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

Author(s)

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

• Document type: Journal article
• Source: Pediatric Nephrology; v. 32, n. 5, p. 843-851, MAY 2017.
• Web of Science Citations: 10

Abstract

Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring. 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. 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. 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. (AU)

• FAPESP's process: 11/17589-1 - Pediastric monosymptomatic nocturnal eEuresis: transdisciplinary evaluation and study of intervention-related changes in polysomnography
• Grantee: Vera Hermina Kalika Koch
• Support Opportunities: Regular Research Grants