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PubMed2004

Nocturnal enuresis in older adults.

BACKGROUND: Nocturnal enuresis is uncommon in older adults. The paucity of literature about this problem prompts us to review our cases to determine the management strategy. METHODS: Six older adults, including 2 females and 4 males, were evaluated for refractory nocturnal enuresis. Only 2 of them had minor daytime urge symptom. Most of them had failed in the treatment using anticholinergics and/or alpha-adrenergic blocker. Evaluation consisted of detailed medical history, voiding diary, and urodynamic studies. Clinical follow-up persisted for 12 months. We define nocturnal polyuria as nighttime urine amount being more than 35% of total daily urine amount. Bladder outlet obstruction in men was diagnosed based on the definition described by International Continence Society. RESULTS: The average age was 71 years (range 61-84). The average duration of the symptom was 3.1 months (range 0.5-6). Two patients had bladder outlet obstruction. Four patients used hypnotics for insomnia, which might result in difficult awakening on bladder distension. Nocturnal polyuria was found in 3 patients. Most patients had multiple factors contributing to their nocturnal enuresis except 1, who was found to have an enlarged prostate with chronic bladder distension. Specific treatments were given based on the causes for each patient. Hypnotics were discontinued for a certain meanwhile in some patients. Nocturnal polyuria was managed with afternoon diuretic or bedtime desmopressin. Bedtime anticholinergic agent was used in patients with detrusor overactivity. The patient with enlarged prostate and urinary retention was managed with indwelling catheter followed by elective transurethral prostatectomy. All patients were dry in the night following the treatment. CONCLUSIONS: Nocturnal enuresis in older adult is usually multi-factorial. Hypnotic usage and nocturnal polyuria are frequently overlooked. Detailed investigation is necessary to identify the causes. Tailored treatment may achieve satisfactory results.

Aged↗
PubMed2004

Intensive behavioral therapy for primary enuresis.

OBJECTIVE: To assess the effect of intensive behavioral therapy on Saudi children with primary enuresis. METHODS: Twenty-six children, aged 6-14-years, presented with complains of bed wetting during a 12-months period from January 2001 through to January 2002, ArAr Central Hospital, Kingdom of Saudi Arabia were studied in an interventional, non-randomized trial without control. After complete verbal autopsy, physical examination and laboratory investigation, they were offered intensive behavioral therapy. They were evaluated for response, regularity, esteem and recurrence of enuresis. RESULTS: Mean age of the study group was 9.6-years (SD = +/- 2.6) and boys were affected almost twice of girls (P<0.05). Family history, social history and school performance did not show any significant (P>0.05) association with enuresis. Sixty point five percent were regular and out of those 27.9% never missed any visits. 91.7% were completely dry out of regular patients. There was 75% success rate in those, who visited 4-8 times while 25% in those, who visited 1-3 times. Ninety-six percent of the parents and 80.7% of the children were fully satisfied with this therapy. Socio-economic status seems to play a significant (P<0.05) role in regularity of follow up and response to behavioral therapy. CONCLUSION: This result shows an excellent response to intensive behavioral therapy in primary enuresis if the follow up is regular.

Adolescent↗
PubMedDate not supplied

The evaluation of desmopressin in treatment of adolescent nocturnal enuresis.

This study was designed to determine the effectiveness of desmopressin in the treatment of adolescent nocturnal enuresis and factors that may predict responsiveness. Eighteen adolescents (14 boys, 4 girls) with monosymptomatic nocturnal enuresis were treated with oral desmopressin for three months, starting with 0.2 mg at night and controlling the symptoms every two weeks. After this period, desmopressin was used every other day and the dose was reduced gradually. The treatment was completed at the end of six months. As factors that may predict response before treatment, a range of variables (family history of enuresis, educational levels of parents, number of children, first child in family, birth weight) and urine osmolality was evaluated. Disappearance of bedwetting by using desmopressin has been observed in adolescents who have a high urine osmolality. We did not observe any relapse during reducing desmopressin dose gradually, but on complete cessation of the treatment, relapses were seen. Six months after the end of the therapy, we could not find any patient who recovered completely. Desmopressin seems to be effective in the treatment of primary nocturnal enuresis while on therapy but during the long-term follow-up, all cases relapsed.

Administration, Oral↗
PubMed2005

[Review of the management of enuresis in a Senegalese hospital].

The profile of enuretic patients consulting a hospital urology department was reviewed over a period of 15 months based on 102 cases. The study concerned 47 male subjects and 55female subjects with a mean age of 15 +/- 5.3 years. The mean weekly frequency of enuresis was 5.2 +/- 1.9 and enuresis occurred more than once a night for 41.6% of patients. Enuresis was primary in almost 67% of cases. Various aetiological factors for enuresis were identified from analysis of the clinical data and were generally associated: sleep factor (n=93), bladder factor (n=84), hormonalfactor (n=52). Patients were managed as a function of the factors identified. With a mean follow-up of 6 +/- 2.1 months, cure was obtained in 30.4% of cases and improvement was obtained in 24.5%. The various management problems are discussed as a function of socio-economic realities in Senegal and the authors emphasize the need for a multifactorial approach.

Adolescent↗
PubMed1990

[Functional state of kinesthetic and acoustic analyzers in children with enuresis after complex reflexotherapy].

A study was made of the time-course of changes in function of kinesthetic and acoustic sensitivity in children (n-62) aged 9 to 14 years suffering from enuresis undergoing acupuncture based on cauterization of acupuncture points with 25% silver nitrate. The patients with enuresis manifested normalization of the sensitivity of the analyzers under study. The clinical results of enuresis treatment depend on the degree of correction of the alterations in function of the analyzers. The measurement of the threshold sensitivity of the sensory systems can be used for the control of the efficacy of the therapeutic measures taken in patients suffering from enuresis.

Acupuncture Therapy↗
PubMedDate not supplied

[Treatment of enuresis with Noveril].

The authors present their observations on treatment with Noveril of nocturnal enuresis in 49 children aged from 6 to 16 years. The drug is a derivative of dibenzodiazepine belonging to the group of thymoleptic agents with an action similar to that of imipramine. Noveril was given in doses from 20 to 100 mg daily during 3 to 9 weeks. In the final evaluation of the drug the frequency of enuresis before, during and after treatment was taken into account. In 25 cases an improvement was observed, usually in psychogenic nocturnal enuresis. Side effects included oral dryness, headaches and dizziness, and sleep disturbances observed in 4 cases. The tolerance of the drug was good. Noveril has a favourable effect in children with nocturnal enuresis, particularly of psychogenic origin.

Adolescent↗
PubMed1987

Childhood enuresis. A comprehensive treatment program.

Enuresis is a common, often misunderstood, condition that affects millions of children in the United States. For most children with primary enuresis, preventing secondary psychological sequelae associated with guilt and shame is an important consideration in the decision whether or not to treat. Because the spontaneous resolution rate is 15 per cent per year, the older the child, the more important treatment becomes. It is important to distinguish primary from secondary enuresis, as most psychogenically induced enuresis is of secondary nature. A careful history can usually elicit the etiology, as well as the exacerbatory factors in both types of conditions, providing direction for treatment. Treatments include pharmacologic, behavioral, and psychotherapeutic. In some cases, surgical intervention of either a urologic or otolaryngologic nature is indicated. A multidimensional approach is often best, and we have described our program with its success rate. Treating the enuretic child can be frustrating, but is usually quite gratifying for the child, parents, and the clinician.

Behavior Therapy↗
PubMed1987

Rhythmic slow wave observed on nocturnal sleep encephalogram in children with idiopathic nocturnal enuresis.

All-night sleep polygraphs, except the first night, were recorded for 15 patients with idiopathic nocturnal enuresis and 10 normal controls. Relations between sleep and the mechanism by which nocturnal enuresis is caused, with special emphasis on the occurrence of rhythmic slow waves (RSW), was studied. The following results were obtained. (a) There was no significant difference between the two groups in the proportions of the electroencephalographic (EEG) sleep stages, under the same conditions. (b) Nocturnal enuresis occurred with almost the same frequency in all sleep stages except stage 1 sleep and was higher in the second and third cycles. (c) Immediately before a nocturnal enuretic event, 6-7 Hz RSW continued for as long as 15-40 s in NREM sleep, or 3-5 Hz RSW was observed in REM sleep. (d) RSW was observed in enuretics and controls, and decreased with increase in age. However, RSW occurred more often, and age-related decrease was delayed in enuretic children. (e) RSW was induced by stimuli such as changes in sleep stages or body movement. During RSW, the variance of heart rate and respiration tended to be low. These results and the similarity between RSW and diffuse rhythmic theta suggest that RSW may be an expression of the process of maintaining a given sleep stage in children. These results may also be caused by the immaturity of the sleep mechanism in enuretic children. The long-lasting RSW on the sleep EEG was considered to be a sign of the onset of nocturnal enuresis.

Child↗
PubMed1983

Childhood enuresis.

Enuresis is a common health problem in children, occurring in approximately 10 percent of five-year-olds and five percent of ten-year-olds. Regardless of the multiple possible causes, enuresis affects the child's development. Following a discussion of epidemiologic, physiologic, psychosocial and predisposing factors to enuresis, this article presents nursing approaches to the assessment and management of enuresis. A variety of management options for the nurse practitioner are discussed with a focus on supporting normal child development and facilitative family interactions.

Adolescent↗
PubMed1978

[Cystomanometric investigations in children with enuresis and chronic urinary tract infection (author's transl)].

Ninety one patients with urinary tract infection, infection with enuresis or enuresis alone, but without any malformation of the lower urinary tract have been examined clinically as well as by cystomanometric und uroflow-metric studies. It could be shown that the most important parameters to evaluate blader function were the bladder compliance and the detrusor contraction during the filling of the bladder. The bladder compliance was estimated from the volume pressure relationship under resting conditions, at the first urgency to voide and at the moment when the maximal bladder capacity was reached, Concerning the detrusor contraction we distinguished partial isovolumetric detrusor contractions with an amplitude of 1--8 mm Hg and uninhibited detrusor contractions with an amplitude of more than 10 mm Hg. According to these two parameters it was possible to differentiate cystomanometrically seven different types of irritable and non irritable bladder, and to introduce a new theory of the pathogenesis of enuresis. According to this theory we suppose that enuresis in childhood is mostly caused by neurovegetative psychogenic disorders similar to anorectal sphincter achalasia in patients with overflow encopresis.

Adolescent↗
PubMed1980

Enuresis: a functional equivalent of a fetish.

The split in the ego between consciousness and unconsciousness which sometimes eventuates in fetishism can also be clinically manifested in sleep disturbances, depersonalization, dejà vu and a variety of alterations in the sense of reality. It is suggested that this same split comprises the central dynamic mechanism in enuresis. The sleep disturbance which accompanies enuresis involves a confusion between waking and sleeping, sometimes taking the form of a dream that one is awake. Three patients(adult males) revealed in the course of their analyses that they suffered from childhood enuresis accompanied by a sleep disturbance. Milder forms of sleep disturbances persisted into adult life. In these analyses, certain perceptual distortions, difficulties in the sense of reality, and between fantasy and reality, confusions between waking and sleeping, could all be linked to the functional split between consciousness and unconsciousness and eventually to disavowal of the female genitals. The enuresis represented a functional equivalent of the fetish (and it may be that the urinary stream itself actually served as a fetish). Psychological test data from nine enuretic boys were examined as well. This material clearly demonstrated that these boys wished to deny the differences between males and females, that they suffered from sleep disturbances and that they confused reality and fantasy, sleeping and waking. The combined data suggest the existence of a functional split in the ego used in the service of defence, the product of a regressive fixation and a reinstatement of an archaic mode of thought.

Adolescent↗
PubMed1994

Functional nocturnal enuresis.

OBJECTIVE: To discuss a patient with primary nocturnal enuresis whose symptoms resolved following manipulation. CLINICAL FEATURES: An 8-yr-old boy with a history of primary functional nocturnal enuresis was under care at this office. The patient's clinical examination was benign. He had several areas of lumbar segmental dysfunction. The patient's medical history was unremarkable except for childhood asthma. INTERVENTION AND OUTCOME: The patient's lumbar spine was manipulated once, and at a 1 month follow-up there was complete resolution of enuresis. The patient had several recurrences of bed-wetting, all of which were associated with minor injury to the lower back. The patient responded positively to subsequent manipulation. CONCLUSION: This patient's enuresis resolved with the use of manipulation. This happened in a manner that could not be attributed to time or placebo effect.

Child↗
PubMed1994

[Infantile enuresis: epidemiologic, clinical, urodynamic, and radiologic data of a consecutive series of 100 cases].

The present paper reports the epidemiological, clinical, urodynamic and cystographic data of 100 consecutive patients (mean age 9.59 years) with nocturnal enuresis. These patients were divided into three groups: group I (4 to 7 years old), 23 patients; group II (8 to 11 years old), 51 patients; and group III (12 to 14 years old), 26 patients. Nocturnal enuresis was more frequent in group II (51%). It was more prevalent in males (51%) of groups I and II. Isolated nocturnal enuresis was more frequent (54%) than nocturnal enuresis associated with diurnal symptoms (46%) in all age groups. Urinary infection was observed in 16% and was more prevalent in girls (68.7%). Detrusor instability was the most common urodynamic finding (40%), particularly in group II and girls. Uncoordinated voiding was the second most common urodynamic finding (24%), particularly in group II and girls. Lower urinary tract infection was observed in 1% (males). No abnormal urodynamic data were observed in 19%. Neurogenic bladder was observed in 16%, mainly in group II (31%). Vesicoureteral reflux was detected in 18%, mainly in girls (66.6%) and a postvoiding residual urine in 10%. A diagnostic and prognostic system and a therapeutic strategy based on our data are proposed.

Adolescent↗
PubMed1994

Assessment and management of the care of children with nocturnal enuresis: guidelines for primary care.

Nocturnal enuresis is a common situation, which may or may not become pathological. The issue of nighttime control of urination is frequently raised in the primary care setting as parents deal with toilet training their children. All NPs who provide care to these families should be knowledgeable about the cause of enuresis and know when to intervene more aggressively. The majority of queries about enuresis will be successfully handled in the primary care setting with minimal intervention and sound anticipatory guidance, education, and support. This article describes the epidemiology, causes, assessment, and treatment for primary and secondary enuresis.

Child↗
PubMed1993

[Enuresis and encopresis: their relationship].

The incidence and types of enuresis in 113 encopretic children were studied. The sex ratio was 5.17 males to every 1 female. Half of the patients were enuretics (50.44%). Of these, 78.9% were primary and secondary enuretics. No primary encopretic manifested secondary enuresis. The ratio of primary to secondary enuresis (3.75:1) in children with encopresis was much lower than in the population of enuretics. Of the enuretic encopretics, 40.34% had mixed or diurnal bladder incontinence. The results emphasize the role of peripheral dysfunctions and constipation-encopresis in the etiology of some enuresis. The therapeutic implications of these findings are also discussed.

Adolescent↗
PubMed1993

[Routine urodynamic studies is not indicated in children with enuresis].

From January 1980 to January 1992, urodynamic examinations were performed in 339 enuretic children without constipation or anatomical or neurogenic causes of incontinence. Nocturnal enuresis was seen in 178 patients, 130 children suffered from nocturnal and diurnal enuresis, and 31 had only diurnal enuresis. M. detrusor instability was found in 44% of the children and 73% showed more than 15% reduction in functional bladder capacity. In 5% an infravesical obstruction was suspected on pressure-flowmetry and in 12% dysfunctional voiding was seen. Routine urodynamic studies are not indicated in children with enuresis.

Child↗
PubMed1996

A survey of physician use of treatment methods for functional enuresis.

We report a survey of treatment methods used by primary care physicians in Worcester, Massachusetts in the treatment of functional enuresis. The results suggest a predominance in the use of psychobehavioral over pharmacologic treatment methods and are in contrast to previous studies. Ninety-one percent of physicians reported recommending the use of rewards to control enuresis. Eighty percent of physicians reported using the "bell-and-pad" conditioning method for treatment of functional nocturnal enuresis, contrasted with 5% of physicians reported in previous studies. Fifty-two percent of physicians reported using medication for treatment of functional nocturnal enuresis, despite substantial evidence of its dubious efficacy.

Attitude of Health Personnel↗
PubMed1996

[Importance of family history in enuresis].

A study on the familial background of nocturnal enuresis was conducted by administering a questionnaire to all school children in 1st year of Elementary Education. A total of 4,425 children were surveyed. The number of questionnaires returned was 2,770. Only 2,616 children born in 1985, aged 6-7 years, with no schooling delay were evaluated. A familial background of enuresis is much more frequent in enuretic than non-enuretic children (p < 0.001). When NE existed in first degree relatives, enuresis was also present in up to 40% children versus 8.5% in those with no familial history (p < 0.001). The background of NE is the father in 39.6% enuretic and 8.2% non-enuretic children (p < 0.001); in 42.1% enuretic children NE background was the mother, while non-enuretic children have maternal background in 10.4% (p < 0.001). Children with NE have a background of enuresis in their siblings in 62.9% cases versus 20.9% of non-enuretic children (p < 0.001).

Child↗