Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial.

PURPOSE: This study aims to evaluate the impact of psychological intervention with parents of children with enuresis on treatment outcome. MATERIALS AND METHODS: A total of 66 children with enuresis were randomized into 2 groups. All children received urotherapy orientation and psychological counseling. Psychological intervention was performed with parents in the experimental group and not in the control group. All parents answered a questionnaire to evaluate violence against their children (Parent-Child Conflict Tactics Scale) and the Tolerance Scale. The Child Behavior Checklist was applied to evaluate behavior problems. Children responded to the Impact Scale and the Children and Youth Self-Concept Scale. Treatment results were assessed with a 14-day wet night diary. RESULTS: Mean age and gender were similar in both groups. Parent-Child Conflict Tactics Scale showed less violence after the treatment in the experimental group (p=0.007). The Tolerance Scale indicated that parents of children with enuresis were intolerant and that, after treatment, intolerance had a greater decrease in the experimental group (p <0.001). The Impact Scale showed that children suffer some impact from enuresis, and that in those in the experimental group this impact was smaller after treatment (p=0.008). No differences were seen in the Child Behavior Checklist or Children and Youth Self-Concept Scale after intervention. After treatment the percentage of dry nights had a greater improvement in the experimental group (52%, range 30% to 91%) than in the control group (10%, range 3% to 22.5%; p <0.001). Children in the experimental group had a 6.75 times greater chance of having a complete response to treatment. CONCLUSIONS: Psychological intervention with parents of children with enuresis during their treatment improved the percentage of dry nights and the impact of enuresis, while their parents started coping better with the problem and became more tolerant, reducing punishment toward their children.

Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Brazilian consensus in enuresis-recomendations for clinical practice.

INTRODUCTION: Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. MATERIALS AND METHODS: The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. RESULTS AND DISCUSSION: Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Enuresis Management in Children: Retrospective Clinical Audit of 2861 Cases Treated with Practitioner-Assisted Bell-and-Pad Alarm.

OBJECTIVE: To establish the treatment efficacy of practitioner-assisted bell-and-pad alarm therapy in children with enuresis between the ages of 5 and 16 years by retrospective medical chart review of 2861 children in multiple clinical settings. STUDY DESIGN: This review was conducted across 7 Australian clinical practices. The primary outcome measure was the time taken for children with either primary, secondary, monosymptomatic, or nonmonosymptomatic enuresis to be dry for 14 consecutive nights. The secondary outcome measure was to determine relapse rates, defined as 1 symptom recurrence per month post interruption of treatment. Data were analyzed by correlation and χ2 test via IBM SPSS Statistics (version 22). RESULTS: The overall success rate of the bell and pad treatment was 76%, irrespective of age. The mean treatment time to achieve dryness was 62.1 ± 30.8 days, and the relapse rate was 23%. Concurrent bowel dysfunction was associated with a slightly lower success rate (74%). Concurrent lower urinary tract symptoms were associated with a lower success rate (73%) and greater relapse (1.75 times more likely to relapse). Children with secondary enuresis had significantly greater success than those with primary enuresis (82% vs 74%). CONCLUSION: The type of alarm therapy reported in this study is highly effective. This study will provide the basis for clinical guidelines and practice tools for clinicians, which will help to reduce variation in care pathways for alarm treatment for enuresis.

Evaluación y tratamiento de la enuresis en niños y adolescentes / Evaluation and treatment of enuresis in children and adolescents

La enuresis, definida como incontinencia urinaria durante el sueño desde los 5 años de edad, es una condición frecuente y estresante que puede llegar a tener un impacto profundo en la conducta, bienestar emocional y vida social del niño o adolescente. El objetivo del presente trabajo es realizar una revisión narrativa de la evidencia en relación a la evaluación y tratamiento de la enuresis. La evaluación inicial debe ir dirigida a diferenciar entre los pacientes con enuresis monosintomática y no-monosintomática, excluir condiciones no funcionales que pueden presentarse como enuresis y detectar problemas psicológicos. Para que la terapia sea exitosa, se debe desarrollar un plan de manejo que sea apropiado para el paciente y su contexto. En el subgrupo de enuresis no-monosintomática, el tratamiento de los síntomas diurnos es necesario antes de iniciar el manejo de la enuresis. Existen diversas alternativas de tratamiento para la enuresis, sin embargo, la terapia de alarma y la desmopresina poseen amplia evidencia para su empleo como primera línea.

Enuresis, defined as urinary incontinence in children older than 5 years old, is a common and stressful condition that may cause deep consequences on the child or young person's behavior, emotional wellbeing and social life. The aim of this work is to make a narrative review of evidence on evaluation and treatment of enuresis. The initial assessment must differentiate between monosymptomatic and non-monosymptomatic enuresis, rule out non-functional conditions that can manifest as enuresis and detect psychological problems. In order to achieve a successful treatment, it is essential to develop a management plan according to the patient and its context. In non-monosymptomatic enuresis, it is necessary to treat daytime symptoms before management of bedwetting. There are many different therapeutic options for enuresis, nevertheless, alarm and desmopressin are evidence-based firstline treatments.

Enuresis en niños: frecuencia y antecedentes familiares / Enuresis in children: frequency and family history

La enuresis es una patología frecuente en pediatría, con potencial impacto en la calidad de vida del niño y sus padres. En Chile no existe literatura respecto al potencial efecto de esta patología en la dinámica familiar. El objetivo de este trabajo fue estimar la frecuencia de enuresis en una población de nivel socioeconómico medio-alto y describir los factores de riesgo familiares asociados y grado de preocupación de los padres respecto al tema. Método. Entre 2010 y 2011 se aplicó una encuesta voluntaria a los padres de pacientes atendidos ambulatoriamente en Clínica Las Condes. Se registraron los antecedentes de enuresis de los padres, número y edad de los hijos, número de hijos con enuresis, preocupación de los padres al respecto. Resultados. Se analizaron 334 familiares, que correspondieron a 499 niños mayores de cinco años, de los cuales 91 (18,2%) presentaron enuresis. El 57% de los pacientes con enuresis tenía antecedentes familiares, 58% correspondía al padre, 36% a la madre y 6% a ambos padres. El 51% de los padres reveló preocupación por este hecho. El grupo etario más afectado correspondió a niños de entre cinco y nueve años con un 38,8% de frecuencia, porcentaje bastante mayor al señalado por la literatura. Respecto a la herencia, un 57% tenía antecedentes familiares de padre y/o madre con enuresis.

Enuresis is a common condition in children, with potential impact on quality of life of children and their parents. In our country there is no literature on the potential impact of this disease on family dynamics. The aim of this study was to estimate the frequency of bedwetting in a population of middle-high socioeconomic level and describe the risk factors associated, family and degree of parental concern regarding the issue. Method: between 2010 and 2011 were surveyed parents of voluntary outpatients seen at Clinica Las Condes. We recorded the history of bedwetting parents, number and age of children, number of children with enuresis, parental concern about it. Results: We analyzed 334 families, which corresponded to 499 children over five years old., Ninety one (18.2%) had enuresis. 57% of patients with enuresis had a family history, 58% belonged to the father, the mother 36% and 6% both parents. 51% of parents showed concern about this. The most affected age group accounted for children between 5 and 9 years with a 38.8% rate, far higher percentage than that reported by the literature. Regarding inheritance, 57% had a family history of father and/or mother with enuresis.

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.

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)

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.

Tratamiento de la enuresis con moxa en niños. Cárdenas 2003-2004 / The enuresis treatment with moxa in children. Cárdenas 2003-2004

La enuresis es uno de los problemas más desconcertantes en la consulta del pediatra y el médico general integral. La bibliografía revisada plantea que ésta resuelve, en algunos casos, con la terapia occidental, aunque esta última ha perdido valor, porque un por ciento no soluciona el problema. Se ha aplicado la Medicina Natural y Tradicional (MNT) en diferentes formas y ha resultado eficaz en la eliminación de la enuresis. Se realizó un estudio prospectivo, longitudinal, con los pacientes que presentaron enuresis del policlínico José Antonio Echeverría, de Cárdenas, durante el año 2003. Hicimos un estudio para comparar los resultados obtenidos con los dos tipos de tratamiento; precisar el umbral de sensibilidad a la exposición de la moxa y determinar el tiempo más efectivo de tratamiento para la eliminación de la enuresis. Se escogieron 25 niños de 5 a 14 años de forma aleatoria como muestra, se dividieron en tres grupos, por condiciones del local, y se aplicó moxa indirecta. Todos estos niños fueron tratados previamente con terapia occidental. Los resultados obtenidos con ambos tratamientos, recogidos de las historias clínicas, fueron procesados en una Pentium 4 utilizando frecuencia absoluta y frecuencia porcentual. Encontramos que los niños de piel más oscura resisten más tiempo el calor, mayor frecuencia de la enuresis en el sexo masculino, una buena respuesta al tratamiento, con desaparición o mejoría de la misma al aplicar la moxibustión, en un período más corto que cuando se usa la terapia occidental en todos los casos estudiados

Tratamiento de la enuresis con moxa en niños. Cárdenas 2003-2004 / The enuresis treatment with moxa in children. Cárdenas 2003-2004

La enuresis es uno de los problemas más desconcertantes en la consulta del pediatra y el médico general integral. La bibliografía revisada plantea que ésta resuelve, en algunos casos, con la terapia occidental, aunque esta última ha perdido valor, porque un por ciento no soluciona el problema. Se ha aplicado la Medicina Natural y Tradicional (MNT) en diferentes formas y ha resultado eficaz en la eliminación de la enuresis. Se realizó un estudio prospectivo, longitudinal, con los pacientes que presentaron enuresis del policlínico José Antonio Echeverría, de Cárdenas, durante el año 2003. Hicimos un estudio para comparar los resultados obtenidos con los dos tipos de tratamiento; precisar el umbral de sensibilidad a la exposición de la moxa y determinar el tiempo más efectivo de tratamiento para la eliminación de la enuresis. Se escogieron 25 niños de 5 a 14 años de forma aleatoria como muestra, se dividieron en tres grupos, por condiciones del local, y se aplicó moxa indirecta. Todos estos niños fueron tratados previamente con terapia occidental. Los resultados obtenidos con ambos tratamientos, recogidos de las historias clínicas, fueron procesados en una Pentium 4 utilizando frecuencia absoluta y frecuencia porcentual. Encontramos que los niños de piel más oscura resisten más tiempo el calor, mayor frecuencia de la enuresis en el sexo masculino, una buena respuesta al tratamiento, con desaparición o mejoría de la misma al aplicar la moxibustión, en un período más corto que cuando se usa la terapia occidental en todos los casos estudiados.

The enuresis is one of the most disconcerting problems at the paediatric and integral general doctor's consult. The reviewed bibliography states that this is solved, in some cases, with the western therapy, although this therapy has lost value, because it does not solve the problem in some percentage of cases. Natural and traditional medicine has being applied in different ways, and it has being efficacious in the enuresis elimination. We made a longitudinal, prospective study of the patients presenting enuresis at the policlinic “José Antonio Echeverría”, of Cárdenas, during 2003. We made a study to compare the obtained results with both kinds of treatment; to precise the sensibility threshold to the moxa exposition and to determine the most effective treatment time for the enuresis elimination. As sample we chose 25 5-to-14-years-old children, divided in three groups, in dependence of the treatment place. Indirect moxa was applied. All of these children were previously treated with western therapy. The obtained results with both treatments, registered in the clinical records, were processed in a Pentium 4, using absolute and percentage frequency. We found that darker skin children resist heat more time; enuresis is more frequently in male sex; a good answer to the treatment, with enuresis disappearing or bettering when applying moxibustion, in a shorter period than when the western therapy is used in all the studied cases.

Diagnóstico e manejo das disfunções miccionais em crianças sem anormalidades neurológicas ou anatômicas / Diagnostic and management of mictional dysfunctions in children without neurological or anatomical abnormalities

As disfunções miccionais incluem a enurese, a urgência miccional, alterações funcionais do detrusor. Existem fatores comportamentais afetando o treinamento no uso de banheiro e há também inibição da maturação do controle urinário normal. O objetivo deste trabalho foi revisar o manehjo terapêutico de disfunções urinárias em crianças sem desordens neurológicas ou comprometimento anatõmico associados. Revisou-se a literatura médica atual, enfatizando metanalises, estudos randomizados e controlados, documentos da biblioteca digital Cochrane. Entre os tratamentos encontram-se medidas dietéticas, registro das micções, biofeedback, urofluxometria, eletromiografia, medicamentos, entre outros. Existem poucos estudos controlados, além de dificuldades metodológicas. Os resultados são muito próximos entre si quando comparados, sendo que alguns autores questionam a existência de evidências científicas para estes tratamentos.

Prevalence and associated factors of enuresis in Turkish children.

OBJECTIVE: Enuresis, which is frequently diagnosed amongst schoolchildren, is an important psychosocial problem for both parents and children. In the present study we aimed to determine the prevalence and associated factors of enuresis in Turkish children and to identify common methods for its management. MATERIALS AND METHODS: A cross sectional epidemiological study was performed among primary school children living in Ankara, Turkey. A self-administered questionnaire was prepared for this study and distributed to the parents of 1,500 schoolchildren whom aged 6-12 years. RESULTS: Of the 1,500 questionnaires distributed, 1,339 (89%) were completed. The overall prevalence of nocturnal and diurnal enuresis were 17.5%(n=234) and 1.9% (n=25), respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased number of people sleeping in the child's room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2%. The most preferred treatment option for enuresis was medications (59.5%), whereas alarm treatment was the least preferred (2.4%). CONCLUSIONS: Our results with enuresis prevalence and associated factors were comparable to other epidemiologic studies from various countries. Furthermore we demonstrated that families in Turkey do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.

Prevalence and associated factors of enuresis in turkish children

OBJECTIVE: Enuresis, which is frequently diagnosed amongst schoolchildren, is an important psychosocial problem for both parents and children. In the present study we aimed to determine the prevalence and associated factors of enuresis in Turkish children and to identify common methods for its management. MATERIALS AND METHODS: A cross sectional epidemiological study was performed among primary school children living in Ankara, Turkey. A self-administered questionnaire was prepared for this study and distributed to the parents of 1,500 schoolchildren whom aged 6-12 years. RESULTS: Of the 1,500 questionnaires distributed, 1,339 (89 percent) were completed. The overall prevalence of nocturnal and diurnal enuresis were 17.5 percent (n = 234) and 1.9 percent (n = 25), respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased number of people sleeping in the child's room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2 percent. The most preferred treatment option for enuresis was medications (59.5 percent), whereas alarm treatment was the least preferred (2.4 percent). CONCLUSIONS: Our results with enuresis prevalence and associated factors were comparable to other epidemiologic studies from various countries. Furthermore we demonstrated that families in Turkey do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.

A enurese em criancas e seus significados para suas famílias: abordagem qualitativa sobre uma intervencão profissional em saúde / Child enuresis and parental meanings: a qualitative perspective for healthcare professionals

OBJETIVOS: discutir as percepcões e significados atribuídos pelas famílias acerca da enurese vivida por seus filhos, através de uma perspectiva socio-antropológica que problematiza as mesmas no contexto das questões identificadas no interior do campo dos modelos explicativos da doenca. MÉTODOS: relato de experiência, baseado em entrevistas semi-estruturadas, realizadas junto a 24 (vinte e quatro) familiares/cuidadores de criancas com quadros de enurese. RESULTADOS: as famílias de pacientes com enurese demonstram a necessidade de definir a doenca de maneira subjetiva, entendendo-a através dos sentimentos que a mesma desencadeia, das mudancas comportamentais e das diferencas encontradas no relacionamento com as outras pessoas devido à mesma. Observa-se que os significados da enurese se organizam em dois campos que se cruzam: a responsabilizacão da própria crianca por sua enurese e os fatores externos, como o ambiente familiar e a situacão econômica e social. CONCLUSÕES: recomenda-se que profissionais de saúde estejam atentos aos perigos da normatividade biomédica de seu discurso, já que o mesmo dificulta a compreensão e elaboracão dos tratamentos necessários. Profissionais de saúde devem estar informados sobre o risco de maustratos relacionados à enurese, o que justifica a discussão acerca de possíveis estratégias de enfretamento dessa realidade na acão profissional junto a essa clientela.

Hipnoterapia en la Enuresis Nocturna / Therapy through hypnosis in nocturnal enuresis

Se presenta el trabajo realizado con hipnoterapia en 22 pacientes con Enuresis Nocturna, que acudieron a la Clínica de la Hipnosis de Santiago de Cuba durante el periodo comprendidoentre Marzo 2002 y Junio de 2003, para ello se realizó un estudio observacional descriptivo y longitudinal a través de larecolección de información aportada por la entrevista a pacientes y padres. El trabajo tuvo como objetivos, valorar la efectividad de la hipnosis en el tratamiento de la Enuresis Nocturna, asícomo identificar los rasgos clínicos de personalidad más frecuentes. El universo estuvo integrado por 22 pacientes que al mismo tiempo se constituyeron en la muestra. Los resultados fueron procesados mediante procedimientos computadorizados,utilizando como medida de resumen para variable cualitativa elporcentaje, siendo llevados para mejor estudio y comprensión a tablas. Como principales resultados obtuvimos que de todos los pacientes atendidos el 90,9 por ciento fue curado, la mayor parte de estos en las primeras ocho semanas y los rasgos clínicos que más sobresalieron en los pacientes según resultados del HTP fueron la inseguridad, y la falta de apoyo. Como conclusión obtuvimos que la hipnoterapia como alternativa de tratamiento logro revertir el cuadro enurético rápidamente en los infantescomprendidos en la primera etapa de dicho periodo, en los cuales primo la inseguridad y la falte de apoyo de sus familiares anteesta patología, sobre la cual nuestra población aun no sé asensibilizado y para muchos es solo un proceso banal que se curacon el tiempo(AU)