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PubMed2006

[The system of management nocturnal enuresis based on functional classification].

UNLABELLED: The aim of the study was to describe our diagnostic and therapeutic logarithm based on functional classification in children with enuresis, and effects of therapy based on this classification. MATERIALS AND METHODS: we reviewed charts of 123 children managed because of nocturnal enuresis (68 boys, 55 girls, aged 4-18 (mean 7,6) years). Every child had routinely performed ultrasonography, urinalysis, uroflowmetry with estimation of residual urine. Children with urinary tract infections or malformations of the urinary tract were not included in this study. At the first visit all children were instructed to conduct voiding diary. On the base of data from voiding diarys and uroflowmetries children are divided in two groups: Group I (n=21) with monosymptomatic nocturnal enuresis. Group II (n=102) children with bladder dysfunction and enuresis. In the first group rehabilitation program with bladder training, conducting voiding diary and conditioning therapy with alarm device was introduced. In children with bladder dysfunctions therapy started with bladder training and pharmacotherapy of bladder dysfunction. RESULTS: 9 children (6 from Group I and 3 from Group II) started to wake after starting bladder training. 81 children from Group II improved bladder function. 30 children from Group II started to wake up during therapy of bladder dysfunction. In 44 children, who improved bladder function and still had episodes of nocturnal enuresis, therapy with alarm device was introduced. From all 66 children treated with alarm device 5 started to wake up without any one episode of wetting. In 20 children the ability to wake up before alarm started to ring occurred in the first month of therapy. 40 children need to be treated for the second month, in 5 children therapy was prolonged for the third month. 9 children did not learn to wake up for urination. We have 8 drop-outs. In 7 therapy was repeated because of recurrence. CONCLUSION: The system of treatment of nocturnal enuresis is effective both in children with monosymptomatic nocturnal enuresis and in children with enuresis and voiding dysfunction.

Adolescent↗
PubMedDate not supplied

[Sound alarms and conditioning therapy in the treatment of childhood enuresis: a study of 180 cases].

The Authors present the study and results in 180 cases of infantile enuresis, treated with a new bell alarm associated to conditioning psychological treatment (toilet training, token economy, motivational counseling, urine stop exercises, etc.). The cases have been subdivided into the type of enuresis, age and sex. 140 (77.8%) subjects aged from 6 years to 16 years with primary enuresis, and 40 (22.2%) aged from 6 years to 15 years with secondary enuresis have been treated. The following results were obtained in the primary enuresis with this type of treatment after a follow-up of 6-12 months: permanent recovery in 85.71% of the cases, relapse after 6 months in 11.42%, improvement in 5% and failures in 9,29% of the cases. In secondary enuresis the following results were obtained: permanent recovery after 12 months in 75% of the cases, relapse after 6 months in 10%, improvement in 7.5% and failures in 17.5% of the cases. The differences in the results between the two types of enuresis with respect to the age of the cases up to 12 years are proved and relatively less with respect to the average time of treatment for the total remission. Regarding the sex of the cases no significant therapeutic answer was noted neither in the final results nor in the time of treatment in both types of enuresis. Finally, it is not the substitution of symptoms which are proved but the benefits of a general and psychological level.

Acoustic Stimulation↗
PubMed1995

[Enuresis from the viewpoint of the pediatric psychiatrist].

The etiological aspects of enuresis are diverse. Biological factors such as infection, developmental delay and genitourinary tract malformation must be excluded before the child psychiatrist ever undertakes to treat enuresis. In enuresis patients treated by a psychiatrist, an important role is played by the patients' social setting. These children came more often than controls from broken families, unhappy and quarreling parents who tends to give less attention to their children and encourage early separation. Enuresis is also more frequently associated with psychosocial changes (e.g., hospitalization, birth of a sibling, moving to a new home, etc.). The paper examines developmental stages of the child from the point of view of toilet training, circadian rhythms, and sleep stages from the point of view of enuresis incidence. What has a child psychiatrist to offer? Treatment of enuresis should involve a detailed analysis of the lifestyle, psychotherapy and drug therapy, rehabilitation and re-educational training. The most effective drugs are reviewed; these include tricyclic antidepressives (with a number of side effects) and Adiuretin as the drug of first choice, therapeutically hard-to-control enuresis, enuresis in adolescence, and the Peter Pan syndrome.

Adolescent↗
PubMed1994

Primary nocturnal enuresis in children. Background and treatment.

UNLABELLED: The aim of the present studies was to investigate background factors and treatment in children with monosymptomatic primary nocturnal enuresis. The study material comprised enuretics, former enuretics and controls from the municipal community of Falkenberg on the west coast of Sweden. Whenever possible all investigations were made with the children staying in their own home environment. Different background factors have been suspected as being causative: sleep disturbances, behavioural or psychological disturbances, small bladder capacity, increased night diuresis and an insufficient production of the antidiuretic hormone during sleep. These factors have been investigated in these studies. The treatment of enuresis has been dominated by the alarm and antidiuretic treatment with DDAVP. Primary nocturnal monosymptomatic enuresis is a common problem in childhood. In this study the prevalence among 392 seven year old children was 7.3%. A prior history of enuresis was found in 65% of families of the enuretics compared to 25% in controls. The enuretic children showed no statistically significant differences in behavioural or psychological problems compared to non-enuretic children. Enuretic children were described as heavy sleepers by their parents and a wake-up test performed at home showed that they were statistically significantly harder to arouse than the controls. Children with nocturnal enuresis, former enuretics and controls did not differ in social or behavioural traits in an interview study. No signs of symptom substitution was found when enuresis was resolved. Enuretic children had a normal bladder capacity and no statistically significant difference was found compared to controls and former enuretics. The enuretic children showed a normal calcium-creatinine quota in the urine. Former enuretic children showed a significantly enhanced calcium/creatinine quota compared to enuretics and controls. Enuretic children had a statistically significant lower morning plasma level of the anti diuretic hormone vasopressin than non-enuretic children. Enuretic children were treated for 12 weeks with DDAVP or the alarm. DDAVP treated patients had a more rapid effect compared with alarm treated patients. Alarm treated children had a lower relapse frequency. Enuretic children were treated in a randomised, double blind, double dummy, cross over, placebo-controlled study with DDAVP 20 micrograms intranasally by a single dose pipette or 200 micrograms orally as a tablet. Both methods were equally effective in controlling enuresis, but significantly superior to placebo. CONCLUSION: Enuretic children are normal, well adjusted children with a normal bladder capacity, a high level of arousal threshold, and a low morning level of plasma vasopressin. The alarm and DDAVP are equally effective in treating enuresis.(ABSTRACT TRUNCATED AT 400 WORDS)

Academic Dissertations as Topic↗
PubMed1996

[Primary and secondary nocturnal enuresis. Are they different entities?].

The aim of this study was to know the prevalence and predominant factors of primary and secondary enuresis in schoolchildren. For this purpose, a randomized epidemiological study was performed on a representative sample of the general population of children, aged 6 and 10 years, living in the province of Leon. Their parents responded to a questionnaire that evaluated, in both forms of enuresis, what are the predominant factors, including: familiar, socioeconomic, personal, education and psychological factors. We found that in a selected population of 1,307 children, 171 presented nocturnal enuresis when they were 6 years old (13.09% +/- 0.93%). Of these, 133 had primary (10.18 +/- 0.84%) and 38 (2.91 +/- 0.46%) secondary enuresis. We found no significant differences between the two forms in regards to familiar, socioeconomic, personal education or psychological factors. The only differences were that in secondary enuresis, the parents were older (p < 0.05) and less education (p < 0.01) on the subject of bladder control, and a later onset of the same (p < 0.05), was given. We conclude that the prevalence of primary enuresis is 10.18% +/- 0.84% and that of secondary enuresis is 2.91% +/- 0.46%. We do not find clear differences that permit us to consider these two types of enuresis as different forms.

Chi-Square Distribution↗
PubMed2002

Prevalence of nocturnal enuresis and associated familial factors in primary school children in taiwan.

PURPOSE: We investigated the prevalence and associated factors of nocturnal enuresis in children in elementary schools in Taiwan. MATERIALS AND METHODS: A cross-sectional study of nocturnal enuresis in Taiwanese school children was performed in 10 primary schools in Tao-Yuan County, Taiwan. Questionnaires on demographic data, familial and physical conditions were completed by 7,225 children assisted by their parents. RESULTS: The overall prevalence of nocturnal enuresis in Taiwanese primary school children was 5.5%. Decreasing age, male gender, family size, birth rank, parental education level and parental raising style were possible familial risk factors for nocturnal enuresis in this study. CONCLUSIONS: The study indicates a prevalence of nocturnal enuresis in the Taiwanese population comparable to that in western populations, showing that nocturnal enuresis is an international problem that should be considered seriously. Findings of familial factors associated with nocturnal enuresis provide a clue for future studies of psychosocial factors in different cultural societies and their intervention.

Birth Order↗
PubMed2005

[Study of renal morphology and function in children with nocturnal enuresis. Relationship with sensitivity or resistance to desmopressin].

BACKGROUND: In the last few years, there have been reports that children with nocturnal enuresis frequently have hypercalciuria. Likewise, children with desmopressin-resistant enuresis have recently been reported to have a higher renal concentration capacity than patients with desmopressin-sensitive enuresis. OBJECTIVES: To study renal function and urinary calcium excretion and to register familial history of enuresis and urolithiasis in a group of children with enuresis, whether responders or nonresponders to desmopressin, followed-up in our hospital. MATERIAL AND METHODS: A cohort of 60 patients (42 boys and 18 girls) who were referred to the hospital because of nocturnal enuresis. RESULTS: Hypercalciuria was detected in 26 children (43.3 %) and hypocitraturia in eight (13.3 %). The frequency of hypercalciuria was higher in desmopressin-resistant patients than in desmopressin-sensitive patients, but this difference was not statistically significant. Sonographic renal morphological anomalies were detected in 11 children (18.3 %). No differences in renal handling of water were detected when the patients were distributed according to the grade of sensitivity to desmopressin. CONCLUSIONS: In our cohort we found a high frequency of hypercalciuria in children with nocturnal enuresis. No differences were observed in maximal urinary osmolality among desmopressin-resistant and desmopressin-sensitive children.

Antidiuretic Agents↗
PubMed1998

A follow-up of enuresis from childhood to adolescence.

OBJECTIVE: To determine the prevalence and treatment of enuresis in a national population-based follow-up study of children aged 8-14 years, to evaluate possible factors that enhance or hamper the attainment of continence and to examine the relationships between enuresis and psychiatric disturbance. SUBJECTS AND METHODS: An initial study was carried out in 1989 as part of the Finnish Child Psychiatric National Epidemiological Study. Three types of questionnaires were used; the Rutter Scale A for completion by parents, including a question about enuresis, the Rutter scale B for completion by teachers and the Children's Depression Inventory (CDI), completed by the children. Parents were also asked about demographic and family issues, teachers about school achievements and children about additional psychosomatic symptoms. In a follow-up in 1995, the target population comprised all previous enuretics and their controls, matched by age, gender, class and school, in the first phase of the study. Replies were received from 315 enuretic boys and 186 girls, with the corresponding values for controls being 310 and 183. The parents were asked about the adolescents' present enuresis and for permission for a treatment trial, if needed. The adolescents completed the CDI, and a questionnaire about enuresis, previous treatments and possible willingness for a treatment trial. They also reported basic somatic data, their life events and living habits. RESULTS: In the initial study, the enuretic children had higher total and subscores as reported by parents, teachers and themselves, except for emotional items reported by the teachers. Additionally, a significantly greater proportion of these children soiled, had sleeping difficulties and difficulties in falling asleep. Enuretic boys had more frequent nightly arousal and early morning waking, while the enuretic girls had more nightmares than non-enuretic girls. At 14 years old, the parents reported that 13 adolescents were enuretic; from the children's replies, nine boys and seven girls were enuretic. CONCLUSIONS: The prevalence of enuresis in those previously enuretic was surprisingly low, probably because of the efficient treatment methods, conditioning and medication. There were evident connections between childhood enuresis and mental well-being.

Adolescent↗
PubMed2005

Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study.

AIMS: A previous prevalence study indicated that the prevalence of ADHD is highly increased in enuretic children. In the current 2-y follow-up study we investigate the relationship between both disorders further. Our goal is to determine whether the ADHD diagnoses can be reconfirmed and whether children with ADHD are more at risk for difficult-to-cure enuresis. Moreover, we explore the effect of medical enuresis parameters on the course of the voiding problem. METHODS: Eighty-six children with enuresis were screened twice on the presence of ADHD with a 2-y interval. A multi-method, multi-informant assessment of ADHD was used, the child's medical file was consulted, and a parent questionnaire on the child's current voiding problems was completed. RESULTS: Although 73% of all children with a 2-y-old diagnosis of ADHD still meet the disorder's criteria, only 66% of all subtype diagnoses can be reconfirmed. The odds that a child with ADHD still has voiding problems after 2 y are 3.17 times higher than for a child without ADHD. Although a slightly increased number of prescribed therapies in the ADHD group was noticed, no other significant differences in enuresis treatment methods were found between the groups. The medical parameters were not associated with treatment outcome. CONCLUSION: Since 73% of ADHD diagnoses can be reconfirmed, the data suggest that the prevalence of the ADHD syndrome rather than reactive ADHD symptomatology is increased in enuretic children. Children with ADHD are at risk for persistent enuresis. Two-year-old medical enuresis parameters seem to have little effect on the current presence/absence of enuresis.

Analysis of Variance↗
PubMed1998

Molecular genetics of nocturnal enuresis: clinical and genetic heterogeneity.

Forty-two children with nocturnal enuresis (27 with primary, 4 with secondary nocturnal enuresis and 11 with combined primary nocturnal enuresis and daytime wetting) were selected retrospectively from a study of 167 consecutive children with enuresis. The aim of the study was to collect formal genetic data, perform molecular genetic linkage-analyses with five microsatellite markers on chromosomes 13q, 12q or 8q and specify the associations between genetic findings and clinical, as well as psychiatric diagnoses. Positive linkage of nocturnal enuresis to one of the microsatellite markers was possible in 27 children from 23 families and was not possible in 15 children. Somatic findings in both the groups with and without possible assignment of nocturnal enuresis to a marker were heterogeneous. Psychiatrically, a low rate of behavioural problems was apparent. These findings support the hypothesis of genetic and phenotypical heterogeneity of nocturnal enuresis, without linkage of specific psychiatric and somatic phenotypes to certain chromosome markers.

Child↗
PubMed2000

Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years.

OBJECTIVE: To estimate the prevalence of nocturnal enuresis and to examine associations between nocturnal urinary control or enuresis and behavioral problems in Chinese children. METHOD: A community sample of 3,600 children aged 6 through 16 years was drawn from Shandong Province of China in 1997; 3,344 (93%) returned completed questionnaires. The Child Behavior Checklist and Teacher's Report Form were used to measure children's behavioral problems. RESULTS: The proportion of children attaining nocturnal urinary control before age 2 was 7.7%; by age 3, this had increased to 53.1%, and by age 5 to 93%. The overall prevalence of nocturnal enuresis was 4.3%, with a significantly higher prevalence in boys than girls. There was no significant decrease in the prevalence of enuresis between 6 and 16 years of age. Multiple logistic regression analyses showed that attaining nocturnal urinary control after age 4 and current enuresis were significantly associated with an increased risk of behavioral, emotional, and academic problems. CONCLUSIONS: Chinese children attain nocturnal urinary control earlier than Western children. The prevalence of nocturnal enuresis is low but fairly stable in children between 6 and 16 years. The findings support the link between nocturnal enuresis and psychopathology in children and adolescents.

Adolescent↗
PubMed2005

Controlled study of encopresis and enuresis in children with a prepubertal and early adolescent bipolar-I disorder phenotype.

OBJECTIVE: To examine the prevalence of encopresis/enuresis, relationship between maternal hostility and encopresis, parent-child concordance of reporting encopresis/enuresis, and familial aggregation of enuresis in subjects with a prepubertal and early adolescent bipolar-I disorder phenotype (PEA-BP), attention-deficit/hyperactivity disorder (ADHD), and healthy controls (HC). METHOD: There were 268 consecutively ascertained subjects (93 PEA-BP, 81 ADHD, and 94 HC). PEA-BP was defined as DSM-IV BP-I (manic or mixed phase) with elation and/or grandiosity. The WASH-U-KSADS and Psychosocial Schedule for School-Age Children-Revised were administered to parents about their children and separately to children about themselves. RESULTS: Encopresis was more prevalent in PEA-BP versus HC subjects (15.1% versus 3.2%, chi2 = 6.4, p = .012). Enuresis was more common in PEA-BP versus HC (21.5% versus 6.4%, chi2 = 7.8, p = .005) and ADHD versus HC (22.2% versus 6.4%, chi2 = 6.1, p = .014) subjects. All enuresis onset in subjects not receiving lithium. Most encopresis (81.8%) and enuresis (75.0%) onset before mania. Familial aggregation of enuresis was more frequent in enuretics than nonenuretics (47.7% versus 5.4%, chi2 = 41.2, p < .0001). Maternal hostility was more prevalent in encopretic versus nonencopretic subjects (91.7% versus 55.6%, chi2 = 8.3, p = .004). Parent-child concordance on reporting encopresis and enuresis was poor to fair. CONCLUSIONS: Children with PEA-BP need to be evaluated for encopresis, enuresis, and mother-child relationships.

Adolescent↗
PubMed1996

Enuresis: prevalence and associated factors among primary school children in Saudi Arabia.

The aim of this study was to determine the prevalence of enuresis and the factors associated with it among primary school children. This is a cross-sectional population-based study. Data were collected using a self-administered questionnaire. Six hundred and forty school children aged 6-16 years were selected randomly. Enuresis prevalence was 16.3% among boys and 13.8% among girls. The overall prevalence was 15%. Breastfeeding, first born children, family integrity and stability were found to be protective. Stressful life events before the age of 6 years, deep sleep, acute family psycho-social problems, recurrent urinary tract infection, constipation and congenital defects were found to be strongly associated with enuresis. Enuresis was also found to be associated with family history of enuresis. An important finding is that of the 83 children who had enuresis during sleep, 25 (30.1%) wet their beds during day time sleep (day sleep wetting). The importance of enuresis as a health problem has been affirmed and specific guidelines were suggested.

Adolescent↗
PubMedDate not supplied

Sociodemographic factors associated with nocturnal enuresis.

This study examined the school nursing/medical examination records of 6206 national school children for sociodemographic factors associated with reported nocturnal enuresis. A point prevalence of 10.7% (n = 666) for nocturnal enuresis was reported by parents during 1970-1993 in children aged 4-14 years. Although a downward linear trend (from 11.5% to 10.7%) was seen for the reported prevalence of nocturnal enuresis over the 23-year period, this trend was not statistically significant. Age, as expected, large family size and low ordinal position in the family were all statistically associated with reported nocturnal enuresis. Gender was statistically associated with reported nocturnal enuresis only in the 6-14 years age group. Paternal social class was not statistically associated with reported nocturnal enuresis, although 15% of children in families where the father was absent were reported enuretic compared with only 10% of children whose father was in social class 1. These findings contribute to an understanding of the relationship between sociodemographic factors and enuresis as reported at school medical examinations and have implications for the planning and development of health services at local levels.

Adolescent↗
PubMed1992

Drug therapy for nocturnal enuresis. Current treatment recommendations.

It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.

Adolescent↗
PubMed1997

Enuresis nocturna in adults.

To assess the prevalence and characteristics of enuresis nocturna in adults, the treatment they received and the perceived impact, a random sample of 13081 non-institutionalized adults (18-64 years old) were asked to participate in the study in January-March 1996. The response rate was 87%. A personal computer questionnaire included 23 questions on frequency of bedwetting, daytime wetting, treatment and perceived impact. Any respondent reporting bedwetting at least once during the previous 4 weeks was considered to have enuresis nocturna. The overall prevalence of enuresis nocturna was 0.5%. Differences between age groups and sexes were not significant. Fifty percent of men and 19% of women reporting enuresis nocturna had primary enuresis nocturna, of those with enuresis nocturna, 12% of men and 29% of women had always daytime incontinence. Fifty percent of the men and 35% of the women had never consulted a care provider for their bedwetting and 38% of the men and 26% of the women had done nothing to become dry. Only 30% believed that bedwetting was treatable. Bedwetting was associated with several psychosocial problems. Enuresis nocturna in adults is common and may lead to embarrassment and discomfort. It may affect careers, social life and personal relationships. Adults should be more aware that bedwetting is a treatable problem. More information should be given on this issue.

Adolescent↗
PubMed1997

Epidemiology of enuresis in Turkish children.

To establish the prevalence of enuresis in Turkish children and to identify common methods of managing enuresis, a self-administered questionnaire was distributed to parents of 5754 children aged 7-12 years. From a response rate of 96% the overall prevalence of any reported nocturnal enuresis was 11.5% and diurnal enuresis was 0.5%. The prevalence of enuresis was higher in boys than in girls. Turkish parents primarily administered behavioural techniques for the management of enuresis. These results suggest that prevalence rates for nocturnal enuresis in Turkish children are similar to those in previous studies reported from Western Europe, the USA and Australia.

Age Factors↗
PubMed2000

[Treatment of nocturnal enuresis in France].

OBJECTIVE: To evaluate the current incidence of nocturnal enuresis in France and the ways this condition is managed. PATIENTS AND METHODS: A survey was conducted amongst 3,803 school children (5 to 10 years old). In addition, management of nocturnal enuresis proposed by various specialists were collected through an analysis of the literature. RESULTS: The incidence of nocturnal enuresis was found to be 9.2% (11.2% in the subgroup of patients 5 to 7 years of age). 42% of the children (the most severe cases) stated they were bothered by their problem and that it affected their social life, although the mothers had a tendency to minimize the impact of enuresis. 66% of the mothers of children suffering from moderate to severe enuresis did address the problem to a medical doctor, mainly a general practitioner. Amongst these latter, 20% did not propose any solution. The remaining mainly proposed advise for lifestyle and dietary habits as well as a "wait and see" attitude. As a specific treatment, drugs (oxybutynin 48%, desmopressin 22%, imipramine 12%) were prescribed more often than alarms as drugs proved to be more effective than alarms. 48% of the mothers of enuretic children considered that doctors do not pay enough attention to this problem. Options for specific treatments of nocturnal enuresis vary from one specialist to another. CONCLUSION: A consensus about the most appropriate management approach to nocturnal enuresis is needed. Management of voiding dysfunction should be part of the medical curriculum.

Age of Onset↗