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Angeli M, Bitsori M, Schiza SE, Mamoulakis C, Mavridis C, Georgiadis G, Tzatzarakis M, Galanakis E. Autonomic nervous system dysregulation in children with monosymptomatic nocturnal enuresis. Acta Paediatr 2024. [PMID: 38940196 DOI: 10.1111/apa.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
AIM To investigate the role of autonomic nervous system in subpopulations of children with enuresis. METHODS We included 35 children with enuresis, divided in children with (17) and without nocturnal polyuria (18) and 43 healthy controls. For all participants hormones and neurotransmitters were measured. Patients and controls wore a sleep tracker device and children with enuresis underwent a 24 h blood pressure monitoring, nocturnal urine output measurement and uroflowmetry. RESULTS Children with enuresis had lower than controls copeptin and aldosterone, with the latter being more prominent in patients without nocturnal polyuria. Dopamine was lower in patients without nocturnal polyuria compared with patients with nocturnal polyuria. Children without polyuria experienced episodes only during NREM sleep, whereas in children with polyuria episodes occurred in both REM and NREM sleep. Children with enuresis experienced a non-dipping phenomenon during sleep which was more prominent in the group without polyuria. CONCLUSION In patients with nocturnal polyuria, nocturnal enuresis is associated with sympathetic hyperactivity which results in pressure polyuria and significantly lower systolic dipping during sleep. On the contrary, in children without nocturnal polyuria, it is mostly associated with bladder overactivity due to parasympathetic overstimulation as demonstrated by the NREM-related enuretic episodes and the lower aldosterone and dopamine levels.
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Affiliation(s)
- Maria Angeli
- School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Bitsori
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Paediatrics, Heraklion University Hospital, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mamoulakis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Urology, Heraklion University Hospital, Heraklion, Greece
| | | | | | - Manolis Tzatzarakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Galanakis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Paediatrics, Heraklion University Hospital, Heraklion, Greece
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Harris J, Lipson A, Dos Santos J. L'évaluation et la prise en charge de l'énurésie en pédiatrie générale. Paediatr Child Health 2023; 28:362-376. [PMID: 37744754 PMCID: PMC10517247 DOI: 10.1093/pch/pxad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 10/26/2022] [Indexed: 09/26/2023] Open
Abstract
Pour évaluer l'énurésie, un trouble pédiatrique courant, il faut en distinguer la forme monosymptomatique de la forme non monosymptomatique et établir la présence d'affections concomitantes. La prise en charge simultanée des facteurs cooccurrents est le meilleur moyen pour obtenir un résultat satisfaisant. Le traitement commence par l'éducation du patient et de sa famille sur l'évolution naturelle de l'énurésie et par des conseils pratiques sur le comportement. Les données probantes en appui à des interventions particulières sont limitées, et les enfants et les familles devraient participer au choix du traitement approprié. Les dispositifs d'alarme contre l'énurésie et la desmopressine représentent des possibilités thérapeutiques lorsqu'une intervention plus active est souhaitée. Des améliorations cliniques et des traitements combinés sont en voie de se dégager.
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Affiliation(s)
- James Harris
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario)Canada
| | - Alisa Lipson
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario)Canada
| | - Joana Dos Santos
- Société canadienne de pédiatrie, comité de la pédiatrie communautaire, Ottawa (Ontario)Canada
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Harris J, Lipson A, Dos Santos J. Evaluation and management of enuresis in the general paediatric setting. Paediatr Child Health 2023; 28:362-376. [PMID: 37744753 PMCID: PMC10517245 DOI: 10.1093/pch/pxad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 10/26/2023] [Indexed: 09/26/2023] Open
Abstract
Assessing enuresis involves distinguishing monosymptomatic from non-monosymptomatic for this common paediatric problem, and identifying concomitant comorbidities. Addressing co-occurring factors concurrently ensures the best opportunity for a satisfactory outcome. Treatment begins with patient and family education on the natural history of enuresis and practical behavioural guidance. Evidence to support particular interventions is limited, and children and families should be involved when choosing appropriate therapy. Enuresis alarms and desmopressin are treatment options when more active intervention is desired. Clinical refinements and combined treatment modalities are emerging.
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Affiliation(s)
- James Harris
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Alisa Lipson
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
| | - Joana Dos Santos
- Canadian Paediatric Society, Community Paediatrics Committee, Ottawa, Ontario, Canada
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Çakıoğlu B, Arıkan MG, Taş T, Bilir B. The role of primary nocturnal enuresis in the aetiology of overactive bladder syndrome. Cent European J Urol 2023; 76:207-211. [PMID: 38045776 PMCID: PMC10690389 DOI: 10.5173/ceju.2023.56] [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: 03/28/2023] [Revised: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The aim of this study was to investigate the effect of nocturnal enuresis (NE) in childhood on the development and course of overactive bladder (OAB) in adulthood. Material and methods Between January and September 2021, data from patients who visited the Urology Outpatient Clinic with OAB symptoms were collected. Patients with a history of diabetes mellitus, neurological diseases, bladder outlet obstruction, active urinary system infection, or previous medical treatment for OAB and those who did not agree to join the study were excluded. Patients with a diagnosis of NE in childhood were classified as group 1, and patients without a diagnosis of NE were classified as group 2. Demographic data were recorded. Frequency of incontinence, and the number of daytime voids and nocturia were evaluated according to a three-day voiding diary. In addition, the maximum urinary flow ratio (Qmax), bladder wall thickness, and postvoid residual volume were determined using uroflowmetry and pelvic ultrasound. Results After applying the inclusion/exclusion criteria, the mean age of the study group of 103 patients, consisting of 34 women and 69 men, was 32.85 ±11.20 years (18-65), and the mean BMI of both groups was 26.62 ±3.34 (19.49-39.18). Sixty-five of 103 patients (63.1%) had a history of childhood NE diagnosis. Patients in the group with a history of NE were younger than those without a history of NE. Conclusions The earlier onset and more intense course of OAB symptoms in patients diagnosed with NE in childhood suggests that NE may be a triggering factor in the aetiology of OAB.
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Affiliation(s)
- Basri Çakıoğlu
- Department of Urology, Hisar Intercontinental Hospital, Galata University, Istanbul, Turkey
| | | | - Tuncay Taş
- Department of Urology, Hisar Intercontinental Hospital, Nisantasi University College of Health Sciences, Istanbul, Turkey
| | - Burak Bilir
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
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Khalid A, Nasiru M, Abdulwahab-Ahmed A, Muhammad AS, Agwu NP, Lukong CS. Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child: A case report. World J Clin Urol 2023; 12:10-16. [DOI: 10.5410/wjcu.v12.i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/21/2023] [Accepted: 07/07/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis. The established aetiological factors for urethral stricture abound in our environment. However, the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence. Patients with enuresis can suffer psycho-social challenges and trauma, especially for a child due to peer stigmatization. This has a great impact on the child's psyche and may affect even his performance at school. The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis (nocturnal urinary incontinence).
CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms (LUTS) for 3 years culminating in chronic urinary retention. He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS. He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization. He was acutely ill-looking, with distended suprapubic region. The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula. He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter. He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.
CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.
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Affiliation(s)
- Abdullahi Khalid
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Musa Nasiru
- Department of Surgery, Paediatric Surgery Unit, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Abdullahi Abdulwahab-Ahmed
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Ngwobia Peter Agwu
- Department of Surgery, Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
| | - Christopher Suiye Lukong
- Department of Surgery, Paediatric Surgery Unit, Usmanu Danfodiyo University and Teaching Hospital, Sokoto 840000, Nigeria
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Ozawa H, Shibano T, Tanaka I, Taniguchi T, Chancellor MB, Yoshimura N. High Prevalence of Dysplastic Development of Sacral Vertebral Arches in Pediatric Enuresis. Int Neurourol J 2023; 27:124-128. [PMID: 37401023 DOI: 10.5213/inj.2346024.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons. METHODS Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups. RESULTS Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1-3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1-3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1-3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5-13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1-3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001). CONCLUSION Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.
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Affiliation(s)
- Hideo Ozawa
- Department of Urology, Mizushima Central Hospital, Kurashiki, Japan
| | - Takakuki Shibano
- Department of Pediatrics, Mizushima Central Hospital, Kurashiki, Japan
| | - Isao Tanaka
- Department of Pediatrics, Mizushima Central Hospital, Kurashiki, Japan
| | | | - Michael B Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Naoki Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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7
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Ghobrial EE, Fawzi NM, Shiba MF, Tawfik MA. Abdomino-Pelvic Ultrasound Evaluation in Monosymptomatic Primary Nocturnal Enuresis. Clin Pediatr (Phila) 2023; 62:33-38. [PMID: 35854637 DOI: 10.1177/00099228221109998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Enuresis is one of the most common childhood problems. Our study aimed to evaluate children with enuresis by renal bladder ultrasound (RBUS) to detect urological abnormalities and to compare the sonographic findings with control group. METHODS Our study included 30 children with primary monosymptomatic nocturnal enuresis (PMNE). Another 30 matched children with normal continence to urine were assigned as controls. The 2 groups were subjected to urine analysis, serum creatinine, and RBUS. RESULTS Ultrasound showed abnormality in 10% of case group, which was not significantly different from controls (p = 1.000). CONCLUSION Abnormalities discovered by ultrasonography in PMNE are more than in control group but without statistical significance and do not require invasive diagnostic tests. Children with sonographic abnormalities appear to be more resistant to treatment. We concluded that ultrasound is not necessary in MPNE and should be done in patients resistant to treatment.
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Affiliation(s)
- Emad E Ghobrial
- Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Nephrology Clinic, Children's Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin M Fawzi
- Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Maha F Shiba
- Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mary A Tawfik
- Department of Pediatrics, Ministry of Health, Cairo, Egypt
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Isfahani M, Yousefichaijan P, Sarmadian R, Salehi B, Habibi D. The association between primary nonmonosymptomatic nocturnal enuresis and the presence of specific phobia: a case–control study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Nocturnal enuresis (NE) is a common childhood condition characterized by recurrent bedwetting in children with normal bladder control over 5 years old. The pathogenesis of this condition is unknown, but it is believed to have a complex etiology. NE is primary or secondary, monosymptomatic or nonmonosymptomatic (NMNE). MNE children do not have lower urinary tract (LUT) impairment, and their voided volumes are generally normal. NMNE is linked to malfunction of the LUT, with or without daytime incontinence. Several investigations have discovered significant associations between psychiatric problems, especially anxiety disorders and NMNE. Specific phobia is the most common lifelong anxiety disorder, characterized by extreme anxiety when a stimulus is encountered or expected. This study investigated the association between specific phobia and primary NMNE.
Methods
A total of 204 children were studied, including 102 children with primary NMNE and 102 children in the control group. Girls with an FSS-II score greater than 75 and boys with a score greater than 78 were considered to have specific phobia disorder. The groups were compared using SPSS software version 23 and descriptive statistical methods.
Results
The results of the recent study showed that the mean age of the children in the case and control groups was 7.69 and 7.19 years, respectively (p-value = 0.063). The male to female ratio was 49–53 in the case group and 43–59 in the control group (p-value = 0.399). In the study, the frequency of specific phobia in the case group was 12.7% and in the control group was 9.8% (p-value = 0.507).
Conclusions
Despite the strong impacts of anxiety on children's NMNE, there is likely no significant association between specific phobia and primary NMNE.
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Smith GA, Kistamgari S, Splaingard M. Age-Dependent Responsiveness to Smoke Alarm Signals Among Children. Pediatrics 2022; 149:186861. [PMID: 35466358 DOI: 10.1542/peds.2022-056460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although it has been established that smoke alarms have more difficulty awakening children from sleep than adults, no attempt has been previously made to characterize how smoke alarm responsiveness changes with age during childhood. The objective of this study is to evaluate the age-dependent responsiveness to various smoke alarm signals among children 5 to 12 years old. METHODS The effect of age on children's response to 4 types of smoke alarms (human voice, hybrid voice-tone, low-frequency tone, and high-frequency tone) was evaluated using combined data from 3 previous studies. RESULTS There were 540 subjects (median age 9 years; 51.7% male). The proportion of children who awakened demonstrated a statistically significant (P < .001) increase of 3.1% to 7.6% for each additional year of age between 5 and 12 years old for the 4 alarm types. Similarly, child age showed a statistically significant (P < .001) effect on the proportion who escaped for each of the 4 alarm types. The proportion of subjects who awakened or escaped did not differ significantly by sex for any of the alarm types. Median time-to-awaken and median time-to-escape decreased with increase in child age for all alarm types. CONCLUSIONS This study demonstrates the substantial influence of child age on the effectiveness of audible smoke alarms during childhood. Among 12-year-olds, only 56.3% escaped within 1 minute (and 67.6% within 2 minutes) to a high-frequency tone. However, a hybrid voice-low-frequency tone alarm is >96% effective at awakening and prompting escape within 1 minute among children 9 years and older.
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Affiliation(s)
- Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Child Injury Prevention Alliance, Columbus, Ohio
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Mark Splaingard
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Sleep Disorders Center, Nationwide Children's Hospital, Columbus, Ohio
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The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study. Sci Rep 2021; 11:17079. [PMID: 34429478 PMCID: PMC8385036 DOI: 10.1038/s41598-021-96519-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 08/11/2021] [Indexed: 11/08/2022] Open
Abstract
Primary nocturnal enuresis (PNE) affects children's physical and mental health with a high rate. However, its neural mechanism is still unclear. Studies have found that the paraventricular thalamus (PVT) is among the key brain regions implicated with awakening regulation and its control of the transition between sleep and wakening is dependent on signaling through the PVT-nucleus accumbens (NAc) pathway. So this study analyzed the function of brain regions and their connectivity of PVT and NAc. A total of twenty-six PNE and typically developing (TD) children were involved in the study and the methods of amplitude of low frequency fluctuation (ALFF), degree centrality (DC) and functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI) were used to analyze the brain functions. Results showed that there was no statistical significant difference in ALFF and DC between PNE and TD children in bilateral PVT and NAc. And there was statistical significant difference of the comparison of the FC of left PVT (lPVT) and left NAc (lNAc) between PNE and TD children. Meanwhile, there was negative correlation between awakening score and the FC of rPVT and lNAc, and no obvious correlation between awakening score and the FC of lPVT and lNAc in PNE children. Meanwhile, there was both negative correlation between awakening score and the FC of lPVT, rPTV and lNAc in TD children. Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. This finding could help establish the evaluation index of PNE.
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Gözüküçük A, Kılıç M, Çakıroğlu B. Desmopressin versus desmopressin + oxybutynin in the treatment of children with nocturnal enuresis. J Pediatr Urol 2021; 17:451.e1-451.e6. [PMID: 33931318 DOI: 10.1016/j.jpurol.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Enuresis is identified as voluntary or involuntary leakage of urine for at least three consecutive months in the daytime and/or nighttime on clothes for children older than five. Monosymptomatic nocturnal enuresis (MNE) describes nighttime wetting without daytime leakage of urine in children with no pathology in the urinary system and it is 80% more common than enuresis. Desmopressin is the most common medical treatment for MNE. The aim of this study is to retrospectively compare the effectiveness of desmopressin as monotherapy and desmopressin + oxybutynin as a combination therapy in the treatment of nocturnal enuresis. MATERIAL AND METHOD This study retrospectively evaluated 183 patients who applied to pediatrics, pediatrics surgery and urology clinics with the complaint of nocturnal enuresis and diagnosed with primary monosymptomatic nocturnal enuresis between January 2014 and December 2019. The patients were divided into two groups (91 patients) who only received desmopressin therapy (Group 1), and those (92 patients) who received desmopressin and oxybutynin combination therapy (Group 2). Response to treatment, compliance and recurrence ratios were determined in the evaluation. Complete response was accepted as 90-100% decrease in the number of nighttime wetting, partial response was accepted as 50-90% decrease in the number of nighttime wetting and those below 50% were regarded as non-response. The 1st, 3rd, and 6th months of control data of treatment effectiveness of both groups were evaluated and their responses to treatment and the side effects of drugs were examined. RESULTS The mean age 183 patients of whom 103 were male and 80 were female was 10 (6-16) year. In the first month of control of Group 1, 71.4% had a complete cure, 8.8% had a partial cure and 19.8% had no response to treatment. In the third month of control of Group 1, 74.73% gave a complete response and were cured, 5.5% gave a partial response and 19.78% had no response. In the sixth month of Group 1, 70 patients were evaluated as complete response (79.5%), and 5 patients were evaluated as partial response (5.6%). In the first month of control of Group 2, 75% gave a complete response, 10.9% gave a partial response, 14.1% had no response to treatment. In the third month of control of Group 2, 86.9% gave a complete response, 6.52% gave a partial response, and 6.52% had no response. In the sixth month of the control of Group 2, the number of patients who did not come for control and could not be reached was 2, 83 patients out of 90 patients were evaluated as complete response (92.2%), 6 patients were evaluated as partial response (6.6%). CONCLUSION Desmopressin is the only FDA approved pharmacologic treatment for nocturnal enuresis. Desmopressin reduces urine production and the anticholinergic agent allows the bladder to store more urine. Therefore, combined therapy can be recommended in the MNE treatment for specially selected cases.
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Affiliation(s)
- Ali Gözüküçük
- Department of Pediatric Surgery, Hisar Intercontinental Hospital, Dogus University, İstanbul, Turkey.
| | - Mehmet Kılıç
- Department of Pediatrics, Hisar Intercontinental Hospital, Dogus University, İstanbul, Turkey.
| | - Basri Çakıroğlu
- Department of Urology, Hisar Intercontinental Hospital, İstanbul, Turkey.
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Bani-Hani M, Alhouri A, Sharabi A, Saleh S, Nawafleh S, Al-zubi M, Alkhatatbeh H, Y altal, Radi M, Al Houri HN. New insights in treatment of monosymptomatic enuresis. Ann Med Surg (Lond) 2021; 67:102470. [PMID: 34158933 PMCID: PMC8196056 DOI: 10.1016/j.amsu.2021.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Nocturnal enuresis (NE) is defined as uncontrollable bed-wetting for at least three consecutive months in children over 5 years. Sleep could be dramatically altered in children with primary nocturnal enuresis (PNE); consequently, this helps to confirm the assumption that PNE appears to modify sleep structure, or it might be the result of an irregular sleep structure itself. METHOD This study conducted on 180 patients with monosymptomatic nocturnal enuresis. Their age was ranged from 6 to 18 years, and they were still having nocturnal enuresis episodes. We record two main points: first, if the child is a regular sleeper or not. The second point if the child is a regular bed wetter or not. This work fully compliant with the STROCCS criteria (Agha et al., 2019). RESULT A total of 180 children were included (Male 122, 67.8%, Female 58, 32.2%). The mean age was 8.9 (±2.4). This study showed that children aged 7-10 years are significantly more inclined to be reported as specific time bed-wetter's, whereas those aged between 11 and 13 are significantly less likely to wet their bed at a specific time (p = 0.001). Children who tend to sleep more often near a specific time each night are 6.74 times more prone to bed-wet around a particular time during their sleep (p < 0.001). CONCLUSION This study can be considered as hypothesis-generating that shed light on the possible correlation between the adherence to sleep at a specific time and its effect on the time of enuresis and the number of bedwetting.
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Affiliation(s)
- Morad Bani-Hani
- Department of Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Abdullah Alhouri
- Department of Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Alaa Sharabi
- Department of Medicine, Faculty of Medicine, University of Science and Technology, Sanaa, Yemen
| | - Saiel Saleh
- Department of Pediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Sager Nawafleh
- Department of Anesthesia, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mohammad Al-zubi
- Department of Urology, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Hassan Alkhatatbeh
- Department of Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Y altal
- Department of Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - M.A. Radi
- Department of Pediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hasan Nabil Al Houri
- Internal Medicine Department, Al Assad University Hospital and AL Mouwasat University Hospital, Damascus, Syria
- Internal Medicine Department, Syrian Private University, Damascus, Syria
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Azarfar A, Ghodsi A, Faravani F, Ghahremani S. Evaluation of Factors Affecting Enuresis in 6- to 12-Year-Old Children Referred to the Pediatric Nephrology Clinic. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1728728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractEnuresis is one of the most common disorders in children, and if left untreated can cause anxiety, low self-esteem, and family problems. The aim of this study was to investigate the factors associated with enuresis to provide recommendations for more efficient prevention and treatment. A cross-sectional study was performed on children aged 6 to 12 years with enuresis, referred to the pediatric clinic between April 2017 and April 2018. Children were divided into two groups: monosymptomatic enuresis and healthy subjects. Then, a questionnaire was completed by their parents to assess the factors related to enuresis. The data were analyzed using SPSS software. In this study, out of 140 children with an average age of 8.22 ± 2.01 years, 77 cases (55%) had enuresis, of which 57 (40.7%) had primary enuresis, and 20 cases (14.3%) had secondary enuresis. There was a significant difference between the control and the case groups in terms of: father's education, family income, family history, number of people sleeping in the room, family problems, problems at school, history of urinary tract infections, history of pinworms, difficulty falling asleep, difficulty in waking up, feeling tired after waking up, and drowsiness during the day. Enuresis is associated with several physiological, psychological, and genetic factors. Controlling these factors requires paying attention to the elements such as the mental health of the family and child's sleep health through education, family awareness, and counseling.
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Affiliation(s)
- Anoush Azarfar
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnoosh Faravani
- Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Ghahremani
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Davaro F, Kaba A, Osei H, Joshi P, Hamilton Z, Phillips T. Treatment of obstructive sleep apnea does not treat primary nocturnal enuresis. J Pediatr Urol 2021; 17:182.e1-182.e6. [PMID: 33461899 DOI: 10.1016/j.jpurol.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/11/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary Nocturnal Enuresis (PNE), obesity, and obstructive sleep apnea (OSA) are suggested to share a complex interaction whereby risk for PNE is increased when obesity and airway obstruction are present. We aimed to evaluate whether surgical or medical management of OSA in the treatment of patients with PNE and improves PNE outcomes. STUDY DESIGN Our institutions electronic medical record was queried for patients who underwent a pediatric diagnostic polysomnogram (PDPSG) for the complaint of PNE between October 2010 and September 2020 and were diagnosed with OSA. Retrospective chart review was performed of the 59 patients identified. Patients were divided based on therapy type for their OSA. Groups included those no therapy, any therapy which includes patients undergoing tonsillectomy and adenoidectomy (T&A) and/or continuous positive airway pressure (CPAP) and those who chose T&A. Primary outcome was to evaluate effects of treating OSA with T&A and effects on PNE outcome based on International Children's Continence Society (ICCS) definitions of complete, partial or no improvement. Separate grouping based on ICCS PNE outcome were also made for evaluation of variables associated with each group. Secondary outcome evaluated role of BMI in success of treatments of PNE. Chi-squared and one-way ANOVA tests were performed. RESULTS 59 patients (64.4% male, mean age at diagnosis 8.8 years old) underwent a PDPSG for PNE. Monosymptomatic PNE was diagnosed in 40.7% while 32.2% had non-monosymptomatic PNE and the remainder were unknown. Patients were predominantly Caucasian (47.5%), with an average BMI of 20.6 kg/m2 25 patients underwent no therapy for their OSA while the remaining 34 received treatment. No statistically significant difference between those receiving and those forgoing therapy were noted in age, race, gender, BMI, type of PNE or Apnea-Hypopnea Index. There was also so significant difference in ICCS defined enuresis outcomes (p = 0.871) with over 60% in both groups experiencing resolution or improvement. Follow up was significantly different between cohorts, measured at 43 months for those receiving therapy for OSA and 29.1 months for those forgoing therapy. When considering only those who chose T&A as their therapy for PNE, there were once again, no significant differences between groups including ICCS enuresis outcome. Sub-grouping based on ICCS enuresis outcome revealed no associations between variables measured and improvement of PNE (p > 0.05), other than defining type of PNE (p = 0.012). CONCLUSION In patients with OSA and PNE, surgical treatment of airway obstruction had no effect on resolution of PNE.
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Affiliation(s)
- Facundo Davaro
- Division of Urology, Department of Surgery, 1008 S. Spring Ave, St. Louis MO 63110, USA.
| | - Aboubacar Kaba
- Saint Louis University School of Medicine, 1402 S. Grand Blvd. Si. Louis MO 63110, USA.
| | - Hector Osei
- Department of Surgery, SSM Health Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd, St. Louis MO 63110, USA
| | - Parth Joshi
- Saint Louis University School of Medicine, 1402 S. Grand Blvd. Si. Louis MO 63110, USA.
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, 1008 S. Spring Ave, St. Louis MO 63110, USA.
| | - Timothy Phillips
- Division of Pediatric Urology, Department of Surgery, SSM Health Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd, St. Louis MO 63110, USA.
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Ghanavati PM, Khazaeli D, Amjadzadeh M. A comparison of the efficacy and tolerability of treating primary nocturnal enuresis with Solifenacin Plus Desmopressin, Tolterodine Plus Desmopressin, and Desmopressin alone: a randomized controlled clinical trial. Int Braz J Urol 2021; 47:73-81. [PMID: 32840337 PMCID: PMC7712704 DOI: 10.1590/s1677-5538.ibju.2019.0448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/08/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Nocturnal enuresis (enuresis) is one of the most common developmental problems of childhood, which has often a familial basis, causes mental and psychological damage to the child and disrupts family solace. OBJECTIVES In this study, we compared therapeutic efficacy and tolerability of treating primary nocturnal enuresis (PNE) with solifenacin plus desmopressin, tolterodine plus desmopressin, and desmopressin alone. Because we don't have enough information about this comparison especially about solifenacin plus desmopressin. PATIENTS AND METHODS This clinical trial study was performed on 62 patients with enuresis aged 5-15 years who referred to the urology clinic of Imam Khomeini Hospital in Ahwaz in 2017-2018. Patients were randomly assigned to one of the three different therapeutic protocols and any participants were given a specific code. After that, we compared the therapeutic response and the level of satisfaction of each therapeutic group in different months. Data were analyzed using SPSS 22 software and descriptive and analytical statistics. RESULTS The mean age of patients was 8.70±66 years. In the therapeutic group with desmopressin and solifenacin, 19 of 20 patients (95%) achieved complete remission (1) after a 3-month treatment in comparison with monotherapy group in which 14 of 22 patients (63.63%) achieved complete remission; and in the combination therapy group of desmopressin and tolterodine, in the study and the evaluation of the consequences of 3-month treatment of this group, it was found that 17 of 20 patients (85%) had complete remission. Overall, the therapeutic response in combination therapy groups of desmopressin plus anticholinergic was higher than the monotherapy group of desmopressin alone. CONCLUSION Our results demonstrate that the combination of desmopressin and an anticholinergic agent is highly effective in treatment of children with PMNE. Although desmopressin has long been a first - line treatment for PMNE, desmopressin monotherapy often fails to achieve a successful response in patients with PMNE.
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Affiliation(s)
| | - Dinyar Khazaeli
- Ahvaz Jundishapur UniversityTehranIranAhvaz Jundishapur University, Ahvaz, Khuzestan, Iran, Tehran, Republic of Islamic
| | - Mohammadreza Amjadzadeh
- Ahvaz Jundishapur UniversityTehranIranAhvaz Jundishapur University, Ahvaz, Khuzestan, Iran, Tehran, Republic of Islamic
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Esmael A, Elsherief M, Abdelsalam M, Bendary L, Egila H. Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children. J Child Neurol 2020; 35:975-982. [PMID: 32762394 DOI: 10.1177/0883073820944051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid-induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid-induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate (P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child's ability to awaken to the sense of bladder fullness or contractions.Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863.
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Affiliation(s)
- Ahmed Esmael
- Department of Neurology, 68780Faculty of Medicine, Mansoura University, Egypt
| | - Mohammed Elsherief
- Department of Neurology, 68780Faculty of Medicine, Mansoura University, Egypt
| | - Mohamed Abdelsalam
- Department of Neurology, 68780Faculty of Medicine, Mansoura University, Egypt
| | - Lotfy Bendary
- Department of Urology, Faculty of Medicine, 68865Zagazig University, Egypt
| | - Hossam Egila
- Department of Neurology, 68780Faculty of Medicine, Mansoura University, Egypt
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Disposable diaper overuse is associated with primary enuresis in children. Sci Rep 2020; 10:14407. [PMID: 32873840 PMCID: PMC7462848 DOI: 10.1038/s41598-020-70195-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/20/2020] [Indexed: 11/15/2022] Open
Abstract
This research investigated the association between prolonged disposable diaper (DD) wearing in infancy and primary enuresis (PNE). As a case–control study, we collected data from 376 children with enuresis and 379 healthy children who were sex- and age-matched at three tertiary care institutions in mainland China from August 2017 to July 2018. The results of adjusted logistic regression showed the odds ratios (95% confidence intervals) for PNE across the categories of age of daytime DD use cessation were as follows: ≥ 25 months: 1.00, 18–24 months: 0.25 (0.17–0.37), and ≤ 17 months: 0.11 (0.06–0.20), independent of age, mother education, residence, toilet training approach, breastfeeding duration, UTI, constipation, anaphylactic disease and family history. After a similar multivariable adjustment, increased age of daytime DD use (per-month) had a positive correlation with PNE, OR = 1.17, 95% CI 1.13–1.20 and non-linear relationship was detected, whose point was 21 months (the effect sizes and the 95%CI on the left and right sides of inflection point were 1.04 (0.99–1.10), P = 0.131 and 1.25 (1.18–1.31), P < 0.001). Subgroup analysis found that the effect of duration of disposable diaper exposure for each additional month, those children had accepted assisted infant toilet training/elimination communication (AITT/EC) practice had a lower risk of PNE (OR = 1.08, 95% CI 1.04–1.12), compared with those without AITT/EC practice (OR = 1.20, 95% CI 1.14–1.27), P for interaction < 0.001. In conclusion, the children diagnosed with primary enuresis after age 5 stopped using disposable diapers at daytime later than the control group. Association between duration of DD exposure and the risk of childhood enuresis is modified by AITT/EC practice. Timely cessation use of disposable diaper and practice AITT/EC may shorten the time to nocturnal continence, and the prospective cohort studies are needed to verify the discoveries.
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Yaradilmiş RM, Büyükkaragöz B, Yilmaz AÇ, Tayfur AÇ. Severity of self-reported depressive symptomatology and relevant factors in children with primary monosymptomatic nocturnal enuresis and their mothers. Pediatr Nephrol 2020; 35:1277-1285. [PMID: 32124028 DOI: 10.1007/s00467-020-04512-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nocturnal enuresis (NE) may negatively affect social and emotional life as well as mood in both children and their mothers. The aim of this study is to evaluate severity of self-reported depressive symptomatology and determine the relevant factors in children with primary monosymptomatic nocturnal enuresis (MNE) and their mothers by using depression inventories. METHODS Children Depression Inventory (CDI) for children and Beck Depression Inventory (BDI) for mothers were administered to the study group. The children and mothers in the patient and control groups were compared according to the depression inventory scores. The relationship of various sociodemographic factors with those scores was also investigated. RESULTS BDI scores of the mothers of children with primary MNE demonstrated minor depressive symptomatology and were significantly higher than the mothers in the control group (p = 0.002). Moreover, although within the normal range, CDI scores of the children with primary MNE were also significantly higher than the controls (p = 0.031). Main factors associated with BDI scores were the presence of primary MNE, maternal educational level, and CDI scores. School achievement of the children, monthly income of the family, and BDI scores were found to be correlated to the CDI scores. CONCLUSIONS Primary MNE was found to be associated with negative mood of the mothers in the present study. As misinformed parental attitudes adversely affect family dynamics, improved awareness of, and maternal education regarding primary MNE is vital in improving the holistic outcome of families affected by MNE.
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Affiliation(s)
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Keçiören Research and Training Hospital, Ankara, Turkey
| | - Aysun Çaltik Yilmaz
- Department of Pediatric Nephrology, Keçiören Research and Training Hospital, Ankara, Turkey
| | - Aslı Çelebi Tayfur
- Department of Pediatric Nephrology, Keçiören Research and Training Hospital, Ankara, Turkey
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Smith E, Cline J, Patel A, Zamilpa I, Canon S. Telemedicine Versus Traditional for Follow-Up Evaluation of Enuresis. Telemed J E Health 2020; 27:213-217. [PMID: 32539570 DOI: 10.1089/tmj.2019.0297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telemedicine allows health care professionals to diagnose and treat patients remotely. Enuresis is one of the most common chronic problems in childhood and specialized care can be limited. Utilization of telemedicine in this setting has not been previously analyzed. Materials and Methods: This study's aim is to evaluate the feasibility and effectiveness of telemedicine follow-up treatment of enuresis compared with traditional follow-up at our institution. A retrospective review of patients treated for nocturnal enuresis with either telemedicine (Group 1) or traditional (Group2) follow-up care was conducted. Patients, aged 5-18 years, treated for enuresis between July 2016 and December 2017 were included. Patients with confounding disease were excluded. Resolution of enuresis was the primary outcome as categorized by the International Children's Continence Society standards. Results: Seventy-seven (n = 77) patients met inclusion criteria with 23 patients in Group 1 and 54 patients in Group 2. Two patients in each group were lost to follow-up and 61.9% in Group 1 and 48.1% in Group 2 responded to treatment. The average age for both groups was 9.2 years. Patients in Group 1 averaged four appointments per patient and patients in Group 2 averaged 3.04 appointments per patient. Telemedicine follow-up patients missed fewer appointments (0.14) than patients with traditional follow-up (0.5) (p-value = 0.016). Thirteen of 21 patients (61.9%) responded to treatment in Group 1 (7 partial and 6 complete responders) as compared with 25 of 52 patients (48.1%) responding to treatment in Group 2 (8 partial and 17 complete responders) (p = 0.22). Of patients in Group 1, 87% reported they would use telemedicine again. Conclusions: Telemedicine follow-up of patients with enuresis demonstrated comparable effectiveness. Most patient families demonstrate a favorable opinion of using telemedicine again for this problem. Further research to understand the efficacy and benefits of telemedicine in this setting is needed.
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Affiliation(s)
- Elias Smith
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph Cline
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashay Patel
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Ismael Zamilpa
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Stephen Canon
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Study on neuropathological mechanisms of primary monosymptomatic nocturnal enuresis in children using cerebral resting-state functional magnetic resonance imaging. Sci Rep 2019; 9:19141. [PMID: 31844104 PMCID: PMC6915704 DOI: 10.1038/s41598-019-55541-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
Primary monosymptomatic nocturnal enuresis (PMNE) is a heterogeneous disorder, which remains a difficult condition to manage due to lack of knowledge on the underlying pathophysiological mechanisms. Here we investigated the underlying neuropathological mechanisms of PMNE with functional MRI (fMRI), combining the amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and seed-based functional connectivity (seed-based FC) analyses. Compared to the control group, PMNE group showed decreased ALFF value in the left medial orbital superior frontal gyrus (Frontal_Med_Orb_L), and increased ReHo value in the left superior occipital gyrus (Occipital_Sup_L). With left thalamus as the seed, PMNE group showed significantly decreased functional connectivity to the left medial superior frontal gyrus (Frontal_Sup_Medial_L). We conclude that these abnormal brain activities are probably important neuropathological mechanisms of PMNE in children. Furthermore, this study facilitated the understanding of underlying pathogenesis of PMNE and may provide an objective basis for the effective treatment.
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Ma Y, Shen Y, Liu X. Constipation in nocturnal enuresis may interfere desmopressin management success. J Pediatr Urol 2019; 15:177.e1-177.e6. [PMID: 30594475 DOI: 10.1016/j.jpurol.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Previous studies indicated that the prevalence of constipation in enuretic patients is higher than that in the general population. Several studies have revealed that successful treatment of constipation may be helpful in resolving enuresis. However, constipation affecting the efficacy of desmopressin in treating enuresis remains to be clarified. OBJECTIVE This study aimed to determine whether the presence of constipation is associated with the efficacy of desmopressin in treating enuresis. STUDY DESIGN Patients diagnosed with nocturnal enuresis (NE) were studied prospectively. Treatment responses in different stratified groups of patients with NE were compared by Chi-squared tests or Wilcoxon rank sum test. A logistic regression model was performed to investigate the relationship between the possible factors and the effectiveness of desmopressin. RESULTS In children with severe enuresis, patients with constipation had significantly lower complete response rate compared with patients without constipation. The presence of constipation was always related to the effectiveness of desmopressin whether in monosymptomatic NE or non-monosymptomatic patients with NE. With stratification for dose of desmopressin, non-constipated patients who received 0.2 mg of desmopressin had significantly higher complete response rate than patients with constipation. However, in subgroups of mild to moderate NE and 0.4 mg desmopressin, constipation was not associated with treatment response of enuresis. Logistic regression analysis revealed that constipation was significantly related to the effectiveness of desmopressin. DISCUSSION This study confirmed the negative effects of constipation in response to desmopressin in patients with NE. To the best of authors knowledge, this work is the first study to evaluate the relationship of constipation in enuretic patients and the efficacy of desmopressin. CONCLUSIONS The presence of constipation negatively affects the response to desmopressin in patients with NE, especially in patients with severe enuresis and in patients prescribed with low dose of desmopressin.
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Affiliation(s)
- Y Ma
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
| | - Y Shen
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
| | - X Liu
- The General Ward, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Xicheng District, Beijing, China.
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Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial. Int Neurourol J 2018; 22:295-304. [PMID: 30599501 PMCID: PMC6312976 DOI: 10.5213/inj.1836142.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/25/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods Ninety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.
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Shah S, Jafri RZ, Mobin K, Mirza R, Nanji K, Jahangir F, Patel SJ, Ejaz MS, Qaiser I, Iftikhar H, Aziz K, Khan W, Maqbool HS, Ahmed H. Frequency and features of nocturnal enuresis in Pakistani children aged 5 to 16 years based on ICCS criteria: a multi-center cross-sectional study from Karachi, Pakistan. BMC FAMILY PRACTICE 2018; 19:198. [PMID: 30547752 PMCID: PMC6293541 DOI: 10.1186/s12875-018-0876-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
Abstract
Background Nocturnal enuresis (NE) is a common symptom in children worldwide. International Children’s Continence Society (ICCS) defines enuresis as either mono-symptomatic, NE with lower urinary tract symptoms and NE with co-morbid conditions. The objectives of this study were to determine the frequencies and types of NE and associated symptoms and conditions in children aged 5 to 16 years based on ICCS criteria. Methods A multi-center cross sectional study was conducted between November 2012 and December 2013 in the primary care clinics of four hospitals in Karachi. Children aged five to fifteen years were included through consecutive sampling. Informed consent was obtained from the parents and a pre-coded semi-structured questionnaire was used to obtain the information. Data was entered on SPSS version 20.0 and multivariable logistic regression analysis was used for data analysis. Results Out of 429 children aged between five and sixteen years, 243(56.9%) were boys and the remaining 186(43.1%) were girls. One hundred and eighty three children (43%) had nocturnal enuresis (NE). Forty four (10.3%), had mono-symptomatic NE, 57(31.1%) had associated lower urinary tract symptoms (NE-LUTS), whereas 30 (16.3%) had NE with a co-morbid condition. Fifty two (28.4%) NE’s had at least one of both LUTS and a co-morbid condition. Out of the 246(57%) non-enuretic’s, 31(12.6%) had a LUTS, 95(38.6%) had a co-morbid condition and 57(23.2%) had at least one of both LUTS and a co-morbid condition. The remaining 63 (25.6%) were symptom free. Increased voiding frequency, urgency, dysuria, suprapubic pain and daytime incontinence were the LUTS significantly associated with NE. Co-morbid conditions significantly associated with NE included constipation, congenital defects, developmental delay, and learning and sleep problems. Conclusion Although NE can be an only symptom, it is often associated with lower urinary tract symptoms like dysuria, urgency, suprapubic pain, and daytime incontinence. Children presenting with NE often have co-morbid conditions like constipation, urinary tract infection, sleep disorders, and developmental delay. Many children presenting with these conditions as the primary complaint may also have NE. It should be addressed as unrecognized and untreated NE can cause additional morbidity and distress.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Rabab Zehra Jafri
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Khalil Mobin
- Community Health Sciences, Karachi Medical and Dental College, Karachi Metropolitan Corporation, Karachi, Pakistan
| | | | - Kashmira Nanji
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Fatima Jahangir
- Department of Family Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | | | - Muzamil Shabana Ejaz
- Dow Medical College, DOW University of Health Sciences, Baba-e-Urdu Road, Karachi, Pakistan
| | | | | | - Komal Aziz
- Saint Louis University, St Louis, MO, USA
| | - Wajiha Khan
- Department of Pediatrics, Aga Khan University, Karachi., Pakistan
| | - Humza S Maqbool
- UC, San Francisco - Fresno medical education program, California, USA
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Song P, Huang C, Wang Y, Wang Q, Zhu W, Yue Y, Wang W, Feng J, He X, Cui L, Wan T, Wen J. Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta-analysis. BJU Int 2018; 123:388-400. [PMID: 30216627 DOI: 10.1111/bju.14539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the efficacy of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agent (AA) therapy in the management of paediatric monosymptomatic nocturnal enuresis (MNE) using a network meta-analysis. MATERIALS AND METHODS We searched the electronic databases PubMed, Cochrane Library, EMBASE and Web of Science from inception to 1 March 2018. Randomized controlled trials (RCTs) that compared desmopressin, alarm, desmopressin plus alarm, and desmopressin plus AAs were identified. The network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. RESULTS Eighteen RCTs with a total of 1 649 participants were included. The meta-analysis results showed that complete response (CR) and success rates with desmopressin plus AAs were higher than with desmopressin or alarm monotherapy. Success rates for desmopressin plus alarm therapy were higher than for alarm monotherapy. No obvious difference was observed between desmopressin plus AAs and desmopressin plus alarm therapy with regard to CR rate and success rate. The relapse rate with alarm monotherapy was much lower than with desmopressin monotherapy. Adverse events seemed to be infrequently and tolerable for all treatments. The ranking probability results were as follows: desmopressin plus AA ranked first for the outcomes of CR and success, desmopressin plus alarm therapy ranked first for mean number of wet nights per week, and alarm therapy had the lowest relapse rate. CONCLUSIONS The network meta-analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AAwere associated with tolerable adverse events; however, additional high-quality studies are needed for further evaluation of these treatments.
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Affiliation(s)
- Pan Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Chuiguo Huang
- Department of Urology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qingwei Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wen Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yiwei Yue
- College of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Wancong Wang
- Department of Digest, The fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jinjin Feng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiangfei He
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lingang Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tingxiang Wan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jianguo Wen
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Kosilov KV, Geltser BI, Loparev SA, Kuzina IG, Shakirova OV, Zhuravskaya NS, Lobodenko A. The optimal duration of alarm therapy use in children with primary monosymptomatic nocturnal enuresis. J Pediatr Urol 2018; 14:447.e1-447.e6. [PMID: 29773463 DOI: 10.1016/j.jpurol.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The prevalence of primary monosymptomatic nocturnal enuresis (PMNE) has a range of 1.6-5.3% in adolescents and 7.5-12.4% in children of 5-10 years. Alarm intervention has been well known for more than 30 years. This method is a reliable and safe means of treating primary monosymptomatic nocturnal enuresis, being effective in 60-80% of cases. OBJECTIVE The objective of this study was to determine the efficacy of alarm intervention prolongation after the cure in order to reduce the risk of disease recurrence. STUDY DESIGN Two hundred ninety-four boys and 161 girls (455 persons in total) of age 9-14 years (average 11.4 years) took part in the prospective randomized study. After preselection and establishing diagnosis, all patients were randomly divided in three groups. In group А (n = 139) alarm system treatment was carried out within 12 weeks, in group В (n = 136) 16 weeks, and in group С (n = 139) 20 weeks. RESULTS The percentage of patients who no longer wet the bed (for 2 weeks or more) immediately after treatment in groups B (80.7%) and C (85.5%) was higher than in group A (67.4%) if the probability of error is pB/A < 0.05; pC/A < 0.05. There was no statistically significant difference in treatment success between groups B and C immediately after treatment. The percentage of patients who no longer wet the bed 3 months after the end of treatment in groups B (71.2%) and C (77.1%) was higher than in the group A (45.9%) if the probability of error is pB/A < 0.05; pC/A < 0.05. There was no statistically significant difference in treatment success between groups B and C 3 months after treatment. During the year this ratio did not change. DISCUSSION These data suggest that the effective duration of alarm intervention is found in the range 16-20 weeks and involves an uninterrupted course of treatment. Perhaps this range of time is optimal for the formation of a neuroreflexive mechanism that creates a habit for independent awakening in children with primary monosymptomatic nocturnal enuresis. CONCLUSION The effective duration of alarm intervention is likely to be 16-20 weeks of an uninterrupted course of treatment. This time interval ensures the maximum effectiveness of treatment and the stability of long-term results.
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Affiliation(s)
- Kirill V Kosilov
- Department of Social Sciences, Far Eastern Federal University, Vladivostok, Russian Federation; Department of Public Health, Pacific State Medical University, Vladivostok, Russian Federation.
| | - Boris I Geltser
- Academy of Medical Sciences of the Russian Federation, Far Eastern Federal University, Vladivostok, Russian Federation
| | - Sergay A Loparev
- Department of Urology, City Polyclinic No. 3, Vladivostok, Russian Federation
| | - Irina G Kuzina
- Department of Social Science, Far Eastern Federal University, Vladivostok, Russian Federation
| | - Olga V Shakirova
- Department of Theory and Methods of Adaptive Physical Education, Far Eastern Federal University, Vladivostok, Russian Federation
| | - Natalia S Zhuravskaya
- Department of Theory and Methods of Adaptive Physical Education, Far Eastern Federal University, Vladivostok, Russian Federation
| | - Alexandra Lobodenko
- Institute of Humanities, Far Eastern Federal University, Vladivostok, Russian Federation
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Cakiroglu B, Arda E, Tas T, Senturk AB. Alarm therapy and desmopressin in the treatment of patients with nocturnal enuresis. Afr J Paediatr Surg 2018; 15:131-134. [PMID: 32769363 PMCID: PMC7646679 DOI: 10.4103/ajps.ajps_115_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the rates of success, relapse, and compliance to treatment in patients undergoing alarm therapy or receiving desmopressin for primary monosymptomatic nocturnal enuresis (PMNE). MATERIALS AND METHODS This retrospective study was performed by reviewing the medical files of patients undergoing alarm therapy (Group 1) or receiving desmopressin (Group 2) for PMNE, between January 2010 and July 2014. Patients undergoing treatment in the 3rd and 6th month as well as 1st year follow-up data were analyzed. Two groups were compared with regard to treatment success, relapse rate, and compliance to treatment. RESULTS Group 1 included 64 and Group 2 included 70 children. Relapse rates at the 3rd month, 6th month, and 1st year were 67.2%, 71.9%, and 17.0% for Group 1 and 74.3%, 80.0%, and 21.4% for Group 2, respectively. There was no statistically significant difference between relapse rates at any point of follow-up. CONCLUSIONS Alarm therapy and desmopressin have the same success rate and relapse rates for PMNE. Compliance with alarm therapy is higher and we recommend it as the first-line treatment. On the other hand, desmopressin has low side effects and can also be used.
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Affiliation(s)
- Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Ersa Arda
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Tuncay Tas
- Department of Urology, Private Esencan Hospital, Istanbul, Turkey
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Kim TB, Kim CH, Kim KT, Yoon SJ, Chung KJ. Urology as rehabilitation medicine: a literature review. J Exerc Rehabil 2018; 14:322-326. [PMID: 30018913 PMCID: PMC6028209 DOI: 10.12965/jer.1836222.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
As a urologist, we usually encounter with two representative functional behaviors, namely, voiding and sexual function. These are not only important but also complex and synchronized so if these functions are impaired, patients need active functional rehabilitation to recover. These functional impairments should be recognized and corrected early because they could not only cause direct damage to the affected functions but also have harmful consecutive consequences such as kidney damage due to voiding abnormality and self-esteem damage due to decreased sexual function. Numerous rehabilitative methods are currently available, which help minimize the negative effects of these functional impairments. In terms of voiding function, pelvic floor muscle exercise, biofeedback, functional magnetic stimulation, neuromodulation, and clean intermittent self-catheterization are representative rehabilitation modalities. In case of children, extra-attention should be paid because this might affect their entire life. In impairment of sexual function, early intervention to maintain male erection is the main target of rehabilitation to prevent corporal fibrosis and penile deformity and increase recovery chance in patients who underwent radical prostatectomy or major surgery. In this review, we will elucidate various rehabilitation methods in urology to further increase our understanding of the rehabilitative characteristics of urology and widen our view of rehabilitation medicine.
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Affiliation(s)
- Tae Beom Kim
- Department of Urology, Gachon University Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Chang Hee Kim
- Department of Urology, Gachon University Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Kwang Taek Kim
- Department of Urology, Gachon University Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Sang Jin Yoon
- Department of Urology, Gachon University Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - Kyung Jin Chung
- Department of Urology, Gachon University Medical Center, Gachon University School of Medicine, Incheon, Korea
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Wang M, Zhang A, Zhang J, Lu H, Xu S, Qin Z, Ma J, Du X. Morphometric Magnetic Resonance Imaging Study in Children With Primary Monosymptomatic Nocturnal Enuresis. Front Pediatr 2018; 6:103. [PMID: 29707531 PMCID: PMC5908894 DOI: 10.3389/fped.2018.00103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/28/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Primary monosymptomatic nocturnal enuresis (PMNE) refers to bed-wetting in children who have no other lower urinary tract symptoms and are never dry for more than 6 months. Our previous studies demonstrated that children with PMNE exhibited brain functional abnormalities compared with healthy controls; however, researches on the abnormalities in gray matter were limited. This study aimed to investigate brain structural changes in gray matter of children with PMNE using magnetic resonance imaging (MRI). METHODS Gray matter volumes (GMVs) and gyrification indices (GIs) were calculated using voxel-based and surface-based morphometry analyses of structural MRI data acquired from 26 children with PMNE and 28 healthy children. To identify between-group differences in gray matter, two-sample t-tests were conducted on GMV and GI images separately. RESULTS Compared with the controls, children with PMNE showed significantly increased GMVs in the supplementary motor area and medial prefrontal cortex regions (mean GMV in PMNE: 0.54 ± 0.07 l; mean GMV in controls: 0.50 ± 0.06 l) and reduced GIs in the right precuneus (mean GI in PMNE: 25.74° ± 2.34°; mean GI in controls: 27.97° ± 1.79°). CONCLUSION Children with PMNE showed abnormal GMVs in frontal lobe and GIs in precuneus, and these changes might be involved in the pathological mechanism of PMNE.
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Affiliation(s)
- Mengxing Wang
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Anyi Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jilei Zhang
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Haifeng Lu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Shuai Xu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Zhaoxia Qin
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
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Mulić B, Mulić M, Muminović S, Mulić M, Vujošević S, Peco-Antić A. Calciuria in children with primary mono-symptomatic nocturnal enuresis. SANAMED 2018. [DOI: 10.24125/sanamed.v13i3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: The prevalence of idiopathic hypercalciuria (IH) in healthy pediatric population ranges from 3.0% to 7.0%. There is insufficient data about IH in children with mono-symptomatic enuresis. The aim of this study was to examine calcium excretion in urine (UCa) in patients with primary mono-symptomatic nocturnal enuresis (PMNE). Methods: In patients with PMNE, aged 5 to 17 years, IH was determined in 24-h urine and from second morning spot urine. The completeness of the 24-h urine collections was estimated via measuring 24h-urine creatinine excretion (UCr) of 0.1-0.2 mmol/kg/24h. Results: Sixty patients with PMNE, 32 males and 28 girls, median age of 9 years were enrolled in the study. Only 41.7% patients successfully completed 24 h urine collection. IH, defined as 24-h UCa > 0.1 mmol/kg body weight, was diagnosed in 12% of the patients, while when defined as UCa/UCr > 0.8 mmol/mmol in children 5-7 years and > 0.6 mmol/mmol in those > 7 years, IH was 8.3% and 6.7% from 24hurine and spot urine, respectively. Conclusion: Children and adolescents with PMNE are in risk of hypercalciuria. Therefore, it is useful to examine 24 hours of urine calcium excretion in these patients.
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Chua ME, Fernandez N, Ming JM, Silangcruz JMA, Dos Santos J, Lorenzo AJ, Koyle MA, Lopes RI. Neurostimulation Therapy for Pediatric Primary Enuresis: A Meta-analysis. Urology 2017; 106:183-187. [DOI: 10.1016/j.urology.2017.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/14/2017] [Accepted: 04/21/2017] [Indexed: 11/28/2022]
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Arena S, Patricolo M. Primary nocturnal enuresis: Assessment and treatment at a single referral center. Pediatr Int 2017; 59:812-815. [PMID: 28415139 DOI: 10.1111/ped.13298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of primary monosymptomatic and non-monosymptomatic nocturnal enuresis (PMNE and PNMNE) and associated factors in a major referral center for NE in Abu Dhabi. METHODS Children referred to the Paediatric Continence Clinic, between 2014 and 2016, for PNE were included in the study. Exclusion criteria were neuropathic bladder, abnormality of the bladder and bowel, urethral stenosis, neurological and psychiatric problems, non-completion of the diagnostic protocol, and follow up <6 months. RESULTS A total of 128 patients were included in the study: 82 boys (64.1%) and 46 girls (35.9%). A total of 42.7% of boys and 8.7% of girls had PMNE, and 57.3% of boys and 91.3% of girls had PNMNE. Constipation was present in 46% of patients. In the male PNMNE group, 74.5% had overactive bladder (OAB), 10.6%, dysfunctional voiding (DV); and 14.9%, OAB + DV. In the female PNMNE group, 35.7% had OAB; 21.4%, DV; 40.5%, OAB + DV; and 2.4%, underactive bladder. A total of 97% and 86 of children with PMNE and PNMNE, respectively, had resolution of NE. Boys had a significantly higher incidence of PMNE, and girls, of DV. CONCLUSION In Abu Dhabi, NE is often associated with bladder dysfunction or DV, mostly in girls, and with constipation. High intake of dry, low fiber foods, along with hot weather and the stress of city living negatively affect the incidence of fecal retention and of NE. A multimodal approach, including the treatment of constipation, led to a satisfactory resolution of PNE in almost 90% of cases.
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Affiliation(s)
- Salvatore Arena
- Unit of Paediatric Surgery, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Mario Patricolo
- Department of Paediatric Surgery, Mediclinic and Al Noor Hospital Group, Abu Dhabi, United Arab Emirates
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Mark A, Meister M, Opara B, Chow R. Nontraumatic urinary bladder rupture presenting as renal pseudo-failure and ascites. Radiol Case Rep 2017; 12:304-307. [PMID: 28491176 PMCID: PMC5417767 DOI: 10.1016/j.radcr.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/29/2022] Open
Abstract
A 24-year-old man, with past medical history significant only for nocturnal enuresis until the age of 12 years, presented to the emergency department with acute abdominal pain after an episode of difficulty with micturition in the middle of the night. On presentation, physical examination was suggestive of ascites and laboratories revealed an elevated serum creatinine of 1.88 mg/dL. He was subsequently found to have a ruptured bladder, without any inciting trauma, which required surgical repair. His only surgical history is an unknown, apparently urologic, surgery when he was 11-12 years old. The patient's unique presentation prompts discussion of bladder rupture and its manifestations, the role of clinical information in informing imaging protocol, and the importance of sagittal images in identifying pathology.
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Affiliation(s)
- Andrew Mark
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201, USA
| | - Moshe Meister
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201, USA
| | - Benjamin Opara
- Division of Urology, Department of Surgery, University of Maryland Medical Center, Midtown Campus, Baltimore, MD, USA
| | - Robert Chow
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, 827 Linden Avenue, Baltimore, MD 21201, USA
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