Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention

Fagundes, Simone Nascimento; Lebl, Adrienne Surri; Soster, Leticia Azevedo; Silva, Guilherme Jorge Sousa e; Silvares, Edwiges Ferreira de Mattos; Koch, Vera H.

doi:10.1007/s00467-016-3510-6

Cited by 38 publications

(29 citation statements)

References 44 publications

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“…Another prospective open-label study in a similar patient population given desmopressin has shown an improvement in sleep pattern post-therapy by a significant decrease in PLMS index ( P <0.001) at six months from baseline and prolonged first undisturbed sleep period (or time to first nocturnal void; P <0.001). This is also the first study to confirm the relationship among enuresis, neuropsychological dysfunction, and sleep disorders in an MNE population 42 . Desmopressin also seems to be an effective treatment option for NE in patients undergoing orthotopic neobladder reconstruction after radical cystectomy, where it significantly reduced the mean number of nocturnal voids ( P = 0.015).…”

Section: Newer Therapeutic Modalitiesmentioning

confidence: 57%

“…Desmopressin has long been the treatment of choice for NE, and the following recent studies support this claim. In a prospective study involving MNE children, desmopressin has shown immediate and long-term effects that are as great as those of alarm therapy or a combination of alarm and desmopressin 42 . Another prospective open-label study in a similar patient population given desmopressin has shown an improvement in sleep pattern post-therapy by a significant decrease in PLMS index ( P <0.001) at six months from baseline and prolonged first undisturbed sleep period (or time to first nocturnal void; P <0.001).…”

Section: Newer Therapeutic Modalitiesmentioning

confidence: 99%

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Recent advances in managing and understanding enuresis

et al. 2017

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Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future.

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Section: Newer Therapeutic Modalitiesmentioning

confidence: 57%

Section: Newer Therapeutic Modalitiesmentioning

confidence: 99%

Recent advances in managing and understanding enuresis

et al. 2017

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“…Four studies used an intranasal spray 7 , 17 – 19 , six used oral tablets 16 , 20 – 24 , four used oral melt 25 – 28 , and one used a nasal spray or oral tablets 29 . Dosage titration to 0.4 mg for oral tablets 20 – 24 and 240 μg for oral melt 25 , 28 was performed in seven studies under differed circumstances and time intervals from the initial treatment. Five studies performed structured withdrawals for desmopressin therapy 17 , 21 , 22 , 24 , 28 .…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis

Peng

Yang

Austin

et al. 2018

Sci Rep

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This study is to compare the efficacy of enuresis alarm and desmopressin therapy in managing pediatric monosymptomatic enuresis. We performed systematic literature searches on different databases from inception until April 2017 without language restriction. All randomized control trials comparing an enuresis alarm and desmopressin in managing children with monosymptomatic enuresis were included. A total of 15 studies with 1502 participants (aged 5 to 16 years) were included for pooled analysis. Overall, an enuresis alarm outperformed desmopressin in achieving at least a partial response (>50% reduction in wet nights) in per-protocol analysis (OR: 1.53, 95% CI 1.05 to 2.23) but not in intention-to-treat analysis (OR: 0.97, 95% CI 0.73 to 1.30) as the alarm was hampered by a high dropout rate (OR: 2.20, 95% CI 3.41 to 4.29). However, alarm therapy yielded a better sustained response (OR: 2.89, 95% CI 1.38 to 6.04) and lower relapse rate (OR: 0.25, 95% CI 0.12 to 0.50). In the intention to treat analysis, the results revealed that alarm and desmopressin therapy are comparable in efficacy with regards to achieving >50% reduction in baseline wet nights in enuretic children. However, enuresis alarms offer a superior treatment response and a lower relapse rate in well-motivated children.

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“…After removing duplicates, 1 625 studies were screened by reading titles and abstracts. Full-text assessment was carried out on a total 57 articles, and a final total of 18 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] RCTs with 1 649 patients was included in the present analysis.…”

Section: Included Studies Characteristicsmentioning

confidence: 99%

Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta‐analysis

et al. 2018

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The network meta-analysis showed that desmopressin had similar efficacy to alarm therapy but a higher relapse rate. Desmopressin plus AA therapy was associated with better efficacy than and a similar relapse rate to desmopressin monotherapy. Desmopressin plus alarm therapy was similar to both desmopressin and alarm monotherapy in efficacy. All treatments, including desmopressin plus AAwere associated with tolerable adverse events; however, additional high-quality studies are needed for further evaluation of these treatments.

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Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention

Abstract: The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.

Cited by 38 publications

References 44 publications

Recent advances in managing and understanding enuresis

Recent advances in managing and understanding enuresis

Systematic Review and Meta-analysis of Alarm versus Desmopressin Therapy for Pediatric Monosymptomatic Enuresis

Comparison of desmopressin, alarm, desmopressin plus alarm, and desmopressin plus anticholinergic agents in the management of paediatric monosymptomatic nocturnal enuresis: a network meta‐analysis

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