Time Course of Treatment for Primary Enuresis With Overactive Bladder

Abstract

PurposeTo characterize the course of treatment for nonmonosymptomatic enuresis with overactive bladder (OAB) in a real clinical setting.MethodsData from 111 OAB patients with moderate to severe enuresis were analyzed. The baseline analysis included a questionnaire, voiding diary, uroflowmetry with postvoid residual urine measurement, and plain abdominal radiography of the kidneys, ureters, and bladder (KUB). Following standard urotherapy for 1 month, anticholinergic medication was administered with or without laxatives. Desmopressin was added if there was a partial response to OAB. Patients were followed every 3 months to evaluate the status of OAB and enuresis. Multivariate analysis was performed to identify predictors associated with the lack of complete response (CR) in enuresis at 12 months.ResultsFollowing 12 months of treatment, 64% and 88% of patients experienced at least partial response in enuresis and OAB, respectively. Urgency improved more quickly than enuresis, supporting the need to address daytime symptoms before enuresis. Seventy-nine patients (71%) had fecal impaction on KUB and/or subjective constipation. The combination of anticholinergics with either laxatives or desmopressin fared better than anticholinergics alone. Daytime incontinence and anticholinergics-only treatment were associated with a lack of CR during 12 months of treatment.ConclusionsThe data confirmed the validity of addressing OAB before treating enuresis. The results of this study also highlight the need to address fecal impaction. Patients should be counseled about the need for a prolonged course of treatment before starting treatment. Anticholinergics should be accompanied with either desmopressin or laxatives for better control of enuresis.

The Desmopressin melt therapy in children with non-monosymptomatic nocturnal enuresis: a prospective study

“…Another study demonstrated that the combination of antimuscarinics and desmopressin was more effective than antimuscarinics alone in children with an overactive bladder and enuresis. 24 Similar to our study, after treating daytime LUTS with antimuscarinics, if enuresis persisted we also used desmopressin to control enuresis.…”

Analysis of measurement electrode location in bladder urine monitoring using electrical impedance

“…Patients suffering from neurological disorders, such as spinal cord injury, generally present a failure of perceiving or voiding their bladders due to neurological damage or muscular atrophy [ 1 , 2 ]. One common solution to address this problem in clinic is to have a physician or nurse manually inspect the bladder fullness of patients and make sure the patients empty their bladders on time.…”

Characterization and treatment of enuresis in overactive bladder patients

“…When considering the two groups in terms of treatment response analysis, secondary enuresis acts as a factor associated with complete enuresis resolution, whereas primary enuresis acts as a lack-of-healing factor. In these cases, enuresis resolution is known to be delayed for months or years (6,12) , thus reducing hopes among parents and patients, and increasing therapy dropout rates. Based on our results, we suggest enuresis management be initiated from the early stages by adding nighttime alarm to standard urotherapy in patients where primary enuresis is detected as an individual entity -present before daytime symptom onset-through relevant questionnaires.…”