1
|
Berhanu T, Abera M, Girma S, Tesfaye Y. Elimination disorders and associated factors among children and adolescents age 5-14 year-old attending paediatric outpatient clinic at Wolaita Sodo University comprehensive specialized hospital, South Ethiopia. Child Adolesc Psychiatry Ment Health 2024; 18:52. [PMID: 38702758 PMCID: PMC11069281 DOI: 10.1186/s13034-024-00739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/03/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Elimination disorder occurs in children over the age of normal toileting who continue to have an inability to control urination or feces, either during the day, at night, or both. Paediatric elimination disorders are not well understood by parents, teachers, medical professionals, mental health practitioners, and researchers. Hence, this study aimed to assess the magnitude of elimination disorder and associated factors among children and Adolescents aged 5-14 years old at Wolaita Sodo University Comprehensive Specialized Hospital, South Ethiopia, in 2022. METHOD A hospital-based cross-sectional study was conducted from September 22 to November 22, 2022, at Wolaita Sodo University Comprehensive Specialized Hospital. A systematic random sampling technique was employed to select 423 study subjects. The data were gathered using a structured, face-to-face interviewer-administered questionnaire. The development of the symptom score for dysfunctional elimination syndrome of Vancouver questionnaires was used to screen for elimination disorders. Logistic regression model was used to determine the association between the outcome and independent variables. A 95% CI and Odds ratio with corresponding p-value < 0.05 were used to determine the predictors of the outcome variable. RESULT The overall magnitude of elimination disorder among children and Adolescents age 5-14 in this study was (n 70, 16.8%); in boys (n 47, 17.3%) and girls (n 23, 15.75%). The prevalence of enuresis was (n 64, 15.3%), encopresis (n 15, 3.6%), both enuresis and encopresis, or combined elimination disorder (n 9, 2.2%). Age 9-11 years (AOR = 3.2, 95%CI:1.09, 9.43), family size four and above (AOR = 3.4, 95%CI:1.78, 6.56), family history of elimination disorder (AOR = 3.9, 95%CI:2.12, 7.45), emotional problem (AOR = 2.2, 95%CI:1.18, 4.05), hyperactive problem (AOR = 3.8, 95%CI:1.83, 7.83), low toilet training skills (AOR = 5.9, 95%CI:2.61, 13.33), bad parenting practices, were poor supervision (AOR = 4.4, 95%CI 1.29, 14.69) were significantly associated with elimination disorder. CONCLUSION AND RECOMMENDATION In this study, approximately one in five children and adolescents had an elimination disorder. Younger age, family size four and above, positive family history of elimination disorder, presence of emotional and hyperactive problems, bad parenting practices, and low toilet training skills were factors associated with elimination disorders. Therefore, preventative, etiological, and therapeutic measure, early toilet training, supportive parenting practices, screening for children's and adolescents' behavioral problems, and elimination disorders need attention to reduce the effect of the problem.
Collapse
Affiliation(s)
- Tamene Berhanu
- Wolaita Sodo University College of Health Science and Medicine, Wolaita Sodo, Ethiopia.
| | - Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Shimelis Girma
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Yonas Tesfaye
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| |
Collapse
|
2
|
Spinzi S, Agrawal G, Sharma A, Venkatapuram P, Sharma K, Brown-Johnson C, Kan KM. Paediatricians' perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study. BMJ Paediatr Open 2024; 8:e002372. [PMID: 38569740 PMCID: PMC10989118 DOI: 10.1136/bmjpo-2023-002372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Paediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these bothersome symptoms, yet there is no formal resource to support them with the treatment of LUTS. Evaluating paediatricians' experiences is an important step in informing health promotion efforts to improve health outcomes in children. This study aims to explore paediatricians' knowledge, beliefs, practice patterns, and perceived barriers and facilitators in providing LUTS care. METHODS In this qualitative study, we conducted semistructured focus groups of paediatricians within California. Focus groups were conducted via Zoom, and participants were enrolled until thematic saturation was reached. Participants were asked about their current practices, knowledge and beliefs, barriers and facilitators to care, training and education, and responsibility for behaviour and action. Thematic analysis was performed using deductive and inductive approaches; themes were mapped through an iterative, team-based process. RESULTS 15 paediatricians, aged 30-69 years, with 13 (86.7%) women, were interviewed. Most (11, 73.3%) practised in general outpatient settings. Interviewed paediatricians recognised paediatric LUTS as a common problem that can significantly impact children's well-being. In practice, paediatricians did not actively screen for LUTS beyond the potty-training milestone due to short visit duration and competing healthcare demands. Lack of guidelines, parental mistrust and inadequate clinical education were barriers identified by paediatricians. CONCLUSIONS Paediatricians expressed a willingness to help patients but indicated several limitations to providing adequate LUTS care. Future professional development work can emphasise guideline development, early screening strategies to support timely intervention and better education for clinicians.
Collapse
Affiliation(s)
- Stav Spinzi
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Gunjan Agrawal
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Flushing Hospital Medical Center, Flushing, New York, USA
| | - Aditi Sharma
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Pranaya Venkatapuram
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Kritika Sharma
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Kathleen M Kan
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
3
|
Uhrenius I, Bergsten A, Nevéus T. Predictors of treatment response in therapy-resistant enuresis. J Pediatr Urol 2024; 20:219.e1-219.e6. [PMID: 37977907 DOI: 10.1016/j.jpurol.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The voiding chart is part of the initial evaluation of enuresis, since the data gathered this way are assumed to carry predictive information. However, there is little evidence that the voiding chart actually does predict therapy response. Lundmark & Nevéus performed a pilot investigation in 2020 and found that anamnestic and voiding chart data did not predict response to second-line therapies. This study aims at evaluating whether these findings could be replicated. PATIENTS AND METHODS This is an evaluation of clinical practice. All patients in a tertiary outpatient clinic with enuresis resistant to first-line therapy (i.e. the enuresis alarm and desmopressin medication) during the evaluation period were included in the study. Baseline anamnestic data focused on bladder and bowel habits, were gathered and the families were instructed to complete a voiding chart including measurements of nocturnal urine production. The children were then treated in accordance with international guidelines, which are anticholinergics and antidepressants as second- and third-line treatment, respectively. Desmopressin was added if needed. RESULTS In total, 70 patients were included. At the end of the study 37 of these patients were dry, 11 patients were still wetting their beds and 22 patients were lost to follow-up. Of the dry patients 21 became dry on anticholinergics (and/or mirabegron, with or without desmopressin), five on tricyclic antidepressants (with or without desmopressin), seven after a new attempt with the alarm and five became dry spontaneously. The only statistically significant differences between responders and non-responders to the various treatments were that children responsive to anticholinergics had harder and more infrequent stools (p = 0.04 and p = 0.03, respectively). CONCLUSION This study found that anamnestic and voiding chart data do not predict response to treatment in children with therapy-resistant enuresis. Because of this and the fact that we lose some children who need our help by demanding that they complete a voiding chart before initiating treatment, we question the use of this instrument in the evaluation of therapy-resistant enuresis.
Collapse
Affiliation(s)
- Ida Uhrenius
- Department of Women's and Children's Health, Uppsala University, Sweden.
| | - Amadeus Bergsten
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Tryggve Nevéus
- Uppsala University Children's Hospital and Department of Women's and Children's Health, Uppsala University, Sweden
| |
Collapse
|
4
|
Dias GCM, Vasconcelos MMDA, Netto JMB, de Miranda DM, Lima EM, Simões E Silva AC, Moreira JM, Mrad FCDC. Translation, cross-cultural adaptation and validation of the Short Screening Instrument for Psychological Problems in Enuresis for use in Brazil (SSIPPE-Br). J Pediatr (Rio J) 2024; 100:218-225. [PMID: 38012954 PMCID: PMC10943317 DOI: 10.1016/j.jped.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE Enuresis is associated with attentional and emotional comorbidities in 20 to 30 % of cases. The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) is a questionnaire that allows the initial screening of these comorbidities. This study aimed to translate, culturally adapt, and validate the SSIPPE for Brazilian children and adolescents (SSIPPE-Br). METHODS Six steps were performed for translation and cross-cultural adaptation: translation, synthesis of translations, back-translation, preparation of the pre-final version of the translated instrument, test of comprehensibility of the pre-final version of the tool, and elaboration of the instrument cross-culturally adapted for Brazil, named 13-itens version SSIPPE-Br. To validate the SSIPPE-Br, a cross-sectional study was carried out, in which the validated Brazilian version of the Child and Adolescent Behavior Inventory (CABI) was used. RESULTS Validation was performed on 127 children and adolescents with a mean age of 9.7 ± 2.8 years, 48 % male. The reliability was estimated using Cronbach's alpha, ranging from 0.86 to 0.89, indicating good internal consistency. The factorial analysis had a good agreement adjustment (KMO 0.755, Bartlett's test < 0.001) and explained 70.5 % of the data variability. In the reproducibility analysis, the Kappa coefficient ranged from 0.94 to 1, which can be considered almost perfect. A highly significant (p-value < 0.001) and direct correlation existed between the three SSIPPE-Br domains and all evaluated CABI domains. CONCLUSION The SSIPPE-Br is a valid and reliable tool for emotional problems screening and ADHD symptoms in children and adolescents with enuresis whose first language is Brazilian Portuguese.
Collapse
Affiliation(s)
- Gláucia Cristina Medeiros Dias
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Departamento de Urologia, Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas de Juiz de Fora, Juiz de Fora, MG, Brazil; Hospital e Maternidade Therezinha de Jesus, Departamento de Urologia, Juiz de Fora, MG, Brazil
| | - Débora Marques de Miranda
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Eleonora Moreira Lima
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte, MG, Brazil
| | - Janaina Matos Moreira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade de Nefrologia Pediátrica, Belo Horizonte, MG, Brazil.
| |
Collapse
|
5
|
Abstract
This article reports on the epidemiology, prevalence, and physiopathology of sleep-related urinary dysfunction, a new syndromic category proposed by the recently revised ICSD-3-TR classification. Sleep enuresis, whether primary or secondary, monosymptomatic or plurisymptomatic, will be reviewed in terms of risk factors, comorbidity, and diagnostic and therapeutic indications. A definition of nocturia and its impact on patients' health, quality of life, and mortality will follow. Finally, the impact of urge incontinence on various medical and neurologic disorders will be discussed. Special emphasis will be placed on the possible association of this parasomnia with several sleep disorders and poor, fragmented sleep.
Collapse
Affiliation(s)
- Rosalia Silvestri
- Sleep Medicine Center, UOSD of Neurophysiopathology and Movement Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| |
Collapse
|
6
|
Eke H, Ball S, Allinson A, Anderson R, Hunt H, Hutton E, Lindsay C, Logan S, Madden N, Melluish J, Richardson D, Rogers J, Thompson Coon J, Whear R, Wright A, Morris C. Interventions to improve continence for children and young people with neurodisability: a national survey of practitioner and family perspectives and experiences. BMJ Paediatr Open 2024; 8:e002238. [PMID: 38242630 PMCID: PMC10806478 DOI: 10.1136/bmjpo-2023-002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Describe families' experiences of interventions to improve continence in children and young people with neurodisability, and health professionals' and school and social care staff's perspectives regarding factors affecting intervention use. DESIGN Four online surveys were developed and advertised to parent carers, young people with neurodisability, health professionals and school and social care staff, via societies, charities, professional contacts, schools, local authorities, and national parent carer and family forums, who shared invitations with their networks. Survey questions explored: difficulties helping children and young people use interventions; acceptability of interventions and waiting times; ease of use and availability of interventions, and facilitators and barriers to improving continence. RESULTS 1028 parent carers, 26 young people, 352 health professionals and 202 school and social care staff registered to participate. Completed surveys were received from 579 (56.3%) parent carers, 20 (77%) young people, 193 (54.8%) health professionals, and 119 (58.9%) school and social care staff. Common parent carer-reported difficulties in using interventions to help their children and young people to learn to use the toilet included their child's lack of understanding about what was required (reported by 337 of 556 (60.6%) parent carers who completed question) and their child's lack of willingness (343 of 556, 61.7%). Almost all (142 of 156, 91%) health professionals reported lack of funding and resources as barriers to provision of continence services. Many young people (14 of 19, 74%) were unhappy using toilet facilities while out and about. CONCLUSIONS Perceptions that children lack understanding and willingness, and inadequate facilities impact the implementation of toileting interventions for children and young people with neurodisability. Greater understanding is needed for children to learn developmentally appropriate toileting skills. Further research is recommended around availability and acceptability of interventions to ensure quality of life is unaffected.
Collapse
Affiliation(s)
- Helen Eke
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Susan Ball
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Annette Allinson
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | - Rob Anderson
- Medical School, University of Exeter, Exeter, UK
| | - Harriet Hunt
- Medical School, University of Exeter, Exeter, UK
| | - Eve Hutton
- Canterbury Christ Church University, Canterbury, UK
| | | | - Stuart Logan
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Nicholas Madden
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julia Melluish
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | | | | | - Jo Thompson Coon
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Anne Wright
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Christopher Morris
- Medical School, University of Exeter, Exeter, UK
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| |
Collapse
|
7
|
Correia Moretti E, da Silva IB, Boaviagem A, de Lima AMJ, Lemos A. Interventions for Enuresis in Children and Adolescents: An Overview of Systematic Reviews. Curr Pediatr Rev 2024; 20:76-88. [PMID: 36043721 DOI: 10.2174/1573396318666220827103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/06/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Enuresis is an involuntary and intermittent loss of urine during sleep, and its treatment can be done by pharmacological and non-pharmacological strategies. OBJECTIVE To conduct an overview to carry out a survey of the systematic reviews about treatment options for children/adolescents with enuresis. METHODS Databases used were Cochrane Library, PROSPERO, MEDLINE/PubMed, EMBASE, LILACS/BVS, PEDro, SciELO and Google Scholar. Any type of intervention for the treatment of enuresis in children/adolescents was selected by two independent researchers. Data extraction was done by two independent researchers. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2). RESULTS Seven systematic reviews were included. According to ROBIS, three reviews had a low risk of bias, while the others had a high risk of bias. Based on AMSTAR-2, four systematic reviews were of moderate quality, two were low quality, and one was critically low quality. CONCLUSION There is moderate confidence that the use of desmopressin plus an anticholinergic agent increases the chance of complete response compared to desmopressin alone. Neurostimulation may increase the risk of responses ≥50% and ≥90% compared to the control group. Likewise, it appears that electrical stimulation is superior to placebo about the chance of response ≥50%. In addition, there is clinical relevance in reducing enuresis episodes per week when neurostimulation is used compared to control groups.
Collapse
Affiliation(s)
- Eduarda Correia Moretti
- Department of Anatomy, Federal University of Pernambuco, Child and Adolescent Health, Federal University of Pernambuco - Recife (PE), Brazil
- Institute of Biological and Health Sciences, Federal University of Alagoas (UFAL), Maceió, Alagoas, Brazil
| | | | - Alessandra Boaviagem
- Department of Physiotherapy, Federal University of Pernambuco - Recife (PE), Brazil
| | | | - Andrea Lemos
- Department of Physical Therapy, Federal University of Pernambuco, Recife (PE), Brazil
| |
Collapse
|
8
|
Capdevila Vilaró B, Casal-Beloy I, Villalón Ferrero FN, Martín-Solé O, Coronas Soucheiron M, González-Temprano N, Larreina De la Fuente L, Carbonell Pradas M, Pérez-Bertólez S, Tarrado Castellarnau X, García-Aparicio L. Characterization and treatment of enuresis in overactive bladder patients. Cir Pediatr 2024; 37:27-32. [PMID: 38180099 DOI: 10.54847/cp.2024.01.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. MATERIALS AND METHODS A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created -primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a > 50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. RESULTS 152 OAB patients were included. 109 of them (71.7%) had enuresis -29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). CONCLUSIONS Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.
Collapse
Affiliation(s)
- B Capdevila Vilaró
- Pediatric Surgery Department. Hospital Sant Joan de Déu. Barcelona (Spain)
| | - I Casal-Beloy
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Virgen del Rocío. Sevilla (Spain)
| | - F N Villalón Ferrero
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Universitario de Donostia. (Spain)
| | - O Martín-Solé
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Sant Joan de Déu. Barcelona (Spain)
| | | | - N González-Temprano
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Universitario de Donostia. (Spain)
| | - L Larreina De la Fuente
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Universitario de Donostia. (Spain)
| | - M Carbonell Pradas
- Pediatric Surgery Department. Hospital Sant Joan de Déu. Barcelona (Spain)
| | - S Pérez-Bertólez
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Sant Joan de Déu. Barcelona (Spain)
| | | | - L García-Aparicio
- Pediatric Urology Unit, Pediatric Surgery Department. Hospital Sant Joan de Déu. Barcelona (Spain)
| |
Collapse
|
9
|
Bacotti JK, Perez BC, Vollmer TR. Reflections and Critical Directions for Toilet Training in Applied Behavior Analysis. Perspect Behav Sci 2023; 46:447-458. [PMID: 38144548 PMCID: PMC10733246 DOI: 10.1007/s40614-023-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 12/26/2023] Open
Abstract
Achieving toileting independence is a critical skill that yields several benefits of pressing social, developmental, and health-related importance. The seminal behavioral approach to toilet training established the conceptualization of continence and framework for toileting research thereafter. Contemporary researchers continue to evaluate toilet training procedures that produce efficacious outcomes for young children that closely align with current applied behavior analysis (ABA) ethics and standards of practice. Despite the overall success of behavior-analytic toileting approaches, there are critical directions still worthy of consideration and investigation. In this paper, we acknowledge the seminal roots and many of the contemporary contributions. We also critically reflect on current practices while proposing necessary areas to advance behavior-analytic toilet training research.
Collapse
Affiliation(s)
- Janelle K. Bacotti
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd., Coral Gables, FL 33146 USA
| | | | | |
Collapse
|
10
|
Dahan P, de Oliveira PMN, Brum AR, Ribeiro ACP, Figueiredo AA, de Bessa J, Murillo B. J. Treating asthma in patients with enuresis: repercussions on urinary symptoms. Int Braz J Urol 2023; 49:590-598. [PMID: 37450772 PMCID: PMC10482458 DOI: 10.1590/s1677-5538.ibju.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.
Collapse
Affiliation(s)
- Patricia Dahan
- Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de PediatriaJuiz de ForaMGBrasilDepartamento de Pediatria, Faculdade de Medicina da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
| | - Pricila Mara Novais de Oliveira
- Universidade Federal de Juiz de ForaHospital UniversitárioDepartamento de Fisioterapia PediátricaJuiz de ForaMGBrasilDepartamento de Fisioterapia Pediátrica do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Aparecida Regina Brum
- Hospital Evandro RibeiroJuiz de ForaMGBrasilServiço de Otorrinolaringologia do Hospital Evandro Ribeiro, Juiz de Fora, MG, Brasil
| | - André Costa Pinto Ribeiro
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia do Hospital UniversitárioDepartamento de OtorrinolaringologiaJuiz de ForaMGBrasilDepartamento de Otorrinolaringologia, Departamento de Cirurgia do Hospital Universitário da Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - André Avarese Figueiredo
- Universidade Federal de Juiz de ForaDepartamento de CirurgiaDivisão de UrologiaJuiz de ForaMGBrasilDepartamento de Cirurgia- Divisão de Urologia, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de CirurgiaDivisão de UrologiaFeira de SantanaBahiaBrasilDepartamento de Cirurgia - Divisão de Urologia, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brasil
| | - José Murillo B.
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaDepartamento de CirurgiaJuiz de ForaMGBrasilDepartamento de Cirurgia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG, Brasil
| |
Collapse
|
11
|
von Gontard A, Kuwertz-Bröking E. [Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. Z Kinder Jugendpsychiatr Psychother 2023; 51:375-400. [PMID: 37272401 DOI: 10.1024/1422-4917/a000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract: Objective: Enuresis and daytime urinary incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. This interdisciplinary guideline summarizes the current state of knowledge regarding somatic and psychiatric assessment and treatment. We formulate consensus-based, practical recommendations. Methods: The members of this guideline commission consisted of 18 professional associations. The guideline results from current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: According to the International Children's Continence Society (ICCS), there are four different subtypes of nocturnal enuresis and nine subtypes of daytime urinary incontinence. Organic factors first have to be excluded. Clinical and noninvasive assessment is sufficient in most cases. Standard urotherapy is the mainstay of treatment. If indicated, one can add specific urotherapy and pharmacotherapy. Medication can be useful, especially in enuresis and urge incontinence. Psychological and somatic comorbid disorders must also be addressed. Conclusions: The recommendations of this guideline were passed with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required especially regarding functional (nonorganic) daytime urinary incontinence.
Collapse
Affiliation(s)
- Alexander von Gontard
- Psychiatrische Dienste Graubünden, Ambulante Dienste für Kinder- und Jugendpsychiatrie, Chur, Schweiz
- Governor Kremers Centre, Department of Urology, Maastricht University Medical Centre, Maastricht, Niederlande
| | - Eberhard Kuwertz-Bröking
- Ehemals: Universitätsklinikum Münster, Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Nephrologie, Münster, Deutschland
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
14
|
Al-Asadi JN, Radhi AM, Jumaa DS, Hassan MK. The Role of Hyposthenuria in Enuresis Among Paediatric Patients With Sickle Cell Disease. Sultan Qaboos Univ Med J 2023; 23:206-211. [PMID: 37377834 PMCID: PMC10292602 DOI: 10.18295/squmj.9.2022.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Enuresis is common among children with sickle cell disease (SCD). Many risk factors have been postulated, but its relation to hyposthenuria is debatable. This study aimed to determine the prevalence of enuresis in children with SCD in Basrah, Iraq, and to examine its relation with hyposthenuria. Methods A cross-sectional epidemiological study was performed on children with SCD who met the inclusion criteria at the Basrah Center for Hereditary Blood Diseases from December 2020 to May 2021. A questionnaire was used to collect relevant data. Blood samples were tested for haemoglobin genotype, certain blood indices and serum haemoglobin. Urine was tested for albumin and creatinine, and the specific gravity was measured using urine dipsticks. The relationships between enuresis and various sociodemographic and clinical variables were assessed. Binary logistic regression analysis was done to examine the independent risk factors of enuresis. Results A total of 161 out of 200 eligible children were included in this study (response rate: 80.5%). The majority of participants (60.9%) were males. The mean age of the participants was 10.9 ± 2.9 years. Enuresis was reported in 50 (31.1%) patients. The independent risk factors for enuresis included family history of enuresis (adjusted odds ratio [OR] = 5.94, 95% confidence interval [CI]: 2.54-13.89; P <0.001), hyposthenuria (OR = 3.76, 95% CI: 1.25-11.30; P = 0.018) and sleep disorders (OR = 2.90, 95% CI: 1.19-7.06; P = 0.019. Conclusion Enuresis is common among children with SCD in Basrah, Iraq. Hyposthenuria was significantly associated with enuresis. Family history of enuresis and sleep disorders were also found to be significantly related to enuresis.
Collapse
Affiliation(s)
| | - Alyaa M. Radhi
- Pediatrics, College of Medicine, University of Basrah, Basrah, Iraq
| | - Dhuha S. Jumaa
- Pediatrics, College of Medicine, University of Basrah, Basrah, Iraq
| | - Meaad K. Hassan
- Pediatrics, College of Medicine, University of Basrah, Basrah, Iraq
| |
Collapse
|
15
|
Lim LY, Chang SJ, Yang SSD. Age- and gender-specific normal post void residual urine volume in healthy adolescents. J Pediatr Urol 2023:S1477-5131(23)00113-4. [PMID: 37029009 DOI: 10.1016/j.jpurol.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. OBJECTIVE To establish age- and gender-specific normal PVR urine volume in adolescents. MATERIAL AND METHODS Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. RESULTS A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV < 100 ml) in both assessments (n = 12), BV < 100 ml in one assessment (n = 1), or failure to provide relevant history (n = 1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n = 152), BV < 100 ml (n = 27), PVR >100 ml (n = 5) and missing information (n = 6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6 ± 1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P < 0.001). Moreover, they were higher in females than in males (P < 0.001). Multivariate analysis revealed that PVR was positively influenced by age (P = 0.001) and BV (P < 0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20 ml (7% BV) for males of both the age groups, and PVR >25 ml (9% BV) and PVR >35 ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30 ml (8% BV) and >30 ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35 ml (11% BV) and >45 ml (13% BV) for females aged 12-14 and 15-18 years, respectively. CONCLUSION PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.
Collapse
Affiliation(s)
- Li Yi Lim
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; Division of Urology, Department of Surgery, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
| | - Shang-Jen Chang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; Department of Urology, National Taiwan University, No 7, Zhongshan S Road, Zhongsheng District, Taipei City, 100, Taiwan, R.O.C.
| | - Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City, 23142, Taiwan, R.O.C; School of Medicine, Tzu Chi University, 289, Jianguo Road, Xindian District, New Taipei City, Hualien, 23142, Taiwan, R.O.C.
| |
Collapse
|
16
|
Martínez Suárez V, Lostal Gracia MI, Sánchez Vázquez A, Carapau Ferreira C, Quintero Del Álamo J. [ Enuresis: Perception and attitude in population of our country]. Semergen 2023; 49:101930. [PMID: 36889224 DOI: 10.1016/j.semerg.2023.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. MATERIAL AND METHODS A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. RESULTS Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. CONCLUSION Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution.
Collapse
Affiliation(s)
- V Martínez Suárez
- Servicio de Salud del Principado, Universidad de Oviedo, Grupo OBGETIBE, Oviedo, España.
| | - M I Lostal Gracia
- Servicio de Pediatría, Centro de Salud Amparo Poch, Zaragoza, España
| | | | - C Carapau Ferreira
- Servicio de Pediatría, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - J Quintero Del Álamo
- Servicio de Psiquiatría, Hospital Universitario Infanta Leonor; Departamento de Psiquiatría Legal y Psiquiatría, Universidad Complutense de Madrid, Madrid, España
| |
Collapse
|
17
|
Karamaria S, Dossche L, Delens V, Degraeuwe E, Raes A, Mauel R, Vande Walle C, Everaert K, Vande Walle J. Circadian rhythm of water and solute excretion in nocturnal enuresis. Pediatr Nephrol 2023; 38:771-779. [PMID: 35748940 DOI: 10.1007/s00467-022-05645-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nocturnal polyuria (NP) due to a suppressed vasopressin circadian rhythm is a well-documented pathogenetic mechanism in enuresis, mainly studied in monosymptomatic enuresis. A substantial percentage of patients do not respond to desmopressin. This suggests that NP may not only be related to vasopressin, but that other kidney components play a role. Solute handling and osmotic excretion have been investigated in the past, especially in refractory patients. Nevertheless, data in treatment-naïve populations with information on timing overnight are sparse. This study aims to investigate the diuresis and solute excretion in treatment-naïve patients with or without NP, with emphasis on circadian rhythms. METHODS Retrospective analysis of 403 treatment-naïve children 5-18 years with severe enuresis (> 8 nights/2 weeks). Circadian rhythms were evaluated by a 24-h urine collection in 8 timed portions (4 day, 4 nighttime) at in-home settings. Urine volume, osmolality, and creatinine were measured. Patients were subdivided into three groups according to nocturnal diuresis (ND) and Expected Bladder Capacity (EBCage) ratio: (a) < 100%, (b) 100-129%, (c) > 130%. RESULTS All groups maintained circadian rhythm for diuresis and diuresis rates. Patients with higher ND (100-129% and > 130% EBCage) had higher daytime volumes and less pronounced circadian rhythm. In the ND group > 130% EBCage, the ND rate was higher during the first night collection and osmotic excretion was significantly higher overnight. CONCLUSIONS Overall 24-h fluid intake (reflected by 24-h diuresis) and nutritional intake (24-h osmotic excretion) might play a role in enuresis. Increased diuresis rate early in the night can be important in some patients, whereas the total night volume can be important in others. A higher resolution version of the Graphical abstract is available as Supplementary Information.
Collapse
Affiliation(s)
- Sevasti Karamaria
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Vincent Delens
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Eva Degraeuwe
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Ann Raes
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Reiner Mauel
- Department of Pediatric Intensive Care, Brussels University Hospital, Brussels, Belgium
| | | | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium.
| |
Collapse
|
18
|
Gaye O, Seck M, Thiam NM, Ndong A, Fall PA. Enuresis and overactive bladder in sickle cell patients: a narrative review of the literature. World J Urol 2023. [PMID: 36662241 DOI: 10.1007/s00345-023-04288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this review is to clarify the prevalence, pathophysiology and clinical presentation of enuresis and overactive bladder in sickle cell patients. MATERIALS AND METHODS This narrative review of the literature was conducted in March 2022 by running a search in PubMed, Embase, Scopus and Cochrane databases without publication date limitation, using the following keywords: enuresis or nocturia or overactive bladder or urinary incontinence or bedwetting and sickle cell. RESULTS Eight cross-sectional studies were included, six of which had a non-sickle cell control population. The prevalence of enuresis in children and adolescents with sickle cell disease ranged from 20.3 to 49.4%. It decreased with age to 2.9% in adult sickle cell patients. Enuresis in sickle cell patients has been attributed to several causes, including lack of urine concentration with nocturnal polyuria, reduced bladder capacity, nocturnal bladder hyperactivity, sleep and/or respiratory disorders are likely causes of enuresis in sickle cell patients. The prevalence of overactive bladder is three times higher in sickle cell patients than in control groups. The latter is also observed three times more frequently in men who have had prior episodes of priapism. CONCLUSION Enuresis and overactive bladder are common in sickle cell patients. Several mechanisms have been described to try to explain enuresis in sickle cell patients but overactive bladder seems to play a major role. Studies evaluating the efficacy of certain experimentally validated treatments must be carried out to improve the management of these complications which affect the quality of life of sickle cell patients.
Collapse
|
19
|
Rouse CM. Pediatric Psychology in a Urology Division: Unifying Complex Medical and Mental Health Treatment. Curr Urol Rep 2023; 24:17-24. [PMID: 36434371 DOI: 10.1007/s11934-022-01127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Although pediatric psychology is heavily involved in many medical divisions, its involvement in a urology division is still relatively new and its role continuously evolving and growing. RECENT FINDINGS This article reviews the limited research on the use of psychology in a urology division, including psychosocial struggles across urology diagnoses, dysfunctional voiding, and anxiety surrounding medical procedures and surgery. Urinary diagnoses and presenting problems seen by pediatric psychologists and medical providers at an urban children's hospital are also included. Based on the complex conditions and varied presenting concerns in a urology division, potential assessments and future research are suggested to help gather data for this population moving forward and expand the literature on urology psychology.
Collapse
Affiliation(s)
- Christina M Rouse
- Division of Urology, Civic Center Boulevard, Children's Hospital of Philadelphia, Philadelphia, PA, 19141, USA.
| |
Collapse
|
20
|
Franck HHM, Guedes ACS, Alvim YFS, de Andrade TMS, Oliveira LF, da Silva LI, de Figueiredo AA, de Bessa J, Murillo B. J. One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children. Int Braz J Urol 2022; 49:89-96. [PMID: 36512457 PMCID: PMC9881818 DOI: 10.1590/s1677-5538.ibju.2022.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days.We hypothesized that one day voiding diary would be enough for guiding treatment. MATERIALS AND METHODS Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. RESULTS Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. CONCLUSION We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.
Collapse
Affiliation(s)
- Hanny Helena Masson Franck
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia da Faculdade de MedicinaJuiz de ForaMGBrasilDepartamento de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Ana Carolina S. Guedes
- Universidade Federal de Juiz de ForaEscola de EnfermagemJuiz de ForaMGBrasilEscola de Enfermagem – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Yago Felyppe S. Alvim
- Universidade Federal de Juiz de ForaEscola de EnfermagemJuiz de ForaMGBrasilEscola de Enfermagem – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Thamires M. S. de Andrade
- Universidade Federal de Juiz de ForaEscola de EnfermagemJuiz de ForaMGBrasilEscola de Enfermagem – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - Liliana Fajardo Oliveira
- Faculdade de Ciências Médicas e da Saúde de Juiz de ForaEscola de FisioterapiaJuiz de ForaMGBrasilEscola de Fisioterapia – Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ/SUPREMA), Juiz de Fora, MG, Brasil
| | - Lidyanne Ilidia da Silva
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia da Faculdade de MedicinaJuiz de ForaMGBrasilDepartamento de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - André Avarese de Figueiredo
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia da Faculdade de MedicinaJuiz de ForaMGBrasilDepartamento de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de Cirurgia da Faculdade de MedicinaFeira de SantanaBABrasilDepartamento de Cirurgia da Faculdade de Medicina – Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brasil
| | - José Murillo B.
- Universidade Federal de Juiz de ForaDepartamento de Cirurgia da Faculdade de MedicinaJuiz de ForaMGBrasilDepartamento de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil,Correspondence address: José Murillo Bastos Netto, MD, Depart. de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Av. Barão do Rio Branco, 2985 / Sala 605, Centro Juiz de Fora, MG, 36010-012, Brasil. Telephone: + 55 32 98415-9909 E-mail:
| |
Collapse
|
21
|
Yitik Tonkaz G, Deliağa H, Çakir A, Tonkaz G, Özyurt G. An evaluation of parental attitudes and attachment in children with primary monosymptomatic nocturnal enuresis: A case-control study. J Pediatr Urol 2022; 19:174.e1-174.e5. [PMID: 36470787 DOI: 10.1016/j.jpurol.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Enuresis is a common childhood disorder associated with the lack of bladder control that would be expected based on the child's age or developmental stage. Enuresis affects the lives of both children and their parents due to the burden it entails in daily life. OBJECTIVE In this study, we aimed to evaluate the dimensions of attachment between children with enuresis and their mothers, as well as the relationship with parental attitudes. METHODS This study included 70 children were diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) based on the guidelines of the International Children's Continence Society (ICCS) along with 70 children with not enuresis and any psychiatric disorders. We asked the mothers of all participants to complete the Parental Attitude Research Instrument, and the children to complete The Experiences in Close Relationships Scale Revised - Middle Childhood. RESULTS Both groups in our study were well balanced in terms of gender, age, and sociodemographic data. Children with enuresis were found to score higher on the anxiety and avoidance dimensions of the attachment scale with statistical significance (p < 0.01). Also, on the scale completed by the mothers of children with enuresis, the subtests indicating overprotective parenting and strict discipline presented significant differences (p < 0.01). DISCUSSION Data obtained in our study demonstrate that enuresis can have a negative effect on the mother-child attachment and parental attitudes. The use of harsh language or punishment by the mother in response to the failure of the child to achieve nocturnal dryness may affect the attachment between the mother and the child, and cause the child to experience negative emotions such as shame, anxiety, embarrassment, frustration, and loneliness. CONCLUSION We think that it would be useful to evaluate the mother-child attachment and the crisis experienced by the family after each wetting incidence in combination with parental attitudes and behaviors in the treatment of enuresis cases.
Collapse
Affiliation(s)
- Gülsüm Yitik Tonkaz
- Child and Adolescent Psychiatry Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Hasan Deliağa
- Pediatric Urology Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Ali Çakir
- Child and Adolescent Psychiatry Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Gökhan Tonkaz
- Radiology Department, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | - Gonca Özyurt
- Child and Adolescent Psychiatry Department, Medical Faculty, Izmir Katip Celebi University, Izmir, Turkey.
| |
Collapse
|
22
|
Carvalho TA, Vasconcelos MMDA, Guimarães ICDO, Dutra MF, Lima EM, Bastos Netto JM, de Bessa Junior J, Simões E Silva AC, de Carvalho Mrad FC. Relationship between toilet training process and primary nocturnal enuresis in children and adolescents - A systematic review. J Pediatr Urol 2022; 18:554-562. [PMID: 35987679 DOI: 10.1016/j.jpurol.2022.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary nocturnal enuresis (PNE) affects the quality of life of children and families and may lead to low self-esteem and social isolation. The pathophysiology of enuresis is multifactorial. This systematic review aimed to investigate the relationship between toilet training (TT) and PNE in children and adolescents. METHODS We searched for articles about TT and PNE in MEDLINE (via PubMed), SCOPUS and WEB of SCIENCE databases. The Preferred Reporting Items for Systematic Reviews (PRISMA) statement was used to guide the systematic review. Prior to the study, the review protocol was registered and approved in PROSPERO under the protocol CRD42021270976. The Risk of Bias in Non-Randomized Studies of Exposures (ROBINS-E) was used to analyze the biases of the select studies. RESULTS A total of 570 studies were initially selected. Of these, eight articles were included in this systematic review, with a total number of 5990 participants aged between 5 and 18 years diagnosed with PNE. Seven of the eight articles reported that prolonged use of disposable diapers for more than one-year, late initiation of the TT process or non-acceptance of the Assisted Infant TT or Elimination Communication approach, use of coercive approaches, and complete of TT after 24 months of age increase the risk of enuresis. Only one of the selected studies did not find an association between the start of TT after 24 months of age and the presence of isolated PNE. Three studies did not mention the approach used in the TT process. CONCLUSION Most of the articles reviewed showed that prolonged diaper use, delay in the start or completion of the TT and use of coercive approaches increase the risk of enuresis. On the other hand, one study showed no relationship between the start of TT after 24 months of age and the presence of isolated enuresis.
Collapse
Affiliation(s)
- Tânia Antunes Carvalho
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Isabela Cristina de Oliveira Guimarães
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Melissa Faria Dutra
- Federal University of Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - Eleonora Moreira Lima
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora, School of Medicine, Urology Department, Brazil; Faculdade de Ciências Médicas de Juiz de Fora e Maternidade Therezinha de Jesus, Urology Department, Brazil.
| | | | - Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil; Interdisciplinary Laboratory of Medical Investigation, UFMG, Brazil.
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas Gerais (UFMG), Faculty of Medicine- Pediatrics Department, Pediatric Nephrology Unit- Hospital Das Clínicas da UFMG, Brazil.
| |
Collapse
|
23
|
Carvalho TA, Vasconcelos MMDA, de Bessa J, Bastos JM, Dutra MF, Guimarães ICDO, Lima EM, Silva ACSE, Mrad FCDC. Relationship between primary monosymptomatic enuresis and process toilet training: a case-control. Int Braz J Urol 2022; 48:944-951. [PMID: 36173406 PMCID: PMC9747032 DOI: 10.1590/s1677-5538.ibju.2022.0381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/05/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Primary monosymptomatic nocturnal enuresis (PMNE) is a prevalent condition in childhood, and the pathophysiology is multifactorial. This study investigated the relationship between the toilet training process (TT) and PMNE in children and adolescents. PATIENTS AND METHODS A case-control study was carried out from 2015 to 2020. The presence of PMNE was identified according to International Children's Continence Society criteria. A semi-structured questionnaire was applied to assess TT. RESULTS The study included 103 children and adolescents with PMNE and 269 participants with normal psychomotor development without PMNE (control group [CG]). Readiness signals were more remembered and less frequent in participants with PMNE (p=0.001) when compared to control group. No differences were found between the groups regarding the onset age of the daytime TT (p= 0.10), the nocturnal TT (p=0.08), the acquisition of daytime continence (p=0.06), and the type of equipment used for the TT (p=0.99). The use of Child-Oriented approach in group of children with enuresis was lower than in controls [87.4% (90/103) versus 94% (250/266)], respectively (OR= 0.44, 95% CI 0.21-0.94, p = 0.039). CONCLUSIONS The age of onset of TT, acquisition of daytime continence, and the type of equipment were not associated with higher occurrence of PMNE. On the other hand, the Child-Oriented approach was a protective factor for the occurrence of PMNE.
Collapse
Affiliation(s)
- Tânia Antunes Carvalho
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Mônica Maria de Almeida Vasconcelos
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - José de Bessa
- Universidade Estadual de Feira de SantanaDepartamento de UrologiaFeira de SantanaBABrasilDepartamento de Urologia, Universidade Estadual de Feira de Santana (UFFS), Feira de Santana, BA, Brasil
| | - José Murillo Bastos
- Universidade Federal de Juiz de ForaFaculdade de MedicinaDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Faculdade de Medicina, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil,Faculdade de Ciências Médicas de Juiz de ForaMaternidade Therezinha de JesusDepartamento de UrologiaJuiz de ForaMGBrasilDepartamento de Urologia, Maternidade Therezinha de Jesus, Faculdade de Ciências Médicas de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Melissa Faria Dutra
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Isabela Cristina de Oliveira Guimarães
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Eleonora Moreira Lima
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Ana Cristina Simões e Silva
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil,Universidade Federal de Minas GeraisLaboratório Interdisciplinar de Investigação MédicaBelo HorizonteMGBrasilLaboratório Interdisciplinar de Investigação Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Flávia Cristina de Carvalho Mrad
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartamento de PediatriaBelo HorizonteMGBrasilDepartamento de Pediatria, Unidade de Nefrologia Pediátrica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil,Correspondence address: Flávia Cristina de Carvalho Mrad, MD Depart. de Pediatria, Unidade de Nefrologia Pediátrica, Fac. de Med., Univ. Federal de Minas Gerais (UFMG) Avenida Alfredo Balena 190. sala 267, Santa Efigênia Belo Horizonte, MG, 30130-100, Brasil E-mail:
| |
Collapse
|
24
|
Moretti E, Barbosa L, da Silva IB, de Lima AMJ, Lemos A. What do cochrane systematic reviews say about interventions for enuresis in children and adolescents? An overview of systematic reviews. J Pediatr Urol 2022; 18:415-445. [PMID: 35661613 DOI: 10.1016/j.jpurol.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct an overview of Cochrane systematic reviews about treatment alternatives for children and/or adolescents with enuresis. SOURCES An overview of Cochrane systematic reviews about interventions for enuresis in children/adolescents was developed between September/2021 and December/2021. The protocol was registered on PROSPERO and the search was conducted only in the Cochrane Library database without any restriction. Reviews involving any type of intervention for the treatment of enuresis in children/adolescents were included. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and the quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). SUMMARY OF THE FINDINGS Seven systematic reviews were identified. Based on the ROBIS assessment, all reviews were classified as low risk of bias. According to the AMSTAR-2 assessment, the three oldest systematic reviews were rated as critically low quality, one review was moderate quality, and the three most recent systematic reviews were rated as high quality. No difference was shown between alarm and desmopressin for a complete response to therapy after treatment (RR = 1.30; 95%CI: 0.92 to 1.84), but alarm use is related to a lower risk of adverse events (RR = 0.38; 95%CI: 0.20 to 0.71). There is a moderate certainty that the association between imipramine and oxybutynin is better than placebo to reduce the risk of children who do not achieve 14 consecutive dry nights after treatment (RR = 0.43; 95%CI: 0.23 to 0.78). CONCLUSIONS There is no difference between alarm and desmopressin for enuresis treatment. However, alarm therapy had fewer adverse events than desmopressin. Moreover, combination therapy between imipramine and oxybutynin is better than placebo.
Collapse
Affiliation(s)
- Eduarda Moretti
- Postgraduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife (PE), Brazil.
| | - Leila Barbosa
- Department of Physical Therapy, Federal University of Pernambuco, Recife (PE), Brazil.
| | | | | | - Andrea Lemos
- Department of Physical Therapy, Federal University of Pernambuco, Recife (PE), Brazil.
| |
Collapse
|
25
|
de Carvalho Mrad FC, da Silva GS, de Souza Rodrigues GK, Bastos Netto JM, Lima EM, Carvalho TA, Dutra MF, de Bessa Junior J, de Almeida Vasconcelos MM. Accuracy of the short screening instrument for psychological problems (SSIPPE) in enuresis in the Identification of attention-deficit/ hyperactivity symptoms in the enuretic population. J Pediatr Urol 2022; 18:350.e1-6. [PMID: 35283019 DOI: 10.1016/j.jpurol.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Enuresis prevalence is approximately 5-15% in children aged 6-7 years. The presence of attention deficit hyperactivity disorder (ADHD) in enuretic children is associated with 3 times greater risk of persistent enuresis. The Multimodal Treatment Study for ADHD (MTA) Swanson, Nolan, and Pelham version IV (SNAP-IV) is one of the most used instruments to evaluate ADHD symptoms, but it is a time-consuming questionnaire. OBJECTIVE This study aims to compare the accuracy of an easy questionnaire named Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) to MTA-SNAP-IV in identifying ADHD symptoms in children and adolescents with enuresis. METHODS ADHD symptoms screening was performed by applying SSIPPE and MTA-SNAP-IV in 160 children and adolescents with enuresis, aged 6-14 years, who regularly attended a specialized clinic for pediatric urology. RESULTS A total of 153 individuals with enuresis were included in the study (52% males), among them 55 (35.9%) were considered positive for inattention and hyperactivity-impulsivity by the MTA-SNAP-IV. Sensitivity for SSIPPE concerning MTA-SNAP-IV was 85.5%, and specificity was 84.7%, with an overall accuracy of 85% in identifying ADHD symptoms. DISCUSSION In the present study, we found high accuracy of SSIPPE in relation to MTA-SNAP-IV in identifying ADHD symptoms in the enuretic population, with substantial agreement between instruments. Its sensitivity and specificity were considered high for a screening method. However, there are some limitations. The population studied is composed of a group of children with enuresis, which can lead to an overestimation of the test's accuracy, as the disorder under investigation is more prevalent in this population. This can be explained by the high specificity of the test (84.7%) associated with the fact that the SSIPPE is an instrument tailored for an enuretic population, unlike the MTA-SNAP IV. CONCLUSION The SSIPPE has proven to be a reliable tool in identifying ADHD symptoms in the enuretic population. In addition to being a quick and easily applicable instrument.
Collapse
|
26
|
Dehghanpour A, Seyedhashemi M, Zare Bidaki A, Mousavi Z, Emtiazy M, Shakiba M. Coconut oil rubbing as an easy and safe way to improve symptoms in primary nocturnal enuresis: A randomized double-blinded placebo-controlled clinical trial. Avicenna J Phytomed 2022; 12:449-456. [PMID: 36249458 PMCID: PMC9516406 DOI: 10.22038/ajp.2022.20346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/15/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022]
Abstract
Objective Enuresis is a common pediatric problem for which, no unique therapy has been suggested. The conventional therapy is effective, but fails in some cases. So, many parents try complementary medicine. Therefore, this study attempted to find if rubbing coconut oil is effective on improving enuresis. Materials and Methods This double-blinded randomized clinical was conducted on 120 children aged 6 to 14 years with mono symptomatic nocturnal enuresis, from 2018 to 2019 in Yazd, Iran. The drug and placebo groups applied 6 drops of the coconut and paraffin oil topically on the suprapubic, sacral and flanks areas one time per night, respectively. Urination pattern was daily recorded for a period of 8 weeks by parents, and after one year, they were asked for any improvement by phone call. Results The mean frequency of enuresis at the first, second, fourth, and eighth week was lower in the intervention group (p<0.001); this difference between the groups remained after one year. Moreover, there was no side effect requiring any medical attention. Conclusion Rubbing coconut oil is effective on improving symptom of primary mono symptomatic enuresis if applied every night for 4 weeks on suprapubic, sacral and flanks areas. This may be related to anticholinergic effect of the oil but its persistent effect for longer time after the end of application period, needs to be investigated in other studies.
Collapse
Affiliation(s)
- Abolfazl Dehghanpour
- Department of Persian Medicine, School of Persian Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - Monire Seyedhashemi
- Research Center for Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmad Zare Bidaki
- Department of Persian Medicine, School of Persian Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - Zohre Mousavi
- Department of Persian Medicine, School of Persian Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
| | - Majid Emtiazy
- Research Center for Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Corresponding Author: Tel: +98-9131518475, Fax: +9835382240001,
| | - Mehrdad Shakiba
- Department of Pediatrics, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Corresponding Author: Tel: +98-9131518475, Fax: +9835382240001,
| |
Collapse
|
27
|
Al-Shawwa B, Ingram DG. Enuresis and sleep fellowship education. Sleep Breath 2021. [PMID: 34727328 DOI: 10.1007/s11325-021-02518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/21/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Enuresis is a common sleep-related concern in school aged children that gradually decreases into adulthood. We performed a survey of sleep providers in order to assess their comfort level in managing patients with enuresis. METHODS Survey participants were recruited via the Pedsleep listserv and sleep medicine program directors in the USA on basecamp application. The Pedsleep list includes a mixture of physicians, psychologists, and other sleep providers/researchers. RESULTS Forty-two sleep providers completed the survey. Forty (95%) were board certified in sleep medicine, and 32 (76%) were board certified in pediatrics. Practice patterns for management of enuresis varied among respondents, with 69% who evaluate for possible contributions from other sleep disorders such as obstructive sleep apnea then refer for additional management. Nineteen (45%) respondents felt that they received inadequate or very inadequate training during their sleep fellowship for management of enuresis. While 83% of respondents worked in an academic medical center setting, none of their respective sleep clinics were the primary managing clinic at their own situation. Participants who endorsed their training as adequate/very adequate were significantly more likely to feel comfortable/very comfortable managing enuresis (90% vs 37.5%, p = 0.009). CONCLUSIONS A large percentage of sleep providers are lacking essential training to manage enuresis patients. These results suggest the need for additional educational initiatives in this area.
Collapse
|
28
|
de Sena Oliveira AC, Athanasio BDS, Mrad FCDC, Vasconcelos MMDA, Albuquerque MR, Miranda DM, Simões E Silva AC. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatr Nephrol 2021; 36:3547-3559. [PMID: 34009466 DOI: 10.1007/s00467-021-05083-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Attention deficit and hyperactivity/impulsivity disorder (ADHD) and enuresis are common behavioral disorders in childhood, impacting adolescence and adult life. Enuresis (NE) is an incontinence disorder frequently observed in children with ADHD. The relationship between ADHD and NE has been a matter of debate. OBJECTIVES We aimed to verify the relationship between ADHD and enuresis and how these conditions can modify each other during development. Using PRISMA guidelines, under the PROSPERO registration number CRD42020208299, we systematically searched the literature and conducted a meta-analysis to answer the following question: how frequent is ADHD and enuresis comorbidity? Twenty-five studies were fully read, and data from seven less heterogeneous case-control studies were pooled to estimate enuresis prevalence comparing ADHD and control samples, whereas six studies were combined to evaluate ADHD frequencies in children with and without enuresis. RESULTS We found the ADHD rates in children with enuresis are similar to the enuresis rates in the group of children with ADHD. The presence of ADHD and enuresis comorbidity does not seem to play a role in gender distribution and the presence of other comorbidities in comparison to controls. However, enuresis seems to persist for more time in children with ADHD. LIMITATIONS The selected papers differed in study type, research question, samples, and controls utilized. CONCLUSIONS Our systematic review with meta-analysis supports the reciprocal association between enuresis and ADHD. Further studies are necessary to build more robust evidence.
Collapse
Affiliation(s)
- Ana Cecília de Sena Oliveira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Bruno da Silva Athanasio
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Flávia Cristina de Carvalho Mrad
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Monica Maria de Almeida Vasconcelos
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Maicon Rodrigues Albuquerque
- Neurosciences of Physical Activity and Sports Research Group, Department of Sports, UFMG, Belo Horizonte, MG, Brazil
| | - Débora Marques Miranda
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
- Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, UFMG, Avenida Alfredo Balena, 190, 2nd floor, room #281, Belo Horizonte, MG, 30130, Brazil.
| |
Collapse
|
29
|
Morais J, Soares S, Correia-Costa L, Santos AC, Barreira JL. Determinants of bedwetting trajectories between 4 and 7 years - A birth cohort analysis. J Pediatr Urol 2021; 17:647.e1-647.e10. [PMID: 34736725 DOI: 10.1016/j.jpurol.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/19/2021] [Accepted: 07/31/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Enuresis is frequent in school-aged children and results from a complex interaction between genetics, biological and psychosocial factors. This study aims to analyze bedwetting trajectories between 4 and 7 years of age and to evaluate the impact of biological and developmental characteristics of the child and sociodemographic factors in those bedwetting trajectories. METHODS Data from 5433 children from the Generation XXI population-based birth cohort was analyzed. Four bedwetting trajectories were defined: normative (acquired nighttime bladder control at 4 years and no enuresis at 7 years); delayed (no nighttime bladder control at 4 years and no enuresis at 7 years); enuresis (no nighttime bladder control at 4 years and enuresis at 7 years); and secondary enuresis (acquired nighttime bladder control at 4 years and enuresis at 7 years). Multinomial logistic regression models were fitted to test the association between biological and developmental characteristics of the child and sociodemographic factors with bedwetting trajectories. RESULTS At the age of 4 years, 36.5% of children had bedwetting (8.1% infrequently and 28.4% frequently) and at the age of 7 years, 11.0% had enuresis (5.8% infrequently and 5.2% frequently). Of the 4-year-old children who were infrequent bedwetters, 14.0% had enuresis at 7 years, while among frequent bedwetters, 30.2% had enuresis at 7 years. Regarding bedwetting trajectories, 26.8% of children were classified in the delayed trajectory, 9.7% in the enuresis trajectory and 1.3% were in the secondary enuresis trajectory. Children with developmental disorders presented an increased risk of being in enuresis trajectory (OR = 1.47, 95% CI 1.15-1.88) than children without developmental disorders. Living in overcrowded houses (OR = 1.60, 95% CI 1.12-2.30), growing up in families with low household income (OR = 1.27, 95% CI 1.03-1.57) and an orphan of one parent (OR = 3.19, 95% CI 1.18-8.64) presented higher odds of being in the enuresis trajectory than in the normative trajectory. Having a sibling both before the age of 4 years and between the ages of 4 and 7 years was associated with delayed trajectory (OR = 1.55, 95% CI 1.16-2.07) and with enuresis (OR = 1.53, 95% CI 1.01-2.33), when compared with children without siblings born at that time. CONCLUSION Both developmental disorders and sociodemographic factors seem to be important determinants of bedwetting trajectories. Further studies are needed to better characterize the impact of biological and environmental determinants, on the nighttime bladder control acquisition, to enable timely medical interventions that improve the quality of life of enuretic children.
Collapse
Affiliation(s)
- Joana Morais
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal
| | - Liane Correia-Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Divisão de Nefrologia Pediátrica, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Luís Barreira
- Divisão de Pediatria, Centro Hospitalar de São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| |
Collapse
|
30
|
Yilmaz EŞ, Büyük ET. Effect of education given to children with enuresis on quality of life. J Pediatr Urol 2021; 17:648.e1-648.e7. [PMID: 34518125 DOI: 10.1016/j.jpurol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 06/28/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The quality of life of children diagnosed with enuresis is affected negatively compared with that of healthy children. OBJECTIVES This study aimed to evaluate the effect of the education program given within the framework of nursing activities on the quality of life of children diagnosed with enuresis. STUDY DESIGN The study was conducted on 60 children aged 7-12 years who applied to the urology clinic of a hospital in Turkey and were diagnosed with enuresis. Data were collected using the Pediatric Incontinence Questionnaire (PINQ). Children who met the study criteria were divided into two groups, control and experimental, using the random draw method. Participants in the experimental group were educated by the researcher with using the Enuresis Education Booklet. RESULTS Of the 60 children, 43.3% were aged 7-8 years and 63.3% were male. At baseline, the children in the control group revealed a total mean PINQ score of 45.00 ± 11.52, and the total mean PINQ score was 45.80 ± 12.05 at 1 month. At baseline, the children in the experimental group revealed a total mean PINQ score of 47.00 ± 11.88, and the total mean PINQ score of was 32.404 ± 8.62 at 1 month. A measurement carried out in the education and control groups 1 month later showed a statistically significant difference in the total mean PINQ scores (P < 0.001). CONCLUSION Explaining the disease thoroughly to a child created a positive effect on the child's quality of life.
Collapse
Affiliation(s)
| | - Esra Tural Büyük
- Department of Child Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey.
| |
Collapse
|
31
|
Arasteh A, Mostafavi S, Zununi Vahed S, Mostafavi Montazeri SS. An association between incontinence and antipsychotic drugs: A systematic review. Biomed Pharmacother 2021; 142:112027. [PMID: 34392083 DOI: 10.1016/j.biopha.2021.112027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022] Open
Abstract
To date, due to the increasing prevalence of psychiatric diseases, the use of antipsychotic drugs has expanded. One of the proven side effects of these drugs is incontinence. Treatment of this complication improves the quality of life in these patients, increases self-confidence, and betters cope with their psychiatric illness. The exact mechanism of this side effect is not fully understood, but various methods have been used experimentally to deal with it. Strategies such as behavior therapy, discontinuation or change of drugs, reducing the dose of drugs, and adding drugs with less incontinence have been used. Each of these methods and studies has different results that need to be summarized to make optimal use of them. Since most of these reports are case reports with a low statistical population, our study has systematically reviewed these studies to find a comprehensive model to deal with this complication.
Collapse
Affiliation(s)
- Amin Arasteh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soroush Mostafavi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | |
Collapse
|
32
|
Breinbjerg A, Rittig S, Kamperis K. Does the development and use of modern disposable diapers affect bladder control? A systematic review. J Pediatr Urol 2021; 17:463-71. [PMID: 34099398 DOI: 10.1016/j.jpurol.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE During the last decades, the development of the modern disposable diaper (DD) has changed the way we diaper our children, as they are safe, easy to use, comfortable and easy to dispose, compared to cloth diapers used earlier. Concurrently, the age of initiating toilet training (TT) is rising. We aimed to investigate the connection between DD usage and the tendencies seen in TT and childhood urinary incontinence, with specific interest on studies evaluating the effect of diapering on enuresis. STUDY DESIGN A literature search was conducted in PubMed and Embase. A systematic literature search was conducted, revealing 309 studies in Embase and 269 studies in Pubmed. After removing duplicates, 400 studies were eligible for screening. All abstracts were screened, and 12 relevant abstracts where identified, but only eight studies were eligible. No prospective intervention studies specifically evaluating the effect of diaper on enuresis were identified. Literature on TT and diapers in general was identified using the respective search terms on both databases. RESULTS The eight studies identified showed a tendency towards diaper use being related to a delay on obtaining continence in children, but no secure conclusions can be made, as the literature is inadequate. DISCUSSION AND CONCLUSION Based on the available literature no secure conclusions can be drawn although an association is suggested. In order to evaluate the effect of diapers on incontinence, prospective randomized studies are needed.
Collapse
|
33
|
Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| |
Collapse
|
34
|
Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Questions. Pediatr Nephrol 2021; 36:2129-2130. [PMID: 33730286 DOI: 10.1007/s00467-021-04994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.
- Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France
- Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| |
Collapse
|
35
|
Alford N, Hashim H. Desmopressin acetate the first sublingual tablet to treat nocturia due to nocturnal polyuria. Expert Rev Clin Pharmacol 2021; 14:939-954. [PMID: 33993824 DOI: 10.1080/17512433.2021.1931122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Desmopressin was widely used to treat nocturnal polyuria in adults under the age of 65 due to the well-established risk of hyponatremia. Since the prevalence of nocturia increases with age, and with an aging population, those most affected were excluded from treatment. Recently, a new lower dose sublingual tablet formulation that optimizes the balance between efficacy and tolerability has been licensed for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults of any age, with the caveat of regular serum monitoring for those over 65. This newer formulation aims to achieve the same clinical outcomes as previous formulations while reducing the risk of hyponatremia.Areas covered: This review will look at the pharmacology of the newly formulated desmopressin and examine the results of the clinical trials that would support its treatment of adult nocturia with idiopathic nocturnal polyuria.Expert opinion: When reporting on the clinical efficacy of desmopressin on nocturia, it is important for clinical trials to publish their complete data on nocturnal and 24-hour urine voided volumes. Further research examining the physiological reasoning behind this gender-specific dosing for desmopressin and the optimal recommended treatment duration of desmopressin for those over 65 is needed.
Collapse
Affiliation(s)
| | - Hashim Hashim
- University of Bristol, Bristol, UK.,Bristol Urological Institute, Southmead Hospital, Bristol, UK
| |
Collapse
|
36
|
Banhara FL, Trindade IEK, Trindade-Suedam IK, Fernandes MDBL, Trindade SHK. Respiratory sleep disorders, nasal obstruction and enuresis in children with non-syndromic Pierre Robin sequence. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S133-S141. [PMID: 34092522 PMCID: PMC9734268 DOI: 10.1016/j.bjorl.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea is highly prevalent in non-syndromic Pierre Robin sequence patients. Studies have found a probable relationship between obstructive sleep apnea and nasal obstruction and between obstructive sleep apnea and enuresis. Assessment of the relationship between these variables in non-syndromic Pierre Robin sequence patients is scarce. OBJECTIVE The present study aims to evaluate the relationship between symptoms of obstructive sleep apnea, nasal obstruction and enuresis, determining the prevalence of symptoms suggestive of these conditions, in schoolchildren with non-syndromic Pierre Robin sequence, and describe the prevalence of excessive daytime sleepiness habitual snoring and voiding dysfunction symptoms associated with enuresis. METHODS This was a prospective analytical cross-sectional study developed at a reference center. Anthropometric measurements and a structured clinical interview were carried out in a sample of 48 patients. The instruments "sleep disorders scale in children" "nasal congestion index questionnaire" (CQ-5), and the "voiding dysfunction symptom score questionnaire" were used. Statistical analysis was performed for p < 0.05. RESULTS Positive "sleep disorders scale in children" scores for obstructive sleep apnea and CQ-5 for nasal obstruction were observed in 38.78% and 16.33%, respectively. Enuresis was reported in 16.33% of children, being characterized as primary in 71.43% and polysymptomatic in 55.55%; according to the "voiding dysfunction symptom score questionnaire". There was a significant relationship between nasal obstruction and obstructive sleep apnea symptoms (p < 0.05), but no significance was found between obstructive sleep apnea symptoms and enuresis, and between nasal obstruction and enuresis. The prevalence of excessive daytime sleepiness was 12.24% and of habitual snoring, 48.98%. A family history of enuresis, younger age in years and a positive "voiding dysfunction symptom score questionnaire" score were associated with a higher prevalence of enuresis (p < 0.05). CONCLUSION Children with non-syndromic Pierre Robin sequence are at high risk for obstructive sleep apnea symptoms and habitual snoring, with a correlation being observed between nasal obstruction and obstructive sleep apnea symptoms. In addition, the study showed that non-syndromic Pierre Robin sequence, obstructive sleep apnea and nasal obstruction symptoms were not risk factors for enuresis in these patients.
Collapse
Affiliation(s)
- Fábio Luiz Banhara
- Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Unidade de Estudos do Sono do Laboratório de Fisiologia, Bauru, SP, Brazil,Corresponding author.
| | - Inge Elly Kiemle Trindade
- Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Unidade de Estudos do Sono do Laboratório de Fisiologia, Bauru, SP, Brazil,Universidade de São Paulo (USP), Faculdade de Odontologia de Bauru, Bauru, SP, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Unidade de Estudos do Sono do Laboratório de Fisiologia, Bauru, SP, Brazil,Universidade de São Paulo (USP), Faculdade de Odontologia de Bauru, Bauru, SP, Brazil
| | - Marilyse de Bragança Lopes Fernandes
- Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Unidade de Estudos do Sono do Laboratório de Fisiologia, Bauru, SP, Brazil
| | - Sergio Henrique Kiemle Trindade
- Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Unidade de Estudos do Sono do Laboratório de Fisiologia, Bauru, SP, Brazil,Universidade de São Paulo (USP), Faculdade de Odontologia de Bauru, Bauru, SP, Brazil,Universidade de São Paulo (USP), Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), Seção de Otorrinolaringologia, Bauru, SP, Brazil,Universidade Nove de Julho, Curso de Medicina, Bauru, SP, Brazil
| |
Collapse
|
37
|
Soundararajan K, Panikkar M, Annappa M. Urinary symptoms in pregnant women in their third trimester-a cross-sectional study. Int Urogynecol J 2021; 32:1867-1873. [PMID: 34028576 DOI: 10.1007/s00192-021-04838-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary symptoms are common in pregnancy. Our study aims to understand the extent of these symptoms in a cohort of pregnant women in the third trimester and their impact on quality of life (QOL) from the women's perspective. METHODS A single-centre cross-sectional study of self-reported urinary symptoms of pregnant women in the third trimester conducted from August 2018 at the Diana Princess of Wales Hospital, Northern Lincolnshire, and Goole NHS Foundation Trust, Grimsby, UK. We used an international validated questionnaire (ICIQ-FLUTS questionnaire) (Brookes et al. Am J Obstet Gynecol. 191(1):73-82, 2004). RESULTS A total of 302 women were included in this study. Nocturia was the most common symptom, reported by 97%, affecting QOL in 80%. Urgency of micturition was the second most common, present in 83%, adversely affecting QOL in 75%. Our study showed a startling finding of bladder pain in 47% (95% CI 41.1%, 52.3%) of these women. There was a high prevalence of nocturnal enuresis in 9.9% (95% CI 7.05%, 13.8%). Straining during micturition is not a well-known symptom in pregnancy, however reported by 18.2% (95% CI 14.2%, 23.0%). CONCLUSION The high prevalences of bladder pain, nocturnal enuresis and straining in the third trimester of pregnancy are novel findings. Our study also confirms that the prevalence of all voiding, filling and incontinence symptoms in pregnancy is significantly higher than in the non-pregnant population, having a negative impact on QOL, and yet is not discussed as part of routine antenatal care.
Collapse
Affiliation(s)
| | - Mohini Panikkar
- Foundation year 1, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Manjula Annappa
- Diana Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby, UK
| |
Collapse
|
38
|
Nardello R, Guccione F, Gliubizzi C, Marino A, Capizzi M, Mangano S. Resolution of enuresis with aripiprazole in children with psychiatric disorders: two case reports. J Med Case Rep 2021; 15:209. [PMID: 33883037 PMCID: PMC8059299 DOI: 10.1186/s13256-021-02691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aripiprazole is a third-generation atypical antipsychotic drug that acts as a stabilizer of the dopaminergic and serotonergic system. As partial agonist of the dopamine (D2) and serotonin (5-HT1A) receptors, it appears to be effective in reducing mania in patients with bipolar disorder, tics in Tourette Syndrome, aggression in schizophrenia and autism spectrum disorder. Enuresis has been reported among its side effects. Only a few studies, with conflicting results, have investigated the relationship between aripiprazole and enuresis. CASE PRESENTATION We report the disappearance of enuresis in a Caucasian girl with intellectual disability and oppositional defiant disorder and in a Caucasian boy with intellectual disability and early-onset psychosis, both following initiation of treatment with aripiprazole. CONCLUSION The aim of this study was to contribute to the literature on the use of aripripazole in subjects with enuresis. Our findings lead us to suggest that aripiprazole is less burdened with side effects, including bedwetting, than other antipsychotic drugs.
Collapse
Affiliation(s)
- Rosaria Nardello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy.
| | - Fulvio Guccione
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Claudia Gliubizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Antonio Marino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Mariarita Capizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| | - Salvatore Mangano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, via A. Giordano, Palermo, Italy
| |
Collapse
|
39
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
40
|
Kim SC, Park M, Chae C, Yoon JH, Kwon T, Park S, Moon KH, Cheon SH, Park S. Efficacy and tolerability of mirabegron compared with solifenacin for children with idiopathic overactive bladder: A preliminary study. Investig Clin Urol 2021; 62:317-323. [PMID: 33834641 PMCID: PMC8100008 DOI: 10.4111/icu.20200380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the efficacy and tolerability of mirabegron and solifenacin in pediatric patients with idiopathic overactive bladder (OAB) and to identify factors affecting OAB symptom improvement after treatment. Materials and Methods We retrospectively reviewed 103 patients (5–15 years old) who visited our hospital with OAB symptoms between July 2017 and March 2019. All participants had received solifenacin or mirabegron. Those who had secondary OAB or who did not complete the frequency-volume chart either before or after treatment were excluded. The age-adjusted bladder capacity ratio was used to evaluate bladder capacity. Efficacy was assessed on the basis of patient reports and changes in the frequency-volume chart, and ≥90% reduction was regarded as “responding to medication.” Tolerability was assessed by obtaining reports from patients about the adverse effects of the drug. Results After the exclusion of 58 patients, 45 patients (29 in solifenacin-group and 16 in mirabegron-group) were included in the primary analysis. The age-adjusted bladder capacity ratio increased from 0.71 to 0.96 (p<0.001) and from 0.57 to 0.97 (p=0.002) after solifenacin and mirabegron use, respectively. Decreased bladder capacity before medication was associated with responding to medication (odds ratio, 7.41; p=0.044). There was no significant difference in efficacy between the two drugs. Drug-induced adverse effects were reported in only 3 (10.3%) of the solifenacin-treated patients. Conclusions Mirabegron showed comparable efficacy to solifenacin in pediatric patients with idiopathic OAB. Additionally, only few adverse effects were reported, suggesting that mirabegron can be a safe alternative for the treatment of idiopathic pediatric OAB.
Collapse
Affiliation(s)
- Seong Cheol Kim
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Myungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chongsok Chae
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Hyung Yoon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyeon Cheon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| |
Collapse
|
41
|
Abstract
Nocturnal enuresis is a common and distressing developmental disease, which may cause various degrees of psychosocial stress and impairment to self-esteem in affected children as well as agitation to their parents or caregivers. Nevertheless, the etiology and pathogenesis of nocturnal enuresis are not understood. Currently, nocturnal enuresis is generally considered a multifactorial disease associated with a complex interaction of somatic, psychosocial, and environmental factors. A variety of postulations have been proposed to explain the occurrence and progression of nocturnal enuresis, including hereditary aberration, abnormal circadian rhythm of antidiuretic hormone secretion during sleep, bladder dysfunction, abnormal sleep, difficulties in arousal, neuropsychological disorders, and maturational delays of the brain. In recent decades, the introduction of functional neuroimaging technologies has provided new approaches for uncovering the mechanisms underlying nocturnal enuresis. The main neuroimaging modalities have included brain morphometry based on structural magnetic resonance imaging (MRI), task-based and event-related functional MRI (fMRI), and resting-state fMRI. The relevant studies have indicated that nocturnal enuresis is associated with functional and structural alterations of the brain. In this review, we briefly summarized the popular hypotheses regarding the pathogenesis of nocturnal enuresis and the current progress of functional neuroimaging studies in examining the underlying mechanisms thereof.
Collapse
Affiliation(s)
- Jiawen Dang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Sichuan Clinical Research Center for Birth Defects, Luzhou 646000, China
| | - Zhanghua Tang
- Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Sichuan Clinical Research Center for Birth Defects, Luzhou 646000, China
| |
Collapse
|
42
|
Jung G, Im YJ, Jang G, Suh JK, Park K. Endoscopic Botulinum Toxin Injection for Refractory Enuresis Based on Urodynamic Assessment. Int Neurourol J 2021. [PMID: 33676380 DOI: 10.5213/inj.2040326.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to determine the urodynamic characteristics of refractory enuresis and explored whether those characteristics can be managed through differential endoscopic injections with botulinum toxin. Methods In total, 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included. The patients then underwent a videourodynamic study and received a differential endoscopic injection of botulinum toxin on the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the 3 major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. An intravesical or intrasphincteric injection of botulinum toxin was attempted according to the videourodynamic study findings. Follow-up was conducted at 1, 3, 6, and 12 months after treatment. Results The median age was 10 years (range, 7–31 years). Although 19 and 8 patients had a preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, the urodynamic diagnosis was different in more than half of the patients. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to be attributable to bladder neck widening. Time had no apparent effect on efficacy, which persisted 6 months after the injection. More than 80% of the patients maintained the benefits of the injection after 1 year. Conclusions Videourodynamic studies were useful for identifying the reasons underlying refractory nonmonosymptomatic enuresis and helpful for determining the appropriate site of botulinum toxin injection.
Collapse
|
43
|
Samir M, Mahmoud MA, Elawady H. Can the combined treatment of solifenacin and imipramine has a role in desmopressin refractory monosymptomatic nocturnal enuresis? A prospective double-blind randomized placebo-controlled study. Urologia 2021; 88:369-373. [PMID: 33568005 DOI: 10.1177/0391560321993587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nocturnal enuresis is a common disease of childhood. It can be classified into monosymptomatic nocturnal enuresis (MNE) or nonmonosymptomatic nocturnal enuresis (NMNE). Imipramine is a tricyclic antidepressant used to treat enuresis with initial success rates are high as 50% but some studies record a high relapse rate and it has a cardiotoxic effect when overdosed. Anticholinergics may be effective in the treatment of children with bladder storage dysfunction, including daytime incontinence. However, anticholinergics monotherapy is not effective in treating MNE. In our study, we used a low dose (25 mg) of imipramine in order to avoid its potential side effects and combined it with the synergistic anticholinergic action of solifenacin. Our objective was to evaluate the efficacy and safety of the combination of solifenacin and imipramine compared with placebo in the treatment of desmopressin refractory MNE. METHODS One hundred children aged 6 years or more with primary MNE unresponsive to desmopressin treatment were included. The children were randomly divided into two equal groups. Group A received imipramine 25 mg and solifenacin 5-10 mg oral tablets and group B received placebo once 1 h before bedtime for 3 months. The primary end point was to investigate the efficacy of the combined treatment of solifenacin and imipramine and the secondary end point was the safety of the drugs. RESULTS Our study showed that the mean post treatment wet nights per month was significantly lesser in the treatment group than placebo group (p < 0.001) and cure rate was significantly higher in treatment group than placebo group (p < 0.001). The relapse rate was statistically significantly lower in treatment group than placebo group (p = 0.032). No significant side effects related to the drugs were reported. CONCLUSION The combination treatment of solifenacin and imipramine is a useful and safe treatment for nocturnal enuresis after failure of everything else.
Collapse
Affiliation(s)
- Mohamed Samir
- Department of Urology, Ain Shams University, Cairo, Egypt
| | | | - Hossam Elawady
- Department of Urology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
44
|
Karaci M. Obesity contributes to lower urinary system voiding dysfunction in childhood. Ir J Med Sci 2021; 190:1459-1463. [PMID: 33433844 DOI: 10.1007/s11845-020-02461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity continues to be a leading public health concern in the world. AIM The aim of our study was to investigate the relationship between obesity, lower urinary tract symptoms (LUTS), and voiding dysfunction. METHODS The study included students aged between 6 and 16 years in Zonguldak. Anthropometric measurements were performed in 404 children using appropriate methods. The body mass index (BMI) of children was calculated. Obesity was defined as a BMI at or above the 95th percentile for age- and sex-specific percentiles of Turkish children. Non-obese children with a BMI below the 85th percentile were defined as the control group. Lower urinary tract voiding dysfunction (LUTVD) was assessed with the dysfunctional voiding and incontinence scoring system (DVISS). RESULTS Of the children participated in the study, 151 (37.4%) were obese and 253 (62.6%) were at a normal weight. There were no significant differences in gender and mean age between the obese and non-obese children (p = 0.81). Monosymptomatic nocturnal enuresis (MSNE) was present in 43 children (10.6%), daytime symptoms were present in 38 children (9.4%), and voiding dysfunction was present in 34 children (8.4%) in the study. These symptoms were more common in the obese group (p = 0.001, p = 0.001, and p = 0.0001, respectively). In our survey study, we found a serious relationship between both bladder emptying symptoms and storage symptoms and obesity (p = 0.0001). CONCLUSION Obese children are at increased risk for enuresis and voiding dysfunction. Screening and treating obese children for the respective symptoms are significantly important for their quality of life.
Collapse
Affiliation(s)
- Mehmet Karaci
- Department of Pediatrics, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, University of Medical Sciences, Emek mahallesi, Namık Kemal caddesi, Sancaktepe, 34785, İstanbul, Turkey.
| |
Collapse
|
45
|
Yılmaz S, Erat Nergiz M, Özlü SG. Effect of enuresis on perceived parental acceptance-rejection in children. Turk Arch Pediatr 2021; 56:62-7. [PMID: 34013232 DOI: 10.14744/TurkPediatriArs.2020.36744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Objective Enuresis is a major problem affecting both the child and his family. This study aimed to investigate the effect of enuresis on mother acceptance-rejection perceived by children. Material and Methods Fourty-six children and their mothers with the diagnosis of primary enuresis were included in the study. Parental Acceptance-Rejection Scale which consisted of 60 questions and consisted of four subscales: affection, hostility, neglect, and undifferentiated rejection was applied to both mothers and children. A dependent Sample t-test was used to compare the scale results of mothers and children, and an independent sample t-test was used to determine the factors affecting perceived high mother hostility in children. Results The mean age was 10.12±1.34 years and 58.70% of the children were boys. There was no statistically significant difference between total acceptance-rejection, affection, neglect, and undifferentiated rejection scores of mothers and children's perceptions. The perceived hostility score of the children (25.71±8.05) was higher than the mothers' hostility score (22.52±6.26) (p<0.05). The presence of maternal chronic disease was found to increase the perceived high hostility, while other factors were not statistically significant. Thirteen cases with chronic illnesses were excluded and re-analysis revealed that the difference between perceived and mother hostility persisted (p<0.05). Conclusion Children with enuresis perceive their mother's behavior as more hostile than they are. It should be kept in mind that enuresis may affect the mother and child relationship, the family should be informed about the approach to the child.
Collapse
|
46
|
Sun C, Xu Y, Luo C, Li Q. Relationship between enuresis and obstructive sleep apnea-hypopnea syndrome in children. J Int Med Res 2020; 48:300060520977407. [PMID: 33290113 PMCID: PMC7727060 DOI: 10.1177/0300060520977407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We explored the relationship between enuresis and obstructive sleep apnea-hypopnea syndrome (OSAHS) in children and influencing factors of enuresis with OSAHS. METHODS We recruited 196 children ≥5 years old from the otolaryngology outpatient department, who experienced snoring and underwent nasopharynx lateral radiography and in-laboratory polysomnography. We analyzed correlations between the apnea-hypopnea index (AHI) and lowest oxygen saturation (L-SaO2) with age, body mass index (BMI), tonsil size, and adenoidal-nasopharyngeal (A/N) ratio using the Pearson correlation test. Differences in severe OSAHS prevalence, age, AHI, L-SaO2, tonsil size, and A/N ratio between children with and without enuresis were assessed using the chi-square test and t-test. Risk factors of enuresis were analyzed using logistic regression. Follow-up was conducted to assess remission in children with enuresis after adenotonsillectomy. RESULTS BMI, tonsil size, and A/N ratio were correlated with AHI and L-SaO2. Severe OSAHS prevalence, AHI, tonsil size, and A/N ratio were higher and L-SaO2 were lower in children with enuresis. Logistic regression showed that BMI, AHI, tonsil size, and sleep apnea were risk factors for enuresis. CONCLUSIONS Our study findings showed that enuresis was associated with OSAHS in children. Adenotonsillectomy may improve the symptoms of enuresis.
Collapse
Affiliation(s)
- Chen Sun
- Department of ENT, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yingpeng Xu
- Department of ENT, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chenxi Luo
- Department of ENT, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qi Li
- Department of ENT, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Medical School of Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
47
|
Gizli Çoban Ö, Önder A, Sürer Adanır A. Psychiatric comorbidities of children with elimination disorders. Arch Pediatr 2020; 28:59-63. [PMID: 33223199 DOI: 10.1016/j.arcped.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/27/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023]
Abstract
Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4-17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.
Collapse
Affiliation(s)
- Ö Gizli Çoban
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey.
| | - A Önder
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey
| | - A Sürer Adanır
- Akdeniz University Tip Faculty, Child and adolescent psychiatry Antalya, Antalya, Turkey
| |
Collapse
|
48
|
Keten T, Aslan Y, Balci M, Erkan A, Senel C, Oguz U, Kayali M, Guzel O, Karabulut E, Tuncel A. Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis. J Pediatr Urol 2020; 16:645.e1-645.e7. [PMID: 32826183 DOI: 10.1016/j.jpurol.2020.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. OBJECTIVE To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. STUDY DESIGN A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. RESULTS The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). DISCUSSION With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. CONCLUSIONS Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation.
Collapse
Affiliation(s)
- Tanju Keten
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Yilmaz Aslan
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey. https://twitter.com/urodrya
| | - Melih Balci
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Anil Erkan
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Cagdas Senel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Ural Oguz
- University of Giresun, Department of Urology, Giresun, Turkey
| | - Mustafa Kayali
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Ozer Guzel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| | - Erdem Karabulut
- University of Hacettepe, Department of Biostatistics, Ankara, Turkey
| | - Altug Tuncel
- University of Health Sciences, Ankara Numune Research and Training Hospital, Department of Urology, Ankara, Turkey
| |
Collapse
|
49
|
Whitley JA, Kieran K. Accuracy and comprehensiveness of publicly-available online data about bedwetting: An actionable opportunity to improve parent and caregiver self-education. J Pediatr Urol 2020; 16:661.e1-661.e8. [PMID: 32753282 DOI: 10.1016/j.jpurol.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/23/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Monosymptomatic nocturnal enuresis (MNE) is one of the most common reasons for referral to pediatric urologists. Prior to subspecialist visits, many parents seek electronically available information online to gather information about this condition and potential treatment options. Previous publications suggest that electronically available information on medical conditions do not always align with evidence-based or expert recommendations. We wondered if the same was true for MNE. OBJECTIVE To describe the content and accessibility of electronically available information on MNE, and its alignment with recommendations from the International Children's Continence Society (ICCS-MNE). STUDY DESIGN We simulated a layperson's electronic search using 10 pertinent search terms associated with bedwetting. We evaluated the first five pages (50 results) for each search. We evaluated all publicly-available (non-paywalled) sites for concordance with ICCS-MNE in eight domains (increasing fluid intake, limiting bladder irritants, optimizing bowel habits, utilizing timed voiding, pelvic floor relaxation, endorsing alarm use, avoiding medications as standard first-line therapies, and pediatrician referral), as well as statements discouraging blaming or punishing the child. Sites were classified as layperson-derived (blogs, communities/forums) or commercially-derived (medical institutions, commercial medical sites, corporations, government). Reading level was assessed by readable.io (compound scoring algorithms). RESULTS Of 500 pages, 410 (82%) met inclusion criteria. Of these, 49.3% were layperson-derived and 47.8% were commercially-derived. Publication year ranged from 1999 to 2017. A median three (range 0-8) therapeutic domains were mentioned per site. Only one site discussed all eight therapeutic domains. Commercial sites discussed more ICCS-MNE domains than blogs and communities/forums (median 4.1 vs. 2.4, p < 0.0001; Figure). Blogs and forums were less likely to recommend subspecialist evaluation (53.0% vs. 81.1%, p < 0.0001), but more likely to recommend alternative medicine therapies (57.9% vs. 28.6%, p < 0.0001). The overall median readability grade level was lower for blogs/communities than for commercial sites (7.9 vs. 8.6, p < 0.0001). DISCUSSION Our findings show that the vast majority of electronically available information on MNE is not congruent with or does not include all ICCS-MNE recommendations. About half of websites are blogs and forums; these not only are more likely to recommend alternative medicine therapies and less likely to recommend subspecialist evaluation, but have lower reading levels and thus may be accessible to more laypersons. CONCLUSION Neither commercially-derived nor layperson-derived websites are comprehensive with regard to ICCS-MNE recommendations. Our findings underscore the need to ensure that electronically published data are accurate, and to understand what data patients may have acquired before visiting with clinicians.
Collapse
Affiliation(s)
- Jorge A Whitley
- Seattle Children's Hospital, Division of Urology, Seattle, WA, USA
| | - Kathleen Kieran
- Seattle Children's Hospital, Division of Urology, Seattle, WA, USA; University of Washington Department of Urology, Seattle, WA, USA.
| |
Collapse
|
50
|
Ferrara P, Franceschini G, Bianchi Di Castelbianco F, Bombace R, Villani A, Corsello G. Epidemiology of enuresis: a large number of children at risk of low regard. Ital J Pediatr 2020; 46:128. [PMID: 32917238 PMCID: PMC7488742 DOI: 10.1186/s13052-020-00896-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/07/2020] [Indexed: 12/03/2022] Open
Abstract
Aim To describe the epidemiological aspects of nocturnal enuresis (NE). In this study we identify the prevalence and the familial conditions in a large, representative sample of children with monosymptomatic NE (MNE) and nonmonosyptomatic NE (NMNE). Material and methods In this descriptive-analytic study the Italian Society of Pediatrics (SIP) promoted a prevalence study of NE using a questionnaire involved 320 primary care Pediatricians from Northern, Central and Southern Italy, from January 2019 to July 2019, with a total of 130,000 children analyzed by questionnaire related to epidemiology and type of NE, familiarity, quality of sleep, eating and drinking habits, pharmacological and psychological/behavioural interventions and family involvement. Results 270/320 (84.4%) Paediatrician replied to our questionnaire. We enrolled a total of 9307/130,000 (7.2%) children with NE, aged between 5 and 14 years: 2141 diagnosed with MNE and 7176 qualified as NMNE. Poor quality of sleep were reported in 7064 patients; 90% of children did not consider a dietary and drinking recommendation. Pediatrician reported a total of 54.1% of parents who declared to have a negative reaction to their children because of the bedwetting. A percentage of 71.4% of parents declared to use or to have used alternative therapies and not to prefer, at first, a pharmacological intervention. Conclusion The choice of treatment should include psychological/behavioural interventions in all cases to improve the therapeutic outcome. All primary care Pediatricians should be aware of the all aspects of NE to choose the best way to treat every patient.
Collapse
Affiliation(s)
- Pietro Ferrara
- Institute of Pediatrics, Catholic University Medical School, Largo A. Gemelli, 8, 00168, Rome, Italy. .,Service of Pediatrics, Campus Bio-Medico University, Rome, Italy.
| | | | | | | | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, AOUP "P. Giaccone", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| |
Collapse
|