Evaluation of the effect of 3-month bladder basic advice in children with monosymptomatic nocturnal enuresis.

INTRODUCTION: Advice (BBA) into the standards of patients' care in both monosymptomatic and non-monosymptomatic nocturnal enuresis. Although the idea of this recommendation was clear and reflects clinical experience, duration and efficacy have not been definitely established. Recent data have demonstrated the lack of efficacy of BBA and a fierce discussion has ensued. The present study was aimed to assess the efficacy of BBA in a group of previously untreated children with primary monosymptomatic nocturnal enuresis (MNE). STUDY DESIGN: The study was a prospective interventional multicenter trial in a cohort of previously untreated MNE patients. Forty-nine children (36 males, 13 females, mean age 7.2 years) were included in the analysis. The treatment efficacy was assessed at the 30th, 60th, and 90th days of BBA. RESULTS: We discovered that the mean number of wet nights decreased significantly (p < 0.001) only after 3 months of BBA from 8.9 to 5.9 episodes every 2 weeks. BBA was fully successful in 2% o the children after 30 day, 12% after 60 days, and 18% after 90 days (Figure). Partial response (by ICCS) was assessed for 8%, 20%, and 34% of the patients. We noted a relatively high rate of non-responders that decreased from 90% to 47% after 90 days. We detected no differences in BBA efficacy between children with night-time polyuria or decreased maximal voided volume. A lower number of wet nights initially predicted the response to the BBA. DISCUSSION: Our study confirmed rather limited efficacy of BBA, similarly to previous observations, but provided more information on isolated MNE, because of a more specific study group and longer period of observation. The limitation of the study was lack of randomization. CONCLUSION: Our study revealed that in treatment-naïve children with monosymptomatic enuresis basic bladder training had a low (18%) and late effect, mostly pronounced after the third month of therapy. It seems that only if the patient presents with a favorable profile of bedwetting, occasionally and with a high maximum voided volume, it is worth maintaining BBA for a longer period of up to 3 months before initiating second-line therapy. In an unfavorable initial profile desmopressin or an alarm may be introduced much earlier.

[Analysis of treatment results of boys referred to outpatient paediatric surgery centre with recognition of phimosis]. / Analiza i ocena wyników leczenia chlopców kierowanych do poradni chirurgii dzieciecej z powodu trudnosci w odprowadzeniu napletka.

UNLABELLED: The problem with prepuce retraction is caused not only by its narrowing, called phimosis, but also frequently by the inner prepuce adhesion to glans. The spontaneous prepuce retraction is received in 80% cases of boys up to the age of two, whereas in remaining cases, after the age of two it is necessary to take up the medical treatment. The purpose of the research was to estimate the effectiveness of conservative therapy using steroid ointments which was undertaken in boys referred to Outpatient Paediatric Surgery Centre with recognition of phimosis. MATERIAL AND METHODS: Cases of 315 boys referred to Outpatient Paediatric Surgery Centre due to phimosis were analyzed between April 2004 and May 2007. At the first appointment the boys were divided into 3 main groups: I--children with foreskin adhesion without visible stenosis (near 20%), who had the prepuce adhesion released in a local anaesthetic with Emla cream; II--children with narrowed foreskin (phimosis) who were treated with the use of conservative therapy by means of topical steroids (about 70%); III--children with stenosed prepuce (phimosis) developed to a large extent, who were immediately qualified to a surgery therapy without trying the conservative therapy (near 10%). RESULTS: Among all patients about 1/5 needed the prepuce adhesion releasing with the use of Emla ointment only. High efficiency of conservative treatment with topical steroids was revealed both in primary and acquired phimosis. Reduction of the therapy time of children treated with topical steroids because of primary phimosis in relation to those treated surgically was taken into account. CONCLUSION: Conservative treatment of phimosis is highly effective and safe method which may also be an initial stage to operative treatment or to cure scarring after surgical treatment as well.