High initial efficacy of full‐spectrum therapy for nocturnal enuresis in children and adolescents

Kampen, Marijke Van; Bogaert, Guy; Feys, Hilde; Baert, Luc; Raeymaeker, I. De; Weerdt, Willy De

doi:10.1046/j.1464-410x.2002.02812.x

Cited by 29 publications

(9 citation statements)

References 22 publications

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“…It has been suggested that in children with NE the short‐term results of full‐spectrum therapy, combining an enuresis alarm, bladder training and motivational therapy, is 76–87%, and thus better than each treatment alone and better than medication or psychological treatment [17,18]. However, the present data show that a stepwise approach also results in a fairly high short‐term cure rate of 67%, and even prolonged RCT as sole treatment seems successful, even in children with refractory NE who are more difficult to treat.…”

Section: Discussionmentioning

confidence: 53%

Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow‐up into adolescence, with attention to the clinical value of normalizing bladder capacity

Vermandel¹,

Wachter²,

Wyndaele³

2005

BJU International

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OBJECTIVETo assess the importance of normalizing bladder capacity to the age-expected capacity in children with refractory monosymptomatic nocturnal enuresis (MNE), and to evaluate the long-term results when these children grow into adolescence. PATIENTS AND METHODSThe study included 34 children with refractory MNE; all were treated > 5 years earlier for their MNE using a combined stepwise approach, consisting of retention control training, oxybutynin and an enuresis alarm. Data were obtained on their enuretic state, night-time voiding behaviour and bladder capacity, from a questionnaire and a voiding chart. RESULTSBefore starting treatment, all patients had a bladder capacity that was too small for their age. After the combined stepwise approach, MNE improved in all patients and 24 (71%) were cured. Although the bladder capacity was increased to the age-expected capacity in 26 (76%), most woke at night to void. Currently, at a mean of 7.7 years after the primary treatment, 28 (82%) of the patients are completely dry at night, of whom 15 (54%) arouse to void for 35% of the nights. Six patients (18%) still have some enuretic episodes. Only those who were dry after primary treatment and remained dry had a normal age-expected increase in bladder capacity. For all others there was a decrease in age-related bladder capacity. CONCLUSIONSIn patients with refractory MNE, a combined stepwise approach improves and may even eliminate enuresis, but normal night-time bladder behaviour in adolescence and adulthood is only achieved in some. Furthermore, about a fifth still have some enuretic episodes. KEYWORDS enuresis, bedwetting, capacity training, follow-upThere are two papers in the paediatric urology section this month. The first, from Belgium, assessed the importance of normalising bladder capacity to the age-expected capacity in children with refractory nocturnal enuresis, and evaluated the long-term results when the children reached adolescence. The second paper from the USA assessed the role of apoptosis and proliferation in children with undescended testes.

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Section: Discussionmentioning

confidence: 53%

Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow‐up into adolescence, with attention to the clinical value of normalizing bladder capacity

Vermandel¹,

Wachter²,

Wyndaele³

2005

BJU International

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“…Alarm and reward system are the components of arousal therapy/training, which was reported to have a high efficacy and low relapse rate in an early literature [24]. However, they have not been recommended by the guideline [10] because there is not enough clinical evidence, which is similar to FSHT [25].…”

Section: Complex Behavioral Interventionsmentioning

confidence: 99%

Advances in Treatment of Nocturnal Enuresis in Children

Zhou¹,

Lü²,

Shi³

et al. 2020

Lower Urinary Tract Dysfunction - From Evidence to Clinical Practice

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Nocturnal enuresis is a condition with complex etiology affecting plenty of children and families. Even though multifarious clinical trials and studies have been designed and completed, some inconclusive results on nocturnal enuresis confuse clinicians. This article aims to provide useful information for clinicians by summarizing the existing evidence on nocturnal enuresis and discussing the effectiveness and safety of different treatments. Nocturnal enuresis mainly results from the disorders related to central nervous system, which may cause nocturnal polyuria, nighttime bladder capacity decline, arousal disorder, and various accompanying diseases. We discussed the efficacy and safety of different treatments for monosymptomatic nocturnal enuresis, including standard therapies, simple behavioral interventions, complex behavioral interventions, alarm therapy, desmopressin and other drugs, biofeedback therapy, electrical stimulation, acupuncture, Chinese herbal medicine, massage, and so on. Alarm is still the most effective single therapy with lower relapse rate. Desmopressin has efficacy mainly in children with nocturnal polyuria. Children with detrusor overactivity or decreasing functional bladder capacity can choose anticholinergics. Additionally, tricyclic drugs, biofeedback therapy, electrical stimulation, acupuncture, massage, and so on are therapeutic options for children with nocturnal enuresis.

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“…[ 34 ] Combination therapy with an enuresis alarm, bladder training, motivational therapy, and pelvic floor muscle training was successful in 87% of patients after 14 weeks and improved functional bladder capacity from 53% to 88%. [ 35 ]…”

Section: Treatment Of Primary Nocturnal Enuresismentioning

confidence: 99%

Nocturnal enuresis in india: Are we diagnosing and managing correctly?

Reddy¹,

Malve²,

Nerli³

et al. 2017

Indian J Nephrol

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Nocturnal enuresis is a common problem affecting school-aged children worldwide. Although it has significant impact on child's psychology, it is always under-recognized in India and considered as a condition which will outgrow with advancing age. Nocturnal enuresis classified as primary or secondary and monosymptomatic or nonmonosymptomatic. Factors that cause enuresis include genetic factors, bladder dysfunction, psychological factors, and inappropriate antidiuretic hormone secretion, leading to nocturnal polyuria. Diagnosis consists of detailed medical history, clinical examination, frequency-volume charts, and appropriate investigations. The frequency-volume chart or voiding diary helps in establishing diagnosis and tailoring therapy. The first step in treating nocturnal enuresis is to counsel the parents and the affected child about the condition and reassure them that it can be cured. One of the effective strategies to manage enuresis is alarm therapy, but currently, it is not easily available in India. Desmopressin has been used in the treatment of nocturnal enuresis for close to 50 years. It provides an effective and safe option for the management of nocturnal enuresis. This review covers the diagnosis and management of nocturnal enuresis and introduces the concept of “bedwetting clinics” in India, which should help clinicians in the thorough investigation of bedwetting cases.

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High initial efficacy of full‐spectrum therapy for nocturnal enuresis in children and adolescents

Cited by 29 publications

References 22 publications

Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow‐up into adolescence, with attention to the clinical value of normalizing bladder capacity

Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow‐up into adolescence, with attention to the clinical value of normalizing bladder capacity

Advances in Treatment of Nocturnal Enuresis in Children

Nocturnal enuresis in india: Are we diagnosing and managing correctly?

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