Epidemiology of enuresis: a large number of children at risk of low regard.

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.

Clinical management of nocturnal enuresis.

Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful.

Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation.

BACKGROUND: Parasacral transcutaneous electrical nerve stimulation (TENS) has emerged as an effective treatment for overactive bladder (OAB) in view of its high success rates in improving lower urinary tract symptoms and constipation, with no direct side effects. However, the clinical characteristics associated with the outcomes remain to be established. OBJECTIVE: The aim of this study was to evaluate potential predictors of outcome in children with OAB treated using parasacral TENS. STUDY DESIGN: This was a prospective study of children with symptoms of isolated OAB, enrolled consecutively to the study and treated with parasacral TENS (figure). Isolated OAB was defined as the presence of urinary urgency with no signs of dysfunctional voiding. The symptoms were considered completely resolved when a patient's parents/guardians or the patients themselves reported a 100% improvement. Parasacral TENS was performed twice weekly for a total of 20 sessions of 20 min each at 10 Hz. The potential predictive factors evaluated were: sex, age, daytime incontinence, nocturia, a prior history of urinary tract infection, the presence of nocturnal enuresis, constipation and holding maneuvers. RESULTS: Eighty-three patients with a mean age of 7.8 ± 2.8 years were included in the study. Complete resolution of symptoms was achieved in 47 (56.6%). Following parasacral TENS treatment, a significant response was reported in 96.4% of cases. Of the 55 patients with nocturnal enuresis, partial resolution was achieved in 30 cases (54.5%), with a statistically significant association between nocturnal enuresis and the patient's response to treatment (p < 0.004; OR = 4.4, 95% CI 1.5-12.5). No other factor was associated with response to treatment. DISCUSSION: To the best of our knowledge, this association between nocturnal enuresis and failure to respond to parasacral TENS treatment for lower urinary tract dysfunction has not previously been reported. The identification of factors capable of predicting therapeutic failure may allow professionals to select those specific patients who would benefit from a multimodal approach in the treatment of this pathology, which has such a significant impact on the quality of life of affected patients. CONCLUSIONS: Nocturnal enuresis was the only symptom associated with a poor outcome following parasacral TENS treatment in children with OAB.

The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding.

PURPOSE: The aim of the study was to compare the treatment outcome of two urotherapy programs in children with dysfunctional voiding (DV) through analyzing the clinical manifestations and uroflowmetry parameters. MATERIALS AND METHODS: Eighty-six children with DV were randomly divided into two groups (A and B). Children in both groups were educated about the importance of regular voiding and hydratation, and about the appropriate posture during voiding. Simple voiding instructions were provided. In group A diaphragmatic breathing and pelvic floor muscles (PFM) retraining were additionally assigned to children. Constipation and recurrent urinary tract infections (UTIs) were treated in both groups. Selected children from both groups received pharmacotherapy (anticholinergics or desmopressin). Uroflowmetry with pelvic floor electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. RESULTS: After one year of therapy, urinary incontinence and nocturnal enuresis were cured in a significantly larger number of children in group A than in group B (P < 0.001; P < 0.05). Although more children with UTIs were cured in group A, the difference was not statistically significant compared to group B. There was a significant recovery constipation-wise in both groups. Post-treatment uroflowmetry parameters and curve pattern were markedly improved only in group A. CONCLUSIONS: Carefully planned and regularly controlled abdominal and PFM retraining is beneficial in children with DV for curing urinary incontinence, nocturnal enuresis, UTIs and normalizing urinary function. Further trials are needed to define the most effective treatment program for achieving the best treatment outcome.

Euresis infantile: la importancia de una correcta intervención / Childhood enuresis: the importance of a correct intervention

Introducción: la enuresis nocturna monosintomática (ENM) es una enfermedad muy frecuente en la infancia que favorece la aparición de problemas psicológicos y de autoestima; sin embargo, sigue siendo una entidad infravalorada. Objetivos: 1. Conocer las características epidemiológicas y clínicas de una serie de niños enuréticos. 2. Seguir la evolución de estos pacientes desde que acudieron a nuestra consulta hasta el alta. Material y métodos: Estudio descriptivo retrospectivo incluyendo 67 niños derivados a una consulta hospitalaria durante los años 1997-2005 por presentar enuresis. Se recogieron los datos epidemiológicos, clínicos y terapéuticos antes y después de la visita a una consulta especializada. Resultados: Se revisaron 67 pacientes. 76,1% correspondieron a ENM y 23,9% a síndrome enurético. Presentamos 51 casos de ENM (66,7% niños y 33,3% niñas). Existían antecedentes familiares en el 80,4%. Solo el 47,1% había recibido tratamiento previo. La valoración psicosocial resultó normal en el 94,1% y la exploración física en el 92,2%. En el 78,4% se solicitaron pruebas complementarias. Los tratamientos más empleados fueron: pauta básica, desmopresina (45,1%) y desmopresina más anticolinérgicos (33,35%). Aparecieron efectos secundarios relacionados con la desmopresina en el 11,8%. Se curó el 74,5%. Conclusiones: Es necesario concienciar al paciente a sus familiares de este problema y fomentar el tratamiento precoz de la ENM. En la ENM la valoración básica psicosocial y la exploración física son casi siempre normales. Los exámenes complementarios pueden reducirse a un examen de orina. Recordar que el tratamiento requiere tiempo y detectar precozmente sus efectos secundarios es fundamental para evitar el abandono del mismo (AU)

Background. Nocturnal Enuresis is a common illness in childhood that involves psychological and self-esteem problems. However, enuresis is often misunderstood. Objective: 1. Review the main epidemiologic and clinical characteristics of a group of enuretic children. 2. Follow up of these patients from admission until discharge from hospital. Material and methods: Descriptive, retrospective study including 67 children sent to the out patient department during 199-2005 for enuresis. Epidemiological, clinical and treatment data were recorded before and after visiting the specialist. Results: 67 patients were reviewed: 76,1% were found to have Monosyptomatic Nocturnal Enuresis (MNE) and 23,9% were found to have enuretic syndrome. In this study we present 51 cases of MNE (66,7% male and 33,3% female under the age of fourteen years). There was a family history of nocturnal enuresis in 80,4%. In our experience we founded that only 47,1% had received treatment before they arrived at hospital. Psychosocial evaluation was normal in 94,1% and physical examination in 92,2%. In 78,4% of the patients routine exams were carried out. The most frequent treatments were: behavioral intervention, desmopressin 845,1%) and desmopressin + cholinergic antagonists (33,35%). Secondary effects related to desmopressin were observed in 11,8%. 74,5% of the subjects mad a good recovery from enuresis. Conclusions: it is important to make patient and family aware of this problem and to promote the early treatment of MNE. Basic psychosocial examination and physical examination are usually normal in MNE. Routine exams can be reduced to an urine exam. The treatment can be over long duration and the early detection of secondary effects is basic to avoid treatment abandonment (AU)