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PubMed1997

Enuresis in children with attention-deficit hyperactivity disorder.

We did a retrospective study of the prevalence of nocturnal and diurnal enuresis in patients with attention-deficit hyperactivity disorder (ADHD). Patients with ADHD were identified at a referral center for developmental pediatrics. Control patients were identified at a general pediatric and pediatric allergy clinic. Adjusting for differences in sex and current age, ADHD children at age 6 were 2.7 times more likely than controls to have nocturnal enuresis and 4.5 times more likely to have diurnal enuresis. Results at children's current age were consistent with results at age 6; however, these differences were not statistically significant. Nocturnal and diurnal enuresis was found to be significantly more common in children with ADHD than in control subjects. Physicians who treat patients with ADHD should routinely inquire about the presence of enuresis.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Attention deficit/hyperactivity disorder in children with nocturnal enuresis.

PURPOSE: Although the relationship between enuresis and psychopathology has been studied intensively, little is known about the prevalence of specific psychiatric disorders. We investigate the prevalence of attention deficit/hyperactivity disorder (ADHD) in children with nocturnal enuresis and correlate these data with clinical subtypes of enuresis/incontinence. MATERIALS AND METHODS: A total of 120 children with nocturnal enuresis 6 to 12 years old participated in a prevalence study. A diagnostic interview was conducted with parents, questionnaires were completed by parents and teachers, and medical files were consulted. RESULTS: Of all enuretic children 15% were diagnosed with the full syndrome of ADHD and 22.5% met the criteria of the ADHD inattentive subtype. Data revealed that the older the children (9 to 12 years), the higher prevalence of attention deficit disorder or ADHD. Nocturnal polyuria had a significantly higher incidence in hyperactive/impulsive children but there was no significant difference in bladder function between enuretic children with or without a comorbid diagnosis of ADHD. CONCLUSIONS: The prevalence of attention deficit disorder or ADHD in nocturnal enuresis is significantly increased, especially in older children. The incidence of nocturnal polyuria is slightly increased in children who meet at least the criteria of ADHD hyperactive/impulsive subtype. No other associations between enuresis and ADHD were found.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

An assessment of internalizing problems in children with enuresis.

PURPOSE: We examine the internalizing problems (anxiety and depression) and self-esteem among 9 to 12-year old children with enuresis to determine whether enuretic children are more in the clinical range, and to study the correlation between child and parent report questionnaires. MATERIALS AND METHODS: A total of 84 children with daytime and/or nighttime wetting were compared to 70 without enuresis using 5 psychometric instruments adjusted for gender and type of enuresis. Differences in mean scores, percentages of children beyond the clinical range, and correlations between child and parent report questionnaires were evaluated. RESULTS: Parental report revealed more internalizing problems ("withdrawn" and "anxious/ depressive") for children with enuresis compared to controls. A higher percentage of the study group were in the clinical range of the "total problem" scale of the Child Behavior Checklist. Child report inventories yielded no differences between groups. Moderate agreement was found between child and parent report. CONCLUSIONS: There is no evidence of internalizing problems (anxiety/depression) and low self-esteem in the self-report of enuretic children. In contrast parents rate enuretic children as having more internalizing problems. Different explanations for this contradictory data are offered. Further research is necessary to explain why parents report psychological symptoms in children with enuresis.

Anxiety↗
PubMed2005

Comparison of effects of treatment of primary nocturnal enuresis with oxybutynin plus desmopressin, desmopressin alone or imipramine alone: a randomized controlled clinical trial.

PURPOSE: We prospectively evaluated the efficacy of a combination of desmopressin and oxybutynin for treating children with nocturnal enuresis, compared to the single drugs imipramine and desmopressin. MATERIALS AND METHODS: We enrolled 158 patients from 2003 to 2004. Children were randomly assigned to 1 of 3 groups and treated with desmopressin, imipramine or a combination of desmopressin plus oxybutynin. Of these patients 145 (100 boys and 45 girls, mean age 7.8 +/- 2.5 years, range 5 to 15) were followed for more than 6 months. Efficacy was measured at 1, 3 and 6 months in terms of average enuretic frequency, 5-scale response based on change in nocturnal enuretic frequency after treatment and posttreatment enuretic frequency as a percentage of pretreatment baseline frequency. The latter efficacy was classified according to daytime voiding symptoms. Statistical evaluation was performed using chi-square tests and ANOVA. RESULTS: Of the 145 children followed 48 received combination therapy, 49 received desmopressin and 48 received imipramine. A total of 68 patients (47%) had monosymptomatic enuresis and 77 (53%) had polysymptomatic enuresis. Combination therapy produced the best and most rapid results regardless of whether the children had monosymptomatic or polysymptomatic enuresis. CONCLUSIONS: Combination therapy with desmopressin plus oxybutynin for the treatment of pediatric nocturnal enuresis was well tolerated, and gave significantly faster and more cost-effective results than single drug therapy using either desmopressin or imipramine.

Adolescent↗
PubMed2005

Ten cases of congenital urethral stricture in childhood with enuresis.

BACKGROUND: To report short-term clinical outcomes of endoscopic correction of congenital urethral stricture in 10 boys who suffer from enuresis resistant to conservative therapy. METHODS: Fifteen boys ranging between 5 and 15 years old consulted our clinics for nocturnal and diurnal enuresis which had not been improved by medication and behavioral therapy. Among them, voiding cystography revealed bulbar narrowing (Cobb's Collar) in 10 cases and vesico-ureteral reflux was found in four cases (seven ureters). Endoscopically, this lesion was recognized as a ring-form stenosis just distal to the urethral sphincter. It was incised with infantile urethrotome. RESULTS: Vesico-ureteral reflux was resolved in four ureters and improved in one. In all cases, daytime enuresis resolved dramatically and night enuresis became controllable. CONCLUSIONS: Boys who suffer from diurnal enuresis should immediately be explored for the existence of congenital urethral stenosis. Early resolution may bring about better urinary behavior.

Adolescent↗
PubMed1988

Treatment of persistent enuresis. Results of severing a tight filum terminale.

A tight filum terminale was severed in an attempt to treat intractable enuresis in 27 children. Urodynamic studies demonstrated pre-operative bladder instability in all cases. Although symptom scores for enuresis improved significantly 6 months after surgery, only 7 patients benefited clinically (3 were cured and enuresis was reduced in 4). An average of 26 months later, 12 patients were either dry or their enuresis was reduced, probably due to spontaneous cure rather than surgery. We found no clinical parameters able to predict a favourable outcome. It was concluded that although a tight filum terminale is a cause of intractable enuresis, transection of the filum is not recommended because of the low success rate.

Adolescent↗
PubMed2005

Persistent and occasional nocturnal enuresis in orthotopic urinary diversion: is there a urodynamic difference?

OBJECTIVE: To establish urodynamic criteria differentiating between men with a radical cystoprostatectomy and ileal neobladder who are persistently enuretic and those who are occasionally enuretic. PATIENTS AND METHODS: Fifty enuretic men at least 1 year after a radical cystoprostatectomy and ileal neobladder (hemi-Kock or 'W' neobladders) were divided into two groups according to the persistence of their complaint; 17 men were persistently enuretic (nightly) and 33 were occasionally enuretic (<3 episodes/week). Both groups were compared with 50 fully continent men with similar reservoirs. Uroflowmetry, enterocystometry and urethral pressure profilometry were carried out according to International Continence Society standards and terminology. RESULTS: Both enuretic groups had significantly higher residual urine volumes, pressure at mid-capacity and at maximum enterocystometric capacity, amplitude of uninhibited contractions, and lower compliance than continent men. Men with occasional enuresis also had a significantly higher frequency and duration of uninhibited contractions than continent men. Men with persistent enuresis had significantly lower average and maximum urinary flow rates than continent men, and significantly lower functional urethral length and maximum urethral pressure. Uroflowmetric and urethral pressure differences were dissimilar between men with occasional enuresis and controls. CONCLUSION: Enuretic men had significantly higher residual urine volumes and enterocystometric pressure variables than continent men. Men with persistent enuresis had significantly lower flow rates and less urethral resistance. Pharmacological inhibition of reservoir contraction and/or management of residual urine by clean intermittent catheterization before sleep might cure occasional enuresis.

Chronic Disease↗
PubMed1996

Going Dutch in nocturnal enuresis.

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.

Adolescent↗
PubMed1990

Predicting treatment outcome in nocturnal enuresis.

A presenting sample of 127 consecutive referrals to a community based enuresis clinic were evaluated after treatment with baseline behavioural recording and the enuresis alarm. Almost one in five became dry after baseline recording only while 81 of 96 (84%) enuretics who used the alarm achieved the initial dryness criterion. Successful outcome was associated with the absence of adverse environmental factors and psychiatric disorders in the child. A logistic regression procedure enabled a risk score to be created so that successful outcome could be predicted. Psychiatric disorder in the child, family stress, and the degree of concern shown by the child emerged as the most important prognostic factors in the treatment of enuresis. The favourable success rates with baseline recording and the enuresis alarm confirm the role of conditioning treatment at the forefront of management of enuresis and the risk score allows outcome to be predicted for the first time.

Adjustment Disorders↗
PubMed1999

Effect of DDAVP on nocturnal enuresis in a patient with nephrogenic diabetes insipidus.

The case of an 8 year old boy with both nocturnal enuresis and nephrogenic diabetes insipidus is presented. Diagnosis of nephrogenic diabetes insipidus was based on a typical medical history, the characteristic result of a fluid restriction test, the lack of an effect of 1-desamino-8-D-arginine (DDAVP) on both urine osmolality and plasma coagulation factors and, finally, the detection of a hemizygous missense mutation within the arginine vasopressin (AVP) receptor gene. Hydrochlorothiazide treatment and dietary measures reduced the patient's urine volume to one third of its original volume. However, this had no effect on enuresis. The daily intranasal application of DDAVP did not further reduce urine output but dramatically decreased the frequency of bed wetting. This observation contradicts the common notion that the therapeutic effect of DDAVP in nocturnal enuresis is the result of compensation for a nocturnal AVP deficit. Rather, it points to a different mode of action of DDAVP in patients with enuresis. It is hypothesised that central AVP receptors are a target of DDAVP and that they might play an important role in the pathogenesis of nocturnal enuresis.

Child↗
PubMed1994

Treatment system for nocturnal enuresis according to an original classification system.

Our department has reported recent studies for nocturnal enuresis. The morning bladder capacity in enuretic children was smaller in the 3- and 4-year-old age range but larger in the 7-year and over age range than that in nonenuretic children. 15% of nonenuretic children showed nocturnal polyuria with nocturnal urination after complete awakening more than once per week. It was not likely from this evidence that an immature bladder capacity or nocturnal polyuria was the primary cause of enuresis. Patients with enuresis were classified into three types based on overnight simultaneous monitoring by electroencephalography and cystometry. The pathogenesis of enuresis type I and type IIa was a disturbance of awakening, while that of type IIb was a disturbance of bladder function not shown in the daytime but only at night. An original systematic therapeutic plan was established with the development of an original therapeutic machine primarily for enuresis type I.

Child↗
PubMed2003

Prevalence and perception of nocturnal enuresis in children of a rural community in southwestern Nigeria.

Nocturnal enuresis after the fifth year of life is a distressing problem. In Nigeria, there is a dearth of information about the condition. This cross-sectional study was carried out to determine the prevalence and perception of the condition among children in Igbo-Ora, a rural community in southwestern Nigeria. Four hundred parents/guardians were interviewed and information obtained on 644 children aged 6-12 years. Overall enuresis prevalence was 17.6% (19.9% among boys and 14.9% among girls). The reported causes of nocturnal enuresis included urinary tract infection (33.5%), excessive play (27.5%) and deep sleep (25%). A majority (74.5%) of the respondents would use herbs or traditional medicine to treat enuresis, while only 6.8% of the respondents sought orthodox healthcare facilities for its management. Only 18 (25%) of the 71 parents/guardians with enuretic children had ever consulted a health worker. The misconceptions and inappropriate enuresis management methods among the parents/guardians require health education intervention.

Adult↗
PubMed1991

Nocturnal enuresis in children with upper airway obstruction.

This study presents the results of our experience with 115 children between the ages of 3 and 19 years who have had symptoms of upper airway obstruction and nocturnal enuresis. Twelve children had secondary enuresis, and 103 children had primary enuresis. Surgical removal of upper airway obstruction led to a significant decrease in or complete cure of nocturnal enuresis in 87 (76%) of the children studied. Eleven children were also studied with polysomnographic tracings in an attempt to determine a relationship between their sleep patterns and nocturnal enuresis.

Adenoidectomy↗
PubMed2004

Enuresis in children and young people: a public health nurse approach in New Zealand.

The involuntary passing of urine at age six and older is called enuresis. Wetting during the day is called diurnal enuresis and wetting at night while asleep is called nocturnal enuresis. Nocturnal enuresis is second only to allergy as the commonest chronic disorder in childhood. Many children (adolescents are included in the term 'children') who are nocturnal enuretics exhibit behaviours such as low self-esteem, withdrawal, less ambition and increased anxiety. These children are often low achievers within the school system and become a problem for their family and school. In this article the author discusses a child/adolescent-centred primary nocturnal enuresis program and service that is administered by a group of public health nurses in South Auckland, New Zealand.

Child↗
PubMed2001

Enuresis services: carers' knowledge and attitudes.

The research described in this article examines parents' and carers of children with bedwetting (enuresis) problems' attitudes to, and knowledge of, enuresis and enuresis services in southern Derbyshire. A specialist enuresis service was already running in this area and the continence nurse advisor (children's services) had noted a high number of referrals complaining about lack of knowledge prior to attending clinic and a lack of clarity and continuity of advice given by other health professionals. The specialist continence service needed to be needs-led and validated as an appropriate and adequate service. Following a literature search and pilot study, a questionnaire was sent to parents of children who had been referred to the clinic in the previous year. Analysis was performed using the SPSS statistical package. Results showed a high value being given to the specialist nurse-led service by parents and children and a high amount of conflicting, non-evidence based advice being given to parents and carers from various health professionals prior to referral to the specialist nurse. The results of the study led to the formulation of recommendations to improve services available to children with enuresis, their parents and carers.

Adolescent↗
PubMed2004

Coping, commitment, and attitude: quantifying the everyday burden of enuresis on children and their families.

OBJECTIVE: To develop and evaluate a parent-completed questionnaire for use by clinicians as part of routine care to assess the burden of diurnal and nocturnal enuresis on children and their families. METHODS: The questionnaire consisted of items that measure the impact on the child and his/her parent, the child's coping ability and commitment to treatment, previous treatment success, family frustration and overall cohesion, and parental attitudes about enuresis and its treatment. Questionnaires (n = 208) were completed by parents during the child's scheduled office visit for enuresis at 5 specialty clinics across the United States. Traditional criteria were used to assess reliability and validity of the questionnaire, including analysis of variance. RESULTS: Success rates provide evidence that many of the items in the child scale (79%) and all items in the parent scale (100%) met stringent criteria. alpha values were.62 and.77, respectively. Statistically significant differences were observed for the scales across responses on all but 1 global item, the majority of parental attitude items, whether the child urinated at bedtime, and the number of pads used. These findings suggest that the child's coping ability and commitment and the family's overall cohesion and frustration with the problem influence parental perceptions about the impact of enuresis on the child and the family. CONCLUSIONS: Findings about the performance of the new measure were satisfactory and suggest that, after further refinement, it should prove as a useful tool for clinicians treating enuresis in children.

Adaptation, Psychological↗
PubMed1996

Enuresis nocturna can be provoked in normal healthy children by increasing the nocturnal urine output.

In a large proportion of enuretics, the enuresis episodes are accompanied by high urine output at night. At this study we provoked a high urine output in normal non-enuretic children in order to investigate whether volume provocation per se could cause enuresis. In six of ten children it was possible to provoke nine enuresis-like episodes. The enuresis volumes were small with no relation to functional bladder capacity. It is concluded, that increased urine output at night may produce enuresis-like episodes even in normal children.

Child↗
PubMed1999

[Long-term treatment with desmopressin in children with primary nocturnal enuresis. An international multicenter study].

BACKGROUND: Desmopressin (an analogue of antidiuretic hormone) holds an important place in the treatment of primary nocturnal enuresis. According to some long-term trials its action is mainly symptomatic. The benefit of treatment and persistence of the effect in relation to the expected decline of enuresis in 15% children/1 year is discussed. METHODS AND RESULTS: The open multicentre trial lasted 42 months. In the first stage 265 patients (164 boys, 101 girls) aged 9.4 +/- 2.8 (5-18 years) were given desmopressin (nasal drops) to achieve a 4-week dry integral. Enuresis stopped in 207/265 (78.1%) children within six (median) weeks of treatment after an effective dose of 10.5 micrograms (median) based on titration. During the second stage 55/265 children (25 boys and 30 girls) proceeded with treatment for 2-30 (median 12) months, one boy did not complete the trial. An effective dose was administered for 3.5 months (median) and then the dose declined depending on the effect by 3.5 micrograms (1 drop) per months (median). In the titration stage enuresis receded in 89.1% (49/55) children. After the first year of the trial there were 72.7% responders (p < 0.001, as compared with the assumed decline), after two years 70.9% (p < 0.01) and after three years 61.1% children (p < 0.05). The trial was completed by 61.1% (33/54) children as respondents. 23 of them 17-38 months after termination of treatment. 29.6% (16/54) patients were relapsing responders on long-term treatment, 5.6% (3/54) patients completed the trial as partial responders and 3.7% (2/54) children as non-responders. Minor side-effects were recorded during the titration stage in 4.5% children, during long-term treatment 5.4% children. The osmolality of morning urine increased during treatment regardless of the final effect (p < 0.01). The authors did not find a significant relationship between age, sex, familial incidence of enuresis, period of treatment and the achieved effect. CONCLUSIONS: The authors provided evidence of a rapid onset of the effect of desmopressin and a high effectiveness throughout the trial. The osmolality of the morning urine was not a reliable predictive factor of the effect. In the authors opinion long-term treatment is important for development of regulation and regression of complaints. During a relapse the authors recommend return to maintenance treatment and gradual discontinuation after 6-12 months. Desmopressin treatment is in the authors' opinion safe, well tolerated and very useful.

Administration, Intranasal↗