Treatment response of an outpatient training for children with enuresis in a tertiary health care setting.

PURPOSE: To evaluate treatment effectiveness for children with enuresis, according to the definitions of the International Children's Continence Society (ICCS, 2006). MATERIAL AND METHODS: Children ≥6 years of age followed a 4-month outpatient treatment consisted of a visit during which history regarding enuresis was taken, causes were explained and therapeutic tips & tricks were discussed. All children received a booklet about enuresis and were trained with an alarm and/or pharmacological therapy. At baseline, 4, 10 and 16 months, the number of wet nights during the previous 28 days and the use of medication were assessed. Success of treatment was determined using ICCS definitions of treatment outcome. RESULTS: 66 children with enuresis were included (48 boys/18 girls) in this retrospective study. Mean age: 11(± 2.6) years. 91%(n = 60) of the children had non-monosymptomatic enuresis. Results at 4 months: 46% full, 15% good, 21% partial response (n = 66). At 10 months: 55% full, 4% good, 29% partial response (n = 49). At 16 months: 53% full, 6% good, 25% partial response (n = 34). Overall, use of pharmacological therapy showed a decline in time. CONCLUSION: According to the ICCS definitions, outpatient treatment for enuresis shows a good overall treatment response, and these results can be used to compare with other studies in the future.

Teaching children clean intermittent self-catheterization (CISC) in a group setting.

OBJECTIVE: To teach children to perform clean intermittent self-catheterization (CISC) at our institution, the nurse practitioner uses a step-by-step approach in combination with an instruction model in an outpatient setting. For a small group of children the procedure remains difficult to learn. For them, we developed a multidisciplinary, group-wise training program. PATIENTS AND METHODS: Small groups of children, aged 7-12 years, and their parents consulted our clinic during six meetings. The group training was provided by a pediatric urology nurse practitioner, physiotherapist and behavioural practitioner. Using a tell/show/do method each intervention was instructed group wise. The actual CISC was performed individually within a private setting. Elements of the training were: sharing of mastery and difficulties with other children/parents, cognitive restructuring to enhance understanding and motivation, handling and trying out of devices, relaxation as a response to physical stress, and supporting parental guidance. RESULTS: The preliminary results of seven children were successful after group-wise intervention. Children were less anxious and more cooperative. Parents could share their difficulties dealing with their child at home and were given suggestions to help their children with CISC. CONCLUSION: Group interactions and a multidisciplinary approach seems to be of great help in learning CISC for selected children.