Effect of traditional Chinese medicine Zhiyi decoction and acupuncture on serum ADH & inflammatory factors in patients of enuresis.

.This study was designed to investigate the curative effect of traditional Chinese medicine Zhiyi decoction combined with acupuncture in the treatment of enuresis and its influence on serum ADH and inflammatory factors. A total of 84 enuresis patients treated were selected as cases from September 2014 to January 2017, randomly divided into study and control group with 42 cases each. The control group was treated with traditional Chinese medicine Zhiyi decoction while the study group was treated with traditional Chinese medicine Zhiyi decoction combined with acupuncture. The clinical efficacy and levels of serum ADH, serum inflammatory factors (TNF-α and IL-6) were compared between two groups before and after treatment. In study group, there were 34 cases cured and 5 cases were improved. Total effective rate was 92.9% and recurrence rate was 4%. In control group, there were 23 and 7 cases cured and improved respectively. Total effective rate was 71.4% and recurrence rate was 14.3%. The total efficiency of study group was significantly higher than that of control group (P<0.05), and the recurrence rate was significantly lower than control group (P<0.05). After treatment, there was no significant change in ADH level of study group at 10am and 11pm (P>0.05). In control group, the level of ADH at 11pm before treatment was lower than that after treatment (P<0.05) and the level of ADH at 10am before treatment was not significantly different from that after treatment (P>0.05). The levels of serum TNF-α and IL-6 in study group and control group decreased at 10am and 11pm after treatment (P<0.05) There was no significant difference in serum TNF-α and IL-6 levels between study group and control group before treatment (P>0.05). Compared with simple acupuncture, traditional Chinese medicine Zhiyi decoction combined with acupuncture of children had more exact effect, changed enuresis symptoms effectively.

Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment.

CONTEXT: Enuresis is a common and possibly underestimated condition. While 5-10% of school-aged children suffer from the condition, a lack of background knowledge may impede timely child-adapted and successful therapy. OBJECTIVE: To provide a comprehensive overview of the pathophysiology, diagnosis, and treatment of enuresis. EVIDENCE ACQUISITION: Guideline and position papers from the European Society of Pediatric Urology, the European Association of Urology, and the International Children's Continence Society were acquired. PubMed was searched for literature on enuresis, and all papers published in the last 5 yr were considered. The most relevant information from the papers with the highest level of evidence was extracted and incorporated into the review. EVIDENCE SYNTHESIS: An altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation are the main pathophysiological factors in primary enuresis. Coexisting constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions influence its prevalence. Diagnosis relies on history-taking and simple noninvasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms. It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections. Further imaging is indicated in complex cases with a suspicion of underlying congenital malformations or systemic or endocrine diseases and in children refractory to initial therapy. In secondary enuresis, psychological causes should also be taken into consideration. While desmopressin melt tablets and alarm systems constitute the mainstays of treatment in monosymptomatic enuresis, anticholinergics and urotherapy play an additional role in nonmonosymptomatic enuresis. For therapy-refractory cases, after a thorough re-investigation to identify any missed comorbidities and anatomical or functional causes of enuresis, combination therapy and stationary urotherapy might be promising options. CONCLUSIONS: While enuresis seems to be an often underestimated condition in terms of the suffering that children and their families, there are efficacious therapy options once a correct and full diagnosis is made. PATIENT SUMMARY: This article reviews primary and secondary nocturnal enuresis, which is the medical term for the condition whereby children wet their beds regularly after their first birthday. We describe the background of enuresis,including its complex underlying mechanisms, as well as diagnosis and treatment in the light of current scientific publications. We conclude that while enuresis seems to be an often underestimated condition in terms of the suffering that children and their families may undergo, there are efficacious therapy options once a correct and full diagnosis is made.

Neurostimulation Therapy for Pediatric Primary Enuresis: A Meta-analysis.

OBJECTIVE: To assess the efficacy and safety of neurostimulation compared with control groups in the treatment of pediatric primary enuresis by performing meta-analysis of randomized controlled trials (RCTs). METHODS: A systematic literature search with no language restriction was performed in August 2016. RCTs were identified and evaluated according to the Cochrane Collaboration risk of bias assessment recommendations. The number of patients with post-treatment responses such as partial response (PR) (50%-89%), complete response (CR) (≥90%), and full response (FR) (100%) were extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled using the Mantel-Haenszel method. The review protocol was registered in the PROSPERO registry (CRD42016043502). RESULTS: A total of 292 subjects from 7 nonheterogeneous RCTs were included for meta-analysis. Pooled effect estimate of subjects with ≥50% post-treatment wet-night reduction (PR, CR, and FR) showed a significantly better outcome after neurostimulation compared with controls (RR = 2.20, 95% CI 1.66, 2.90), whereas patients with ≥90% post-treatment wet-night reduction (CR and FR) showed a significantly better outcome in the neurostimulation groups (RR = 2.79, 95% CI 1.54, 5.06). Furthermore, a significant mean difference in wet-night reduction per week was noted between treatment groups in favor of neurostimulation treatment (mean difference -1.95, 95% CI -2.84, -1.07). No serious adverse effects were noted related to neurostimulation therapy. CONCLUSION: Current evidence suggests that neurostimulation therapy is efficacious and safe for the treatment of PPE. Head-to-head randomized clinical trials are needed to further assess relative efficacy among variable treatment protocols.

Biofeedback animado para el tratamiento de la micción disfuncional / Animated biofeedback for the dysfunctional voiding syndrome

Objetivos. Se pretende analizar resultado clínico y electromiográfico del tratamiento de la micción disfuncional (MD) con Biofeedback (Bfb) animado. Además, se estudia si existen variables clínicas o electromiográficas asociadas a mayor tasa de éxito. Pacientes y métodos. Se realizó corte transversal de pacientes con MD, que en 2010- 2015 siguieron programa de Bfb animado. El control post-tratamiento se realizó con Uroflujometría más Electromiografía y cuestionario validado. Se excluyeron los pacientes con mielodisplasia, malformaciones anatómicas, y a los que recibieron menos de 3 sesiones. Las variables clínicas estudiadas fueron: edad, número de sesiones, fugas diurnas, enuresis nocturna, estreñimiento, ITU, RVU. Las flujométricas fueron: morfología de curvas, electromiograma, flujos, y residuo postmiccional (RPM) elevado. Resultados. De 37 pacientes que recibieron Bfb, se seleccionaron 27 niñas que cumplieron criterios de inclusión. Edad media: 7,8 años (DE: 2,5). Doce (44%) presentaron hiperactividad del detrusor asociado a la MD. De manera global, todos los parámetros clínicos y flujométricos mejoraron. Clínicamente 33,5% presentó resolución completa de síntomas y el 37% mejoraron (desaparecieron más del 50% de los síntomas según criterios ICCS). El 29% no presentó mejoría. Electromiográficamente el 74% logró flujometrías normales. El estreñimiento al inicio del estudio se asocia a tasas menores de éxito (curación: 13 vs. 58%, p= 0,019; curación + mejoría: 60% vs. 83% p > 0,05). La ausencia de RPM al final del estudio se relacionó con la mejoría clínica (curación: 66,7% vs. 0%, p= 0,012; curación + mejoría: 89% vs. 60%, p > 0,05). Conclusiones. El Bfb en la micción disfuncional proporciona tasas de curación/mejoría clínica y de resolución electromiográfica del 69 y 74%, respectivamente. La ausencia de estreñimiento se asocia a mayores tasas de éxito. La persistencia de clínica se relaciona con RPM elevado post-tratamiento

Objectives. To analyze clinical and electromyographic treatment outcome of dysfunctional voiding (DV) with animated Biofeedback (Bfb). Clinical or electromyographic variables associated with higher success rate were checked. Patients and Methods. Cross-sectional study of patients with DV, that in 2010- 2015 followed animated Bfb program. Efficacy was measured with Uroflowmetry, Electromyography (EMG) and validated clinical questionnaire. Inclusion criteria: no myelodysplasia, no anatomical malformations and a minumin of 3 Bfb sessions. Clinical variables: age, number of sessions, daytime leaks, nocturnal enuresis, constipation, UTI, VUR. Flow measurement variables: morphology of curves, electromyogram, flows, and elevated post void residual (PVR). Results. Of 37 patients who received Bfb, 27 girls who met inclusion criteria were selected. Mean age: 7.8 years (2.5). Twelve (44%) had detrusor overactivity on urodynamics concomitantly. Globally, all clinical and flowmetry parameters improved. Clinically 33.5% had complete resolution of symptoms, 37% improved (> 50% of symptoms according to criteria ICCS) and 29% had no improvement. In EMG, 74% achieved normal perineal relaxation. Constipation at baseline is associated with lower rates of success (cure: 13 vs. 58%, p = 0.019; cure + improvement: 60% vs. 83% p> 0.05). The absence of RPM at the end of the study was associated with clinical improvement (cure: 66.7% vs. 0%, p = 0.012; cure + improvement: 89% vs. 60%, p> 0.05). Conclusions. Bfb in DV provides cure or improvement and electromyographic resolution are 69 and 74% respectively. The absence of constipation is associated with higher success rates. The High RPM correlates with persistence of clinics

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 and more.

We describe Pervasive Refusal Syndrome, an important but rare, debilitating condition that may present to paediatric services. Although previous reports have described improvement seen with care delivered in the mental health setting, we have demonstrated treatment predominately delivered in a paediatric ward environment associated with successful recovery.

Transcutaneous parasacral electrical neural stimulation in children with primary monosymptomatic enuresis: a prospective randomized clinical trial.

PURPOSE: Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. MATERIALS AND METHODS: This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 µs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. RESULTS: Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). CONCLUSIONS: Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.

Prospective evaluation of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.

PURPOSE: We conducted a prospective controlled study evaluating the results of a clinical voiding reeducation program (voiding school) for treatment of lower urinary tract conditions in children compared to no treatment. MATERIALS AND METHODS: A total of 38 children with nonneurogenic lower urinary tract conditions were included in the study. Controls, consisting of 15 children on the waiting list for the same program, received no treatment. The clinical voiding reeducation program consisted of instruction on voiding and drinking, individualized voiding diaries, pelvic floor biofeedback training, uroflowmetry, alarm therapy, cognitive therapy and psychological support. Data on voiding, drinking, pelvic floor control, voided volume, uroflow, incontinence and stool habits were gathered before the program, during the program and 6 months after the program. In the control group the same data were gathered. RESULTS: In the study group a positive effect of voiding school was observed in 92% of children, with 42% becoming completely dry, 24% improving from incontinence during the day and night to incontinence during the day or night only, and 26% remaining incontinent. In all patients the number and amount of incontinence episodes decreased. In the control group no differences were observed between the start of study and 6 months later. The study group did significantly better on voided volume and incontinence compared to controls. CONCLUSIONS: In this prospective controlled study a positive effect was noted on voided volume and incontinence with a clinical voiding reeducation program (voiding school).

An 8-year-old boy with treatment-resistant encopresis.

CASE: Paul is an 8-year-old boy with a long-standing history of encopresis and enuresis. Potty training was initiated when he was 2(1/2) years old. At this time, his mother was absent from the home for 6 weeks when she cared for her ill father in a different city. The process of teaching Paul to use the bathroom was described as "inconsistent" due to multiple caretakers.Paul never successfully mastered bowel and bladder control. He continues to wet and soil his clothes on a daily basis at home and school. According to his parents, he does not accept responsibility and comments about his soiling such as, "I didn't do it; someone else must have put it there." One of Paul's teachers commented that she could tell at the beginning of the school day whether he would maintain bowel and bladder control. If he was "agitated and talkative" in the early morning, he would often soil that day.He had a pediatric gastroenterological evaluation at the age of 5 years when he was having daily episodes of stool soiling. Physical examination revealed normal anal tone, normal placement of the anus, and moderate stool in the rectal vault. An abdominal radiograph revealed moderate stool throughout the colon. He was treated with Miralax and instructed to sit on the toilet twice daily. Paul did not respond to these interventions and was diagnosed with "overflow incontinence secondary to stool withholding." When he was taking Miralax, he had a normal barium enema radiograph. He was admitted to the hospital for a clean out with a polyethylene glycol/electrolyte solution. Although abdominal radiographs demonstrated absence of colonic stool for the following 5 months, he continued to soil his clothing. Play therapy and biofeedback did not change the chronic soiling and wetting pattern. An evaluation at the Continence Clinic resulted in a rigorous program including stooling after each meal, wearing a vibrating watch reminding him to void every 2 hours, drinking 60 ounces of water per day, tracking elimination patterns on a calendar, and a daily laxative (polyethylene glycol). A neuropsychological evaluation revealed a superior aptitude associated with unresolved early childhood issues of self-control, self-care, and frustration tolerance. Family therapy was initiated. However, daily fecal soiling and wetting persisted.Paul was born full-term without prenatal or perinatal complications. He was breast fed for 1 year and described as an easy baby. He achieved motor, social, and language milestone on time. Paul had difficulty with separation and aggression in preschool (e.g., biting). In school, teachers report inattention, fidgetiness, and difficulty following directions. He has been obese since age 3 years; his current body mass index is 29.

Eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes / Effectiveness of the hypnotherapy against the nocturnal enuresis in children and adolescents

Se realizó un ensayo terapéutico en fase III para evaluar la eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes remitidos con ese diagnóstico a la Clínica de Hipnosis de Santiago de Cuba durante el período comprendido de enero a octubre del 2006, previa valoración de la causa del trastorno (no orgánica) por pediatras, urólogos, psiquiatras, neurólogos y psicólogos. El tratamiento basado en la hipnosis fue tan eficaz para eliminar esa molestia como el medicamentoso con imipramina, pero en el primer caso no se produjeron efectos adversos.

A therapeutic trial in phase III was carried out to evaluate the effectiveness of hypnotherapy against nocturnal enuresis in children and adolescents referred with that diagnosis to the Hypnosis Clinic from Santiago de Cuba during the period from January to October, 2006, with a previous evaluation of the cause of the dysfunction (not organic) by pediatricians, urologists, psychiatrists, neurologists and psychologists. The treatment based on hypnosis was as effective to eliminate that disorder as the drug therapy with imipramine, but in the first case adverse effects did not take place.

Eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes / Effectiveness of the hypnotherapy against the nocturnal enuresis in children and adolescents

Se realizó un ensayo terapéutico en fase III para evaluar la eficacia de la hipnoterapia contra la enuresis nocturna en niños y adolescentes remitidos con ese diagnóstico a la Clínica de Hipnosis de Santiago de Cuba durante el período comprendido de enero a octubre del 2006, previa valoración de la causa del trastorno (no orgánica) por pediatras, urólogos, psiquiatras, neurólogos y psicólogos. El tratamiento basado en la hipnosis fue tan eficaz para eliminar esa molestia como el medicamentoso con imipramina, pero en el primer caso no se produjeron efectos adversos(AU)

A therapeutic trial in phase III was carried out to evaluate the effectiveness of hypnotherapy against nocturnal enuresis in children and adolescents referred with that diagnosis to the Hypnosis Clinic from Santiago de Cuba during the period from January to October, 2006, with a previous evaluation of the cause of the dysfunction (not organic) by pediatricians, urologists, psychiatrists, neurologists and psychologists. The treatment based on hypnosis was as effective to eliminate that disorder as the drug therapy with imipramine, but in the first case adverse effects did not take place(AU)

[Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis]. / Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática.

AIM: To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. METHODS: We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34 boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction (DSD) (47 patients), detrusor overactivity (DO) (25 patients), urge syndrome (US) (15 patients), sphincter hypertony (SH) (10 patients) and "retentionist" bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20 minutes each session) with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week, 30 minutes each session). RESULTS. The success rate has been 78.9% in DSD group, 80% in DO group, 85% in US group, 75% in SH group, 100% in RB group. CONCLUSIONS: Effectiveness of biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time.

Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática / Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis

Objetivo. Mostrar nuestra experiencia con las técnicas de biofeedbacky electro estimulación en el tratamiento de la enuresis no monosintomática. Material y métodos. Se analizaron los datos de 99 niños atendidos entre 1995 y 2000 por enuresis no monosintomática con edades comprendidas entre 5 y 14 años (65 niñas y 34 niños). Se les realizó estudio urodinámico completo para definir a los pacientes en cinco grupos: disfunción vesicoesfinteriana (47 pacientes), hiperactividad de detrusor (25 pacientes), urgencia sensorial (15 pacientes), hipertonía de esfínter (10 pacientes) y vejiga “retencionista” (2 pacientes). Se consideró como éxito menos de 3 noches húmedas al mes. El biofeedbacky la electroestimulación consistieron en 10 sesiones semanales de20 minutos con el equipo SIGMAX-Biomedical. Se indicó estimulación tibial en patologías en las que fracasaron tratamientos anteriores(12 sesiones de 30 minutos con el equipo SANS de UroSurge).Resultados. El éxito al fin del tratamiento fue del 78,9% en la disfunción vesicoesfinteriana, del 80% en la hiperactividad del detrusor, del 85% en la urgencia sensorial, del 75% en la hipertonía de esfínter y del 100% en la vejiga “retencionista”.Conclusiones. Los llamados “tratamientos alternativos” como el biofeedback y la electro estimulación son eficaces en el tratamiento dela enuresis no monosintomática. Esta eficacia se mantiene en el tiempo y es independiente de la disfunción miccional hallada (AU)

Aim. To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. Methods. We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction(DSD) (47patients), detrusor over activity (DO) (25 patients), urge syndrome(US) (15 patients), sphincter hypertony (SH) (10 patients) and “retentionist” bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20minutes each session)with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week,30 minute seach session).Results. The success rate has been 78,9% in DSD group, 80% in DO group , 85% in US group, 75% in SH group, 100% in RB group. Conclusions. Effectiveness of biofeedback and electrostimulation echniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time (AU)

Secondary diurnal enuresis treated with hypnosis: a time-series design.

A case of secondary diurnal enuresis (SDE) after a car accident was treated with hypnosis by means of the Hypnotic Trauma Narrative, an instrument created by the authors for use with children who have been exposed to traumatic events and develop either classic symptoms of posttraumatic stress disorder or manifest other psychosomatic symptoms. An ABAB time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of diurnal incontinence. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Hypnosis with the Hypnotic Trauma Narrative was deemed efficacious as a method for the treatment of secondary diurnal enuresis. The patient was symptom-free at follow-up 6 months later.