Severity of self-reported depressive symptomatology and relevant factors in children with primary monosymptomatic nocturnal enuresis and their mothers.

BACKGROUND: Nocturnal enuresis (NE) may negatively affect social and emotional life as well as mood in both children and their mothers. The aim of this study is to evaluate severity of self-reported depressive symptomatology and determine the relevant factors in children with primary monosymptomatic nocturnal enuresis (MNE) and their mothers by using depression inventories. METHODS: Children Depression Inventory (CDI) for children and Beck Depression Inventory (BDI) for mothers were administered to the study group. The children and mothers in the patient and control groups were compared according to the depression inventory scores. The relationship of various sociodemographic factors with those scores was also investigated. RESULTS: BDI scores of the mothers of children with primary MNE demonstrated minor depressive symptomatology and were significantly higher than the mothers in the control group (p = 0.002). Moreover, although within the normal range, CDI scores of the children with primary MNE were also significantly higher than the controls (p = 0.031). Main factors associated with BDI scores were the presence of primary MNE, maternal educational level, and CDI scores. School achievement of the children, monthly income of the family, and BDI scores were found to be correlated to the CDI scores. CONCLUSIONS: Primary MNE was found to be associated with negative mood of the mothers in the present study. As misinformed parental attitudes adversely affect family dynamics, improved awareness of, and maternal education regarding primary MNE is vital in improving the holistic outcome of families affected by MNE.

A comparative study of transcutaneous interferential electrical stimulation and transcutaneous electrical nerve stimulation on children with primary nocturnal enuresis: a randomized clinical trial.

INTRODUCTION: Nocturnal enuresis is an infrequent uncontrolled voiding during sleep in a child aged 5 years or more without any congenital or acquired disorders of the central nervous system. OBJECTIVE: To compare immediate and short-term effects of interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) in the treatment of children with primary nocturnal enuresis (PNE) in numbers of wet nights and quality of life (QoL). STUDY DESIGN: 52 children aged 7-14 (10.6 ± 1.9) having PNE, were assigned randomly into two groups (26 children for each group). Both IFC and TENS groups continued treatment session for 20 min, 3 sessions per week for 6 weeks. The outcome measures were the number of wet nights, and QoL through pediatric incontinence questionnaire (PinQ).The measurements were evaluated before treatment (Pre-), after the last session (Post-1), and 6 months later (Post-2). RESULTS: By comparing the Pre- and Post-1 mean values, the number of wet nights, reduced significantly (P < 0.05) in both groups, in favor of IFC group. Post-1 showed many children with full and good responses and few numbers with partial or no responses to IFC than TENS. Post-1 revealed that PinQ was significantly reduced in both groups in favor of the IFC group (P < 0.05). The values were slightly improved in both groups in Post-2, they were significantly different between Pre- and post-measurements in each group (P < 0.05). Comparison between both groups showed significant differences in the mean values between Post-1 and Post-2 in favor of IFC group (P < 0.05). CONCLUSIONS: IFC and TENS had immediate and short-term improvements in children with PNE by reducing numbers of wet nights and enhancing QoL in favor of the IFC group.

A case study: Effects of foot reflexotherapy on ADHD symptoms and enuresis nocturia in a child with ADHD and enuresis nocturia.

BACKGROUND AND PURPOSE: Symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) can occur in association with enuresis nocturia. Alternative therapies may be effective in addressing the maladies of children with ADHD comorbidities. The purpose of this study was to investigate the effects of foot reflexotherapy in a child with ADHD and enuresis nocturia. MATERIALS AND METHODS: The patient was an 8-year-old child with ADHD and enuresis nocturia. Pre- and post-tests for ADHD were completed using Vanderbilt ADHD Diagnostic Teacher Rating Scale. The subject was treated with foot reflexotherapy for 20-min per session twice per week for a period of 8 weeks. RESULTS: The child showed improvement in ADHD symptoms and his enuresis nocturia disappeared completely after foot reflexotherapy. CONCLUSION: Foot reflexotherapy was effective in improving inattention, hyperactivity in the child with ADHD. The results of this novel study suggest that foot reflexotherapy can be effective in treating ADHD child with enuresis nocturia.

A double-blind randomized clinical trial on the efficacy of magnetic sacral root stimulation for the treatment of Monosymptomatic Nocturnal Enuresis.

PURPOSE: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE). METHODS: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions. RESULTS: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group. CONCLUSION: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.

"Nobody asked us if we needed help": Swedish parents experiences of enuresis.

OBJECTIVE: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals. SUBJECTS AND METHODS: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation. RESULTS: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers. CONCLUSION: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families.

[Professor LI Rui's mind regulation theory in the clinical application of acupuncture and moxibustion].

The experience in the clinical application of Professor LI Rui's "mind regulation" theory is introduced in the paper. The substantial foundation of mind and the brief understanding of "mind derangement" are explained and the content of the theory of mind regulation in acupuncture and moxibustion is explained in detail. It is important to emphasize the mind regulation in the heart, brain and spleen as well as the promotion of qi activity.

Differentiation of subgroups of monosymptomatic enuresis according to prepulse inhibition of the startle reflex.

AIM: Monosymptomatic enuresis (ME) is a common disorder in children with serious social and psychological consequences. Treatment is usually initiated with desamino-arginine vasopressin (dDAVP) and/or alarm therapy as first-line treatment and imipramine as second-line. All treatments have proven efficacy, but are not successful with all patients. Therefore, a differentiation into subgroups according to treatment efficacy would be beneficial. METHODS: A group of patients resistant to first-line treatment was treated with imipramine and compared with matched controls successfully treated with dDAVP and/or alarm therapy. Prepulse inhibition (PPI) to acoustic startle reflexes was measured in all patients. RESULTS: In a group of 23 nonresponders, the median PPI was 72% (range 43-94%) compared with the matched dDAVP/alarm - responders with a median PPI of 26% (range 0-61%) (p < 0.0001). The response rate to imipramine was 87%. CONCLUSION: The presented data provide evidence that PPI allows to identify two subgroups of ME. The results offer further insight into (at least) two different pathomechanisms involved in ME: (i) a maturational delay of reflex inhibition with reduced PPI and (ii) a normal PPI, possibly with abnormal sleep patterns, that can be influenced by imipramine.

Twelve-year experience with Hinman-Allen syndrome at a single center.

OBJECTIVE: To report the long-term follow-up results of patients with Hinman-Allen syndrome (HAS) at our institution. METHODS: The data from 22 children with HAS were retrospectively analyzed. The patients were followed up every 3-6 months with serial physical examinations, voiding charts, urine culture, postvoid residual urine volume determination, serum creatinine measurement, and urinary imaging. The follow-up time was calculated from the day of the first visit to the day of the latest dimercaptosuccinic acid scan. Urotherapy, pharmacotherapy, clean intermittent catheterization, biofeedback therapy, and surgery were performed sequentially and/or combined, depending on the disease course. Renal deterioration was defined as any presence of a new scar or cortical thinning compared with the findings from the first dimercaptosuccinic acid scan. Upper urinary tract deterioration was defined as the persistence or progression of hydronephrosis on ultrasonography. RESULTS: The mean age at referral was 9.18 ± 3.36 years (range 2-14), and the mean follow-up period was 80.90 ± 19.57 months (range 54-144). Conservative therapy resulted in improvement of the bladder function in 14 patients; however, 8 patients required surgery owing to failure of this approach. Asymptomatic bacteriuria developed in one half of the children (n = 11, 50%), and in 6 (22.7%), ≥1 febrile urinary tract infection developed. None of the patients had upper urinary tract deterioration; however, renal deterioration developed in 3 patients (13.6%). The mean creatinine levels had remained stable at the end of the follow-up. CONCLUSION: Close follow-up at a single institution and proactive treatment resulted in successful stabilization of HAS in most of our children with HAS.

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)

[Efficacy of the pharmacotherapy of secondary enuresis in children].

43 children, 8-16 years old, suffering from secondary nocturnal enuresis were treated using different schemes. The most effective treatment of patients with only nocturnal enuresis was using a complex of nootropic psychostimulant medications (Fesam, B vitamins, apilak, Ca Glycerophosphat) with xanthinol nicotinat and combined treatment with the help of day-light therapy (motivating and regimen measures).