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.

Wilson disease patient with rare heterozygous mutations in ATP7B accompanied by distinctive nocturnal enuresis: A case report.

INTRODUCTION: Wilson disease (WD) is an autosomal-recessive disorder of copper metabolism, which exhibits various symptoms due to the combination of environmental and genetic factors. Here, we report a WD patient who displayed distinctive symptom of nocturnal enuresis. PATIENT CONCERNS: The patient was a 31-year old woman, who recently developed nocturnal enuresis, combined with hand tremors, trouble speaking, and panic disorder at night. DIAGNOSIS: The patient had been diagnosed with WD by Kayser-Fleischer rings, abnormal copper metabolism, neuropsychiatric symptoms, and magnetic resonance imaging when she was 17. The diagnosis was further confirmed by genetic analysis, which revealed a compound heterozygous mutations in ATP7B gene (c.2195T>C and c.3044T>C). The patient exhibited nocturnal enuresis, but the ambulatory electroencephalogram, routine urinalysis, residual urine detection, color doppler ultrasound of kidney, ureter, and bladder all displayed no abnormality. INTERVENTIONS: The patient was treated with sodium dimercaptosulphonate, supplemented with Glutathione and Encephalin-inosine. OUTCOMES: The urinary copper excretion level decreased gradually, and the nocturnal enuresis was alleviated along with the neuropsychiatric symptoms by copper chelation therapy. CONCLUSION: In this study, we proved that variants c.2195T>C and c.3044T>C is involved in pathogenesis of WD, and revealed that nocturnal enuresis may be a symptom of WD.

Outcome of a standardized approach to childhood urinary symptoms-long-term follow-up of 720 patients.

AIMS: To investigate the relevance of enuresis subtyping for selection of treatment modality and for long-term outcome in a large consecutive patient cohort. MATERIALS AND METHODS: We included all patients referred for urinary incontinence during a 5-year period but excluding recurrent urinary tract infections (UTI). Type and severity of incontinence, prior history, results of examinations performed, number of visits, and effect of all treatments provided, were included in a clinical database. RESULTS: Seven hundred twenty children aged 4-16 years (mean 8.5 ± 2.2 years, 239 girls) were included in the analysis (42% with monosymptomatic (MNE), 55% with non-MNE, and 3% with isolated daytime incontinence). Initial evaluation revealed only few underlying causes (one neurological and eight anatomical). Investigations showed significant differences between MNE and non-MNE patients as both maximal voided volume and nocturnal urine volume was lower in non-MNE patients (P < 0.001). Follow-up for average 1,587 days (3.4 years) was performed in 660 (92%) patients. A higher number of visits and a longer treatment period were needed for non-MNE patients (on average 4.7 ± 2.8 visits) than MNE patients (3.1 ± 1.6 visits, P < 0.001). The most common treatment regimen that resulted in dryness in both MNE (40%) and non-MNE (36%) was the alarm system. Interestingly, of the 539 patients who initially were referred due to desmopressin resistance 177 (33%) of these were dry on desmopressin monotherapy. CONCLUSIONS: The study indicated that MNE and non-MNE are two distinct disease entities with different optimal treatments and showed that the latter patients are more difficult and time-consuming to manage.

Enuresis nocturna y sindrome de disfunción evacuatoria en niños varones: respuesta al tratamiento con biofeedback urinario de vaciado / Nocturnal enuresis and voiding dysfunction syndrome in boys: response to treatment with biofeedback urinary drainage

La enuresis o síndrome de la "cama mojada" representan un porcentaje importante de la consulta diaria del pediatra y del urólogo pediatra. Se estima que entre el 15 y el 20% de los niños a los 5 años de edad mojan la cama (Moffatt 1994). El Síndrome de disfunción evacuatoria se asocia con mucha frecuencia a niñas enuréticas nocturnas. De los niños varones enuréricos un 20.9% presenta además incontinencia diurna y constipación. OBJETIVOS: demostrar que los niños enuréticos que asocian síntomas diurnos de incontinencia y constipación, presentan una incoordinación miccional por hábito retencionista y que mejoran con re-educación miccional mediante biofeedback de vaciado. MATERIAL Y METODOS: se estudiaron 50 niños que asociaban enuresis y síntomas diurnos de inestabilidad vesical y constipación. Fueron tratados mediante biofeedback urinario de vaciado, enseñando a los pacientes a relajar su periné durante la micción. Estadísticamente los resultados se obtuvieron con una alfa de 0.005 y una beta de 0.30. El delta observado en estudios previos fue bastante amplio de que no permitió obtener un power o poder del 70% con el estuido de 50 pacientes. RESUTLTADOS: La enuresis nocturna mejoró un 86%(p=<0,001), la urgencia mejoró del 98% al 8% y la incontinencia diurna paso de 7,22 veces por día a 0,36.(p=<0,001). La constipación mejoró de un promedio de 4,34 deposiciones por semana a 6,44(p=<0,001). CONCLUSIONES: El biofeedback urinario de vaciado resulto útil en el tratamiento de la enuresis y síntomas de vejiga hiperactiva así como de la constipación en niños portadores de síndrome de disfunción evacuatoria. No hubo diferencias significativas entre los resultados obtenidos en las dos primeras semana de tratamiento y al final (7 meses) lo que muestra la persistencia de los resultaods durante este tiempo...

Enuresis nocturna y sindrome de disfunción evacuatoria en niños varones: respuesta al tratamiento con biofeedback urinario de vaciado / Nocturnal enuresis and voiding dysfunction syndrome in boys: response to treatment with biofeedback urinary drainage

La enuresis o síndrome de la "cama mojada" representan un porcentaje importante de la consulta diaria del pediatra y del urólogo pediatra. Se estima que entre el 15 y el 20% de los niños a los 5 años de edad mojan la cama (Moffatt 1994). El Síndrome de disfunción evacuatoria se asocia con mucha frecuencia a niñas enuréticas nocturnas. De los niños varones enuréricos un 20.9% presenta además incontinencia diurna y constipación. OBJETIVOS: demostrar que los niños enuréticos que asocian síntomas diurnos de incontinencia y constipación, presentan una incoordinación miccional por hábito retencionista y que mejoran con re-educación miccional mediante biofeedback de vaciado. MATERIAL Y METODOS: se estudiaron 50 niños que asociaban enuresis y síntomas diurnos de inestabilidad vesical y constipación. Fueron tratados mediante biofeedback urinario de vaciado, enseñando a los pacientes a relajar su periné durante la micción. Estadísticamente los resultados se obtuvieron con una alfa de 0.005 y una beta de 0.30. El delta observado en estudios previos fue bastante amplio de que no permitió obtener un power o poder del 70% con el estuido de 50 pacientes. RESUTLTADOS: La enuresis nocturna mejoró un 86%(p=<0,001), la urgencia mejoró del 98% al 8% y la incontinencia diurna paso de 7,22 veces por día a 0,36.(p=<0,001). La constipación mejoró de un promedio de 4,34 deposiciones por semana a 6,44(p=<0,001). CONCLUSIONES: El biofeedback urinario de vaciado resulto útil en el tratamiento de la enuresis y síntomas de vejiga hiperactiva así como de la constipación en niños portadores de síndrome de disfunción evacuatoria. No hubo diferencias significativas entre los resultados obtenidos en las dos primeras semana de tratamiento y al final (7 meses) lo que muestra la persistencia de los resultaods durante este tiempo...(AU)