Journal Article

Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention

Silvares, Edwiges Ferreira de Mattos, Lebl, Adrienne Surri, Sousa e Silva, Guilherme Jorge, Azevedo Soster, Leticia, Koch, Vera H., Fagundes, Simone N.

2017

Overview

Background Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. Methods This was a prospective study of MNE patients, aged 6–16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal. Results Of the 82 patients [mean age 9.5 (SD ± 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group ( p  = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group ( p  = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group ( p  = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement. Conclusions The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adolescent / Behavior modification / Child / Child Behavior / Child, Preschool / Chronic illnesses / Clinical Alarms / Combined Modality Therapy / Constipation / Constipation - therapy / Deamino Arginine Vasopressin - therapeutic use / Disease Management / Female / Humans / Intervention / Male / Medical schools / Medicine / Medicine & Public Health / Multidisciplinary teams / Nephrology / Nocturnal Enuresis - psychology / Nocturnal Enuresis - therapy / Original Article / Patient Care Team / Patient Dropouts / Patients / Pediatrics / Prospective Studies / Quality of Life / Recurrence / Renal Agents - therapeutic use / School dropout programs / Success / Teenagers / Urinary incontinence / Urine / Urology