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Pediastric monosymptomatic nocturnal eEuresis: transdisciplinary evaluation and study of intervention-related changes in polysomnography

Grant number: 11/17589-1
Support type:Regular Research Grants
Duration: November 01, 2011 - August 31, 2014
Field of knowledge:Health Sciences - Medicine - Maternal and Child Health
Principal researcher:Vera Hermina Kalika Koch
Grantee:Vera Hermina Kalika Koch
Home Institution: Instituto da Criança Professor Doutor Pedro de Alcantara (ICR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Assoc. researchers: Adrienne Surri Lebl Teixeira de Carvalho ; Clarice Tanaka ; Edwiges Ferreira de Mattos Silvares ; Elisa Marques Ribeiro ; Erika Arai Furusawa ; Leticia Maria Santoro Franco Azevedo Soster ; Rita Pavione Rodrigues Pereira ; Simone Nascimento Fagundes


Bedwetting is the involuntary elimination of urine at night, after a complete urinary voiding in individuals with five or more years of age. Nocturnal Enuresis (NE) can be either monosymptomatic (MNE), when it occurs in the absence of other symptoms, or polysymptomatic (PNE) in the presence of symptoms such as daytime and nocturnal urinary loss, urinary tract infection and / or encopresis. EN is called primary when involuntary urinary loss was never controlled, and secondary, when there has been adequate prior sphincteric control for at least six months.NE is a mismatch between the amount of urine produced at night and the functional capacity of the bladder, in a patient in whom the stimulus of a full bladder is not capable of producing sleep arousal. MNE can be characterized as a multifactorial disease expressed predominantly as nocturnal polyuria or as a functional reduction of bladder capacity The possible causes of nocturnal polyuria are missing/inadequate nocturnal peak of antidiuretic hormone, increased nocturnal urinary excretion of solute and possibly other factors such as sleep apnea, hypercalciuria and aquaporin 2 dysfunction. Polysomnography studies show bladder filling and bladder emptying predominantly during deep.Brazilian studies on management of MNE, are very scarce. In the present study, participants with MNE and nocturnal polyuria will be included after informed consent, this selection criteria will eliminate the bias of most previous studies in which patients with low functional bladder capacity and nocturnal polyuria were evaluated in the same treatment group, without taking into account the pathophysiological aspects of these two differing forms of ENM when choosing therapy,. Previously to intervention, the participants will be evaluated in terms of postural health, mental status and polysomnography to study the sleep pattern and to exclude cases of obstructive sleep apnea related enuresis. The study protocol consists of three parallel groups of patients, constituted of 20 patients randomly each, who will undergo intervention with desmopressin (DDAVP), bed alarm or both for 6 months, followed by 6 months of further observation, which will enable the evaluation of the therapeutic efficiency/frequency of relapse of each one of the interventions Polysomnography will be repeated at the end of the treatment period to evaluate intervention related changes in the sleep pattern. (AU)

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Scientific publications (7)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
SOUSA E SILVA, GUILHERME JORGE; FAGUNDES SAMMOUR, SIMONE NASCIMENTO; FERRARO, ALEXANDRE ARCHANJO; KALIKA KOCH, VERA HERMINA. Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis. Jornal de Pediatria, v. 95, n. 2, p. 188-193, MAR-APR 2019. Web of Science Citations: 1.
GUILHERME JORGE SOUSA E SILVA; SIMONE NASCIMENTO FAGUNDES SAMMOUR; ALEXANDRE ARCHANJO FERRARO; VERA HERMINA KALIKA KOCH. Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis,. Jornal de Pediatria, v. 95, n. 2, p. 188-193, Abr. 2019.
FAGUNDES, SIMONE N.; LEBL, ADRIENNE SURRI; SOSTER, LETICIA AZEVEDO; SOUSA E SILVA, GUILHERME JORGE; DE MATTOS SILVARES, EDWIGES FERREIRA; KOCH, VERA H. Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention. Pediatric Nephrology, v. 32, n. 5, p. 843-851, MAY 2017. Web of Science Citations: 10.
SOSTER, LETICIA AZEVEDO; ALVES, ROSANA CARDOSO; FAGUNDES, SIMONE NASCIMENTO; LEBL, ADRIENNE; GARZON, ELIANA; KOCH, VERA H.; FERRI, RAFFAELE; BRUNI, OLIVIERO. Non-REM Sleep Instability in Children With Primary Monosymptomatic Sleep Enuresis. JOURNAL OF CLINICAL SLEEP MEDICINE, v. 13, n. 10, p. 1163-1170, 2017. Web of Science Citations: 1.
FAGUNDES, SIMONE NASCIMENTO; SOSTER, LETICIA AZEVEDO; LEBL, ADRIENNE SURRI; RODRIGUES PEREIRA, RITA PAVIONE; TANAKA, CLARICE; PEREIRA, RODRIGO FERNANDO; DE MATTOS SILVARES, EDWIGES FERREIRA; KOCH, VERA H. Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis. Pediatric Nephrology, v. 31, n. 8, p. 1295-1303, AUG 2016. Web of Science Citations: 9.
PAVIONE RODRIGUES PEREIRA, R.; NASCIMENTO FAGUNDES, S.; SURRY LEBL, A.; AZEVEDO SOSTER, L.; MACHADO, M. G.; KOCH, V. H.; TANAKA, C. Children with nocturnal enuresis have posture and balance disorders. JOURNAL OF PEDIATRIC UROLOGY, v. 12, n. 4 AUG 2016. Web of Science Citations: 2.
SOSTER, LETICIA AZEVEDO; ALVES, ROSANA; FAGUNDES, SIMONE N.; KOCH, VERA H. K.; BRUNI, OLIVIERO. Sleep disturbances associated with sleep enuresis: A questionnaire study. EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY, v. 20, n. 2, p. 282-285, MAR 2016. Web of Science Citations: 7.

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