Characterization and treatment of enuresis in overactive bladder patients. / Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva.

OBJECTIVE: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. MATERIALS AND METHODS: A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created -primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a > 50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. RESULTS: 152 OAB patients were included. 109 of them (71.7%) had enuresis -29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). CONCLUSIONS: Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.

OBJETIVOS: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. RESULTADOS: Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). CONCLUSIONES: La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.

Predictors of response and adherence to enuresis alarm therapy-a confirmatory study.

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.

Applying children's enuresis treatment with amitriptyline for canine post-spaying urinary incontinence: A pilot estriol-controlled randomized clinical trial.

Urinary incontinence due to urethral sphincter mechanism incompetence (USMI) affects up to 20% of bitches that undergo spaying surgery. Amitriptyline is a tricyclic antidepressant whose urinary retention is a reported side effect. This study aimed to assess the efficacy and safety of amitriptyline when compared to estriol orally. Fifteen bitches with a clinical diagnosis of post-spaying UI were evaluated during 60 days in a non-blinded randomized clinical trial. All patients were enrolled after clinical evaluation consisting of anamnesis, physical examination, and complementary exams (complete blood count, biochemical parameters, urinalysis, and abdominal ultrasound). The amitriptyline (AMT) group consisted of 8 bitches, which received the initial dose of 1 mg/kg every 12 h, whereas the estriol (EST) group consisted of 7 bitches which were initially treated with 1 mg/animal every 24 h. Patients underwent clinical evaluation at 7 days, and then at 21 and 60 days of treatment to assess safety and efficacy, as well as adjustments of dose when necessary. A urinary incontinence scale was used to assess the level of incontinence and therapeutic response to treatment. During the period of the study, estriol was fully effective in 71% of cases and amitriptyline in 62%. Both drugs proved safe in the medical treatment of USMI, with adverse effects such as somnolence (AMT, n = 5/8) and male attraction (EST, n = 1/7). The results support the amitriptyline recommendation as a substitute for estriol in USMI treatment.

Enuresi: del ritual màgic fins als tractaments actuals / Enuresis: desde el ritual mágico hasta los tratamientos actuales / Enuresis: From magic rituals to current treatments

Introducció. L’enuresi és un trastorn greu, per la gran prevalença i la repercussió que té sobre la qualitat de vida dels pacients i les seves famílies. Al llarg de la història s’han emprat diferents teràpies, i fins avui no es disposa d’una solució definitiva. Objectiu. Examinar l’evolució del concepte d’enuresi, les causes atribuïdes i els tractaments aplicats des de les primeres referències fins a l’actualitat. Mètode. Revisió bibliogràfica del concepte, les causes atribuïdes i els tractaments aplicats contra l’enuresi, estructurada en etapes històriques. Resultats. Al llarg de la història s’han donat diferents explicacions sobre l’origen de l’enuresi, des de la invasió del cos per animals fins a càstigs divins o debilitat de l’individu. La ciència ha descartat diferents teories fins a conèixer els veritables mecanismes fisiopatològics, dels quals encara queden molts aspectes per aclarir. Al llarg dels segles s’han aplicat càstigs, s’han elaborat pocions màgiques, dispositius complexos que inhibeixen la micció, teràpies conductuals, intervencions quirúrgiques i tractaments tòpics i sistèmics. També les alarmes d’enuresi evolucionen, des de les que aplicaven descàrregues elèctriques fins a les actuals que desperten el pacient mitjançant senyals acústics o vibratoris. Conclusions. Els tractaments aplicats per a l’enuresi al llarg de la història han estat relacionats amb el concepte de malaltia de cada època. Conèixer els mecanismes fisiopatològics ha permès trobar tractaments efectius que han millorat la qualitat de vida dels enurètics. Avançar en aquest coneixement és clau per trobar la solució definitiva. (AU)

Introducción. La enuresis es un trastorno grave por su gran prevalencia y repercusión sobre la calidad de vida de los pacientes y sus familias. A lo largo de la historia se han utilizado diferentes terapias y, hasta hoy, no se dispone de solución definitiva. Objetivo. Examinar la evolución del concepto, causas atribuidas y tratamientos aplicados para la enuresis, desde las primeras referencias hasta la actualidad. Método. Revisión bibliográfica del concepto, las causas atribuidas y tratamientos aplicados contra la enuresis, estructurada en etapas históricas. Resultados. A lo largo de la historia se han dado diferentes explicaciones sobre el origen de la enuresis, desde la invasión del cuerpo por animales hasta castigos divinos o debilidad del individuo. Diferentes teorías han sido descartadas por la ciencia hasta el conocimiento de los verdaderos mecanismos fisiopatológicos, de los cuales aún quedan muchos aspectos por aclarar. A lo largo de los siglos se han aplicado castigos, se han elaborado pociones mágicas, complejos dispositivos que inhiben la micción, terapias conductuales, intervenciones quirúrgicas y tratamientos tópicos y sistémicos. También las alarmas de enuresis evolucionan, desde las que aplicaban descargas eléctricas hasta las actuales que despiertan al paciente mediante señales acústicas o vibratorias. Conclusiones. Los tratamientos aplicados para la enuresis a lo largo de la historia se han relacionado con el concepto de enfermedad de cada época. Conocer los mecanismos fisiopatológicos ha permitido encontrar tratamientos efectivos que han mejorado la calidad de vida de los enuréticos. Avanzar en este conocimiento es clave para hallar la solución definitiva. (AU)

Background. Enuresis is a severe disorder because of its high frequency and impact on the quality of life of affected children and their families. Although until today there is no established treatment for enuresis, diverse therapies have been applied over history. Objective. To examine the historic evolution of the concept, presumed causes, and treatments of enuresis from first references until today. Method. Bibliographical review of presumed causes and treatments applied in the treatment of enuresis, structured in historical stages. Results. Throughout history, enuresis has been considered as the invasion of human body by animals, divine punishments, or weakness. Different theories have been rejected by science until the knowledge of the true pathophysiological mechanisms. Punishments, potions and magic, complex devices inhibiting the urination, behavioral therapies, surgical trials, and topical and systemic treatments have been applied throughout history. In addition, different “alarm systems” have been used, evolving from applying electric shocks to wake patients by acoustic or vibrating signals. Conclusions. Treatments applied in the management of enuresis throughout the centuries have been closely related to the understanding of its cause over time. Knowing the pathophysiological mechanisms has made it possible to find effective treatments that have improved the quality of life of affected children. However, to establish a definitive treatment for enuresis, it is necessary to advance in the understanding the diverse mechanisms involved in its etiopathogenesis. (AU)

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study. / Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico.

OBJECTIVE: To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). MATERIALS AND METHODS: A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. RESULTS: 66 patients -50% of whom were female- were included, with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). CONCLUSIONS: S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

OBJETIVOS: Determinar si la electroterapia nerviosa transcutánea a nivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractarios a fármacos anticolinérgicos (Ach). MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fue evaluada utilizando el calendario miccional y el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo sus preguntas 3 y 4 (referidas a la enuresis) para analizar solamente la evolución de la sintomatología diurna (variable LUTS). RESULTADOS: Fueron incluidos 66 pacientes (50% niñas), con una edad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1 inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones (8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina en los registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). La enuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicación del TENS-S). CONCLUSIONES: El TENS-S es efectivo y seguro a corto plazo en pacientes con VH refractarios a los Ach. Deben realizarse estudios para evaluar la eficacia a largo plazo y posibles recaídas.

Treating asthma in patients with enuresis: repercussions on urinary symptoms.

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.

[Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment]. / Enuresis und nicht-organische (funktionelle) Harninkontinenz bei Kindern und Jugendlichen ­ klinische Leitlinie zur Diagnostik und Therapie.

Functional (Nonorganic) Enuresis and Daytime Urinary Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract: Objective: Enuresis and daytime urinary incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. This interdisciplinary guideline summarizes the current state of knowledge regarding somatic and psychiatric assessment and treatment. We formulate consensus-based, practical recommendations. Methods: The members of this guideline commission consisted of 18 professional associations. The guideline results from current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: According to the International Children's Continence Society (ICCS), there are four different subtypes of nocturnal enuresis and nine subtypes of daytime urinary incontinence. Organic factors first have to be excluded. Clinical and noninvasive assessment is sufficient in most cases. Standard urotherapy is the mainstay of treatment. If indicated, one can add specific urotherapy and pharmacotherapy. Medication can be useful, especially in enuresis and urge incontinence. Psychological and somatic comorbid disorders must also be addressed. Conclusions: The recommendations of this guideline were passed with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required especially regarding functional (nonorganic) daytime urinary incontinence.

Diagnóstico y tratamiento de pacientes con vejiga neurogénica en la Unidad Técnica de Cirugía Pediátrica / Diagnosis and treatment of patients with Neurogenic bladder in the Surgery Technical Unit Pediatric

El presente trabajo toma como base el documento: "Manejo Urológico del Mielomeningocele" de las Guías de Atención Pediátrica, del Hospital De Pediatría "Juan P. Garrahan" de la ciudad de Buenos Aires - Argentina; de los autores: Dra. Carol Burek y Dra. Liliana Campmany. En la Unidad Técnica de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, se atienden por mes unos 50 a 70 pacientes afectos de vejiga neurogénica desde el nacimiento hasta la adolescencia. Es una enfermedad crónica que requiere un diagnóstico correcto con estudios de imagen y función de la vía urinaria además de un posterior manejo diario por parte de los padres con la guía del médico especialista.

This work is based on the document: "Urological Management of Myelomeningocele" from the Pediatric Care Guidelines of the Hospital De Pediatría "Juan P. Garrahan" of the city of Buenos Aires - Argentina; by the authors: Dr. Carol Burek and Dr. Liliana Campmany. In the Pediatric Surgery Technical Unit of the Carlos Andrade Marín Specialties Hospital, 50 to 70 patients affected by neurogenic bladder from birth to adolescence are treated every month. It is a chronic disease that requires a correct diagnosis with imaging and urinary tract function studies, as well as subsequent daily management by the parents under the guidance of the specialist.

Parasacral transcutaneous electrical neural stimulation versus urotherapy in primary monosymptomatic enuresis: A prospective randomized clinical trial.

OBJECTIVE: To evaluate the clinical response of parasacral transcutaneous electrical neural stimulation (parasacral TENS) associated with urotherapy in children with primary monosymptomatic nocturnal enuresis (PMNE) compared to urotherapy alone. MATERIAL AND METHODS: This prospective controlled clinical trial enrolled 72 children over 5 years of age with PMNE. Children were randomly divided into two groups, control group (CG), treated with urotherapy and scapular stimulation, and experimental group (EG), treated with urotherapy and parasacral TENS. In both groups, 20 sessions were performed, 3 times weekly, for 20 min each, with 10 Hz frequency, 700 µS pulse width and intesity determinated by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4), and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for three consecutive months. RESULTS: Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 36%, at T1 49%, at T2 54%, at T3 54%, at T4 54%, and 57% at T5; while in CG, these percentages were 28%, 39%, 37%, 35%, 36%, and 36%, respectively. CONCLUSIONS: Parasacral TENS associated with urotherapy improves the percentage of dry nights in children with PMNE, although no patient had complete resolution of symptoms in this study.

Initial outcomes using a novel bedwetting alarm (Gogoband®) that utilizes real time artificial intelligence to wake users prior to wetting.

We evaluated a new bedwetting alarm, GOGOband®® which utilizes real time heart rate variability (HRV) analysis and applied artificial intelligence (AI) to create an alarm that can wake the user prior to wetting. Our aim was to evaluate the efficacy of GOGOband® for users in the first 18-months of use. METHODS: A quality assurance study was conducted on data retrieved from our servers, of initial users of the GOGOband® which includes a heart rate monitor, moisture sensor, bedside PC-tablet, and a parent app. There are three sequential modes beginning with Training, Predictive mode and Weaning mode. Outcomes were reviewed and data analysis was done with SPSS and xlstat. RESULTS: All 54 subjects who used the system from Jan 1, 2020, to June 2021 for more than 30 nights were included in this analysis. The mean age of the subjects is 10.1 ± 3.7 yrs. Subjects wet the bed a median of 7 (IQR6-7) nights per week prior to treatment. Severity and number of accidents per night had no impact on the ability to achieve dryness with GOGOband®. A crosstab analysis was performed which indicated that high compliant users (>80%) can remain dry 93% of the time compared to the whole group 87.7%. Overall ability to achieve 14 dry nights in a row was 66.7% (36/54) with some achieving a median of 16 14-day periods of dryness (IQR 0-35.75). CONCLUSIONS: We found 93% dry night rate in high compliance users in Weaning, this translates to 1.2 wet nights per 30 days. This compares to all users who wet 26.5 nights prior to treatment and 11.3 wet nights per 30 days during Training. The ability to achieve 14 days straight of dry nights was 85%. Our findings indicate that GOGOband® provides a significant benefit to all its users reducing nocturnal enuresis rates.

Eficácia E Custo-Utilidade De Intervenções Para O Tratamento Da Enurese Em Crianças E Adolescentes Sob A Perspectiva Do Sistema Único De Saúde Brasileiro: Effectiveness and Cost-Utility of Interventions for Enuresis Treatment in Children and Adolescents From the Brazilian Single Health System Perspective.

OBJECTIVES: This study aimed to estimate the cost-utility of effective interventions for enuresis treatment in children and adolescents and to calculate the incremental cost-utility ratio from the perspective of the Brazilian Unified Health System in a 1-year time horizon. METHODS: The economic analysis is in 7 stages: (1) survey of evidence of treatments for enuresis, (2) performing the network meta-analysis, (3) estimation of the probability of cure, (4) cost-utility analysis, (5) model sensitivity analysis, (6) analysis of acceptability of interventions by acceptability curve, and (7) monitoring the technological horizon. RESULTS: The association between desmopressin and oxybutynin is the therapeutic strategy with the highest probability of success in the treatment of enuresis in children and adolescents compared with placebo (relative risk [RR] 2.88; 95% confidence interval [CI] 1.65-5.04), followed by the combination therapy between desmopressin and tolterodine (RR 2.13; 95% CI 1.13-4.02), alarm (RR 1.59; 95% CI 1.14-2.23), and neurostimulation (RR 1.43; 95% CI 1.04-1.96). Combination therapy between desmopressin and tolterodine was the only 1 considered not to be cost-effective. Neurostimulation, alarm therapy, and therapy had the respective incremental cost-utility ratio values: R$5931.68, R$7982.92, and R$29 050.56/quality-adjusted life-years. CONCLUSION: Among the therapies that are on the borderline of efficiency, the combined therapy between desmopressin and oxybutynin presents the greatest incremental benefit at an incremental cost that is still feasible, given that it does not exceed the reference value of the cost-effectiveness threshold established in Brazil.

Enuresis: percepción y actitud en la población de nuestro país / Enuresis: Perception and attitude in population of our country

Objetivo Conocer la percepción y la actitud hacia la enuresis por parte de familias y cuidadores con el objetivo de establecer un plan terapéutico racional. Material y métodos Se realizó una encuesta de 25 preguntas a padres y madres mayores de 18años con al menos un hijo de entre 5 y 13años, manteniendo la representatividad nacional en términos de residencia, clase social y edad de los hijos. La recogida de datos se realizó en abril del 2021. Resultados Se obtuvieron datos de 501 encuestas de 626 enviadas, en su mayoría relativos a familias de clase social media de Andalucía, Cataluña y la Comunidad de Madrid. El 47,9% de los encuestados conocían la existencia de la enuresis, aunque únicamente el 23,8% sabían cuál era el término médico. Solo el 16,6% y el 9,6% recordaban que el/la pediatra o el/la enfermero/a, respectivamente, se hubieran referido en algún momento a la misma. Entre los participantes con algún conocimiento, las fuentes de información principales fueron los casos cercanos (36,6%), los medios de comunicación (31,1%) y el pediatra (27,8%). Los padres se preocuparían mucho (35,3%) o bastante (43,1%) ante un caso. Sin embargo, el nivel de conocimiento fue mayor y el grado de preocupación menor entre padres con hijos con enuresis respecto a los que no tenían casos en la familia. Conclusiones Mejorar el conocimiento de los padres sobre la enuresis y cambiar la percepción que tienen de la misma puede resultar de importancia para mejorar su atención y anticipar su resolución (AU)

Objective To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. Material and methods A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. Results Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. Conclusion Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution (AU)

[Enuresis: Perception and attitude in population of our country]. / Enuresis: percepción y actitud en la población de nuestro país.

OBJECTIVE: To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. MATERIAL AND METHODS: A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. RESULTS: Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. CONCLUSION: Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution.

Alarm-assisted urotherapy for daytime urinary incontinence in children: A meta-analysis.

OBJECTIVES: Wearable alarm systems are frequently used tools added to urotherapy for children with both daytime and nighttime urinary incontinence. For functional daytime incontinence (DUI) specifically, the effect of alarm interventions has not been systematically reviewed. This study systematically evaluates, summarizes, reviews, and analyzes existing evidence about the effect of wearable alarm systems in urotherapy for children with functional DUI. STUDY DESIGN: We completed a comprehensive literature search in August 2022 using MEDLINE/PUBMED, EMBASE, PsycINFO, Cochrane Library, Web of Science, Google Scholar, conference abstracts, and citation tracking. Clinical controlled trials at controlled-trials.com and clinicaltrials.gov were consulted, as was the National health Service Center For Reviews And Dissemination. Eligible studies including the use of noninvasive wearable alarm systems as (part of) treatment for functional DUI in children were included. The main outcome was continence after treatment. Three independent reviewers extracted data. Risk of bias was assessed using Cochrane and National Heart, Lung and Blood Institute quality assessment tools. RESULTS: A total of 10 studies out of 1,382 records were included. Meta-analysis revealed a nonsignificant risk ratio of 1.4 (95% CI: 0.8-2.6) for the use of alarm systems. Urotherapy with alarm systems resulted in a 48% (95% CI: 33-62%) continence rate after treatment. CONCLUSIONS: Alarm systems might be helpful as part of urotherapy for functional DUI in select cases. Adherence is problematic, and the optimal duration of the use of alarm systems is to be determined. Overall, the risk of bias was high in all studies.

Correlation between serum copeptin and urinary aquaporin-2 levels in children with primary monosymptomatic nocturnal enuresis.

OBJECTIVES: To determine the utility of serum copeptin and urinary aquaporin-2 (AQP2) levels in diagnosing primary monosymptomatic nocturnal enuresis (PMNE) in children. METHODS: This study comprised 58 children (30 males and 28 females), aged 9.7 (±2.9) years with PMNE enuresis. Another 29 children (16 males and 13 females) aged 10.2 (±3.3) without nocturnal enuresis (NE) were recruited as a control group. History taking, clinical examination, and assessment of serum copeptin (blood) and AQP-2 levels (urine) were performed in all participants. RESULTS: Serum levels of copeptin, potassium and urinary AQP-2, and urine creatinine levels were lower in the PMNE group compared to the control group (p < 0.001 for all). No significant differences in body mass index, urine specific gravity, serum sodium, serum creatinine, or estimated glomerular filtration rate were observed between groups. This study evaluated both serum copeptin and AQP-2 levels in healthy and enuretic children. CONCLUSIONS: In this study, serum levels of copeptin (blood) and AQP2 (urine) were significantly lower in enuretic patients compared to healthy controls. Further, the measurement of urinary AQP-2 levels is more practical than serum copeptin levels due to lower invasiveness.

A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis.

BACKGROUND: Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vasopressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medications such as desmopressin and imipramine. OBJECTIVE: To compare the effectiveness of different treatments of MNE. STUDY DESIGN: Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. INCLUSION CRITERIA: age between 5 and 16 years old, with MNE, evaluated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial responders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group - DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were monitored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE. RESULTS: 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group - DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms. DISCUSSION: Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study. CONCLUSION: All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.