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PubMed2001

The effect of desmopressin on short-term memory in children with primary nocturnal enuresis.

PURPOSE: The use of desmopressin in patients with primary nocturnal enuresis is based on the hypothesis of a nocturnal lack of endogenous arginine vasopressin. However, in addition to the kidney, other targets of desmopressin are known. Therefore, we examined whether the administration of desmopressin influences central nervous function in children with primary nocturnal enuresis. MATERIALS AND METHODS: Our prospective, randomized, double-blind, placebo controlled cross-over study was performed on 40 children with nocturnal enuresis. Patients were randomly assigned to receive either 20 microg. desmopressin intranasally or 0.9% saline solution. Each group comprised 19 and 21 to children, respectively. After 2 weeks the groups were switched. The children were tested for short-term memory and reaction time to both treatments. Statistical analysis was done using the Wilcoxon matched pairs test. RESULTS: Median patient age was 8.0 years (range 6 to 13). During desmopressin treatment children in both groups had a significant decrease of wet nights (5.3 to 3.2 per week). In contrast to reaction time, short-term memory was significantly different between both groups (p <0.05). CONCLUSIONS: Our results demonstrate an increase in short-term memory after desmopressin treatment in children with nocturnal enuresis. This finding indicates the central nervous system as a target involved in the pathogenesis of nocturnal enuresis as well as the therapeutic benefit of desmopressin treatment.

Adolescent↗
PubMed2001

Central nervous system involvement in nocturnal enuresis: evidence of general neuromotor delay and specific brainstem dysfunction.

PURPOSE: To assess the involvement of central nervous system factors in the etiology of childhood nocturnal enuresis, an ongoing study of the fine neurology and neurophysiology has been instituted. MATERIALS AND METHODS: A total of 22 patients 8 to 14 years old were subcategorized sporadic and familial groups. Patients underwent a number of examinations, including a complete family pedigree; blood samples for linkage analyses; pediatric examination; urinalysis; uroflowmetry with pelvic floor electromyography; 24-hour flow charts; parental micturition questionnaire; child behavior checklist; intelligence test; standardized child psychiatric interview; acoustic, visual and event related late evoked potentials; Zurich Neuromotor Test Battery and the startle-blink paradigm. In this preliminary report only the results of the Zurich Neuromotor Test Battery and startle-blink paradigm are reported. RESULTS: In the Zurich Neuromotor Test Battery patients with enuresis had a longer timed performance but did not have more associated movements than the controls. In the startle-blink modulation paradigm inhibition of the electromyograph amplitudes was greatest following prestimulation with an interval of 120 milliseconds. This inhibition is known to be reduced among patients with enuresis compared to nonwetting children. The results indicated a general developmental (neuromotor) delay, in addition to specific dysfunction of the brain stem in patients with enuresis. The pre-pulse inhibition, as well as inhibition of bladder emptying at sleep, are regulated by brainstem centers in close anatomical proximity to the pontine micturition center and by analogous mechanisms. CONCLUSIONS: Reduced pre-pulse inhibition may represent a genetically transmitted trait indicative of nocturnal enuresis.

Adolescent↗
PubMed2002

The aquaporin-2 water channel in autosomal dominant primary nocturnal enuresis.

PURPOSE: Nocturnal enuresis is one of the most common diagnoses in a pediatric clinic. Recently, linkage analysis revealed a 2-point lod score of 4.2 in 6 families with dominant primary nocturnal enuresis around the aquaporin-2 (AQP2) water channel locus. Since primary nocturnal enuresis is ameliorated by desmopressin, AQP2 expression is increased by desmopressin and AQP2 is essential for concentrating urine, we determined whether a mutation in the AQP2 gene could cause primary nocturnal enuresis in these families. MATERIALS AND METHODS: Genomic DNAs of several patients from the 6 families were analyzed for disease causing mutations in the 4 exons of the AQP2 genes. RESULTS: In 1 family a G to A transition in the intron 1 splice donor site was found but it was also found in healthy subjects. In another family a C to T transition in the intron 1 splice acceptor region was identified but it was often found in splice acceptor sites. In 2 families a C to T transition was identified in the coding region of exon 3 but this mutation did not lead to a changed amino acid. CONCLUSIONS: Since no mutation in the AQP2 coding sequence was found, while this is essential for involvement in dominant primary nocturnal enuresis, the AQP2 gene is excluded as a candidate for autosomal dominant PNE in these families in which the disease co-segregates with chromosome 12q.

Aquaporin 2↗
PubMed1976

Relationship of allergy, enuresis, and urinary infection in children 4 to 7 years of age.

A group of 234 children, 4 to 7 years old, in a middle- to upper-middle-class Caucasian population, were divided into four groups and matched for age and sex. Group 1 consisted of 50 children previously treated for urinary infection: control group 1 contained 55 well children; group 2 consisted of 69 children treated for respiratory allergy; and control group 2 contained 60 well children. There was no statistical difference in persistent enuresis (night wetting every week), persistent day wetting (every week), allergy, or family history of enuresis, when group 1 and control group 1 were compared. A family history of urinary infection was higher (P less than .05) in group 1. There was no statistical difference in persistent enuresis, persistent day wetting, previous urinary infection, or family history of enuresis or urinary infection when group 2 and control group 2 were compared. This study suggests that there is no relationship between respiratory allergy, enuresis, and urinary infection.

Child↗
PubMed2003

Nocturnal enuresis.

Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.

Adolescent↗
PubMed2005

Nocturnal enuresis in children. A four-year experience in outpatient clinics of pediatric urology.

AIM: We present our experience in the treatment of enuresis at the Pediatric Urology Outpatient Office over a period of four years. We report pertinent epidemiological data, diagnostic workup, as well as routine treatment protocol. MATERIAL AND METHODS: Between April 1998 and May 2002, 142 healthy children, aged between 6.5 and 18 years (mean: 9 +/- 0.5 years), were referred to us for bedwetting. Ninety three of them were boys and 49--girls. Eight of them had also concurrent daytime enuresis. According to our protocol, the type of enuresis was identified (primary or secondary) and then we administered the respective treatment. Sixteen children underwent behavioural therapy only. Fifteen children with detrusor instability received oxybutinine or tolterodine. Twenty children with diurnal and nocturnal enuresis were given desmopressin and oxybutinine or desmopressin and tolterodine. The remaining 91 children received monotherapy with desmopressin (individualized dose). The initial follow up ranged from 3 to 6 months. RESULTS: Out of 111 children receiving desmopressin, 66 stopped wetting, but 28 relapsed in two weeks and treatment continued for 3 more months. Nine children became dry. In the other groups there was almost complete response to treatment. CONCLUSION: Enuresis continues to be a suppressed problem for both children and parents; however, effective treatment is possible.

Adolescent↗
PubMed1991

Nocturnal enuresis in normal Jamaican children. Implications for therapy.

The prevalence of nocturnal enuresis has been investigated in 477 children (243 boys, 234 girls) attending government Basic Schools in Kingston, Jamaica. Enuresis, defined as wet at least 2 nights a week, occurred in 62%, 48%, 42% and 40% at 2, 3, 4 and 5 years of age, respectively. Enuresis, defined as wet at least one night a month, occurred in 68%, 58%, 53% and 52%, respectively. There was no significant difference between the sexes. Children with a family history of enuresis (first degree relatives wet beyond 8 years of age) were more likely to be enuretic than those with no family history, the difference reaching statistical significance for girls (less than 0.001) and for the sexes combined (p less than 0.001) but not for boys alone (p = 0.06). The prevalence of nocturnal enuresis in Jamaican children is higher than reported for Black children elsewhere, which in turn is higher than in their White counterparts. Cultural attitudes to bedwetting contribute to this variation and have implications for choice of therapy, both in Jamaica and elsewhere.

Black or African American↗
PubMed1989

[Enuresis in children. Diagnostic assessment and treatment].

Many theories on the etiology of enuresis have been suggested, including psychogenic, structural abnormalities, dysfunctional aspects. The study consisted of 95 children with primary enuresis (35 girls, 60 boys). 58% of patients presented with enuresis plus evidence of voiding dysfunction. Patients with pure nocturnal enuresis were 17%. 42% of children have normal bladder on urodynamic testing. Anticholinergic medication was effective in children with voiding dysfunction. The base line treatment program, in children with normal urodynamic studies, included psychotherapy, medications, bladder training. Authors present their experience and results of treatment. The usefulness of urodynamic assessment in children with only nocturnal enuresis is discussed.

Adolescent↗
PubMed1989

A proposal for a classification system of enuresis based on overnight simultaneous monitoring of electroencephalography and cystometry.

A classification system of enuresis was proposed based on the overnight simultaneous electroencephalographic (EEG) and cystometric (CM) monitoring of 204 cases. The classification types proposed were as follows: (a) Type I (125 cases, 61%). The first bladder contraction (FBC) in CM is noticed on cystometrogram (CMG) during Stage 4 sleep when the bladder is full. An evidence of arousals in EEG appears and EEG changes to a Stage 1 or 2 sleep pattern; however, enuresis occurs without waking. (b) Type IIa (22 cases, 11%). FBC is noticed as in Type I, but no EEG response is observed; enuresis occurs. (c) Type IIb (57 cases, 28%). An uninhibited contraction of the bladder is observed on CMG only during sleep (not on awakening). No change in either FBC or EEG is found, but enuresis occurs. It is expected that new methods of treatment for enuresis will be developed based on this classification system.

Adolescent↗
PubMed1988

Oxybutynin efficacy in the treatment of primary enuresis.

The effectiveness of oxybutynin in the treatment of primary enuresis was evaluated in a double-blind study. A total of 30 children (25 boys, five girls), at least 6 years of age, with primary enuresis and no daytime incontinence or history of other urinary tract problems were selected at random from an enuresis clinic population. The study was explained to the families and they were told how to keep records of nocturnal bed-wetting episodes and side effects. The patients were treated with a 10 mg of oxybutynin at suppertime for 28 days. Before or after the treatment period, all children received an identical placebo for 4 weeks. Two-sided paired t tests were used to compare frequency of nocturnal enuresis. Frequency during the drug regimen did not differ significantly from that during the placebo study. There were no differences in findings between boys and girls or between children who had previously taken imipramine and those who had not. The study showed no evidence that oxybutynin is effective in treating primary enuresis.

Adolescent↗
PubMedDate not supplied

[Treatment of nocturnal enuresis with a sound alarm. Study of 130 cases].

Nocturnal enuresis is a very common problem in childhood, various treatment have been suggested to cure bed-wetting, but the two most commonly used methods are the buzzer alarm and drugs. At Children's Hospital of Florence University, we dealt a trial to evaluate the effectiveness of conditioning treatment for nocturnal enuresis. We used a model alarm called "bell and pad". The child sleeps on a detector mechanism such as two separate metal mats that are connected with a buzzer alarm. When the voided urine wets the sheet, completing the electrical circuit, triggers the alarm and the child awakes. With repetition and unconscious inhibitory reflex is developed. 130 children were treated, 84 males and 46 females. Subjects were at least 6 years of age and not older than 15. 112 children had nocturnal primary enuresis and 18 secondary. The family history was positive in 70%. We had an initial interview with child and his parents. During this initial approach we explained the conditioning treatment. The child was given a diary card to record the bedwetting nights. We liked to see the child at three weekly intervals. After the child was dry for three consecutive weeks the metal mats was removed the bed. After a further three weeks of dryness the alarm was returned. Out of 130 cases there have been 109 cures (83%), whereas 21 (17%) haven't achieved dryness. There have been 14 relapses. Most children (77%) became dry within 12 weeks. The children with nocturnal secondary enuresis achieved later dryness. We believe that the use of enuresis alarm gives a high cure rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Enuresis in children 5-18 years old in severe dysfunctional families].

In a primary care setting 698 children aged 5-18 years were examined and 27 in 21 families were found to have enuresis nocturna. The control group included 127 children in 79 families who did not have enuresis. 13 (48.1%) children with enuresis, but only 8 (6.3%) control children, were from severe dysfunctional families. Such families are characterized by chronic and persistent conflicts, absence of closeness and lack of trust between parents and children, and lack of parental support (p < 0.001). Results were similar for boys and girls. The rate of parents with 8 or fewer years of education was significantly higher among children with enuresis as compared to controls, both with regard to fathers (p = 0.05) and mothers (p < 0.01). These findings indicate that severe dysfunctional families do not support maturation and personality development of their members. Early discovery of severe dysfunctional families promotes early intervention and effective treatment of enuresis in childhood.

Adolescent↗
PubMed1996

[Functional enuresis. Which is the border between the organic and the pathological?].

The importance of the psychological aspects in treating the enuretic patient is often underestimated. The author reports 13 patients with functional enuresis, whose emotional implications of the symptom are very clear. In 7 patients a psychodiagnostic evaluation, with colloquia, tests, play and drawing, was carried out: the personality and family features of the children resulted similar to those described in literature (a too close mother-child relationship preventing child's separation, with both aggressiveness against mother and regression; depression; a difficult sexual identification). In 3 patients a psychotherapy lasting more than 6 months was undertaken. Psychologic care and short psychotherapy were always useful to relieve the neurotic symptoms connected with enuresis and to better child's personality; in some patients, they were not completely successful on the symptom, because this persisted although the number of episodes was reduced. The clinical approach depends on the type of enuresis. A psychologic care of the patients with secondary enuresis and of children with neurotic personality is necessary; in the other cases it is advisable to set up a therapeutic alliance with the child against his symptom, and to deal with the depressive traits related to it. We have to think of enuresis not as a border between organic and psychological, but as a problem in which the two aspects are closely linked together without excluding each other. The author believes that psychotherapy with enuretic patients is frequently lasting.

Adolescent↗
PubMed1997

Prevalence and incidence of enuresis before puberty.

OBJECTIVE: A mixed study of the prevalence and incidence of enuresis addressed to the schools of the province of Sassari was planned over a 2-year period. METHODS: School children aged between 3 and 11 years were considered. 734 children aged 3, 6, and 9, of 3 schools representative of the urban, suburban and rural areas of Sassari were selected by "cluster" sampling. In this first stage of the project a study of prevalence in children aged 3, 6, and 9 years was carried out. The second stage encompasses a 1-year longitudinal study of the cohort selected in the first stage and provides incidence data pertinent to children aged 4, 7 and 10 years. RESULTS AND CONCLUSIONS: Cross sectional study: In the 73 children aged 3 years who attended nursery schools, 7 cases of enuresis (9.6%) were identified. In the 306 6-year old children of the first year of primary school, 22 cases of enuresis (7.2%) were observed. In the 355 9-year-old students of the fourth year of primary school, 10 cases (2.8%) were reported. Follow up: No case of enuresis was observed among children of the nursery school (aged 4 years); 2 new cases (0.7%) were identified in the 7 year-old group and only 1 new case (0.57%) was encountered in the group of children aged 10. Prevalence of enuresis reached 5.3% in the overall sample and showed a progressive decrease from the younger to the older age group.

Child↗
PubMed2001

Fluvoxamine is ineffective in the treatment of enuresis in children and adolescents: an open-label pilot study.

Tricyclic antidepressants possess established antienuretic properties. The selective serotonin reuptake inhibitors (SSRIs) have similar antidepressant properties to the tricyclic antidepressants and a safer side effect profile. The aim of the present study was to evaluate the antienuretic efficacy of one SSRI, fluvoxamine. Nine children aged 9 to 14 years with primary enuresis which was resistant to behavioral therapy participated in the study. All received fluvoxamine, 75-100 mg per day. In four, the enuresis was the only focus of clinical attention, and five received fluvoxamine for other primary indications. Enuresis was monitored daily, and mean voiding frequency was compared between three phases: baseline, on treatment and off treatment. Fluvoxamine had no statistically significant effect on enuresis. Fluvoxamine does not seem to possess significant antienuretic properties. We suggest that the combination of serotonergic with anticholinergic activity is a major factor in the antienuretic activity. In the treatment of children or adolescents with obsessive-compulsive disorder and comorbid enuresis, clomipramine may be preferred over SSRIs. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2026

Neurocorrelates of nocturnal enuresis in pre-adolescent children.

INTRODUCTION: Nocturnal enuresis (NE) is a common neurodevelopmental condition, yet its underlying neural mechanisms remain unclear. This study leverages the large-scale Adolescent Brain Cognitive Development (ABCD) dataset to identify structural and functional brain correlates associated with active symptoms and the resolution of bedwetting. METHODS: Using cross-sectional data from 3472 participants aged 9-10 years, children were categorized into three groups: active nocturnal enuresis (ANE, n = 225), history of nocturnal enuresis (HNE, n = 1171), and healthy control groups (CG, n = 2076). Multimodal neuroimaging protocol evaluated macrostructural properties via structural MRI (sMRI), microstructural white matter integrity via diffusion MRI (dMRI), and functional connectivity via resting-state fMRI (fMRI). Group differences were evaluated using linear models within an ANCOVA framework, adjusting for intracranial volume and handedness with False Discovery Rate (FDR) correction. RESULTS: Compared to controls, the ANE group exhibited a significant volume deficit in the right caudate, decreased sulcal depth in the left insula, and lower internal correlation within the Cingulo-Opercular Network (CON). Conversely, the dry HNE group demonstrated significant structural adaptations, including bilaterally larger putamen volumes and increased right caudate volume compared to the ANE group. The HNE group also showed increased microstructural density (decreased mean diffusivity) in the bilateral hippocampus and an increased cortical surface area in the left insula. Both NE groups demonstrated persistently reduced functional coupling within the CON. CONCLUSIONS: Nocturnal enuresis appears to be associated with a potential complex central signaling deficits. Reduced internal correlation within the CON across both active and former bedwetters indicates a potential for impairment in processing internal homeostatic bladder signals during sleep.

Humans↗
PubMed2003

A nocturnal enuresis service for a deprived inner city.

AIM: Glasgow is a city where 80% of the most deprived children in Scotland live within 20% of the overall population. Of 168,000 children in Glasgow, an estimated 5000 aged 5-15 y have primary nocturnal enuresis. The aim of this study was to establish a nocturnal enuresis service for Glasgow. METHODS: Needs assessment was performed and the incident cases were documented at school entry healthcare appraisal, at the age of 5 y. A cohort of these children was followed up at 8 y of age and symptom resolution was no better than natural remission. Parents, general practitioners, clinical medical officers and a hospital paediatrician were interviewed face-to-face about their need for a service. RESULTS: Ten of 11 general practitioners expressed a need for a specialist service. Ten school nurse-led local nocturnal enuresis clinics were established. Accommodation, funding, default and managing alarms were major problems. School nurses enjoyed extra training and quickly became skilled therapists. Two research projects highlighted that most children at first attendance did not believe they could ever be dry, which predicted outcome. Deprived families, once motivated, could successfully undertake complex behavioural therapies. CONCLUSION: A comprehensive nocturnal enuresis service begins when children stop using night nappies at the age of 3-4 y. Appropriate waterproof mattress, duvet and pillow coverings should be advocated until 5 y, when desmopressin may be helpful. For continued wetting at the age of 7 y, a local service should be led by a team of well-trained nurses using enuretic alarms.

Behavior Therapy↗
PubMed1995

Urine concentration and enuresis in healthy preschool children.

OBJECTIVES: To determine whether children concentrate their urine overnight and to assess the correlation between specific gravity of a first morning urine specimen and the results of a questionnaire concerning bedwetting, voiding habits, and continence in 47 healthy children aged 3 to 6 years. DESIGN: A prospective observer-blinded consecutive sample. SETTING: Two San Francisco, Calif., preschools. PARTICIPANTS: Forty-seven children attending preschool during the study period. MEASUREMENTS/MAIN RESULTS: Forty of 47 children had a urine specific gravity greater than 1.020. None of these children wet the bed during this study, although four (11%) of 36 had a history of bedwetting. Furthermore, seven children with a urine specific gravity of 1.015 or lower had a history of bedwetting and wet the bed during this study. A voiding frequency of six or more times per day, by history, was associated with a 3:1 relative risk of bedwetting but did not segregate children with primary enuresis from those with secondary enuresis. CONCLUSIONS: Our results indicate that healthy children aged 3 to 6 years are able to concentrate their urine. In addition, urine specific gravity was an accurate predictor of the presence of nocturnal enuresis in this group of children. Our results suggest that a specific gravity of the first morning urine specimen should be correlated with appropriate history before extensive diagnostic evaluation or empiric therapy is performed in children with nocturnal enuresis.

Child↗