Academic literature on the topic 'Enuresis – Treatment'

This paper presents the link between self-control and childhood enuresis, assuming that enuresis is maintained by deficiencies in self-control skills, whether caused by physiological, behavioral, or cognitive components. Acquisition of self-control skills is proposed as helping in eliminating enuresis. Seventy-seven enuretic children (aged 7 to 14) were randomly assigned to three treatment modes (bell and pad, token economy, and cognitive therapy) and to one control group. The self-control skills of children and their parents and the frequency of enuresis were measured before and after treatment. Results showed a negative correlation between self-control and enuresis on the one hand and between the acquisition of self-control skills and recovery from enuresis on the other hand. The results also highlighted the need for a follow-up period to determine the different longer-term effects of treatments.

The enuresis alarm is a very successful method of treating nocturnal enuresis. Nevertheless many children drop-out of treatment and many relapse once dryness has been achieved. This paper examines the relationship between 30 variables, measured during the pre-treatment assessment of 75 enuretic children, and treatment outcome (success, failure, drop-out and relapse). Treatment was either by the enuresis alarm alone or the enuresis alarm preceded by four weeks of retention control training. Two features of diurnal bladder control (frequency and urgency) were related to failure in treatment and two factors reflecting parental intolerance to wetting (early toilet training and parental urging to use the toilet) were related to treatment drop-out.

Primary nocturnal enuresis (PNE), a biobehavioral problem affecting approximately 5,000,000 children in the United States, is among the most bothersome and frustrating disorders of childhood. Negative psychosocial consequences are common, secondary to the impact of enuresis on family members and others. The enuretic child may be at increased risk for emotional or even physical abuse from family members and may experience stress related to fear of detection by peers. These factors contribute to the loss of self-esteem that the enuretic child often experiences. Fortunately, a number of treatments — most commonly pharmacologic or behavioral intervention — are often effective in improving or correcting PNE. This disorder not only can be addressed but should be addressed because effective treatment benefits both the patient and the patient's family.

Nocturnal enuresis is a symptom of environmental, physical, and psychosocial factors. In addition to a physical examination, the initial workup of the enuretic child should include a careful voiding, psychosocial, and family history. Studies have shown that the parents of enuretic children often have a history of enuresis. An increased incidence of enuresis has also been demonstrated in children from large families and lower socioeconomic groups. Daytime voiding symptoms (e.g., frequency, urgency, or enuresis) suggest the possibility of underlying voiding dysfunction. A complete urinalysis and urine culture also should be performed to exclude urinary infection and certain metabolic or nephrologic disorders. Finally, it is important that the treating physician understand the attitudes of both the child and the family concerning enuresis. Parents who feel that the child is at fault need to be educated and reassured. A careful, complete evaluation will allow the physician to tailor treatment to the individual child and family.

The transition from day to night is associated with a pronounced decline in diuresis with reductions in the amount of excreted water, electrolytes, and other end products of our metabolism. Failure to do so leads to a large urine output at night, a condition known as nocturnal polyuria, encountered in a large proportion of children with nocturnal enuresis. The aim of this study was to clarify the mechanisms responsible for the nocturnal polyuria seen in enuretics with inadequate response to desmopressin (dDAVP). Forty-six enuretics (7–14 yr of age) and fifteen age-matched controls were admitted for a 24-h protocol with standardized fluid and sodium intake, comprising urine collections, blood sampling, and blood pressure monitoring. We included patients with severe enuresis (5 ± 1 wet nights/wk) showing <50% reduction in wet nights on dDAVP. We characterized the patients on the basis of their nocturnal urine production. The children with nocturnal polyuria excreted larger amounts of sodium and urea at night than nonpolyurics and controls. Solute-free water reabsorption as well as urinary arginine vasopressin and aquaporin-2 excretion were normal in polyurics, and no differences were found in atrial natriuretic peptide, angiotensin II, aldosterone, and renin levels. Urinary prostaglandin E2 (PGE2) excretion was significantly higher in polyurics. The nocturnal polyuria in children with dDAVP-resistant nocturnal enuresis seems to be the result of augmented sodium and urea excretion. The high urinary PGE2 levels found in these children point toward a role for increased prostaglandin synthesis in the pathogenesis of enuresis-related polyuria.

Bedwetting is the most common urologic complaint among children. Wetting frequency at age 7 years varies from 5% to 15%. Treatment has been multimodal: drugs to depress bladder activity, increase urethral resistance, or modulate sleep; electrophysiologic treatment; and, recently, urine production modulation. All of these approaches reflect a lack of sufficient knowledge of the underlying pathophysiology of nocturnal enuresis. Over the last 13 years, enuresis studies at the Institute of Experimental Clinical Research, the University of Aarhus, Denmark, have focused on sleep disturbances, bladder reservoir function, urine output, and a combination of the three. Sleep studies indicate that: enuretic patients are normal sleepers; the voiding characteristics of an enuretic episode are similar to those of voluntary voiding during the day; and enuresis can take place during any stage of sleep, but generally occurs when the bladder is filled to the equivalent of maximal daytime functional capacity. Bladder reservoir capacity appears to be normal and bladder instability an unimportant factor in the pathology of nocturnal enuresis. However, enuretic patients have been shown to lack the normal nocturnal increase in antidiuretic hormone levels and had nocturnal urine production up to four times the volume of functional bladder capacity, which explains the need for bladder emptying. These findings open new avenues to the approach to treatment based on antidiuretic therapy.

This paper centre around a particular treatment procedure for a 6 years old boy with primary enuresis. According to Hudson (1980) the term “enuresi” mean “persistent wetting of the bed by children over the age of 3 or 4 years in the absence of any demonstrable organic pathology”. (P. 70).Although there have been various ways of handling this over the centuries (mostly unsuccessful), according to many modern researchers, the bell and pad or enuresis alarm has the best record of success. Hudson claims “a continually demonstrated high success rate of approximately 75%” (p.18). He does emphasize, however, that these figures are for good quality equipment, used with professional supervision.

Nocturnal enuresis and albuminuria or proteinuria are markers of renal damage in sickle cell disease (SCD) and commonly develop early on in life. Proteinuria progresses with age, leading to chronic kidney disease in adulthood. The aims of this study were to identify the prevalence of enuresis and albuminuria/proteinuria in paediatric patients with SCD in London and to determine the relationship between these and various demographic and clinical variables. Methods A cross sectional, single centre study was conducted. Questionnaire-based interviews themed on nocturnal enuresis were undertaken for patients between the ages of 6 and 17. Urinalysis was performed for the presence of albuminuria or proteinuria. Hospital patient records were accessed for clinical data. Results A total of 56 patients were recruited to the study, of which 27 (51.8%) were female. Twenty patients (35.7%) had a history of enuresis and met the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria for nocturnal enuresis compared to 5% prevalence in children in the general population1. There was a statistically significant association between enuresis and age, overactive bladder (OAB) symptoms, sleep-disordered breathing (SDB), painful crises and regular transfusions (Table 1). Fourteen out of 29 patients (48.3%) with OAB symptoms reported nocturnal enuresis compared to six out of 27 patients (22.2%) who did not (p<0.05). Of the patients reporting SDB, 48.6% were enuretic compared to 14.3% who did not (p<0.01). Incidence of painful crises per month was higher for the enuretic group (2.29 vs. 0.88, p<0.05) but the mean number of emergency admissions in the preceding 18 months was similar. Of the 14 regular blood transfusion patients, only one (7.1%) was currently enuretic compared to 14 out of 32 (40.6%) who were not receiving any treatment (p<0.05). Seven patients (13.4%) had albuminuria/proteinuria. (Table 2) There was no difference in albuminuria/proteinuria prevalence between the hydroxycarbamide or blood transfusion group compared to the non-treatment group. There was no difference in HbF percentage, systolic BP, frequency of emergency admissions, painful crises per month, haemoglobin levels and estimated glomerular filtration rates (eGFR) in patients with albuminuria/proteinuria and those without. The prevalence of haematuria increased with age; 6.7% in the 6-9 age category compared to 36.4% in the 16 to 17 age category (p=<0.05). Conclusions Nocturnal enuresis and albuminuria or proteinuria is prevalent at an early age in many children with SCD. Early identification and initiation of treatment such as Angiotensin Converting Enzyme inhibitors2 may delay onset of complications especially alongside beneficial sickle cell treatments such as hydroxycarbamide and regular blood transfusions. Questioning parents on enuresis, OAB and SDB sumptoms and undertaking regular urinalysis on younger age groups is a practical and cost-effective surveillance method. References 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatric Publishing, Inc.; 2000. Angiotensin-converting enzyme (ACE) inhibitors for proteinuria and microalbuminuria in people with sickle cell disease Cochrane Database of Systematic Reviews, 2013. Disclosures: No relevant conflicts of interest to declare.

Childhood nocturnal enuresis (bedwetting) is a prevalent, clinically demanding condition affecting approximately 500,000 children in the United Kingdom. At the age of 5 years, around 15-20% of all children wet the bed at least twice weekly, this figure falling to 5% at age 10 years. The disorder can have far-reaching social and emotional consequences for both the child and their family if left untreated. The most successful treatments for childhood functional (non-organic) nocturnal enuresis are of behavioural origin, namely urine alarm training and dry-bed training. The former is widely adopted in the treatment of bedwetting; however, it has a high relapse rate. In contrast, the latter tends to have a better long-term remission rate. However, due to the intricate nature of dry-bed training and costs relating to its implementation, it is rarely utilised by healthcare practitioners. Two studies reported in this thesis (the first a pilot investigation, and the second a main investigation) examined the relative efficacy of urine alarm training and a modified version of drybed training in the treatment of childhood functional nocturnal enuresis when both were delivered by identical minimal intervention methods (i.e., biblio-cumvideo therapy combined with telephone and intermittent clinic supervision) at the primary care level of service delivery. The findings demonstrated that modified drybed training was significantly superior to urine alarm training in terms of its long term remission rate. Moreover, families of bedwetting children found the modified dry-bed training programme simple to understand and implement. As a result of these findings, and as an extension into the evaluation of minimal intervention service delivery, a study was conducted to investigate the relative efficacy of modified dry-bed training delivered via video-mediated consultation and face-to-face consultation in the treatment of childhood functional nocturnal enuresis. A further objective was to evaluate patient, parent, and therapist satisfaction with video mediated consultation as compared to face-to-face consultation. The findings revealed that modified dry-bed training was equally efficacious across both consultation modes in terms of its long-term remission rate. Patients and their parents were generally satisfied with both modes of consultation, with few significant differences between the 2 consultation groups on any variable as assessed by a post-treatment patient and parent satisfaction scale. However, the therapist was more satisfied with face-to-face consultation than video-mediated consultation. Results are discussed in terms of their relevance to future research and clinical practice.

Section A examines the association between nocturnal enuresis (NE) and Quality of Life (QoL) in children and young people. This paper systematically reviews the research literature in this area considering relationships between NE and QoL across demographic variables such as gender and age. Future research avenues and implications for clinical practise are discussed. Section B reports on a tailored hypnosis treatment for children and young people with NE. This used a prospective case series with multiple-case AB design with follow-up, and tested the hypothesis that this approach would increase number of dry nights. Changes in child and parent psychosocial variables were also examined. Results indicated that participants improved in nighttime dryness as predicted, and that improvements were sustained at follow up. Self-reported continence specific QoL showed improvement approaching significance from baseline to follow up. Mixed Results were found as to changes in other psychosocial variables as a result of treatment. Limitations of the research and its implications are discussed. Section C is a critical appraisal of the research process as a whole, covering issues such as choice of research and how this developed through clinical practice, training and previous research experiences. It explores issues across the research process at individual, team, systems and organisational levels. It provides a critique of the design and methodology, as well a reflection on personal and professional development. Section D reports on the results of a local questionnaire based service evaluation examining young people’s views of their paediatric diabetes clinics; including examples of good practice valued by young people. It also reports young people’s opinions and ideas about possible future service provision. It makes clear recommendations as to the ways forward in service user led service development.

Worldwide, millions of children 5 years of age and older suffer with nocturnal enuresis, also known as nighttime bedwetting. Nocturnal enuresis is a chronic elimination disorder that while usually benign, too often results in the child being emotionally and physically abused. Efforts to design effective treatments with low relapse rates have thus far been thwarted by the array of organic and psychosocial variables related to its development. Guided by the 5-factor theory of personality, this cross-sectional study investigated whether a parent's personality characteristics significantly predict effective treatment for a child's nocturnal enuresis. Effective treatment was defined as having no relapses of symptoms in the 6 months following initial treatment success. A convenience sample of parents (n = 165) was recruited from the online social network Facebook and other online educational and support forums for parents seeking information on enuresis. Participants completed the NEO-FFI-3 to measure their personality characteristics, and logistic regression analyses were used to determine if parental personality characteristics, parental history of childhood enuresis, and/or the child's gender were significant predictors of effective treatment for a child's enuresis. None of these factors were found to significantly predict effective treatment for enuresis. This study promotes positive social change by identifying the need for an integrated biopsychosocial approach to treating children with enuresis with effective evidence-based treatments. These treatments are expected to result in fewer children exposed to the high rates of abuse and the development of psychosocial disorders often associated with nocturnal enuresis

The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect.   Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy.  Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data.    Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.

The first part of this thesis examines the psychosocial characteristics of a cohort oj 270 bedwetting children attending a community enuresis service for treatment These children were recruited to a stratified cluster randomised controlled trial which forms the second part of this thesis in which additional information wa~ provided via a multimedia computer program and written leaflets. The mail clinical outcome measures were becoming dry and remaining dry six months pos discharge, time to dry, non-attendance and dropout rates. The main psycho socia measures were maternal tolerance, the impact of bedwetting and self-esteem. Th theoretical basis for the intervention(s) was the 'incomplete learning' model c bedwetting.' It was hypothesised that the intervention (s) would improve the sell efficacy of children through the mediation of cognitive, motivational, affectiv and self-selection changes (Bandura 1977). The randomisation procedure was slightly biased with children in the comput( group being sampled from a more affluent population and those in tl control/leaflets group from a more deprived population. There were also few, children from minority ethnic groups in the computer group. Significa differences were found between the ethnic groups in response to the impact bedwetting and maternal tolerance scales, together with parents' reports of th{ child's distress and parental worry. Therefore analysis was conducted on a samI matched by Jarman scores which excluded the children from affluent areas in t computer group and children from deprived areas in the control and leaflets grm Analysis was also conducted on the entire cohort. Bedwetting children had a lower self-esteem than school children. However, selfesteem improved with treatment with the greatest changes occurring for those who became dry. Low self-esteem was significantly related to a high impact of bedwetting. The presence of housing difficulties produced the least positive response on the psychosocial measurement scales. Low parent reported child distress and less severe wetting at initial assessment predicted a successfu: outcome. Although self-esteem was significantly lower for bedwetting children compared t( the school children the mean difference of less than one item suggests this result i not clinically meaningful. Nevertheless there are clearly some bedwettinJ children with less positive psychosocial and clinical situations. Bedwetting seem to be worse psychosocially for children from less affluent backgrounds, measure by the presence of housing difficulties, and those who are most distressed by it ne only have a lower self-esteem, but they are less likely to get dry. Howeve children's self-esteem does improve with treatment. The intervention( s) made no significant difference to any of the clinical outcorr measures or any of the psychosocial measures recorded during and post-treatmel for either the matched sample or the entire cohort. The absence of an intervention effect is disappointing and suggests that it is n sufficient merely to provide novel additional information to bedwetting childre Two main problems with the study design were identified. The large variation bedwetting children's time to dry suggests the outcome measures used may not sufficiently precise to detect a difference if one was present. The computer and the leaflets may have had insufficient power to produce changes in children at the level measured. Future research might wish to use a more intensive program where the computer intervention is combined with the leaflets. Nevertheles~ whilst this intensive training input and measurement is likely to motivate somt children this will not be the case for all.

Uma vez que atraves do uso do alarme de urina nem todas as criancas com enurese obtem os criterios definidos para o sucesso (14 noites secas consecutivas), buscou--se investigar procedimentos complementares para potencializar o seu efeito: a) o diario miccional, utilizado como um instrumento de avaliacao diagnostica da enurese e como uma medida dos efeitos de tratamentos e b) a uroterapia, que consiste de um conjunto de medidas comportamentais que tem como objetivo corrigir dificuldades provavelmente relacionadas a enurese nao corrigidas pelo uso do alarme. O diario miccional e o registro do volume de liquidos ingeridos e eliminados no periodo de dois dias pela crianca, que pode indicar, dentre outros padroes, urgencia miccional, hiperatividade detrusora, poliuria, bem como ingestao irregular de liquidos. As medidas comportamentais que compoe a uroterapia podem ser exemplificadas por: miccoes em horarios regulares; aumento da ingesta de liquidos e evitacao de irritantes vesicais. Neste estudo participaram 65 criancas e adolescentes com enurese distribuidas em dois grupos de tratamento. O primeiro grupo foi exposto a uroterapia e ao tratamento com alarme (grupo Uroterapia), enquanto o segundo grupo foi exposto somente ao tratamento com alarme (grupo Alarme). Por volta de 70% dos participantes de ambos os grupos obtiveram sucesso no tratamento, independentemente da realizacao da uroterapia. Os participantes do grupo Uroterapia apresentaram uma melhora mais acentuada no inicio do tratamento, mas esta nao se manteve como tendencia ao longo do tempo. Os participantes de ambos os grupos tiveram um aumento significativo da porcentagem da capacidade volumetrica da bexiga utilizada. Os participantes do grupo Uroterapia tiveram um aumento significativamente maior dos volumes de ingesta de liquidos e miccional<br>Not all children with enuresis reach 14 consecutive dry nights thought the use of the bell and pad alarm. That considered, we aimed to investigate additional procedures to enhance its success rate: a) the voiding diary, used as a diagnostic tool for evaluating enuresis and to measure overall treatments effects and b) urotherapy, consisting of a set of behavioral measures that aims at problems probably related to enuresis not corrected by the use of the bell and pad alarm. The voiding diary is a two--day record of fluid intake and micturition habits. It may indicate, among other patterns, urgency, detrusor overactivity, polyuria and irregular fluid intake. Urotherapy is composed of behavioral measures such: voiding at regular times; increased fluid intake; and avoidance of bladder irritants. 65 children and adolescents participated in this study. They were assigned to two treatment groups. The first group was exposed to urotherapy and to an alarm treatment (Urotherapy group), while the second was exposed only to an alarm treatment (Alarm group). Around 70% of participants became dry, regardless of the group they were assigned to. Participants from the Urotherapy group showed a more marked improvement early in treatment, but this trend was not maintained over time. Participants from both groups had a significant increase in the percentage of volumetric bladder capacity used and participants from the Urotherapy group had a significantly greater increase of fluid intake and voided volume

A enurese é uma condição caracterizada pela eliminação de urina durante o sono, em crianças com mais de cinco anos, em função da dificuldade de acordar associada à baixa produção do hormônio vasopressina ou à instabilidade da bexiga, sem outra condição clínica que explique os episódios de molhar a cama. A intervenção comportamental com alarme é a mais recomendada pela literatura para a cura da enurese. O acompanhamento do uso do alarme pode ser realizado através de contatos telefônicos, em que são investigados pontos chave do procedimento a ser realizado em casa pelas famílias. Uma pesquisa verificou que o acompanhamento telefônico é uma alternativa eficaz para a população que faz uso do alarme de urina para enurese, mas sem obter clareza na questão da sua validade para crianças com escores clínicos de problemas de comportamento. O presente estudo teve como objetivo geral comparar a eficácia do tratamento para enurese entre dois grupos de participantes que receberam acompanhamento telefônico, sendo previamente classificados pelos pais de duas maneiras: um com índices clínicos de problemas de comportamento e outro sem tais índices. Como objetivos específicos: (1) classificar as crianças quanto aos problemas de comportamento a partir de observação feita por uma pesquisadora; (2) verificar a eficácia do tratamento para crianças com e sem problemas de comportamento, a partir da avaliação da pesquisadora; (3) Verificar a evolução dos problemas de comportamento comparando escores pré e pós tratamento a partir da avaliação dos pais (4) comparar o nível de autoconceito reportado pela criança antes e após a intervenção (5) verificar possíveis correlações entre nível de autoconceito e o resultado do tratamento. Participaram do estudo 31 crianças com idades entre seis a 11 anos, (média=8,3, DP=1,3), sendo 15 do sexo masculino e 16 do sexo feminino e seus pais. Para a inclusão da criança no tratamento, o diagnóstico de enurese foi obtido através do Formulário de Avaliação de Enurese. Para a avaliação dos problemas de comportamento foram aplicados o Inventário de Comportamento para Crianças e Adolescentes (CBCL), destinado aos pais e o Inventário de Observação Direta (DOF), instrumento que permite ao pesquisador observar e qualificar o comportamento infantil em escalas semelhantes às obtidas pelo preenchimento do CBCL durante atividades recreativas. Este último instrumento foi preenchido por uma pesquisadora vinculada ao Projeto Enurese. Para mensurar o autoconceito foi utilizado a Escala de Autoconceito Infanto-Juvenil. Setenta e um por cento dos participantes, independente do grupo (clínico ou não clinico) ao qual pertenciam obtiveram sucesso no tratamento, não havendo correlação entre os problemas de comportamento e os resultados do tratamento. A única variável 8 relacionada com o sucesso foi a menor frequência de episódios de molhadas antes do tratamento. As avaliações feitas pelos pais e pela pesquisadora em relação aos problemas de comportamento apresentaram um ligeiro grau de concordância (57,2%). Conforme esperado, o grupo das crianças que obteve sucesso no tratamento apresentou melhora nos índices de problemas de comportamento totais e autoconceito pessoal e social quando comparado ao daquelas que não obtiveram sucesso<br>Enuresis is a condition defined by urine loss during sleep due to the incapacity to wake up in response to the full bladder signals associated to a lack of vasopressin hormone or dysfunctional bladder activity, when the child is at least five years-old and has no other condition that explains bedwetting. Behavioral intervention with alarm is one of the most effective ways to cure enuresis. One method to monitor the alarm use by the families is periodic phone calls, in which the researcher checks if the treatment procedure is being correctly done. A past research concluded that monitoring the intervention by phone is a effective alternative for the treatment, but it was unclear if children with clinical levels of behavioral problems would benefit of it. This study aimed to compare the treatment efficacy with two groups receiving alarm treatment with phone follow up, one group with clinical levels of behavioral problems and the other without it, according to the parents\' view. Specific objectives were: (1) to use an alternative method to assess behavioral problems, according to a researcher\'s point of view; (2) to verify treatment efficacy for children with and without clinical levels of behavioral problems according to the researcher\'s point of view; (3) to compare behavioral problems levels before and after treatment, according to the parents\' point of view; (4) to compare children\'s self-concept levels before and after treatment; and (5) to investigate correlations between self-concept levels and treatment result. Thirty-one children aged 6 to 11 (mean=8,3, SD=1,3) were included in the study. Fifteen were male and 16 were females. To assess enuresis the Enuresis Assessment Form was used; to assess behavioral problems, the Child Behavior Checklist (CBCL) and the Direct Observation Form (DOF) were applied, the first instrument was filled up by the parents at home and the second by a researcher during recreational activities. The Child Self-Concept Scale was used to assess participants\' self-concept. Seventy-one percent of the children reached the criterion for treatment success. There was no influence of behavioral problems in the treatment result. A higher bedwetting frequency prior to treatment was the only variable related to a better treatment result. The comparison between the parents and the researchers evaluation about the behavioral problems showed a moderated level of agreement (57,2%). As expected, children who were successful in the treatment showed a significantly higher improvement in total behavioral problems levels and personal and social self-concept, when compared to those who did not had success

Introdução: A enurese (EN) é uma condição clínica de etiologia multifatorial com característica de perda de urina intermitente no período noturno que promove uma dificuldade ao convívio social da criança/adolescente e pode ser afetada pela presença de comorbidades e por imaturidade do sistema nervoso na regulação central sobre o funcionamento vesical. O conjunto de eventos promotores do episódio da enurese, desde o enchimento vesical durante o sono até a deflagração do esvaziamento vesical involuntário sem acordar constitui-se no foco principal de abordagem clínico-laboratorial e terapêutica. Objetivo: Estudar o impacto de uma avaliação multidisciplinar do indivíduo com enurese noturna monossintomática (ENM) sobre a eficácia terapêutica dos métodos tradicionalmente utilizados em sua abordagem, assim como comparar, pela polissonografia (PSG), os efeitos da intervenção sobre a estrutura do sono. Método: Estudo prospectivo de crianças de 6 a 17 anos incompletos, com ENM, diagnosticada por avaliação multidisciplinar utilizando anamnese estruturada com enfoque nefropediátrico, exame clínico, diários das eliminações, ultrassonografia de rins e vias urinárias, análises laboratoriais de sangue e urina, exame neurológico, diário do sono, questionários de avaliação do sono e polissonografia, avaliação psicológica de distúrbios do comportamento pelo CBCL e da qualidade de vida pelo PedsQL 4.0 e avaliação fisioterapêutica do equilíbrio. Condições crônicas e genéticas constituíram exclusão do protocolo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do HCFMUSP de número 0649/10 e apoio da FAPESP (2011/17589-1). Das 140 crianças/adolescentes ingressantes, foram excluídos 58 (41,4%) por comorbidades não tratáveis e/ou não aderência ao protocolo, 82/140 (58,6%) pacientes com ENM foram incluídos para intervenção terapêutica em três grupos de tratamento (alarme, desmopressina e alarme com desmopressina). A resposta à intervenção terapêutica foi avaliada no período pós-intervenção imediato (após seis meses de tratamento) e tardio (após 12 meses da suspensão do tratamento). A PSG foi realizada pré e pós-tratamento para análise comparativa da estrutura do sono. Resultados: Dos 82 pacientes, com idade média de 9,5 anos (? 2,6), 62 eram do sexo masculino (75,6%). Diagnosticou-se antecedente familiar de EN em 91,1% considerando parentes de 1° e 2° graus, constipação em 81,7% e apneia leve/moderada em 40,7%. A avaliação fisioterapêutica realizada na fase pré-intervenção demonstrou presença de alteração no controle do equilíbrio nos pacientes com enurese. A associação entre os fatores reconhecidos na abordagem clínica inicial e a gravidade da enurese (% de episódios/mês) na fase préintervenção, apresentou significância para prematuridade (p=0,03). Previamente à randomização, após abordagem clínica de constipação e/ou terapia comportamental simples, verificou-se cura de 7/82 pacientes. Foram randomizados para tratamento nas três modalidades de intervenção 75 pacientes. Durante a fase de intervenção ocorreram 14/75 (18,7%) desistências, principalmente no grupo alarme (p=0,00). Verificou-se nos 61 pacientes em tratamento, sucesso inicial (resposta completa e parcial) em 56,6% do grupo alarme, 70% do grupo desmopressina e 64% do grupo combinado (p=0,26). Sucesso contínuo (SC) ocorreu em 70% do grupo Alarme, 84,2% do grupo Desmopressina e 100% do grupo combinado (p=0,21). A recidiva ocorreu em 3/20 (15%) pacientes do grupo Alarme e 1/19 (5,2%) do grupo Desmopressina. O sucesso terapêutico se associou a redução nos escores de problemas de comportamento e melhora dos escores de qualidade de vida dos pacientes. A análise comparativa do sono pré e pós-intervenção nos pacientes com e sem alarme demonstrou aumento dos microdespertares (p=0,00), diminuição da eficiência do sono (p=0,02), diminuição de N2 (p=0,00) no grupo alarme. Conclusão: A enurese é um distúrbio multifatorial que exige uma abordagem diagnóstica estruturada. No presente estudo, a abordagem terapêutica utilizando três metodologias de intervenção demonstrou eficácia semelhante. Os benefícios associados ao sucesso terapêutico são amplos, sugere-se, no entanto, que a terapia com alarme possa repercutir negativamente na estrutura do sono<br>Introduction: Enuresis (NE) is a clinical condition of multifactorial etiology with intermittent nocturnal urine loss characteristic at night that leads to difficulties in child / adolescent social interaction. It can be affected by comorbidities and by immaturity of the central nervous system in the regulation of bladder function. The range of events of the bedwetting episode, from bladder filling until the involuntary triggering of bladder emptying during sleep, constitutes the main focus for clinical-laboratory and therapeutic approach. Objective: To study the impact of a multidisciplinary assessment of the patient with monosymptomatic nocturnal enuresis (MNE) on the therapeutic efficacy of the interventions traditionally used in its approach, and to compare, by polysomnography (PSG), the effects of intervention on sleep structure. Method: Prospective study of children, of 6 to 17 incomplete years, with MNE diagnosed by multidisciplinary assessment, based on: pediatric nephrology - oriented structured history, clinical examination, kidney and urinary tract ultrasound, laboratory tests of blood and urine and daily bladder and intestinal elimination diaries; neurological examination, sleep diary and sleep questionnaires and PSG; psychology evaluation using CBCL and PedsQL 4.0 questionnaires; physiotherapic evaluation of balance. The study was approved by the HCFMUSP Ethics Committee in Research of number 0649/10 and was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant # 2011/17589-1. Of the 140 children/adolescents entering the study, 58 (41.4%) were excluded because of non - treatable comorbidities and / or nonadherence to study protocol, 82/140 (58.6%) patients with MNE were included for therapeutic intervention in three treatment groups (alarm, desmopressin and alarm with desmopressin). The response to therapeutic intervention was evaluated in the immediate and late post-intervention period, respectively after six of treatment and after 12 months of posttreatment follow-up. Pre and post intervention PSG were compared to evaluate therapy impact on the structure of sleep. Results: Of 82 patients, 62 were male (75.6%) with mean age of 9.5 years (± 2.6). Family history of NE was diagnosed in 91.1% of first and second degree relatives, constipation in 81.7% and mild/moderate apnea in 40.7%. The physical therapy preintervention evaluation identified an alteration in the balance control of the MNE patients. In the pre-intervention phase, an association of prematurity with severity of enuresis (% of episodes/month) (p = 0.03) was identified. Enuresis cure was achieved, prior to randomization, after clinical approach to constipation and / or simple behavioral therapy, by 7/82 patients, 75 patients were randomized to treatment with three modes of intervention. During the intervention phase, a dropout rate of 14/75 (18.7%) patients was verified, especially in the alarm group (p = 0.00). Initial success (complete and partial response) was observed in 56.6% patients of the alarm group, 70% of the desmopressin group and 64% of the combined group (p = 0.26). Continued success (SC) occurred in 70% patients of the alarm group, 84.2% of desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients of the alarm group and 1/19 (5.2%) of desmopressin group. Therapeutic success was associated with a reduction in scores for behavioral problems and with improvement of patients\' quality of life scores. The comparative analysis between pre and post-intervention sleep structure parameters, in patients treated with and without alarm, showed increased arousals (p=0.00), decreased sleep efficiency (p = 0.02), decreased N2 (p = 0.00) in the alarm group. Conclusion: Enuresis is a multifactorial disorder that requires a structured diagnostic approach. In the present study, three therapeutic intervention methodologies demonstrated similar efficacy. The benefits associated with treatment success are multiple; the present study data suggest, however, that alarm therapy can have a negative effect on sleep structure

Incontinence in childhood in either of its forms, enuresis and encopresis, is one of the most prevalent and distressing of all childhood problems. Due to widespread misunderstanding, incontinence is a significant precipitating factor in the mistreatment of afflicted children. Interpretations of and treatments for enuresis and encopresis have shifted in the past few decades from a mostly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of incontinence are medical/organic, environmental and psychosocial elements are factors, and the most empirically supported treatments have a significant behavioral dimension. This chapter reviews the literatures on enuresis and encopresis with attention focused on clinical description, causes and correlates, assessment, treatment, challenges, and implications for practice. Case examples are included to illustrate these features.