Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Evaluación y tratamiento de la enuresis en niños y adolescentes / Evaluation and treatment of enuresis in children and adolescents

La enuresis, definida como incontinencia urinaria durante el sueño desde los 5 años de edad, es una condición frecuente y estresante que puede llegar a tener un impacto profundo en la conducta, bienestar emocional y vida social del niño o adolescente. El objetivo del presente trabajo es realizar una revisión narrativa de la evidencia en relación a la evaluación y tratamiento de la enuresis. La evaluación inicial debe ir dirigida a diferenciar entre los pacientes con enuresis monosintomática y no-monosintomática, excluir condiciones no funcionales que pueden presentarse como enuresis y detectar problemas psicológicos. Para que la terapia sea exitosa, se debe desarrollar un plan de manejo que sea apropiado para el paciente y su contexto. En el subgrupo de enuresis no-monosintomática, el tratamiento de los síntomas diurnos es necesario antes de iniciar el manejo de la enuresis. Existen diversas alternativas de tratamiento para la enuresis, sin embargo, la terapia de alarma y la desmopresina poseen amplia evidencia para su empleo como primera línea.

Enuresis, defined as urinary incontinence in children older than 5 years old, is a common and stressful condition that may cause deep consequences on the child or young person's behavior, emotional wellbeing and social life. The aim of this work is to make a narrative review of evidence on evaluation and treatment of enuresis. The initial assessment must differentiate between monosymptomatic and non-monosymptomatic enuresis, rule out non-functional conditions that can manifest as enuresis and detect psychological problems. In order to achieve a successful treatment, it is essential to develop a management plan according to the patient and its context. In non-monosymptomatic enuresis, it is necessary to treat daytime symptoms before management of bedwetting. There are many different therapeutic options for enuresis, nevertheless, alarm and desmopressin are evidence-based firstline treatments.

Stressful life event presenting as enuresis, dissociative disorder and worsening school performance.

Stressful life events are associated with various psychiatric problems. Secondary enuresis and dissociative disorders both may appear in context of traumatic life events. These problems following a trauma may further increase the risk of stress in the family and may in turn result into a vicious cycle of difficulties. We present a case report of stressful life events presenting as enuresis, dissociative disorder and worsening school performance and careful appreciation of situations and rigorous interventions improved the clinical status.

Levantamento de enurese noturna no município de São Paulo / A survey of nocturnal enuresis in the city of São Paulo

O presente trabalho faz um breve histórico do estado atual sobre o estudo da enurese, fornecendo critérios diagnósticos. Trata-se de um trabalho de levantamento da presença da enurese noturna em crianças e adolescentes do município de São Paulo, tendo participado 670 pais ou responsáveis por crianças ou adolescentes de 4 a 18 anos, com o objetivo de fornecer subsídios a pediatras e educadores para melhor atenderem à população enurética. O instrumento utilizado foi o “Child Behavior Checklist” – CBCL. Foram encontrados casos de enurese em todas as faixas etárias. Na faixa etária não considerada EN pelo DSM IV, foram encontrados níveis mais elevados do que os encontrados na literatura. Quanto às diferenças entre gêneros foi encontrado que na faixa etária de 4 a 5 anos os índices de EN são mais altos nas meninas, havendo uma inversão nas faixas etárias mais velhas, predominando significativamente o sexo masculino.

The present work briefly presents the history of the current state of the study of enuresis, providing diagnostic criteria. It is a survey of the presence of nocturnal enuresis in children and adolescents of the city of São Paulo. The study involved the participation of 670 parents or guardians of children and adolescents between 4 and 18 years of age, with the objective of offering subsidies to pediatricians and educators so that they can provide better care for the enuretic population. The instrument utilized was the "Child Behavior Checklist" - CBCL. Enuresis cases were found in all age groups. In the age group not considered EN by the DSM IV, higher levels were found in comparison with our literature. Regarding differences between genders, it was found that in the age group of 4 to 5 years, EN levels are higher in girls, and there is an inversion in the older ages, in which the male sex significantly predominates.

epidemiological study of enuresis among primary school children in Isfahan, Iran

To estimate the prevalence of enuresis in primary school children in Iran and to determine the factors associated with this disorder. A cross-sectional time-ordered study was performed at the Faculty of Medicine, Isfahan Medical University, Isfahan, Iran from September 2005 to January 2006. A total of 4500 self-administered questionnaires were distributed to parents of children aged 6-12 years attending 30 primary schools. From an overall response rate of 69.9%, enuresis was reported in 216 children [7%], comprising 6.2% for nocturnal enuresis according to ICD10 and 3.3% according to DSM IV, 0.5% for diurnal enuresis and 0.8% for combined day and night wetting. Primary nocturnal enuresis was reported in 166 children [5.3%]. Seventy-one [50.7%] of the 140 children with nocturnal enuresis had ?3 wet nights per week. A positive family history in father and mother was seen in 51% and 39% of children with primary nocturnal enuresis respectively. Using logistic regression analysis, younger age [p<0.002], gender [p<0.0001] and low level of education of mother [p<0.028] were significant predictors of enuresis. Positive history of enuresis in father was a significant predictor of primary nocturnal enuresis [p<0.012]. The prevalence of nocturnal enuresis in Iran is lower than those reported in western countries, however, higher percentage demonstrated severe enuresis. The prevalence of diurnal enuresis is lower than previous studies. Age, gender and the educational level of the mother are the main risk determinants of enuresis and the prevalence of primary nocturnal enuresis appears to be significantly related to positive history of enuresis in father

Diagnóstico clínico de disfunção miccional em crianças e adolescentes enuréticos / Clinical diagnosis of bladder dysfunction in enuretic children and adolescents

OBJETIVO: Estimar o valor preditivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional em crianças e adolescentes enuréticos atendidos no Ambulatório de Urodinâmica do Instituto Fernandes Figueira. MÉTODOS: De junho de 1999 a maio de 2002, foram avaliados 91 pacientes, entre 5 e 17 anos de idade, portadores de enurese, mono ou polissintomática, através de anamnese, mapa da micção, exame físico e estudo urodinâmico. A anamnese baseou-se em um modelo desenvolvido para detecção de sintomas urinários diurnos. O valor preditivo da presença destes sintomas para o diagnóstico de disfunção miccional foi estimado neste grupo. RESULTADOS: O percentual de disfunção miccional entre as crianças e adolescentes atendidos por enurese no Ambulatório de Urodinâmica do Instituto Fernandes Figueira foi de 94,5 por cento. A anamnese identificou 97,3 por cento dos pacientes com sintomas urinários diurnos. Apenas 2,7 por cento dos pacientes apresentaram aumento da freqüência urinária detectado apenas pelo mapa da micção. O valor preditivo positivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional foi de 98,6 por cento. Houve associação, estatisticamente significante, entre sintomas urinários diurnos e disfunção miccional (p < 0,005), e o risco de a urodinâmica estar alterada foi de cerca de 20 vezes maior na presença destes. CONCLUSÕES: A presença de sintomas urinários diurnos apresentou um elevado valor preditivo positivo para disfunção miccional. A anamnese foi um instrumento útil para a detecção dos sintomas urinários diurnos, contribuindo para o diagnóstico de disfunção miccional.

Nocturnal enuresis.

Nocturnal enuresis is a benign condition, yet needs treatment to relieve the child and parents of the accompanying anxiety and the stigma attached to it. It is defined as normal nearly complete evacuation of the bladder at a wrong place and time at least twice a month after the fifth year of life. The underlying cause of enuresis is functional and various proposed pathophysiological mechanisms like maturational delay, genetics, role of sleep, antidiuretic hormone, and bladder capacity are discussed. These factors have a bearing on the management. As no treatment plan is ideal, various treatment modalities currently available including good supportive care are elaborated and a plan of management discussed.

Actualización en el estudio y tratamiento de la enuresis primaria noctura / Update in the study and treatment of the nocturnal primary enuresis

La enuresis primaria nocturna no es una entidad nosológica sino un signo que está presente en un grupo heterogéneo de enfermedades. Constituye un problema de salud de amplia distribución, ya que está presente en todas las civilizaciones y áreas geográficas; afecta a todas las razas y estratos sociales con discreta predominancia en las clases menos favorecidas económicamente. A los 5 años de edad afecta al 15 por ciento de niños de ambos sexos con un predominio de 3:1 a favor del sexo masculino y es ligeramente más frecuente en zurdos. En Estados Unidos se calcula que hay de 5 a 7 millones de niños que padecen de enuresis nocturna primaria. En México no se cuenta con cifras exactas, pero considerando los datos proporcionados en el XII Censo de población realizado por el Instituto Nacional de Estadística, Geografía e Informática en el 2000, en México hay 2.250.886 niños de 5 años de edad, de ellos el 15 por ciento , es decir 337.633 padecen enuresis y considerando la población total de niños de 5 a 16 años de edad (26.031.931), es muy posible que en nuestro país haya aproximadamente de 4 a 5 millones de jóvenes que padecen de este problema médico el cual no solo afecta la salud física y emocional del paciente sino también a su propia familia y a la sociedad que le rodea

Enuresis in children 5-15 years at Queen Sirikit National Institute of Child Health.

A cross-sectional descriptive study was conducted to compare 179 enuretic and 811 non-enuretic patients at Queen Sirikit National Institute of Child Health from July 1998 through December 1998. The objective was to study the epidemiology, risk factors, behavioral and learning problems associated with enuresis in children 5-15 years old. Chi-squared analysis was used. The prevalence of primary, secondary and total enuresis was 15.4, 2.7 and 18.1 per cent respectively in 5-15 year old children. Of these, 88.5 per cent had nocturnal enuresis, 0.6 per cent had diurnal enuresis, 10.6 per cent had diurnal and nocturnal enuresis. Risk factors which significantly correlated with enuresis were the history of bed-wetting in the parents/sibling and inconsistent toilet training. We found that enuresis was not related to sex, birth order, LBW, socioeconomic, marital and parental educational status. Fifty-eight per cent of the parents thought that the enuretic problem needed further treatment.

Riñón en herradura: presentación de un caso y revisión / Horseshoe kidney: case presentation and review

Informamos el caso de una paciente de doce años de edad con un cuadro de enuresis nocturna de 12 meses de evolución, quien se presentó espontáneamente al Hospital General San Felipe y Asilo de Inválidos, Tegucigalpa, D.C. En base a los estudios de gabinete se postuló el diagnóstico de riñón en herradura. El estudio radiológico por contraste mostró sombras renales de bajo nivel, ausencia de sombras en el polo inferior, convergencia inferior en el axis renal, la pelvis renal en situación media, falla en su rotación, no se observó litos ni hidronefrosis llegándose el diagnóstico de riñón en herradura. Este diagnóstico es importante en casos con estrechez en la unión ureteropiélica por las complicaciones que sobrevienen

Enuresis: current concepts.

Incontinence disorders are an important group of problems that clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, etiologic concepts of incontinence disorders, a general clinical approach to enuretic patients, laboratory evaluation and general principles of management. Neurological and nephrological concepts of enuresis are emphasized in this discussion.

Enuresis funcional. Manejo psicomotor de los esfínteres vesicales / Functional enuresis

La enuresis es un problema cotidiano de salud en un número importante de niños mayores de 3 años de edad, aunque su frecuencia y prevalencia reales se desconozcan en nuestro país. Su importancia se incrementa debido a la gran vinculación que tiene con los padres de familia y, además, porque su manejo es aún tema de controversia. En la presente revisión bibliográfica se describen los principales aspectos clínicos de esta anomalía; se incluye un cuadro de facíl manejo sobre el criterio diagnóstico en la enuresis funcional, y se hace énfasis en la vigilancia que debe ejercer el médico cuando instituye tratamiento farmacológico. En especial, se destaca la trascendencia que ofrece educar al paciente y a sus padres o cuidadores, a través de instituir, a la brevedad posible, la práctica cotidiana del manejo de los esfínteres vesicales al aportador al niño cantidades generosas de líquidos durante el día. Insistiéndole en la necesidad imperiosa que existe en su caso, de que concientice las sensaciones de la necesidad de miccionar y la conveniencia de controlar los esfinteres mencionados

Diagnósticos psiquiátricos en una cohorte de escolares de primer año de enseñanza básica del área occidente de Santiago / Psychiatric diagnosis in a cohort of school children from the western area of Santiago de Chile

Psychiatric evaluation was performed in a sample of 99 children at 7 schools of West Santiago, representative of a cohort of 684 children attending first grade basic course during 1993, previously assesed by parents and teachers questionnaires. Syndromatic, psychosocial and dissability diagnosis was done according to ICD-10 criteria, using a semistructured interview. 24.2 percent of children had a syndromatic diagnosis, 53,4 percent a psychosocial diagnosis and disability was found in 17.2 percent. Disorder of Activity and Attention was the most frequent diagnosis, followed by Non Organic Enuresis and adaptation disorders. Children with a syndromatic diagnosis showed significantly more abnormal psychosocial situations and disability than children without diagnosis. 43.4 percent had 2 or more psychosocial diagnoses. 10 percent of the entire sample had a family member with mental disorder. Positive correlations were found between psychiatric diagnosis, high score on first stage questionnaires and need for behavioral evaluation percieved by teachers in boys and girsl. Results are compared with chilean and international literature, and ICD-10 criteria are discussed

Enuresis en pediatría / Enuresis in pediatrics

La enuresis es un problema frecuente en pediatría; su orgien es aún obscuro y su tratamiento se presta a controersias. Obedece generalmente a un retardo en la maduración neurológica del niño; sin embargo en muchos pacientes es posible reconocer un problema orgánico.

Enurese e encoprese: diagnostico e tratamento / Enuresis and encopresis: diagnosis and treatment

No presente trabalho, a autora realizou uma revisao bibliografica dos disturbios da eliminacao. Posteriormente, relatou sua experiencia no tratamento da Enurese Noturna Primaria com imipramina e apresentou casos de pacientes com encoprese, bem como respectivo tratamento desta patologia.