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1.
Sleep Med Clin ; 19(1): 169-176, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38368063

RESUMEN

This article reports on the epidemiology, prevalence, and physiopathology of sleep-related urinary dysfunction, a new syndromic category proposed by the recently revised ICSD-3-TR classification. Sleep enuresis, whether primary or secondary, monosymptomatic or plurisymptomatic, will be reviewed in terms of risk factors, comorbidity, and diagnostic and therapeutic indications. A definition of nocturia and its impact on patients' health, quality of life, and mortality will follow. Finally, the impact of urge incontinence on various medical and neurologic disorders will be discussed. Special emphasis will be placed on the possible association of this parasomnia with several sleep disorders and poor, fragmented sleep.


Asunto(s)
Nocturia , Enuresis Nocturna , Trastornos del Sueño-Vigilia , Humanos , Calidad de Vida , Enuresis Nocturna/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/terapia , Sueño
2.
Int Braz J Urol ; 50(2): 136-151, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38386785

RESUMEN

BACKGROUND: Parasacral Transcutaneous Electrical Nerve Stimulation (PTENS) is a treatment used in enuresis refractory to first-line treatment. This review aimed to evaluate the effectiveness of PTENS in treating monosymptomatic enuresis (MNE) in children and adolescents. METHODS: The study followed the Preferred Reporting Items for Systematic (PRISMA) guidelines. The search was carried out in the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Central Cochrane Library and Physiotherapy Evidence Database (PEDro). The selected studies were randomized clinical trials (RCTs). The "Risk of Bias tool for randomized trials" and the "Risk of Bias VISualization" were used to analyze the risk of bias. RESULTS: Of the 624 studies selected, four RCTs were eligible. Three included 146 children and adolescents aged between six and 16.3 years and used similar PTENS protocols with a frequency of 10 Hz, pulse duration of 700 µs and 20 minutes three times/week. One study enrolled 52 patients aged seven to 14 years used PTENS at home, with a pulse duration of 200 µs and 20 to 60 minutes twice/day. Risk of bias was observed in three studies due to results' randomization and measurement. Two studies showed a partial response with a reduction in wet nights, one a complete response in 27% of patients, and one showed no improvement. CONCLUSION: PTENS reduces wet nights' frequency but does not cure them, except in 27% of patients in one study. Limited RCTs and data heterogeneity are limitations.


Asunto(s)
Enuresis Nocturna , Estimulación Eléctrica Transcutánea del Nervio , Niño , Adolescente , Humanos , Lactante , Bases de Datos Factuales
3.
Int Braz J Urol ; 50(2): 192-198, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38386789

RESUMEN

PURPOUSE: One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. MATERIALS AND METHODS: ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. RESULTS AND CONCLUSION: ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.


Asunto(s)
Enuresis Nocturna , Médicos , Urología , Humanos , Inteligencia Artificial , Reproducibilidad de los Resultados
4.
Eur J Pediatr Surg ; 34(1): 84-90, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37595631

RESUMEN

INTRODUCTION: Nocturnal enuresis is a common yet quality-of-life-limiting pediatric condition. There is an increasing trend for parents to obtain information on the disease's nature and treatment options via the internet. However, the quality of health-related information on the internet varies greatly and is largely uncontrolled and unregulated. With this study, a readability, quality, and accuracy evaluation of the health information regarding nocturnal enuresis is carried out. MATERIALS AND METHODS: A questionnaire was administered to parents and patients with nocturnal enuresis to determine their use of the internet to research their condition. The most common search terms were determined, and the first 30 websites returned by the most popular search engines were used to assess the quality of information about nocturnal enuresis. Each site was categorized by type and assessed for readability using the Gunning fog score, Simple Measure of Gobbledygook (SMOG) index, and Dale-Chall score; for quality using the DISCERN score; and for accuracy by comparison to the International Children's Continence Society guidelines by three experienced pediatric urologists and nephrologists. RESULTS: A total of 30 websites were assessed and classified into five categories: professional (n = 13), nonprofit (n = 8), commercial (n = 4), government (n = 3), and other (n = 2). The information was considered difficult for the public to comprehend, with mean Gunning fog, SMOG index, and Dale-Chall scores of 12.1 ± 4.3, 14.1 ± 4.3, and 8.1 ± 1.3, respectively. The mean summed DISCERN score was 41 ± 11.6 out of 75. Only seven (23%) websites were considered of good quality (DISCERN score > 50). The mean accuracy score of the websites was 3.2 ± 0.6 out of 5. Commercial websites were of the poorest quality and accuracy. Websites generally scored well in providing their aims and identifying treatment benefits and options, while they lacked references and information regarding treatment risks and mechanisms. CONCLUSION: Online information about nocturnal enuresis exists for parents; however, most websites are of suboptimal quality, readability, and accuracy. Pediatric surgeons should be aware of parents' health-information-seeking behavior and be proactive in guiding parents to identify high-quality resources.


Asunto(s)
Comprensión , Enuresis Nocturna , Humanos , Niño , Enuresis Nocturna/terapia , Esmog , Internet , Motor de Búsqueda
5.
Neurourol Urodyn ; 43(1): 114-125, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37916430

RESUMEN

BACKGROUND: A higher incidence of lower urinary tract symptoms (LUTS) in people with schizophrenia compared to the general population is often suggested. However, it is not clear whether this is a genuine association, and whether it is a direct result of schizophrenia itself, or a side-effect of certain antipsychotics. METHODS: We undertook a narrative review evaluating how the published literature reports the relationship between LUTS and schizophrenia and its treatments. We searched Embase, Ovid Emcare, and Ovid MEDLINE(R) ALL to August 2022, limited to the English language. We selected the following search terms: schizophrenia, schizophrenic, LUTS, overactive bladder, urinary urgency, urinary incontinence, overactive bladder, enuresis, nocturnal enuresis, and voiding dysregulation. We identified seven domains for assessment in advance of commencing the review. These were the categorization, description, and treatment status of schizophrenia; evaluation of LUTS; categorization of LUTS confounders; recapturing of the disease states of both schizophrenia and LUTS after therapies; assessment of the association between LUTS and schizophrenia and/or antipsychotics. RESULTS: The association between LUTS and schizophrenia was poorly described. The evidence was low quality and focused predominantly on urinary incontinence as an antipsychotic side effect, neglecting other LUTS. The status of schizophrenia was often incompletely characterized, and no papers made use of a bladder diary or LUTS-specific questionnaires to assess symptoms. No papers collected information about LUTS in patients not on antipsychotics, nor did any thoroughly evaluate the influence of confounding variables. Despite the tendency of symptoms and severity of both conditions to fluctuate over time, no studies fully assessed the status of both schizophrenia and LUTS at baseline, therapy initiation, and follow-up. CONCLUSIONS: It is not possible to state whether there is an association between LUTS and schizophrenia or its treatments. This review highlights the need to improve research and clinical management of the urinary tract in schizophrenia, with meticulously designed longitudinal studies.


Asunto(s)
Síntomas del Sistema Urinario Inferior , Enuresis Nocturna , Esquizofrenia , Vejiga Urinaria Hiperactiva , Incontinencia Urinaria , Humanos , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/epidemiología , Esquizofrenia/complicaciones , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/epidemiología , Síntomas del Sistema Urinario Inferior/epidemiología , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Incontinencia Urinaria/epidemiología , Micción/fisiología , Enuresis Nocturna/complicaciones
6.
Acta Paediatr ; 113(3): 573-579, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37955310

RESUMEN

AIM: To look for predictors to response and adherence to the enuresis alarm while exploring the possibility of families managing therapy independently. METHODS: We used a body-worn alarm linked to a smartphone app. Subjects with enuresis were recruited both via paediatric nurses and independently as families bought the alarm and downloaded the app on their own. RESULTS: We recruited 385 nurse-supported and 1125 independent subjects. Many (79.9%) dropped out before 8 weeks, but among adherent subjects 48.2% had a full or partial response. Age was a predictor of non-response (p = 0.019). Daytime incontinence did not influence response. If enuresis frequency did not decrease during the first 4 weeks of therapy the chance of response was very small (p < 0.001). Adherence was higher among subjects supported by a nurse (p < 0.001), but for adherent subjects the outcome was similar regardless of nurse support (p = 0.554). CONCLUSIONS: Daytime incontinence is no contraindication to enuresis alarm therapy. Treatment can be managed independently by the families, but adherence is enhanced by nurse support. Alarm treatment should be reassessed after 4 weeks. Enuresis alarm treatment guidelines need to be updated.


Asunto(s)
Enuresis , Enuresis Nocturna , Niño , Humanos , Enuresis/terapia , Enuresis Nocturna/terapia , Comportamiento del Consumidor , Desamino Arginina Vasopresina
7.
Physiother Res Int ; 29(1): e2048, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37664896

RESUMEN

BACKGROUND AND AIM: Nocturnal enuresis (NE) is prevalent in children and adolescents and affects their social life later. Therefore, the objective of this study was to ascertain laser acupuncture (LA) therapy's effect on NE in adolescent females. METHODS: Sixty adolescent females diagnosed with chronic monosymptomatic nocturnal enuresis (MNE) were randomly divided into two equal groups: The intervention group (received LA and desmopressin) and the control group (received desmopressin only) (n = 30 each). Treatment was delivered and LA was used three times a week for 12 successive weeks. Abdominal ultrasonography and voiding calendar were used to assess bladder capacity and maximum voiding volume (MVV), respectively. The frequency of bed wetness was assessed throughout the trial period in a diary. RESULTS: Statistically significant differences were reported in the intervention group. Bladder capacity significantly increased in the intervention group (LA and desmopressin) than in the control group. CONCLUSIONS: The results of this study suggest the beneficial influences of LA on MNE, despite the very poor quality of the literature's available evidence.


Asunto(s)
Terapia por Acupuntura , Enuresis Nocturna , Niño , Humanos , Adolescente , Femenino , Enuresis Nocturna/terapia , Desamino Arginina Vasopresina/uso terapéutico , Terapia por Acupuntura/métodos , Rayos Láser
8.
Neurourol Urodyn ; 43(1): 183-195, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37787540

RESUMEN

OBJECTIVE: This pooled analysis aims to demonstrate the clinical efficacy and safety of combined desmopressin and anticholinergic therapy in the treatment of pediatric nocturnal enuresis (NE). METHODS: A systematic search was conducted through PubMed, MEDLINE, EMBASE, ResearchGate, and Cochrane Library to identify all randomized controlled trials (RCTs) comparing monotherapy with desmopressin versus combined therapy with desmopressin and anticholinergic agents for the treatment of NE. Data analysis was performed using RevMan version 5.4.1. RESULTS: This study included 8 RCTs involving a total of 659 patients. The frequencies of complete response (CR), partial response (PR), and nonresponse (NR) were computed for both short-term treatment (1 month) and long-term treatment (3 months). Additionally, alterations in the mean number of NE episodes, adverse events, and relapse were assessed. Our analysis indicates that, in comparison to the monotherapy group, the combination therapy group plays a pivotal role in augmenting the CR odds and diminishing the NR ratios in both short-term and long-term treatments (1 month CR ratio [risk ratio (RR): 1.84; 95% confidence interval (CI): 1.22-2.76; p = 0.003, I2 = 72%]; 3 months CR ratio [RR: 1.48; 95% CI: 1.25-1.76; p < 0.00001, I2 = 0%]; 1 month NR ratio [RR: 0.67; 95% CI: 0.55-0.82; p = 0.0001, I2 = 0%]; 3 months CR ratio [RR: 0.37; 95% CI: 0.19-0.73; p = 0.004, I2 = 0%]). Furthermore, in both short-term and long-term treatment, the combined therapy group exhibits a greater magnitude of change in the average number of NE episodes compared to patients receiving monotherapy (1 month, mean difference [MD] = -2.97; 95% CI: -4.23 to -1.71, p < 0.0001; 3 months, MD = -4.30; 95% CI: -7.18 to -1.43, p = 0.003). Moreover, the combination therapy group exhibits a significant reduction in the recurrence rate (RR: 0.36; 95% CI: 0.15-0.86; p = 0.02). There is no significant difference in the incidence of adverse events between the two groups (RR: 1.16; 95% CI: 0.58-2.31; p = 0.67). CONCLUSION: Combining desmopressin with anticholinergic medications is more effective for NE than desmopressin alone, with lower recurrence and minimal adverse effects.


Asunto(s)
Enuresis Nocturna , Niño , Humanos , Enuresis Nocturna/tratamiento farmacológico , Desamino Arginina Vasopresina/efectos adversos , Terapia Combinada , Quimioterapia Combinada , Antagonistas Colinérgicos/efectos adversos
9.
IEEE J Transl Eng Health Med ; 12: 204-214, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38088989

RESUMEN

Our study was designed to develop a customisable, wearable, and comfortable medical device - the text so-called "MyPAD" that monitors the fullness of the bladder, triggering an alarm indicating the need to void, in order to prevent badwetting - i.e., treating Nocturnal Enuresis (NE) at the text pre-void stage using miniaturised mechatronics with Artificial Intelligence (AI). The developed features include: multiple bespoke ultrasound (US) probes for sensing, a bespoke electronic device housing custom US electronics for signal processing, a bedside alarm box for processing the echoed pulses and generating alarms, and a phantom to mimic the human body. The validation of the system is conducted on the text tissue-mimicking phantom and volunteers using Bidirectional Long Short-Term Memory Recurrent Neural Networks (Bi-LSTM-RNN) and Reinforcement Learning (RL). A Se value of 99% and a Sp value of 99.5% with an overall accuracy rate of 99.3% are observed. The obtained results demonstrate successful empirical evidence for the viability of the device, both in monitoring bladder expansion to determine voiding need and in reinforcing the continuous learning and customisation of the device for bladder control through consecutive uses. Clinical impact: MyPAD will treat the NE better and efficiently against other techniques currently used (e.g., post-void alarms) and will i) replace those techniques quickly considering sufferers' condition while being treated by other approaches, and ii) enable children to gain control of incontinence over time and consistently have dry nights. Category: Early/Pre-Clinical Research.


Asunto(s)
Enuresis Nocturna , Niño , Humanos , Enuresis Nocturna/terapia , Inteligencia Artificial , Vejiga Urinaria , Micción , Redes Neurales de la Computación
10.
J Urol ; 211(3): 364-375, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38150394

RESUMEN

PURPOSE: Children referred to specialist outpatient clinics by primary care providers often have long waiting times before being seen. We assessed whether an individualized, web-based, evidence-informed management support for children with urinary incontinence while waiting reduced requests for specialist appointments. MATERIALS AND METHODS: A multicenter, waitlisted randomized controlled trial was conducted for children (5-18 years) with urinary incontinence referred to tertiary pediatric continence clinics. Participants were randomized to the web-based eHealth program electronic Advice and Diagnosis Via the Internet following Computerized Evaluation (eADVICE), which used an embodied conversational agent to engage with the child at the time of referral (intervention) or 6 months later (control). The primary outcome was the proportion of participants requesting a clinic appointment at 6 months. Secondary outcomes included persistent incontinence, and the Paediatric incontinence Questionnaire (PinQ) score. RESULTS: From 2018 to 2020, 239 children enrolled, with 120 randomized to eADVICE and 119 to the control arm. At baseline, participants' mean age was 8.8 years (SD 2.2), 62% were males, mean PinQ score was 5.3 (SD 2.2), 36% had daytime incontinence, and 97% had nocturnal enuresis. At 6 months, 78% of eADVICE participants vs 84% of controls requested a clinic visit (relative risk 0.92, 95% CI 0.79, 1.06, P = .3), and 23% eADVICE participants vs 10% controls were completely dry (relative risk 2.23, 95% CI 1.10, 4.50, P = .03). The adjusted mean PinQ score was 3.5 for eADVICE and 3.9 for controls (MD -0.37, 95% CI -0.71, -0.03, P = .03). CONCLUSIONS: The eADVICE eHealth program for children awaiting specialist appointments doubled the proportion who were dry at 6 months and improved quality of life but did not reduce clinic appointment requests.


Asunto(s)
Enuresis Nocturna , Telemedicina , Incontinencia Urinaria , Humanos , Niño , Masculino , Femenino , Calidad de Vida , Incontinencia Urinaria/terapia , Encuestas y Cuestionarios
11.
Acta Biomed ; 94(6): e2023223, 2023 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-38054679

RESUMEN

Nocturnal enuresis (NE) is a common condition in the pediatric age. NE is defined as an intermittent bedwetting with any frequency while sleeping in children. NE is classified into primary form (patient never had achieved nocturnal urinary control) or secondary form (children with a period of 6 consecutive months of night-time urinary control before incontinence, which is generally associated with organic or psychological causes). Moreover, NE could be monosymptomatic (MNE) or non-monosymptomatic (NMNE), depending on the presence of daytime incontinence or any other lower urinary tract symptoms (LUTS). We report a 7-year- old female with a history of recent onset of sphincter troubles and recurrent low urinary tract infections. She presented urinary urgency associated to daytime incontinence, bedwetting almost every night in the previous 3 months and sometimes encopresis. The physical and neurological examination was silent, no psychological or social problem intercurred. As first approach, she was treated with deamino-delta-D-arginine vasopressin (dDAVP) 120 mcg associated with oxybutynin 5 mg and educational therapy, for 3 months without benefits. So, she underwent a magnetic resonance imaging (MRI) of the spinal cord, that highlighted the presence of hydrosyringomyelia from D6 to D10, lipoma of the terminal filum and the presence of synovial cyst between L5-S1. This case remarks that in secondary NMNE, any possible organic cause must be investigated.


Asunto(s)
Enuresis Nocturna , Niño , Humanos , Femenino , Enuresis Nocturna/diagnóstico , Enuresis Nocturna/etiología , Enuresis Nocturna/terapia , Examen Físico
12.
Pediatr. catalan ; 83(4): 147-148, Oct.-Des. 2023.
Artículo en Catalán | IBECS | ID: ibc-229244
13.
Arq Gastroenterol ; 60(4): 410-418, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38018546

RESUMEN

BACKGROUND: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. OBJECTIVE: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). METHODS: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). RESULTS: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. CONCLUSION: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.


Asunto(s)
Enuresis Nocturna , Adolescente , Humanos , Niño , Masculino , Femenino , Enuresis Nocturna/diagnóstico , Enuresis Nocturna/terapia , Estreñimiento/complicaciones , Estreñimiento/diagnóstico , Estreñimiento/terapia , Defecación , Terapia Conductista
14.
Arch Esp Urol ; 76(7): 525-531, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37867338

RESUMEN

OBJECTIVE: This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). METHODS: From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. RESULTS: A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). CONCLUSIONS: Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE.


Asunto(s)
Enuresis Nocturna , Niño , Humanos , Enuresis Nocturna/diagnóstico , Enuresis Nocturna/terapia , Enuresis Nocturna/psicología , Desamino Arginina Vasopresina/uso terapéutico , Estudios Retrospectivos , Calidad de Vida , Vejiga Urinaria
16.
Investig Clin Urol ; 64(5): 501-509, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37668207

RESUMEN

PURPOSE: To investigate the treatment outcome of nocturnal enuresis (NE) according to first-morning urine osmolality (Uosm) before treatment. MATERIALS AND METHODS: Ninety-nine children (mean age, 7.2±2.1 y) with NE were enrolled in this retrospective study and divided into two groups according to first-morning Uosm results, that is, into a low Uosm group (<800 mOsm/L; 38 cases, 38.4%) or a high Uosm group (≥800 mOsm/L; 61 cases, 61.6%). Baseline parameters were obtained from frequency volume charts of at least 2 days, uroflowmetry, post-void residual volume, and a questionnaire for the presence of frequency, urgency, and urinary incontinence. Standard urotherapy and pharmacological treatment were administered initially in all cases. Enuresis frequency and response rates were analyzed at around 1 month and 3 months after treatment initiation. RESULTS: The level of first-morning Uosm was 997.1±119.6 mOsm/L in high Uosm group and 600.9±155.9 mOsm/L in low Uosm group (p<0.001), and first-morning voided volume (p=0.021) and total voided volume (p=0.019) were significantly greater in the low Uosm group. Furthermore, a significantly higher percentage of children in the low Uosm group had a response rate of ≥50% (CR or PR) at 1 month (50.0% vs. 24.6%; p=0.010) and 3 months (63.2% vs. 36.1%; p=0.009). CONCLUSIONS: Treatment response rates are higher for children with NE with a lower first-morning Uosm.


Asunto(s)
Enuresis Nocturna , Incontinencia Urinaria , Niño , Humanos , Preescolar , Enuresis Nocturna/terapia , Estudios Prospectivos , Estudios Retrospectivos , Concentración Osmolar
18.
Urology ; 182: 218-224, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37696309

RESUMEN

OBJECTIVE: To prospectively investigate the nocturnal bladder function and sleep in children with refractory primary monosymptomatic nocturnal enuresis (RPMNE). MATERIALS AND METHODS: Fifty-three children diagnosed with RPMNE and 30 controls who had upper urinary tract abnormality but without any voiding problems were included in the study. RPMNE patients underwent a standardized investigation protocol, including the Pittsburgh Sleep Quality Index (PSQI) questionnaire, a 7-day bladder diary, and the simultaneous ambulatory urodynamic monitoring and polysomnography (PSG); controls were evaluated using the PSQI questionnaire and PSG. RESULTS: The children with RPMNE were subdivided into the nocturnal detrusor overactivity (NDO) case group and the non-NDO case group. The children in the NDO case group had a higher percentage of total sleep time in light sleep and a lower percentage in the N3 sleep stage than those in the non-NDO case group and control group (P <.05). The cortical arousal index and PSQI scores of both RPMNE subgroups were higher compared to the control group (P <.05). The incidences of reduced nocturnal bladder capacity (NBC) in the NDO case group were higher than in the non-NDO case group (P <.05). The frequency of involuntary detrusor contractions during sleep was positively correlated with cortical arousal index in the NDO case group (r = 0.811, P <.0001). CONCLUSION: In addition to the reduced NBC, the RPMNE is related to abnormal NDO, increased light sleep period, and cortical arousal dysfunction. Moreover, there is a certain correlation between the abnormal degrees of NDO and cortical arousal dysfunction.


Asunto(s)
Enuresis Nocturna , Enfermedades de la Vejiga Urinaria , Niño , Humanos , Enuresis Nocturna/complicaciones , Vejiga Urinaria , Estudios Prospectivos , Sueño
19.
Arch. esp. urol. (Ed. impr.) ; 76(7): 525-531, 28 sept. 2023.
Artículo en Inglés | IBECS | ID: ibc-226431

RESUMEN

Objective: This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). Methods: From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. Results: A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). Conclusions: Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE (AU)


Asunto(s)
Humanos , Masculino , Femenino , Niño , Grupo de Atención al Paciente , Enuresis Nocturna/terapia , Resultado del Tratamiento , Estudios Retrospectivos
20.
Int Braz J Urol ; 49(5): 590-598, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37450772

RESUMEN

BACKGROUND: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.


Asunto(s)
Asma , Enuresis , Hipersensibilidad , Enuresis Nocturna , Niño , Humanos , Preescolar , Enuresis Nocturna/etiología , Enuresis Nocturna/terapia , Asma/complicaciones
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