients with normal results. The responses to desmopressin treatment and clinical and demographic characteristics affecting response were compared. Results: The response to desmopressin treatment was found to be significantly low in the patients who were non‐dippers on 24 h ABPM before treatment compared to those with normal ABPM results (P < 0.05). Similarly, the waking problems in the non‐dipper group were found to be high by a significant degree (P < 0.05). In the non‐dipper group, the systolic non‐dipping rate was higher. Conclusions: Before desmopressin use, assessment of patients with a 24 h ABPM may be beneficial to select the method to be used for treatment. [ABSTRACT FROM AUTHOR]

Objective: In 2018, we reported 86% cure of day/night enuresis in a randomized controlled trial of 48 children applying three different squatting-based exercises. All children who were cured were by 4 weeks. A follow-up validation study which also aimed to assess whether singular squatting 10 times twice daily protocol was sufficient to cure day/night enuresis and whether most cures occur by 4 weeks. Materials and Methods: The study was conducted by three centres, Argentina, Brazil, Equador. Intended protocol: 10 squats twice daily for 4 months. Eligibility criteria were daytime urine leakage plus night-time bedwetting. Exclusion criterion was refusal to sign consent forms. Assessment was by intention to treat, criterion for cure was complete dryness. Results: When interrupted by the COVID virus, 25 cases had been assessed (ages: 6-11, one aged 17 years). Complete cure: Ecuador 5/8, Brazil 4/5, Argentina 7/12, 64% cure, plus 4 (16%) more than 50% improved, with no further changes noted after 4 weeks. The study were analysed with a McNemar's test, with a null hypothesis of no treatment effect. Small numbers clouded definitive conclusions. Calculating 16/25 cured, the two-tailed p=0.2301; for 20/25 cured or improved, p=0.0051. Conclusion: The method is easily applicable, costs virtually nothing, does not require special equipment. It compares favourably with other methods such as bedwetting alarms. The results, 64% cure and 16% improvement support the 1st study, and we believe are sufficiently encouraging to recommend adoption by parents and therapists. [ABSTRACT FROM AUTHOR]

Bedwetting, also called nocturnal enuresis, is a common developmental problem in school-aged children. In a study by Van Tijen, Messer, & Namdar (1998), children ranked it as the third most stressful life event, after parental fighting and divorce. About 15% of affected children outgrow bedwetting on their own each year without medical intervention (Kiddoo, 2015), but inadequate knowledge and lack of support and guidance from family may lead to low self-esteem and mental distress in children dealing with this situation. Nonpharmacologic interventions like bedwetting alarms have a higher success rate (75%) and lower relapse rate (41%) than pharmacologic interventions (Monda & Husmann, 1995). This article discusses nonpharmacologic interventions for nocturnal enuresis: bedwetting alarms, motivational therapy, dietary modification, behavioral modification, and pelvic floor muscle training. [ABSTRACT FROM AUTHOR]

Objective: To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis. Methods: A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire. Results: The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them. Conclusion: All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups. [ABSTRACT FROM AUTHOR]

Unsatisfactory cure rates for the treatment of nocturnal enuresis (NE), i.e. bed-wetting, have led to the need to explore alternative modalities. New treatment methods that focus on preventing enuretic episodes by means of a pre-void alerting system could improve outcomes for children with NE in many aspects. No such technology exists currently to monitor the bladder to alarm before bed-wetting. The aim of this study is to carry out the feasibility of building, refining and evaluating a new, safe, comfortable and non-invasive wearable autonomous intelligent electronic device to monitor the bladder using a single-element low-powered low-frequency ultrasound with the help of Machine Learning techniques and to treat NE by warning the patient at the pre-void stage, enhancing quality of life for these children starting from the first use. The sensitivity and specificity values are 0.89 and 0.93 respectively for determining imminent voiding need. The results indicate that customised imminent voiding need based on the expansion of the bladder can be determined by applying a single-element transducer on a bladder in intermittent manner. The acquired results can be improved further with a comfortable non-invasive device by adding several more features to the current features employed in this pilot study. Graphical Abstract Ultrasound device design: echoed US pulses reflected from the bladder and related tissues around the bladder is detected. These pulses are analysed, and an alarm is triggered when needed to treat nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis (NE) is involuntary urination that occurs at night during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. For this review, a thorough internet search was done using the search engines of PubMed, Scopus, PsycInfo, ScienceDirect, and Google Scholar. In this review, we glow the light on new-insights of behavioral treatment of nocturnal enuresis. The management of nocturnal enuresis has converted from a strictly psychopathological perspective to a bio-behavioral perspective in the past few decades. There are a number of treatment options are available for NE; such as drug therapy, bladder training, auro therapy, positive reinforcement, and the enuresis night alarm. Enuresis night alarm therapy, is presenting lower rates of relapse in the long term, higher cure rate and therefore being considered a gold standard treatment for enuresis, but it is a conditional treatment; it requires patience, persistence and motivation. Several behavioral approaches can be used for treatment such as enuresis night alarm therapy and various skills oriented components, we must do physical examination and rule out a specific medical or organic etiology, as well as urine test should be negative. [ABSTRACT FROM AUTHOR]

Background: Sleep disorders are strongly associated with childhood nocturnal enuresis (NE). In this study, we examined whether sleep disorders are present in children with NE, and whether NE is caused by sleeping disorders, or is simply comorbid. Methods: We examined 14 children with monosymptomatic NE and 15 age‐matched controls. Sleep disorders were assessed for ≥5 days using contactless biomotion sensors to detect breathing and body movements during at‐home sleep. To assess sleep quality, we compared median sleep efficiency and the number of shallow sleep episodes between the groups. We also investigated the change in sleep quality after successful NE treatment in five children. Results: Median sleep efficiency was significantly lower in the NE group (87.3%) than in the control group (93.4%; P < 0.001). The number of shallow sleep episodes per night was significantly higher in the NE group (5.11) than in the control group (1.50; P < 0.001). Neither sleep efficiency nor the number of shallow sleep episodes improved in the five children whose NE was successfully stopped after bedwetting‐alarm therapy (P = 0.50 and 0.22, respectively). Conclusions: Sleep disorders are present in children with NE. Although there are insufficient data to conclude that sleep disorders are not the cause of NE, we suggest that they are comorbid because sleep disorders persisted even after NE was halted. [ABSTRACT FROM AUTHOR]

Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered. [ABSTRACT FROM AUTHOR]

Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis – or bed-wetting – is one of the most common chronic conditions of childhood. It has a significant effect on the quality of life of affected children and their families and is associated with several comorbidities, some of which resolve on successful treatment. The causes of this troublesome condition are explored and the principles of assessment and treatment are discussed with reference to National Institute for Health and Care Excellence guidance as well as research. Response to treatment resistance is considered and appropriate onward referral discussed. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful. [ABSTRACT FROM AUTHOR]

Children with developmental disabilities (DD) are more likely than typically developing peers to have issues with enuresis. Past research has shown the success of behavioral treatments consisting of scheduled sits and reinforcement for continent voids. However, this research has included small sample sizes, while studies with larger numbers have lacked key information (i.e., baseline rates and follow-up data to evaluate maintenance and generalization). The current study conducted a consecutive case series analysis of 44 individuals with developmental disabilities who completed a 2-week program for enuresis. Results showed significant improvement in continent voids and follow-up data suggested positive results maintained when treatment was implemented by caregivers in a home environment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the impact of a motivational therapy (MT) on the outcomes for individuals diagnosed with nocturnal enuresis (NE). Material and methods: We enrolled 158 patients with NE referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome, from January 2013 to September 2017. Of these, 21 were excluded because they didn't meet the inclusion criteria. The study was carried out in compliance with the Helsinki Declaration. Results: A hundred and thirty seven enuretic patients [100 (72.9%) male and 37 (27.1%)] female patients with a median age of 8.8 years were included in the study. The patients were assigned to receive pharmacological therapy with desmopressin (dDAVP) (G1) (n=51), MT (G2) (n=33) and both of them (G3) (n=53). The three groups were homogeneous, with no significant differences in gender, age and family history of NE. In G1, 30/51 (58.82%) children achieved response vs. 1/33 (3.0%) children in G2 vs. 35/53 (66.04%) children in G3. About these results, The differences between G2 vs. G1 (p<0.01) and vs. G3 (p<0.01) were statistically significant while the difference between G1 vs G3 was not statistically significant (p=0.45). Conclusion: Our study underlines the importance of MT in the management of NE and highlights the safety of treatment and the positive effect of MT on the compliance and the adherence to pharmacological therapy. Considering the importance of the impact of such evidence on children's lifestyle, we expect that further study with a larger sample size may confirm our hypothesis. [ABSTRACT FROM AUTHOR]

Desmopressin is used to treat primary nocturnal enuresis in children. Over the years, various formulations of desmopressin were commercialized of which the sublingual melt tablet is preferred in the pediatric population, despite the lack of full PK studies in this population. A full PK study was performed in growing conventional piglets to evaluate if this juvenile animal model can provide supplementary information to complement the information gap in the pediatric population. A desmopressin sublingual melt tablet (120 μg) was administered to 32 male piglets aged 8 days, 4 weeks, 7 weeks, and 6 months (each group n = 8). Population PK (pop-PK) analysis was performed to derive the PK parameters, the between- and within-subject variabilities and the effects of covariates. Desmopressin demonstrated two-compartmental PK, with a dual, sequential absorption process, and linear elimination. Body weight was the only significant covariate on clearance and on apparent volume of distribution of the central compartment. In human pediatric trials, no double peak in the absorption phase was observed in the plasma concentration-time curves, possibly due to the sparse sampling strategy applied in those pediatric studies. Therefore, it is recommended to perform additional studies, based on the sampling protocol applied in the current study. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis is a common problem affecting school-aged children worldwide. Although it has significant impact on child's psychology, it is always under-recognized in India and considered as a condition which will outgrow with advancing age. Nocturnal enuresis classified as primary or secondary and monosymptomatic or nonmonosymptomatic. Factors that cause enuresis include genetic factors, bladder dysfunction, psychological factors, and inappropriate antidiuretic hormone secretion, leading to nocturnal polyuria. Diagnosis consists of detailed medical history, clinical examination, frequency-volume charts, and appropriate investigations. The frequency-volume chart or voiding diary helps in establishing diagnosis and tailoring therapy. The first step in treating nocturnal enuresis is to counsel the parents and the affected child about the condition and reassure them that it can be cured. One of the effective strategies to manage enuresis is alarm therapy, but currently, it is not easily available in India. Desmopressin has been used in the treatment of nocturnal enuresis for close to 50 years. It provides an effective and safe option for the management of nocturnal enuresis. This review covers the diagnosis and management of nocturnal enuresis and introduces the concept of "bedwetting clinics" in India, which should help clinicians in the thorough investigation of bedwetting cases. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the clinical efficacy and safety of combination therapy comprising desmopressin plus anticholinergic agent compared with desmopressin alone for children with nocturnal enuresis (NE). A meta-analysis of 8 eligible studies was performed to analyze the effects of desmopressin plus anticholinergic agent combination therapy and desmopressin monotherapy in the treatment of NE in children. The overall odds ratio (OR) or standardized mean difference (SMD) and 95% confidence interval were calculated for full responders (FR), partial responders (PR), non-responders (NR), the change in the mean number of wet nights and adverse events. Following 1 month of treatment, efficacy analysis yielded an OR of 3.736, which suggested that the proportion of FR for patients treated with the combination therapy was higher than that for patients treated with monotherapy. Analysis of the change in the mean number of wet nights yielded an SMD of 0.719, which indicated that the change in the mean number of wet nights in the patients treated with combination therapy was greater than that in the patients treated with monotherapy. Following 3 months of treatment, the OR calculated for FR plus PR compared with NR was 2.857, indicating that the proportion of FR and PR was elevated by the combination therapy compared with desmopressin alone. The OR for adverse events was 4.074, which suggested that the combination therapy did not lead to more adverse events in the treatment of NE. Therefore, the present meta-analysis suggests that, compared with desmopressin monotherapy, a combination therapy comprising desmopressin and anticholinergic agent is more effective with equivalent safety for children with NE. [ABSTRACT FROM AUTHOR]

Nocturnal Enuresis (NE) is the involuntary urination during sleep after the age at which bladder control usually occurs. It is a socially stigmatizing and stressful condition which affects around 15%-20% of five years old. Various treatment options for PNE include behavioral therapy, alarm therapy, pharmacotherapy and combinations. Current study was aimed to evaluate outcome of behavioral therapy alone and in combination with pharmacological treatment. OBJECTIVE: To compare the outcome of behavioral therapy alone and in combination with pharmacotherapy in management of NE. OPERATIONAL DEFINITION: Behavioral therapy was performed with prompted voiding (voiding by clock) at day time & reducing fluid intake at bedtime. Pharmacotherapy was performed with orally administered imipramine at bedtime. MATERIAL AND METHOD: STUDY DESIGN: Comparative study. SETTING: Urology department, Children Hospital, Faisalabad. SAMPLING: One hundred & thirty consecutive children in age range of 5-13 years with nocturnal enuresis were enrolled in the study and randomly allocated in two groups. One group was advised behavioral treatment alone and other was advised pharmacotherapy (imipramine) along with behavioral therapy. The children with known urinary tract pathologies/congenital anomalies, active urinary tract infection, acquired urologic disease, neurologic diseases and children with daytime LUTS were excluded from the study. Results: At first follow up (15-days), in group-A (behavioral therapy alone), 7.7% children reported complete resolution of NE, 23.1% showed improvement (reduction in episodes of NE) and 69.2% showed no improvement. At first follow up (15-days), in group-B (combination therapy), 15.4% children reported complete resolution of NE, 61.5% showed improvement (reduction in episodes of NE) and 23.1% showed no improvement. At second follow up (30-days), in group-A (behavioral therapy alone), 38.5% children reported complete resolution of NE, 38.5% showed improvement (reduction in episodes of NE) and 23% showed no improvement. At second follow up (30-days), in group-B (combination therapy), 38.5% children reported complete resolution of NE, 46.2% showed improvement (reduction in episodes of NE) and 15.4% showed no improvement.CONCLUSION: Behavioral therapy can be offered as an initial treatment step in management of nocturnal enuresis. However, combination therapy (behavioral +pharmacotherapy) gives an overall better outcome in the treatment of Nocturnal Enuresis as compared to behavioral therapy alone. [ABSTRACT FROM AUTHOR]

Purpose Desmopressin is a synthetic V2 specific analogue of antidiuretic hormone (arginine vasopressin) that is widely used as first line treatment for monosymptomatic nocturnal enuresis. However, no biomarkers to predict desmopressin effectiveness have yet been established. Because arginine vasopressin is unstable, we prospectively measured the major urine concentration factor aquaporin 2 and serum copeptin (as a surrogate marker for vasopressin) in patients with monosymptomatic nocturnal enuresis, and evaluated whether they are useful for predicting desmopressin treatment outcome. Materials and Methods The study included 32 children 6 to 11 years old with monosymptomatic nocturnal enuresis and nocturnal polyuria. Exclusion criteria were daytime urinary symptoms and underlying diseases causing nocturnal enuresis. Subjects were treated with 120 μg or 240 μg desmopressin oral disintegrating tablet and were divided into responders (at 120 or 240 μg) and nonresponders (at 240 μg). Day/night ratios of plasma copeptin and urinary aquaporin 2 were measured during desmopressin treatment. Results There was no significant difference in baseline day/night ratio of urinary aquaporin 2 between desmopressin responders and nonresponders. After 8 weeks of treatment there was a significant correlation between day/night ratio of aquaporin 2 and percentage of wet nights. In responders (but not nonresponders) there was a significant difference in the change in aquaporin 2 day/night ratio from before treatment to complete remission (p = 0.0004). For plasma copeptin the baseline day/night ratio for responders at 120 μg was significantly lower than in the 240 μg nonresponder group (p = 0.02). Conclusions Urinary aquaporin 2 appears to be a biomarker of desmopressin treatment effectiveness during therapy, while plasma copeptin levels before treatment are predictive of desmopressin response. [ABSTRACT FROM AUTHOR]

There are two types of refractory nocturnal enuresis. The first type corresponds to patients who are refractory from initial success, and the second type refers to refractory nocturnal enuresis after long-term success, in patients who cannot discontinue medications for enuresis. In the former type, it is necessary to determine whether the timing of medications is appropriate, whether the usage of antidiuretics is appropriate, whether any lifestyle changes have taken place, and whether there are secondary causes of enuresis. In the latter type, enuretic alarm treatment should be considered initially, and it is then important to investigate whether a respiratory obstruction is present in patients with nocturnal polyuria, whether the patient is constipated, and whether patients with non-monosymptomatic nocturnal enuresis have lower urinary tract symptoms or attention deficit hyperactivity disorder. [ABSTRACT FROM AUTHOR]

Behavioral therapy refers to a broad range of treatment modalities that regulate the child's behavior to induce a therapeutic effect on nocturnal enuresis. Simple behavioral therapies include fluid restriction, lifting, waking, introducing reward systems, and bladder training. Simple behavioral therapy is significantly less effective than an enuresis alarm or desmopressin. If a child needs treatment, an enuresis alarm or desmopressin should not be delayed. Enuresis alarms are an effective form of treatment, although they require active involvement of the health care provider to reduce the likelihood of dropout and to motivate the child and parents. [ABSTRACT FROM AUTHOR]

Enuresis affects up to 20% of children of 5 years old, enuretic children present arginine vasopressin secretion deficiency, compared to normal children. To keep the level of antidiuretic hormone in the body, the aim of this work was to develop natural rubber latex membranes loaded with desmopressin peptide and characterize itsin vitrorelease. Results demonstrated that 60% of desmopressin incorporated in natural latex was released up to 96 h. Furthermore, hemolysis tests showed no detectable disturbance of the red blood cell membranes. Based on the results, it was possible to conclude that natural latex membranes are able to load desmopressin. [ABSTRACT FROM PUBLISHER]

Objectives To investigate renal concentrating ability after long-term fast-melting oral desmopressin lyophilisate treatment in children with monosymptomatic nocturnal enuresis. Methods The present retrospective study involved 58 children (43 boys, 15 girls; aged 6-12 years) with nocturnal enuresis receiving oral desmopressin lyophilisate. After treatment for 4 weeks with a complete response, patients were placed on a reduced dose of 120 μg on alternate days. Moring urine osmolality was measured using urine samples obtained after medication and non-medication dry nights. Patients who experienced ≥1 wet nights/month during alternate-day oral desmopressin lyophilisate treatment or within 6 months after its cessation were assigned to the relapse group, whereas those who experienced <1 wet night/month were assigned to the continued success group. Results The continued success and relapse groups included 41 and 17 patients, respectively. The mean duration of treatment was 18.5 and 18.3 months in the continued success group and relapse group, respectively. There was no significant difference in morning urine osmolality after medication nights between the continued success and relapse groups; however, morning urine osmolality after non-medication nights was significantly higher in the continued success group than in the relapse group ( P < 0.0001). Similarly, nocturnal urine volume was significantly higher in the relapse group than in the continued success group ( P = 0.046). Conclusions These results suggest that patients receiving long-term oral desmopressin lyophilisate treatment develop increased nocturnal renal concentrating ability, which results in sustained dryness even after treatment cessation. [ABSTRACT FROM AUTHOR]

Introduction: The first-line treatments of primary monosymptomatic night enuresis (PMNE) are alarm intervention and desmopressin. Some patients are resistant to these modes of treatment. Therefore Reboxetine has been used to treat PMNE in these scenarios in recent years and published in many studies. The aim of the study was to determine effectiveness and safety of combination of Alarm intervention and Reboxetine, to treat patients with therapyresistant enuresis. Material and Methods: Two hundred and nineteen children of both sexes were participated in the experiment (average age, 11.3 years). Participants were divided into three groups: Group A (71 patients, Alarm intervention), Group B (79 patients, Reboxetine as monotherapy), Group C (69 patients, Alarm intervention + Reboxetine). The duration of treatment was twelve weeks, followed by follow-up period of twelve weeks to see efficacy. Result: There was no significant change in number of enuresis episodes per week before and after treatment in a group B. The number of enuresis episodes per a week (weekly) in a group C reached: before treatment 5.3 (1.5), after treatment 1.0 (0.8), 3 three months after the end of treatment 0.7 (0.7). The percentage of patients with PMNE in a group C was significantly less immediately after the course of treatment (17.4%), and three months after treatment (24.6%). Conclusion: Combined treatment of therapy-resistant enuresis with use of Alarm Intervention and Reboxetine gives a high percentage of cured patients both immediately after therapy (82.6%) and three months after the end (75.4%). [ABSTRACT FROM AUTHOR]

Purpose In a third of all children with monosymptomatic nocturnal enuresis their condition is refractory to first line treatments. Transcutaneous electrical nerve stimulation has been documented to be efficacious in children with daytime incontinence. We investigated the effect of transcutaneous electrical nerve stimulation in children with monosymptomatic nocturnal enuresis without nocturnal polyuria. Materials and Methods Children with monosymptomatic nocturnal enuresis (3 or more wet nights per week) and no nocturnal polyuria were randomized to treatment with active or sham transcutaneous electrical nerve stimulation involving 1-hour sessions twice daily for 10 weeks in a double-blind design. Results Of the 52 children with monosymptomatic nocturnal enuresis included in the study 47 completed treatment (mean age 9.5 ± 2.1 years, 38 males). None of the children experienced a full response with complete remission of enuresis. Treatment with transcutaneous electrical nerve stimulation did not lead to significant changes in number of wet nights, nocturnal urine production on wet or dry nights, maximum voided volume with and without first morning voided volume, or voiding frequency when comparing parameters before and after treatment. Conclusions The present study demonstrates no anti-enuretic effect of transcutaneous electrical nerve stimulation in children with monosymptomatic nocturnal enuresis without nocturnal polyuria. Nocturnal urine production and bladder capacity remained unchanged during and after treatment with transcutaneous electrical nerve stimulation. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of neurostimulation compared with control groups in the treatment of pediatric primary enuresis by performing meta-analysis of randomized controlled trials (RCTs).Methods: A systematic literature search with no language restriction was performed in August 2016. RCTs were identified and evaluated according to the Cochrane Collaboration risk of bias assessment recommendations. The number of patients with post-treatment responses such as partial response (PR) (50%-89%), complete response (CR) (≥90%), and full response (FR) (100%) were extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled using the Mantel-Haenszel method. The review protocol was registered in the PROSPERO registry (CRD42016043502).Results: A total of 292 subjects from 7 nonheterogeneous RCTs were included for meta-analysis. Pooled effect estimate of subjects with ≥50% post-treatment wet-night reduction (PR, CR, and FR) showed a significantly better outcome after neurostimulation compared with controls (RR = 2.20, 95% CI 1.66, 2.90), whereas patients with ≥90% post-treatment wet-night reduction (CR and FR) showed a significantly better outcome in the neurostimulation groups (RR = 2.79, 95% CI 1.54, 5.06). Furthermore, a significant mean difference in wet-night reduction per week was noted between treatment groups in favor of neurostimulation treatment (mean difference -1.95, 95% CI -2.84, -1.07). No serious adverse effects were noted related to neurostimulation therapy.Conclusion: Current evidence suggests that neurostimulation therapy is efficacious and safe for the treatment of PPE. Head-to-head randomized clinical trials are needed to further assess relative efficacy among variable treatment protocols. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a 3-month enuresis alarm (EA) treatment and repeat EA treatment among pediatric patients with nocturnal enuresis, and to compare patient characteristics among "responders" and "nonresponders" to treatment.Materials and Methods: Clinical outcomes were retrospectively evaluated for 137 children (94 boys and 43 girls, mean age, 10.1 years). Effectiveness was evaluated after an initial 3-month treatment, using the International Children's Continence Society criteria. Among children in the no-response group at 3 months, those who continued the EA treatment for ≥4 months were subclassified into group 1, whereas children who repeated the EA treatment at an interval ≥6 months were subclassified into group 2.Results: Among our 137 cases, 19 achieved complete response and 47 achieved partial response at 3 months, for an overall treatment effectiveness rate of 48%. Among the no-response group, treatment was extended in 17 cases (group 1), with 3 (18%) achieving a successful outcome. Treatment was repeated in 18 cases (group 2). In group 2, 8 (44%) achieved successful outcome at 3-month time point. Daytime urinary incontinence did not modify treatment effectiveness.Conclusion: EA treatment should be given for a short period of time and should not be continued without a definite purpose or clear response. Suspending and then repeating this treatment after an appropriate interval is effective for patients who do not respond to the initial course of treatment. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to investigate the prevalence of primary monosymptomatic and non-monosymptomatic nocturnal enuresis ( PMNE and PNMNE) and associated factors in a major referral center for NE in Abu Dhabi. Methods Children referred to the Paediatric Continence Clinic, between 2014 and 2016, for PNE were included in the study. Exclusion criteria were neuropathic bladder, abnormality of the bladder and bowel, urethral stenosis, neurological and psychiatric problems, non-completion of the diagnostic protocol, and follow up <6 months. Results A total of 128 patients were included in the study: 82 boys (64.1%) and 46 girls (35.9%). A total of 42.7% of boys and 8.7% of girls had PMNE, and 57.3% of boys and 91.3% of girls had PNMNE. Constipation was present in 46% of patients. In the male PNMNE group, 74.5% had overactive bladder ( OAB), 10.6%, dysfunctional voiding ( DV); and 14.9%, OAB + DV. In the female PNMNE group, 35.7% had OAB; 21.4%, DV; 40.5%, OAB + DV; and 2.4%, underactive bladder. A total of 97% and 86 of children with PMNE and PNMNE, respectively, had resolution of NE. Boys had a significantly higher incidence of PMNE, and girls, of DV. Conclusion In Abu Dhabi, NE is often associated with bladder dysfunction or DV, mostly in girls, and with constipation. High intake of dry, low fiber foods, along with hot weather and the stress of city living negatively affect the incidence of fecal retention and of NE. A multimodal approach, including the treatment of constipation, led to a satisfactory resolution of PNE in almost 90% of cases. [ABSTRACT FROM AUTHOR]

Background: Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. Methods: This was a prospective study of MNE patients, aged 6-16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal. Results: Of the 82 patients [mean age 9.5 (SD ± 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group ( p = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group ( p = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group ( p = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement. Conclusions: The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores. [ABSTRACT FROM AUTHOR]

Enuresis was historically viewed as a primarily psychiatric disorder, but this understanding has changed dramatically since the end of the last century, when it became clear that somatic factors, such as nocturnal polyuria as a result of vasopressin deficiency, nocturnal detrusor overactivity and high arousal thresholds, all play a crucial role in enuresis pathogenesis. It has also become clear that enuresis is inherited in the majority of cases, although the correlation between genotype and enuretic phenotype is not straightforward. The standard view of enuresis as being the result of either (i) nocturnal polyuria and high arousal thresholds; or (ii) nocturnal detrusor overactivity and high arousal thresholds has become well-established, but further research now complicates the picture. First, psychological/psychiatric problems are overrepresented in enuresis, and might in a minority of cases have a causal or aggravating role. Second, nocturnal polyuria is not always linked to vasopressin deficiency. Third, nocturnal detrusor overactivity is in itself pathogenetically heterogeneous, and could be linked to constipation. Fourth, the sleep of enuretic children might be 'deep,' but possibly also disturbed (by obstructed airways or a distended or contracting bladder). These children might have high arousal thresholds because of the enuresis instead of the other way around. The same might possibly be said about nocturnal polyuria. Taking these new insights into account, a new model of enuresis pathogenesis is presented, which is more complicated but hopefully also more true than the standard consensus. [ABSTRACT FROM AUTHOR]