1
|
von Gontard A, Mattheus H, Friese-Jaworsky J, Moritz AM, Thome-Granz S, Roozen S, Curfs L, van Koeveringe G, Hussong J. Incontinence and sleep disturbances in young children: A population-based study. Neurourol Urodyn 2022; 41:633-642. [PMID: 34989456 PMCID: PMC9306626 DOI: 10.1002/nau.24866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Aims Nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI), as well as sleep and behavioral problems are common in young children. The aim of this study was to analyze the association of sleep and psychological parameters for all types of incontinence in a representative sample of young children. Methods Six hundred thirty eight (of 1161) children with a mean age of 5.9 years (50.9% boys) were assessed during their mandatory school entry examination. The participation rate was 55%. Instruments included the Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire and other clinical questions. Incontinence was diagnosed according to ICCS standards. Constipation was assessed by two questions. Results 17.1% of children had at least one type of incontinence, 14.8% had NE, 5.0% DUI, 2.1% FI, and 4.8% were constipated. 6.7% of children had clinically relevant psychological problems. 22.7% of children had sleep problems regularly (5−7 times/week). A wide variety of sleep problems were reported. Children with incontinence were not affected by a higher rate of sleep problems. Children with NE had fewer night wakings and those with constipation fewer parasomnias. Sleep and psychological problems were significantly associated, especially in children with DUI and FI. Conclusions Sleep and behavioral problems are common in young children. Psychological problems have a clear impact on sleep. Young children with incontinence do not have more sleep problems than continent children. Therefore, both sleep and psychological problems should be addressed in young children with incontinence.
Collapse
Affiliation(s)
- Alexander von Gontard
- Department of Urology, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Outpatient Services for Child and Adolescent Psychiatry, Psychiatric Services Graubünden (PDGR), Chur, Switzerland
| | - Hannah Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jana Friese-Jaworsky
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | | | | | - Sylvia Roozen
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
2
|
Di Carlo G, Zara F, Rocchetti M, Venturini A, Ortiz-Ruiz AJ, Luzzi V, Cattaneo PM, Polimeni A, Vozza I. Prevalence of Sleep-Disordered Breathing in Children Referring for First Dental Examination. A Multicenter Cross-Sectional Study Using Pediatric Sleep Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228460. [PMID: 33207543 PMCID: PMC7698058 DOI: 10.3390/ijerph17228460] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022]
Abstract
Background: Sleep-related breathing disorders (SRDB) are a group of pathological conditions characterized by a dysfunction of the upper airways. The value of SRDB's prevalence, in the pediatric population, ranges from 2 to 11% depending on the different methodologies used in measure and the difficulties in the diagnosis. The aim of this study was to assess the prevalence of SRDB using the Pediatric Sleep Questionnaire (PSQ). Methods: 668 patients were enrolled from the Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy and from the Unit of Integrated Pediatric Dentistry, University of Murcia, Spain. The questionnaires were administered to patients with no previous orthodontic and surgical treatment who attended on the first visit at the two units of pediatric dentistry. Data regarding general health status were extracted from the standard anamnestic module for first visit. Prevalence and logistic regression models were computed. Results: The ages ranged from 2 to 16 years old (average 7 years old). The prevalence of SRDB was 9.7% for the entire sample. The models showed a positive correlation between three variables (snoring, bad habits, and anxiety) and SRDB. Conclusions: The prevalence obtained demonstrates the relevance of sleep disorders in the pediatric population and highlights the central role of pediatric dentists in the earlier diagnosis of these disorders.
Collapse
Affiliation(s)
- Gabriele Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
- Correspondence:
| | - Francesca Zara
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Milena Rocchetti
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Angelica Venturini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Antonio José Ortiz-Ruiz
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, University of Murcia, 30008 Murcia, Spain;
| | - Valeria Luzzi
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Paolo Maria Cattaneo
- Department of Dentistry, Section of Orthodontics, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark;
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| | - Iole Vozza
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.Z.); (M.R.); (A.V.); (V.L.); (A.P.); (I.V.)
| |
Collapse
|
3
|
Abstract
Intermittent incontinence of urine in a sleeping child who has previously been dry for less than 6 months without any other lower urinary tract symptoms is considered to be primary monosymptomatic nocturnal enuresis (PMNE). Although, most children outgrow PMNE with age, the psychological impact on the child warrants parental education and patient motivation and treatment. Motivational therapy, alarm therapy and drug therapy are the mainstay of treatment. Motivational and alarm therapy have better success rates than drug therapy alone. Desmopressin is the commonly used first-line drug and is best for short-term relief. Other drugs such as anti-cholinergics, imipramine and sertraline are used in resistant cases. This review focuses on the assessment and treatment of PMNE.
Collapse
Affiliation(s)
- Shikha Jain
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS) , Bhopal, Madhya Pradesh, India
| | | |
Collapse
|
4
|
Abstract
The objective is to provide a review of nocturnal enuresis (NE), including its epidemiology, etiology, pathophysiology, evaluation, and current management. We also set to provide further insight on the treatment of this condition from the experience derived from patients cared for at our tertiary-care institution. NE affects approximately 15% of all children at 5-year-old, affecting boys more frequently than girls. At our large university tertiary pediatric urology center, NE and incontinence, in general, is one the most common chief complaints prompting urologic care. In this review, we examine the condition in detail, highlighting specific goals of the initial evaluation and treatment. We contrast the commonly implemented treatment recommendations, available from the literature with strategies we have found valuable from our extensive experience in treating patients with this disorder. Using current urologic reference textbooks, book chapters, Medline, journal articles and reviews describing the many aspects of NE were reviewed in order to describe NE and the current practices at our institution. Although, this is not a systematic literature review, it includes relevant available research, institutional experience and urological expert opinion and current practices at a tertiary state health facility. The treatment of NE remains a challenge for many pediatricians and pediatric urologists. This likely stems from the multiple possible etiologies of the disorder. We have established a treatment algorithm at our institution, which we have found successful in the majority of our patients. This consists of starting patients on urotherapy, then offering both the enuresis alarm device and medication therapy as first line treatments, and finally adding anticholingerics for combination therapy. Our hope is with further research the treatment of NE will continue to improve.
Collapse
Affiliation(s)
| | - Chad Morley
- Department of Surgery, Division of Urology, West Virginia University Robert C. Byrd Sciences Center, Morgantown, WV, USA
| | - Osama Al-Omar
- Department of Surgery, Division of Urology, West Virginia University Robert C. Byrd Sciences Center, Morgantown, WV, USA
| |
Collapse
|
5
|
Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of khorramabad in 2013. Int J Pediatr 2014; 2014:120686. [PMID: 25374608 PMCID: PMC4211300 DOI: 10.1155/2014/120686] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Nocturnal enuresis refers to an inability to control urination during sleep. This study aimed to determine the prevalence of nocturnal enuresis and its associated factors in children in the city of Khorramabad. Materials and Methods. In this descriptive-analytic, cross-sectional study, 710 male and female children were divided into two groups with equal numbers. The samples were selected from the schools of Khorramabad using the multistage cluster and stratified random sampling methods based on the diagnostic criteria of DSM-IV. The data was analyzed using the logistic regression. Results. The results showed that 8% of the children had nocturnal enuresis, including 5.2% of primary nocturnal enuresis and 2.8% of secondary nocturnal enuresis. The prevalence of nocturnal enuresis in the boys (10.7%) was higher compared with that in the girls (5.4%) (P = 0.009). There were statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (P = 0.023), respiratory infections (P = 0.036), deep sleep (P = 0.007), corporal punishment at school (P = 0.036), anal itching (P = 0.043), and history of seizures (P = 0.043). Conclusion. This study showed that the prevalence of nocturnal enuresis in the boys was higher compared with that in the girls.
Collapse
|
6
|
Kotagal S, Nichols CD, Grigg-Damberger MM, Marcus CL, Witmans MB, Kirk VG, D'Andrea LA, Hoban TF. Non-respiratory indications for polysomnography and related procedures in children: an evidence-based review. Sleep 2012; 35:1451-66. [PMID: 23115394 DOI: 10.5665/sleep.2188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This evidence-based review provides a systematic and comprehensive review of the literature regarding the utility of polysomnography for the evaluation of non-respiratory sleep disorders in children including hypersomnias, parasomnias, sleep-related movement disorders, and sleep in other special populations. METHODS A task force of pediatric sleep medicine experts performed a systematic review of the literature regarding the use of polysomnography for non-respiratory sleep disorders in children. They identified and graded 76 papers as evidence. RESULTS The main results include (1) polysomnography combined with the multiple sleep latency test is useful for evaluating disorders of excessive somnolence to objectively quantify sleepiness. The results have to be interpreted with consideration of the pubertal stage and regularity of the sleep patterns of the child; (2) polysomnography is indicated in children with parasomnias or sleep related movement disorders who have a high likelihood of having obstructive sleep apnea (OSA); (3) polysomnography is not routinely indicated in children with enuresis unless there is a high likelihood of OSA; (4) polysomnography can be helpful in evaluating children with restless legs syndrome (RLS) and when periodic limb movement disorder (PLMD) is suspected. CONCLUSIONS These findings suggest that, in children with non-respiratory sleep disorders, polysomnography should be a part of a comprehensive sleep evaluation in selected circumstances to determine the nature of the events in more detail or when the suspicion of OSA is relatively high.
Collapse
|
7
|
Cohen-Zrubavel V, Kushnir B, Kushnir J, Sadeh A. Sleep and sleepiness in children with nocturnal enuresis. Sleep 2011; 34:191-4. [PMID: 21286252 DOI: 10.1093/sleep/34.2.191] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To assess if sleep patterns and sleepiness are compromised in children with nocturnal enuresis (NE), in comparison with normal control subjects, and to evaluate the role of enuresis-related events during sleep. DESIGN Assessment of natural sleep patterns at home in a sample of children referred to enuresis clinics and controls. SETTING Children's homes. PARTICIPANTS Thirty-two children (19 boys and 13 girls aged 5.1 to 9.1 years) who suffer from primary NE and 94 healthy control subjects (49 boys and 45 girls aged 5 to 8.58 years). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Sleep measures were derived from 3 to 5 nights of actigraphy and daily logs. Additional information on events related to enuresis and daytime sleepiness was collected using daily reports. Children with NE slept significantly worse than did the control subjects. Their compromised sleep patterns were reflected in a higher number of actigraphic nighttime awakenings, the reduced percentages of motionless sleep, the higher number of reported nighttime awakening, and the increased sleep latency. Children with NE also reported higher levels of sleepiness in the morning and in the evening. CONCLUSIONS Compared with the sleep of control subjects, the natural sleep of children with NE is significantly more fragmented, and the children with NE experience higher levels of daytime sleepiness. This phenomenology is associated with bedwetting episodes and attempts to keep the child dry during the night. These findings may suggest that children with NE suffer from sleep fragmentation, which may explain their higher arousal threshold. These findings have clinical implications for enuresis management.
Collapse
Affiliation(s)
- Vered Cohen-Zrubavel
- The Adler Center for Research in Child Development and Psychopathology, Department of Psychology, Tel-Aviv University, Israel
| | | | | | | |
Collapse
|
8
|
|
9
|
Nevéus T, Läckgren G, Tuvemo T, Jerker H, Hjälmås K, Stenberg A. Enuresis - Background and Treatment. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/003655900750169257] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Tryggve Nevéus
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Göran Läckgren
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Torsten Tuvemo
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Hetta Jerker
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Kelm Hjälmås
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Arne Stenberg
- Dept of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden
| |
Collapse
|
10
|
Nevéus T. Enuretic sleep: deep, disturbed or just wet? Pediatr Nephrol 2008; 23:1201-2. [PMID: 18481106 DOI: 10.1007/s00467-008-0859-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 04/04/2008] [Accepted: 04/08/2008] [Indexed: 11/28/2022]
Abstract
Enuretic children sleep "deeply" in the sense that they are difficult to arouse from sleep, but not in the sense that their sleep is necessarily polysomnographically different from other children. The enuretic children's arousal difficulties may be due to a disturbance at the brainstem level and/or to frequent arousal stimuli from the bladder. It may be hypothesised that the sleep disturbance of enuretic children may lead not only to the wetting of the sheets but to disturbances of daytime psychological functioning as well.
Collapse
|
11
|
Sans Capdevila O, Crabtree VM, Kheirandish-Gozal L, Gozal D. Increased morning brain natriuretic peptide levels in children with nocturnal enuresis and sleep-disordered breathing: a community-based study. Pediatrics 2008; 121:e1208-14. [PMID: 18450864 DOI: 10.1542/peds.2007-2049] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Habitual snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may improve enuresis. OBJECTIVES The purpose of this work was to assess whether habitual snoring is associated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels. METHODS Parental surveys of 5- to 7-year-old children were reviewed for habitual snoring and enuresis. Enuresis was also assessed in a cohort of 378 children with habitual snoring undergoing overnight polysomnographic evaluation, and brain natriuretic peptide plasma levels were determined in 20 children with obstructive sleep apnea, 20 with habitual snoring without obstructive sleep apnea, and 20 nonsnoring children, matched for enuresis. RESULTS There were 17,646 surveys completed (50.6% boys; 18.3% black). A total of 1976 (11.2%) of these children were habitual snoring (53% boys; 25.2% black). A total of 531 habitual snoring children also had enuresis (26.9%), with a predominant representation of boys (472 boys [87.5%]). Among the 15670 nonsnoring children, enuresis was reported in 1821 children (11.6%), of whom 88.8% were boys. However, enuresis among 378 children with habitual snoring did not correlate with the magnitude of sleep respiratory disturbances. Indeed, enuresis was reported in 33 of 149 children with obstructive sleep apnea (obstructive apnea hypopnea index: >2 per hour of total sleep time; 53% boys) as compared with 36 habitual snoring children with enuresis (62% boys) and obstructive apnea hypopnea index <2 per hour of total sleep time. Brain natriuretic peptide levels were elevated among children with enuresis and were marginally increased among children with obstructive sleep apnea. CONCLUSIONS Habitual snoring is associated with increased prevalence of enuresis, and brain natriuretic peptide levels are increased in enuretic children with further increases with obstructive sleep apnea. However, the prevalence of enuresis is not modified by severity of sleep disturbance. Even mild increases in sleep pressure because of habitual snoring may raise the arousal threshold and promote enuresis, particularly among prone children, that is, those with elevated brain natriuretic peptide levels.
Collapse
Affiliation(s)
- Oscar Sans Capdevila
- Division of Pediatric Sleep Medicine and Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky 40202, USA
| | | | | | | |
Collapse
|
12
|
Erdogan A, Akkurt H, Boettjer NK, Yurtseven E, Can G, Kiran S. Prevalence and behavioural correlates of enuresis in young children. J Paediatr Child Health 2008; 44:297-301. [PMID: 18036143 DOI: 10.1111/j.1440-1754.2007.01255.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Previous studies based on clinical samples report that enuresis in children is associated with behavioural problems and reduced self-esteem, but the relationship between behavioural problems and enuresis remains controversial. This population-based study investigated the prevalence and behavioural correlates of enuresis in a group of preparatory school children. METHODS This cross-sectional survey involved 356 parents and their children aged 5-7 years, all residents of Istanbul, Turkey. Parents completed the Child Behaviour Checklist and socio-demographic data form (response rate: 90%). Fifty-three children with enuresis were compared with 303 non-symptomatic children. Differences in the mean scores and the percentages of children falling beyond pre-selected clinical thresholds were compared between the groups. RESULTS The prevalence of enuresis was 14.9%, and enuresis was more frequent among boys. Children with enuresis were reported by their parents to have greater social problems and higher total problem scores than control children (P = 0.019, P = 0.048, respectively). However, there were no differences in the percentages of children falling beyond pre-selected clinical thresholds between the groups. CONCLUSIONS Children with enuresis had higher mean scores for total and social behavioural problems than controls; however, clinically relevant behavioural problems did not show differences between the groups. Given the inconsistent research findings across studies, longitudinal research and outcome studies could help determine whether there is a causal relationship between psychopathology and enuresis.
Collapse
Affiliation(s)
- Ayten Erdogan
- Department of Child and Adolescent Psychiatry, Zonguldak Karaelmas University, Faculty of Medicine, Zonguldak, Turkey.
| | | | | | | | | | | |
Collapse
|
13
|
Tai HL, Chang YJ, Chang SCC, Chen GD, Chang CP, Chou MC. The epidemiology and factors associated with nocturnal enuresis and its severity in primary school children in Taiwan. Acta Paediatr 2007; 96:242-5. [PMID: 17429913 DOI: 10.1111/j.1651-2227.2007.00025.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate the prevalence of nocturnal enuresis among children in elementary school in Taiwan and to evaluate its associated factors and severity. MATERIALS AND METHODS A randomly selected cross-sectional study was conducted from elementary schools in Changhua county, Taiwan in 2003. In all, 9228 questionnaires were sent to 46 schools in 26 districts. RESULTS A total of 92.1% (8496/9228) of questionnaires were completed. The overall prevalence of nocturnal enuresis was 6.8%. The ratio of male to female was about 1.5 (8.0% vs. 5.5%). The prevalence of enuresis according to age group declined from 12.5% at 6 years to 2.0% at 12 years. The prevalence of enuresis in the urban area did not show significant difference from that of rural area (6.2% vs. 6.9%). Of the factors associated with enuresis, gender, age, urinary frequency or urgency, heredity, drinking habit before sleep and difficulty in waking showed significant difference after multiple logistic regression analysis. After multivariate analysis, difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis. CONCLUSION Our investigation showed the prevalence of enuresis is similar to those reports from the north of Taiwan and most of other western countries, but higher than that of China and Hong-Kong. Difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis.
Collapse
Affiliation(s)
- Hui-Lung Tai
- Division of Urology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 500 Taiwan.
| | | | | | | | | | | |
Collapse
|
14
|
Ergüven M, Celik Y, Devecí M. Bone age and probable aetiological causes in primary nocturnal enuresis. Acta Paediatr 2005; 94:1416-20. [PMID: 16299873 DOI: 10.1111/j.1651-2227.2005.tb01813.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate probable aetiological risk factors and to identify whether there are any differences in bone age between normal children and children with primary nocturnal enuresis (PNE). METHODS Ninety children with primary nocturnal enuresis and 40 healthy children were included in the study. Enrolment began in January 2001, and continued through July 2002. Data were obtained via consultation with children and their families, physical examination and laboratory findings. Left hand and wrist graphs of each patient were acquired, and, using Tanner Whitehouse charts (TW-2), bone ages were determined via comparison of 20 hand and wrist bones. RESULTS Of the total of 90 children with primary nocturnal enuresis participating in the study, 52 (57.8%) were male and 38 (42.2%) were female. Of the control group, 24 (60%) were male and 16 (40%) were female. Differences between chronological ages and bone ages of the PNE and control groups were 0.57+/-0.59 and 0.54+/-0.67 y, respectively, and no significant difference was seen (p = 0.484). In 90% of the children in the PNE group there was found to be a primary nocturnal enuresis history in the family, whereas in the control group this rate was only 7.5%. Of the children with PNE, 62.2% had very deep sleeping habits, while 7.5% of the control group had this problem. CONCLUSION Our study provides no evidence that bone ages of children suffering from PNE are lower than normal children. We found that a family history of enuresis, male sex and difficulty in waking were risk factors in primary nocturnal enuresis.
Collapse
Affiliation(s)
- Müferet Ergüven
- Department of Paediatrics, SSK Goztepe Educational Hospital, Istanbul, Turkey
| | | | | |
Collapse
|
15
|
Gurbuz A, Karateke A, Kabaca C. Enuresis in childhood, and urinary and fecal incontinence in adult life: do they share a common cause? BJU Int 2005; 95:1058-62. [PMID: 15839932 DOI: 10.1111/j.1464-410x.2005.05466.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting. PATIENTS AND METHODS In all, 1021 patients who were admitted to the outpatient gynaecology clinics of the authors' institution for an annual gynaecological examination were included in this descriptive clinical study. A simple multi-choice screening questionnaire was used to collect data for analysis. RESULTS There was a history of bedwetting in childhood in 181 (21.1%) of women without and in 48 (29.6%) of those with UI; the difference was significant (chi-square, P < 0.05). Women with stress UI had significantly higher rates of enuresis in childhood (35.4%) than those without UI (21.1%; P = 0.003). Of women who had a history of bedwetting in childhood, 12.2% had stress UI, but only 6.4% of those with no such history had stress UI. Fecal incontinence was significantly more common in women with a history of bedwetting in childhood (P < 0.05). CONCLUSION A history of childhood bedwetting seems to increase the risk of having UI, stress UI and fecal incontinence. Being aware of this association may provide an opportunity to avoid exposing these women to additional risk factors for these condition.
Collapse
Affiliation(s)
- Ayse Gurbuz
- Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | | | | |
Collapse
|
16
|
Chandra M, Saharia R, Hill V, Shi Q. PREVALENCE OF DIURNAL VOIDING SYMPTOMS AND DIFFICULT AROUSAL FROM SLEEP IN CHILDREN WITH NOCTURNAL ENURESIS. J Urol 2004; 172:311-6. [PMID: 15201802 DOI: 10.1097/01.ju.0000132363.36007.49] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We analyzed the relative contribution of detrusor instability and difficult arousal from sleep in the genesis of nocturnal enuresis (NE), and evaluate a clinical feature that may prospectively help differentiate patients with monosymptomatic NE (mono NE) from those with diurnal voiding symptoms (DVSs) of urgency and urge incontinence associated with NE (NE + DVSs). MATERIALS AND METHODS Patients referred for voiding problems and 627 controls were evaluated for NE, DVSs, nocturia and arousal from sleep on a scale of 1 to 8. Patients were categorized into 3 groups-mono NE of primary or secondary onset (200, boys 71%, girls 29%), primary or secondary NE + DVSs (329, boys 43%, girls 57%) and isolated DVSs (146, boys 21%, girls 79%). RESULTS DVSs were noted in 49% of boys and 76% of girls with NE, although 40% of patients or parents did not complain of DVSs. The DVSs were elicited on detailed interrogation or on finding evidence of urinary incontinence on perineal examination. While one-third of controls and patients with isolated DVSs manifested nocturia at least twice a month, only 6% of bedwetters did so. Difficult arousal from sleep (scores 6 to 8) was more prevalent in patients with NE (59%) than controls (20%) or patients with isolated DVSs (5%), and in patients with mono NE and primary NE than in NE + DVSs or secondary NE, with reverse prevalence for nocturia. Easy sleep arousal (scores 1 to 3) was noted in 65% of patients with secondary NE + DVSs vs up to 6% of other NE subgroups. Compared to patients with mono NE, those with NE + DVSs had a higher prevalence of urinary tract infection (UTI), encopresis, psychosocial/learning problems, and family history of UTI and DVSs, ie problems associated with detrusor instability. CONCLUSIONS DVSs accompany NE in two-thirds of patients but can be missed during a cursory history. Difficult sleep arousal seems to have a major role in primary mono NE, and detrusor instability in secondary NE + DVSs. In patients with NE a history of frequent nocturia, easy sleep arousal, UTI, encopresis, psychosocial learning problems or family history of UTI and DVSs should raise the suspicion for associated undisclosed DVSs.
Collapse
Affiliation(s)
- Manju Chandra
- Division of Pediatric Nephrology, Schneider Children's Hospital at North Shore and North Shore University Hospital, Manhasset, New York 11030, USA.
| | | | | | | |
Collapse
|
17
|
Sarici SU, Kismet E, Türkbay T, Kocaoğlu M, Aydin HI, Dündaröz MR, Balcioğlu I. Bone mineral density in children with nocturnal enuresis. Int Urol Nephrol 2004; 35:381-5. [PMID: 15160545 DOI: 10.1023/b:urol.0000022936.78678.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In enuretic children there is a significantly higher incidence of fine and gross motor clumsiness, delayed developmental milestones, slower and poor linear growth, and these patients are shorter than normal children. Skeletal maturation of enuretic children has been determined with bone age in only two studies before, but to our knowledge bone mineral content of enuretic children has not previously been determined by bone mineral density measurement. Bone mineral density was measured by the dual-energy x-ray absorptiometry method in children with nocturnal enuresis and compared with that of a control group to detect whether there were any delay in bone development and any decrease in bone mass. Thirty enuretic children were compared with a control group of 40 healthy children with respect to body height and weight measurements, daily calcium intake, serum calcium, phosphorus and ALP levels, chronological and bone ages, and bone mineral density measurements. Of the parameters compared, bone age was significantly retarded, and bone mineral density was significantly reduced in children with enuresis (8.3 +/- 1.9 vs 9.7 +/- 2.3 years; p = 0.01, and 0.5476 +/- 0.07 vs 0.6077 +/- 0.05 g/cm2; p = 0.001, respectively). Chronological ages demonstrated a significant correlation with the bone ages in both the study and control groups (r = 0.852, p < 0.001, and r = 0.844, p < 0.001, respectively). However, the mean chronological age was significantly greater than the mean bone age in the study group (p < 0.001), whereas the mean chronological age was not significantly different from the mean bone age in the control group (p = 0.514). To clarify the exact mechanism responsible for these manifestations of skeletal maturation retardation, the relationship between the maturational delay of the central nervous system connections or the effect of any perinatal insult and the retardation in skeletal maturation remains to be determined.
Collapse
Affiliation(s)
- S Umit Sarici
- Department of Pediatrics of Gülhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
18
|
El-Radhi AS, Board C. Providing adequate treatment for children with nocturnal enuresis. Br J Community Nurs 2003; 8:440-6. [PMID: 14581847 DOI: 10.12968/bjcn.2003.8.10.11696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nocturnal enuresis is the most common urological problem in children. With increasing age and persistence of enuresis, children may experience psychological problems. Active treatment is therefore required not only to achieve dryness but also to prevent and treat such an experience. Although nocturnal enuresis has multiple causes, in recent years emphasis has focused on three main causes: lack of arousal, lack of antidiuretic hormone secretion and lack of bladder stability. This article stresses the importance of applying a specific treatment based on this ‘three system approach’ for every child presenting with enuresis.
Collapse
|
19
|
Kawauchi A, Yamao Y, Nakanishi H, Naito Y, Tanaka Y, Ukimura O, Mizutani Y, Miki T. Relationships among nocturnal urinary volume, bladder capacity, and nocturia with and without water load in nonenuretic children. Urology 2002; 59:433-7. [PMID: 11880087 DOI: 10.1016/s0090-4295(01)01620-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the relationships among nocturnal urinary volume (NUV), bladder capacity, and nocturia in nonenuretic children with and without water load. METHODS We evaluated 72 healthy nonenuretic volunteers. The NUV and bladder capacity were measured for 2 nights at volunteers' homes with and without water load. RESULTS Of the 72 nonenuretic children, 45 (63%) were classified into the large NUV group in which the NUV with water load was more than the upper limit of the 95% confidence interval of NUV in Japanese nonenuretic children, and the other 27 (37%) were classified into the small NUV group. In the large NUV group, 33 (73%) had one or two episodes of nocturia because of water intake, and 12 (27%) did not. The nocturnal bladder capacity in the latter 12 children was significantly larger than that in the former 33, although no significant differences were found in functional bladder capacity and NUV with water intake. CONCLUSIONS Most nonenuretic children were able to cope with the physiologic loading of water that would cause bedwetting in enuretic children. After water loading, three quarters of the nonenuretic children were able to awake easily because of the need to urinate with a certain volume of urine in the bladder, and the one quarter who did not awake were able to hold more urine in their bladder in the sleep state.
Collapse
Affiliation(s)
- Akihiro Kawauchi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | |
Collapse
|
20
|
CENTRAL NERVOUS SYSTEM INVOLVEMENT IN NOCTURNAL ENURESIS:. J Urol 2001. [DOI: 10.1097/00005392-200112000-00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
VON GONTARD ALEXANDER, SCHMELZER DAGMAR, SEIFEN STEPHANIE, PUKROP RALF. CENTRAL NERVOUS SYSTEM INVOLVEMENT IN NOCTURNAL ENURESIS: EVIDENCE OF GENERAL NEUROMOTOR DELAY AND SPECIFIC BRAINSTEM DYSFUNCTION. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65613-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- ALEXANDER VON GONTARD
- From the Departments of Child and Adolescent Psychiatry, and Psychiatry, University of Cologne, Cologne, Germany
| | - DAGMAR SCHMELZER
- From the Departments of Child and Adolescent Psychiatry, and Psychiatry, University of Cologne, Cologne, Germany
| | - STEPHANIE SEIFEN
- From the Departments of Child and Adolescent Psychiatry, and Psychiatry, University of Cologne, Cologne, Germany
| | - RALF PUKROP
- From the Departments of Child and Adolescent Psychiatry, and Psychiatry, University of Cologne, Cologne, Germany
| |
Collapse
|
22
|
Abstract
OBJECTIVE To review the progress made over the past decade with regard to the treatment of enuresis and encopresis, as well as advances in the understanding of etiological mechanisms. METHOD Separate computerized literature (English language only) searches of Medline and PsycINFO databases were conducted under the parameter of enuresis and children-adolescents, as well as encopresis and children-adolescents. RESULTS There has been a substantial decrease in published research concerning the use of imipramine to treat enuresis compared with the prior two decades, accompanied by a corresponding increase in the number of papers concerning desmopressin acetate (DDAVP), which has become the primary pharmacological treatment. Genetic studies of large pedigrees have further confirmed the importance of heritable factors. With regard to encopresis, the research has focused primarily on pathophysiological factors related to the colon and anal sphincter. CONCLUSIONS The widespread use of DDAVP has been the primary addition to treatment strategies over the past decade. The bell-and-pad method of conditioning, the only major treatment that has enduring benefit after being withdrawn, is the most cost-effective and appears to be underutilized. Research into etiological mechanisms has focused primarily on the mechanism of action of DDAVP and advances in the understanding of genetic factors. Advances in the treatment and etiological understanding of encopresis have been less impressive.
Collapse
|
23
|
Kruse S, Hellström AL, Hanson E, Hjälmås K, Sillén U. Treatment of primary monosymptomatic nocturnal enuresis with desmopressin: predictive factors. BJU Int 2001; 88:572-6. [PMID: 11678753 DOI: 10.1046/j.1464-410x.2001.02321.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate predictive factors for the outcome of treatment of primary monosymptomatic nocturnal enuresis (PMNE) with desmopressin. PATIENTS AND METHODS Data from a large open multicentre study were analysed. The study comprised 399 children with PMNE who were recruited for long-term desmopressin treatment. Before treatment a history was taken and the children observed for 4 weeks. After a 6-week dose-titration period with desmopressin, the children were classified into four groups depending on the response rate. RESULTS The children who improved during desmopressin treatment were older, had fewer wet nights during the observation period and had only one wet episode during the night, mostly after midnight. Many of them did not require the maximum dose of desmopressin to become dry. No hereditary factor for the response to desmopressin was found. CONCLUSION Those most likely to be permanently dry with desmopressin treatment are older children who respond to 20 microg desmopressin and who do not wet frequently.
Collapse
Affiliation(s)
- S Kruse
- The Urotherapeutic Unit, The Queen Silvia Children's Hospital, Department of Nursing, Göteborg University, Sweden.
| | | | | | | | | |
Collapse
|
24
|
|
25
|
Ornitz EM, Russell AT, Hanna GL, Gabikian P, Gehricke JG, Song D, Guthrie D. Prepulse inhibition of startle and the neurobiology of primary nocturnal enuresis. Biol Psychiatry 1999; 45:1455-66. [PMID: 10356628 DOI: 10.1016/s0006-3223(98)00205-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with primary nocturnal enuresis (PNE) wet the bed during all stages of sleep and irrespective of state of arousal, suggesting that during sleep, when voluntary, i.e., cortical control, is not available, the signal from the distended bladder is not registered in the subcortical centers inhibiting micturition. Deficient prepulse inhibition (PPI) of startle has been reported in PNE. This study evaluates the association of this PPI deficit in PNE with comorbidity with attention-deficit hyperactivity disorder (ADHD) and with intelligence. METHODS Prepulse modulation of startle was studied in 96 boys with PNE and 105 nonenuretic boys using intervals of 60, 120, and 4000 msec between the onset of a 75-dB 1000-Hz tone and a 104-dB noise burst. Thirty-one percent of the enuretic and 36% of the nonenuretic boys were diagnosed with ADHD. RESULTS After adjustment for presence or absence of ADHD, lower or higher IQ, age, and unmodulated startle amplitude, there was a significant association between PNE and deficient PPI of startle following the 120-msec prepulse interval. Those enuretic boys who also were ADHD or had higher performance IQs (> or = 110) showed the greatest PPI deficit. CONCLUSIONS A common deficiency of inhibitory signal processing in the brain stem may underlie both deficient PPI and the inability to inhibit micturition in PNE. Strong familiarity for PNE, ADHD, and intelligence suggests a possible genetic mediation of these effects.
Collapse
|
26
|
Nevéus T, Läckgren G, Stenberg A, Tuvemo T, Hetta J. Sleep and night-time behaviour of enuretics and non-enuretics. BRITISH JOURNAL OF UROLOGY 1998; 81 Suppl 3:67-71. [PMID: 9634023 DOI: 10.1046/j.1464-410x.1998.00011.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate connections between nocturnal enuresis and sleep factors such as the subjective depth of sleep and classical parasomnias. PATIENTS, SUBJECTS AND METHODS One hundred school children aged 6-10 years answered a questionnaire, with their parents, and the same questions were asked of a group of 29 children of the same age suffering from severe nocturnal enuresis. RESULTS There were significant differences in arousability, with the enuretic group being 'deep sleepers', and in the prevalence of onset insomnia, nightmares, interrupted sleep and bedtime struggles, which were all less common among the enuretics. The prevalence of classical parasomnias did not differ between the groups. CONCLUSION A high arousal threshold is one of the pathogenetic factors underlying nocturnal enuresis and we propose that this group of therapy-resistant enuretic children might not only sleep more deeply than their nonenuretic peers, but perhaps have 'better' sleep.
Collapse
Affiliation(s)
- T Nevéus
- Department of Paediatrics, Uppsala University, Sweden
| | | | | | | | | |
Collapse
|
27
|
Abstract
Primary nocturnal enuresis (PNE) is prevalent among the pediatric population, but not all professionals are aware of the current research regarding the etiology and treatment of this disorder. This paper presents a broad overview of PNE, including etiology and evaluation, with a specific emphasis on treatment issues. The most current treatments (imipramine, desmopressin acetate arginine vasopressin, enuresis alarms) are discussed, including recent research on their effectiveness. In considering the recent data on long-term efficacy, overall cost, and safety, the treatment of choice appears to be the enuresis alarm for those families who are capable of following protocols. Desmopressin acetate arginine vasopressin is a safe alternative that has the advantage of quick response and ease of administration.
Collapse
|
28
|
Abstract
OBJECTIVE To assess the link between enuresis nocturna and the severity of behavioural and/or emotional problems in Dutch children and the course of these problems. SETTING West-Mine Region in the Netherlands. SUBJECTS AND METHODS Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region. After 1 y, contact was still possible with 64 of the enuretics. We used the Dutch version of the Child Behaviour Checklist (CBCL) and a questionnaire about bedwetting. RESULTS The mean T-score for Total Problems (CBCL score) in 1992 (M1; mean age 8.6) was 52.1, and 1 y later was 49.2 (M2). There was no significant difference in the CBCL scores for M1, M2 and a matching group from the Dutch CBCL norm population, either in the group who remained wet or in the group who became dry. There were no differences between the sexes. There was no link between the severity of behavioural and emotional problems and the frequency of bedwetting. However, more children with bedwetting than expected were in the clinical range. CONCLUSION There was no difference in behavioural and/or emotional problems between the first and the second measurement and the matching group from the CBCL norm group. There were no differences in behavioural and/or emotional problems between primary and secondary bedwetters, nor were there any consequences related to the frequency of bedwetting.
Collapse
Affiliation(s)
- R A Hirasing
- TNO Prevention and Health, Leiden, The Netherlands
| | | | | | | |
Collapse
|
29
|
Abstract
Nocturnal enuresis in children is not a psychogenic disorder. It is caused by a hereditary delay in maturation of the somatic mechanisms (reduction of nocturnal urine production and a normal arousal to a full bladder) which prevent the child from wetting the bed. Traditionally, doctors treating bedwetting children have used an expectant attitude, because nocturnal enuresis has been looked upon as self-limiting and harmless. According to recent research this is not true. More than 5% of children and 0.5% of the adult population report nocturnal enuresis, meaning that 10% of enuretic children will remain bedwetters for life if left untreated, and nocturnal enuresis is perceived as a shameful condition, giving a significant impairment of self-esteem at an age when an intact self-image is extremely important for an optimal development of the child's personality. Treatment should be given when the enuretic child wants to sleep dry.
Collapse
Affiliation(s)
- K Hjälmås
- Department of Paediatrics, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
| |
Collapse
|
30
|
Affiliation(s)
- M Super
- Department of Paediatric Genetics, Royal Manchester Children's Hospital, UK
| | | |
Collapse
|
31
|
Affiliation(s)
- D A Husmann
- Department of Urology E 17B, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
32
|
Abstract
Social and behavioural traits in children with primary nocturnal enuresis were compared with children who had outgrown their enuresis and children who had never bed-wetted after three years of age. The study group included 14 children with primary nocturnal enuresis, 15 children who had had primary nocturnal enuresis and 15 age- and sex-matched controls. The mothers of all children were interviewed using a 32-item questionnaire. If primary nocturnal enuresis were a neurotic disease, we would have expected a higher frequency of emotional dysfunction in children with enuresis and an increase in the symptoms or symptom substitution when bed-wetting was resolved. No significant differences in emotional or behavioural traits among the three groups were found. We conclude that children with primary nocturnal enuresis were well adjusted individuals and display similar social and behavioural traits as their peers. This study lends further support to the theory that primary nocturnal enuresis is not a psychological disorder.
Collapse
Affiliation(s)
- S Wille
- Paediatric Clinic, Falkenberg, Sweden
| | | |
Collapse
|