Research

posted on 20 Jan 2010 and tagged children, eric, night, nocturnal enuresis, research

ERIC is pleased to provide abstracts of recent research into childhood continence for your information.

BMC Public Health. 2009 Sep 22;9:357

The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey: a cross sectional study.

Gunes A, Gunes G, Acik Y, Akilli A.

BACKGROUND: Nocturnal enuresis is an important problem among young children living in Turkey. The purpose of this study was to determine the possible differences in the prevalence of enuresis between children in boarding school and daytime school and the association of enuresis with socio demographic factors. METHODS: This was a cross-sectional survey. A total of 562 self-administered questionnaires were distributed to parents from two different types of schools. One of them was a day-time school and the other was a boarding school. To describe enuresis the ICD-10 definition of at least one wet night per month for three consecutive months was used. Chi-square test and a logistic regression model was used to identify significant predictive factors for enuresis. RESULTS: The overall prevalence of nocturnal enuresis was 14.9%. The prevalence of nocturnal enuresis declined with age. Of the 6 year old children 33.3% still wetted their beds, while the ratio was 2.6% for 15 years-olds. There was no significant difference in prevalence of nocturnal enuresis between boys and girls (14.3% versus 16. 8%). Enuresis was reported as 18.5% among children attending day time school and among those 11.5% attending boarding school (p < 0.05). Prevalence of enuresis was increased in children living in villages, with low income and with positive family history (p < 0.05). After multivariate analysis, history of urinary tract infection (OR = 2.02), age (OR = 1.28), low monthly income (OR = 2.86) and family history of enuresis (OR = 3.64) were factors associated with enuresis. 46.4% of parents and 57.1% of enuretic children were significantly concerned about the impact of enuresis. CONCLUSION: Enuresis was more frequent among children attending daytime school when compared to boarding school. Our findings suggest that nocturnal enuresis is a common problem among school children, especially with low income, smaller age, family history of enuresis and history of urinary tract infection. Enuresis is a pediatric public health problem and efforts at all levels should be made such as preventive, etiological and curative.

J Pediatr. 2009 Sep;155(3):432-4.

Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases.

Gish P, Mosholder AD, Truffa M, Johann-Liang R.

We reviewed Food and Drug Administration post marketing reports of central nervous system (CNS) anticholinergic effects in association with oxybutynin. Taking domestic usage by age group into account, there is a disproportionately higher number of CNS adverse event cases reported in pediatric patients as compared with adult patients. CNS stimulation was prominent in the pediatric cases.

J Pediatr (Rio J). 2009 Sep-Oct;85(5):433-7

Assessment of domestic violence against children and adolescents with enuresis.

Sapi MC, Vasconcelos JS, Silva FG, Damião R, da Silva EA.

OBJECTIVE: To describe the frequency of domestic violence against Brazilian children and adolescents due to episodes of enuresis, as well as associated risk factors. METHODS: A cross-sectional study was carried out with 149 patients aged between 6 and 18 years who received the diagnosis of primary monosymptomatic nocturnal enuresis. A semi-structured interview was done with the patients and their guardians to collect information about the characteristics of domestic violence and abusers. In addition, a playful activity was performed by the patients. Abuse was characterized as verbal aggression, physical aggression without physical contact, and physical aggression with physical contact. RESULTS: Eighty-nine percent (n = 132) of the patients suffered abuse due to episodes of urine leakage. All cases were characterized by verbal punishment associated or not with other types of aggression. Physical punishment without physical contact occurred in 50.8% of the cases, while physical punishment with physical contact accounted for 48.5% of the cases. The main abuser was the mother (87.9%). One patient suffered an intentional severe genital injury, and reconstructive surgery was necessary. There was a significant correlation (p = 0.043, r = -0.768) between the abuser’s educational level and punishment severity. CONCLUSIONS: Punishment rates due to episodes of urine leakage are alarming. Children and adolescents with enuresis who live with low-educated people can be considered a population at risk of suffering domestic violence.

 

J Pharm Pharmacol. 2009 Sep;61(9):1229-32.

Synthesis of a quaternary bis derivative of imipramine as a novel compound with potential anti-enuretic effect.

Jamali B, Roodsari MS, Soleymani Z, Faizi M, Shafaghi B, Kobarfard F.

OBJECTIVES: Imipramine has been used for over four decades (early reports in 1960s) for the treatment of nocturnal enuresis, although the reason for its effect is not clear. Imipramine is a tertiary amine, which may act both in the periphery and/or pass through the blood-brain barrier (BBB) in unionized form and exhibit a central effect. Since imipramine has anti-cholinergic properties, some believe it may exert its anti-enuretic effect by affecting peripheral cholinergic receptors, i.e. its anti-enuretic effect may be due to peripheral anti-cholinergic properties, whereas others think it can pass through the BBB and interact with central nervous system (CNS) receptors. If the anti-enuretic effect of imipramine is due to its peripheral anti-cholinergic effects, its entrance into the CNS is unnecessary. Therefore, the synthesis of a form of imipramine that can exhibit peripheral anti-cholinergic effects but does not have CNS adverse effects would have a safer drug profile in this case. On the other hand, if the anti-enuretic effect of imipramine is primarily due to its action on the CNS, a form of imipramine that cannot pass through the BBB has no effect on nocturnal enuresis treatment and thus may help to clarify the mechanism of action of imipramine in nocturnal enuresis treatment. METHODS: This article describes the synthesis and evaluation of the anti-cholinergic effect of a new bis derivative of imipramine, which contains two imipramine units in its structure. KEY FINDINGS: The compound exhibited anti-cholinergic activity comparable with that of imipramine on isolated guinea pig ileum. CONCLUSIONS: Being a quaternary ammonium, this compound is not expected to be able to cross the BBB and thus would cause fewer CNS side effects.

 

Singapore Med J. 2009 Sep;50(9):879-80

The efficacy of an enuresis alarm in monosymptomatic nocturnal enuresis.

Ozgür BC, Ozgür S, Doğan V, Orün UA.

INTRODUCTION: Monosymptomatic nocturnal enuresis (MNE) is a frequent problem in children older than five years of age. Of the various treatment options, the enuresis alarm has been widely advocated for treating nocturnal enuresis. This study was designed to evaluate the success rates of the enuretic alarm device in patients with MNE. METHODS: 40 patients who had significant MNE (three or more wet nights per week) were included. They used an enuretic alarm for 12 weeks initially. If a relapse was observed, re usage of the device was provided. A success criterion was defined as “14 consecutive dry nights” and a relapse criterion was “more than one wet night a week”. RESULTS: The patients’ mean age was 8.1 (range 6-16) years and the mean follow-up time was 10.2 (range 6-19) months. 27 patients became dry at night at the end of three months. In the follow-up period, a relapse was observed in 66.7 percent of the initial responders. For recovery, 14 patients started to reuse the device, and seven of them responded positively. At the end of the treatment, a total of 13 of the patients had benefited from the enuretic alarm. CONCLUSION: During the follow-up, the enuretic alarm device provided acceptable initial and long-term complete dryness in patients with primary nocturnal enuresis. Without the need for expensive pharmacological intervention, the alarm treatment is an effective choice for children with nocturnal enuresis.

Nurs Stand. 2009 Sep 16-22;24(2):49-56

Assessing and treating faecal incontinence in children.

Dobson P, Rogers J.

Faecal incontinence can have a profound effect on the lives of children and their families. Children who have faecal incontinence have a greater risk of being bullied at school, and parents are often frustrated and concerned by the associated social stigma. The social and psychological effects of faecal incontinence on the child can last for a long time. This article provides an overview of the causes of faecal incontinence discusses assessment of bowel dysfunction and outlines current treatments. The article also highlights the importance of the nurse’s role, as part of the multidisciplinary team, in assessing, treating and supporting children and their families to ensure that any interventions have the best chance of succeeding and to minimise the risk of relapse.

 

J Pediatr Surg. 2009 Sep;44(9):1791-8

Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure.

Keshtgar AS, Ward HC, Clayden GS.

PURPOSE: Constipation is a common problem in children, and when it becomes chronic fecal impaction, overflow soiling and megarectum may develop. Children with chronic idiopathic constipation (IC) may not respond to conventional treatments of laxatives, enemas, and toilet training. The aims of the study were to evaluate the long-term outcome of transcutaneous needle-free injection of botulinum toxin (TNFBT) into the external anal sphincter (EAS) and to assess the extent of the toxin penetration into the sphincter. METHOD: Children were recruited if symptomatic with chronic constipation, soiling, painful defecation, and withholding behavior requiring disimpaction of stool and rectal biopsy under general anesthesia. A total dose of 200 U of botulinum toxin (BT) (Dysport; Ipsen Limited, Slough, United Kingdom) was injected transcutaneously into the EAS at 3 and 9-o’clock positions using J-tip needle-free syringes (National Medical Products Inc, Irvine, Calif). The depth and width of toxin penetration was assessed by endosonography. Outcome was measured by a validated symptom severity (SS) score questionnaire. The total SS score ranged between 0 (best) and 65 (worst). The outcome was compared with 31 children in a comparable historical control group at 3 and 12-month follow-up. RESULTS: Sixteen children were recruited with median age of 6.11 (range, 3-14.85) years and median duration of symptoms of 3.9 years (1.6-11.5). On endosonography, the median depth and width of BT penetration was 8 (7-10) mm and 8 (6-10) mm, respectively. At 3-month follow-up, the median SS score improved in all children after TNFBT from 32.50 (5-57) to 7.50 (0-26) (Wilcoxon’s P < .0001). There were significant improvements in symptoms of constipation, soiling, painful defecation, general health and behavior, and fecal impaction of rectum (P < .05). Anal fissures healed in all 4 children. The SS score in the control group improved from 33 (12-49) to 15 (0-40) (P < .0001). At 12-month follow-up, the improvement of SS score in TNFBT group was significantly more than the control group as follows: 4 (0-25) vs 15 (0-51), respectively (Mann-Whitney U P < .002). Three patients had a second TNFBT injection for relapsed symptoms. There were no complications. The transcutaneous needle-free injection of botulinum toxin eliminates the risk of intravascular injection or needlestick injury. The transcutaneous needle-free injection of botulinum toxin also has other therapeutic applications including an alternative therapy to biofeedback training for dyssynergia of the EAS, treatment of muscle limb spasticity in cerebral palsy, and cosmetic treatment of overactive facial muscles and wrinkles and hyperhydrosis. CONCLUSION: Transcutaneous needle-free injection of botulinum toxin into the external anal sphincter is a novel and safe new treatment of chronic idiopathic constipation and anal fissure in children. A second injection may be required in 20% of patients.

J Manipulative Physiol Ther. 2009 Oct;32(8):675-81.

Chiropractic treatment for primary nocturnal enuresis: a case series of 33 consecutive patients.

van Poecke AJ, Cunliffe C.

OBJECTIVE: The purpose of this study was to evaluate the effect of a specific type of chiropractic treatment on the wet night frequency of patients between the ages of 3 and 18 years who were treated for primary nocturnal enuresis (PNE) in the chiropractic setting. CLINICAL FEATURES: Thirty-three consecutive patient records, dating over a 3-year period, of children 3 to 18 years old who had been treated for PNE using a form of chiropractic treatment method (NeuroImpulse Protocol) were included. INTERVENTION AND OUTCOME: All patient records were analyzed for a baseline wet night frequency and at 3, 6, 9, and 12 months after the commencement of treatment. Data were collected regarding the number of treatment visits over the 12-month period and the presence of constipation and/or positive family history at presentation. Data were analyzed using descriptive statistics, Friedman’s test, and Dunn’s Multiple Comparison test. Of the 33 patient records analyzed, 22 showed resolution of PNE during the 12 months after commencement of chiropractic care. The mean number of treatments in the responders group was 2.05 +/- 1.33. Ten responders presented with constipation and a further 8 with a positive family history of PNE. Resolution of constipation was noted to be essential to the successful response to treatment. A combination of constipation and positive family history at presentation represented a poor prognostic factor. CONCLUSIONS: There was a 66.6% resolution rate within 1 year in 33 consecutive children and teenagers who experienced PNE. This study provides an indication for possible effectiveness of chiropractic treatment in patients with PNE.

J Urol. 2009 Oct;182(4 Suppl):2067-71.

Influence of pelvic floor muscle exercises on full spectrum therapy for nocturnal enuresis.

Van Kampen M, Lemkens H, Deschamps A, Bogaert G, Geraerts I.

PURPOSE: We investigated the effect of pelvic floor muscle training on the efficacy of full spectrum therapy and maximal voided volume in children with nocturnal enuresis. We also determined factors predicting treatment outcome, full spectrum therapy duration and the relapse rate. Full spectrum therapy is a combination of alarm, reward, timed voiding and drinking, over learning and pelvic floor muscle training. MATERIALS AND METHODS: A total of 63 consecutive children were referred to the physiotherapy department for full spectrum therapy to resolve nocturnal enuresis, including 32 in the experimental group who underwent full spectrum therapy with pelvic floor muscle training and 31 in the control group who underwent full spectrum therapy without training. RESULTS: There was no significant difference in treatment outcome, duration, maximal voided volume and relapse between the 2 groups. Of all children 89% became dry within 6 months. During the year after treatment 33.3% and 37.9% of the experimental and control groups relapsed, while the relapse rate at 1 year was 7.4% and 20.7%, respectively. Age and child motivation were associated with the duration of success (p = 0.04 and <0.01, respectively). Secondary enuresis and psychosocial problems were factors significantly related to relapse (each p <0.01). CONCLUSIONS: There is no beneficial effect of including pelvic floor muscle training in full spectrum therapy. Older children and those with better motivation experienced more rapid success. Factors predicting relapse were secondary enuresis and psychosocial problems.

J Urol. 2009 Oct;182(4 Suppl):2020-1.

Problem behavior, parental stress and enuresis.

De Bruyne E, Van Hoecke E, Van Gompel K, Verbeken S, Baeyens D, Hoebeke P, Vande Walle J.

PURPOSE: We determined maternal and paternal ratings of problem behavior in 5 to 13-year-old children with (non)monosymptomatic enuresis and investigated parental stress and the association between parental ratings of child behavior and parental stress. MATERIALS AND METHODS: We compared problem behavior in 78 children with (non)monosymptomatic enuresis vs that in 110 without enuresis using the Child Behavior Checklist and the Disruptive Behavior Disorders Rating Scale. Parental stress was measured using the Parenting Stress Index. RESULTS: Maternal results replicated previous findings of significantly higher Child Behavior Checklist scores for externalizing and total problems compared with those in the control group, whereas no significant differences were found for paternal ratings. Mothers and fathers of enuretic children reported significantly higher scores on the Disruptive Behavior Disorders Rating Scale inattention, hyperactivity/impulsivity and oppositional defiant disorder subscales than parents of children without enuresis. The Parenting Stress Index revealed significantly higher overall stress in mothers and fathers of children with (non)monosymptomatic enuresis compared with that in parents of controls. Especially parental stress related to child characteristics was associated with a greater report of child behavior problems. CONCLUSIONS: Each parent but especially mothers reported more problem behavior in children with (non)monosymptomatic enuresis than in controls. They also reported more stress, which correlates highly with parental ratings of problem behavior in children with (non)monosymptomatic enuresis

J Urol. 2009 Oct;182(4 Suppl):2032

Methylphenidate for giggle incontinence.

Berry AK, Zderic S, Carr M.

PURPOSE: Giggle incontinence or enuresis risoria is a socially embarrassing problem characterized by involuntary and complete bladder emptying in response to laughter. To our knowledge the cause of giggle incontinence is unknown, although a functional relationship to cataplexy was suggested. We retrospectively examined the effectiveness of methylphenidate for giggle incontinence in children. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients referred to a pediatric specialty voiding center between 2004 and 2008 for wetting associated with laughter. Patients who met giggle incontinence criteria with no associated urgency or urge incontinence were offered a trial of methylphenidate. Wetting frequency was assessed before and during methylphenidate treatment. RESULTS: A total of 20 patients with a mean age of 12.4 years (range 7.5 to 15.5) met giggle incontinence criteria with no other wetting reported. Incontinence frequency was daily to less than once weekly. After a timed voiding trial 15 of 20 patients (75%) elected a methylphenidate trial, of whom 12 (80%) reported prompt and complete cessation of wetting. Treatment duration was 2 months to greater than 3 years. CONCLUSIONS: Giggle incontinence with no other urinary symptoms is a rare form of incontinence. Methylphenidate was a viable option for giggle incontinence but it was not accepted by all families.

J Urol. 2009 Oct;1828(4 Suppl):1967-72

Clinical differences in daytime wetting subtypes: urge incontinence and postponed voiding.

Kuhn S, Natale N, Siemer S, Stoeckle M, von Gontard A.

PURPOSE: Urge incontinence and voiding postponement are common subtypes of daytime wetting in children. We analyzed clinical and behavioral differences in children with urge incontinence, voiding postponement and healthy controls at 2 centers. MATERIALS AND METHODS: A total of 49 consecutive children 5 to 13 years old with urge incontinence (22) or voiding postponement (27) who presented to the department of urology or child psychiatry were examined as well as 32 age and gender matched controls. Instruments included physical examination, sonography, uroflowmetry, urinalysis, a 48-hour bladder diary, the Child Behavior Checklist, a structured psychiatric interview and an intelligence test. RESULTS: The incontinent group consisted of 28 boys and 21 girls with a mean age of 7.35 years. Controls included 13 girls and 19 boys with a mean age of 7.31 years. Incontinent children had a higher rate of pathological uroflow curves (33% vs 25%) and urinary tract infection (6% vs 3%), greater post-void residual volume (6.3 ml vs 3.8 ml) and a thicker bladder wall. Mean IQ was the same in the 2 groups (103). The Child Behavior Checklist showed that significantly more incontinent children had clinical total behavior (41% vs 9%, p <0.01), and externalizing (35% vs 0%, p <0.001) and internalizing (29% vs 6%, p <0.05) scores than controls. Also, more children with voiding postponement had total clinical scores than those with urinary incontinence (56% vs 24%, p <0.05). Of incontinent children 49% fulfilled the criteria for at least 1 ICD-10 psychiatric diagnosis vs 9% of controls (p <0.001). There were no differences between children recruited at the departments of urology and child psychiatry. CONCLUSIONS: This study shows that urge incontinence and voiding postponement are significantly associated with somatic complaints and psychological abnormalities compared to a control population. Children with voiding postponement have more externalizing behavioral disorders. Children seen at urological departments carry the same psychiatric risks and require the same attention to behavioral problem diagnosis.

J Urol. 2009 Oct;182(4 Suppl):2045-9.

Poor compliance with primary nocturnal enuresis therapy may contribute to insufficient desmopressin response.

Van Herzeele C, Alova I, Evans J, Eggert P, Lottmann H, Nørgaard JP, Vande Walle J.

PURPOSE: Studies of desmopressin in children with primary nocturnal enuresis show a greater than 90% decrease in wet nights in 20% to 30%, a 50% to less than 90% decrease in 20% to 40% and less than a 50% decrease in up to 60%. Insufficient response to desmopressin is attributable to various factors, including differences in the primary nocturnal enuresis definition, underlying bladder dysfunction and/or desmopressin pharmacokinetic characteristics. However, little attention has been given to poor compliance with therapy as a possible explanatory factor. For a drug with an effect duration limited to the night after administration a high degree of compliance is essential to ensure consistent therapeutic effects. MATERIALS AND METHODS: This was a substudy of an international investigation of treatment for 6 months or less with desmopressin tablets in children with primary nocturnal enuresis. Medication was dispensed at each visit as required and collected at each subsequent visit. Compliance was determined by pill counts by study staff. RESULTS: Compliance data were available on 723 patients. Of the patients 81% to 91% ingested all medication as instructed during the initial run-in phases. However, this decreased to 77% and 71% during the first and second 3-month treatment periods, respectively. CONCLUSIONS: Patient motivation and compliance are generally stronger in clinical trials than in clinical practice. However, this study shows that some patients were poorly compliant with medication even at study initiation and only 71% were fully compliant with long-term treatment. Decreased compliance was associated with a lower response rate. Patients should be encouraged to comply fully with treatment to achieve an optimal outcome.

J Urol. 2009 Oct;182(4 Suppl):2079-84.

Adequate fluid intake, urinary incontinence, and physical and/or intellectual disability.

Van Laecke E, Raes A, Vande Walle J, Hoebeke P.

PURPOSE: Urinary incontinence in physically and/or intellectually disabled children is a common problem. Literature on therapy is sparse. In these patients we prospectively studied the effect of urotherapy, particularly adequate fluid intake. MATERIALS AND METHODS: In a prospective study 66 boys and 45 girls with a mean age of 9.1 years were included, of whom 22 were motor disabled, 16 were mentally disabled and 73 had mental and motor disability. All patients were put on a fluid intake schedule of 1,500 ml/m(2) body surface. Mean followup was 22.9 months (range 12 to 30). Patients were evaluated using a diary, uroflowmetry and bladder scan. RESULTS: Of the children 44 (39.6%) were dry at study inclusion, 41 (46.9%) had daytime and nighttime urinary incontinence, 11 (9.9%) had daytime urinary incontinence and 15 (13.5%) had nocturnal enuresis. Anticholinergics were started in 18 children, of whom 11 became dry. The other children received only an adequate fluid intake schedule. Eight patients (7.2%) withdrew from study. At study end 69 children (67%) were completely dry during the day and night, 14 (13.6%) remained urinary incontinent during the day and night, 5 (4.9%) had daytime urinary incontinence and 15 (14.6%) had nocturnal enuresis. Of the children 73 (65.8%) drank at least 25% less than the physiologically necessary quantity. Initially 62 children (55.9%) had a small age related expected maximum voided volume, which decreased to 24 (21.6%) at end of study. CONCLUSIONS: Adequate fluid intake is an important part of urotherapy for urinary incontinence in mentally and/or motor disabled children.

J Urol. 2009 Oct;182(4 Suppl):1961-5.

Abnormal sleep architecture and refractory nocturnal enuresis.

Dhondt K, Raes A, Hoebeke P, Van Laecke E, Van Herzeele C,