Monosymptomatic nocturnal enuresis

Abstract

Enuresis Nocturna is the most common urologic problem in childhood. There is not a consensus about terminology. Terminology identified by The International Children's Continence Society (ICCS) is recommended. Bed-wetting at night during sleep (incontinence) in children above 5 years of age who don\'t have congenital or acquired central nervous system defect is defined as enuresis nocturna. There are two groups monosymptomatic (simple) and non-monosymptomatic (complicated). Monosymptomatic enuresis nocturna (MNE) has no symptoms other than bed-wetting at night during sleep. Various theories concerning etiology of MNE has been suggested; one or more of ge-netic, hormonal, bladder associated and sleep disorders are stated to play a role. Self-improvement can be achieved each year by 15% increasing maturity. Under pinning treatment and in addition to this unique treatment must be done by considering the factors in the pathophysiology. The success of the treatment and roadmap to be followed must be arrange with child and family. The purpose of this eclectic is; evaluation of correct diagnosis, differential diagnosis, patient follow-up and treatment options of the cases applicant with nocturnal enuresis based on the current knowl-edge of ICCS and Turkey Enuresis Treatment Guide.

Keywords

• Enuresis, child, treatment.

Monosymptomatic nocturnal enuresis

Abstract

Enüresiz noktürna (EN) çocukluk çağının en sık karşılaşılan ürolojik problemidir. Terminoloji konusunda tam bir görüş birliği olmayıp Uluslararası Çocuk Kontinans Derneği\'nin (ICCS) yaptığı tanımlamaların kullanılması önerilmektedir. Doğuştan ya da kazanılmış santral sinir sistemi defekti olmayan 5 yaşın üzerindeki çocuklarda istemsiz olarak gece uykuda altını ıslatma EN olarak tanımlanır. Monosemptomatik (basit), monosemptomatik olmayan (komplike) grupları vardır. Monosemptomatik noktürnal enüreziste (MNE) gece yatağa ıslatma dışında gün içinde herhangi belirti yoktur. MNE etyolojisinde çeşitli teoriler öne sürülmüş; genetik, hormonal, mesane ile ilişkili ve uyanma bozukluklarının bir veya birden fazlasının rol oynayabileceği bildirilmiştir. Matüritenin artmasıyla her yıl %15 oranında kendiliğinden dü-zelme görülür. Tedavi destekleyici ve buna ilaveten patofizyolojideki faktörler göz önüne alınarak özgün tedavi olarak yapılmaktadır. Tedavinin başarısı ve izlenecek yol haritası çocuk ve aile ile birlikte planlanmalıdır. Bu derlemede nok-türnal enürezisle başvuran olguları değerlendirirken doğru tanı, ayırıcı tanı, izlem ve tedavi seçenekleri ICCS ve Tür-kiye Enürezis Tedavi Kılavuzu (TEK) temel alınarak güncel bilgiler ışığında verilmesi amaçlanmıştır.

Keywords

• Enürezis, çocuk, tedavi.

References

1. 1. Neveus T, Eggert P, Evans J, et al. International Children’s Continence Society. J Urol 2010; 183(2): 441-7.
2. 2. Avanoğlu A, Baskın E, Söylemezoğlu O, Tekgül S, Ziylan O, Zorludemir Ü. Türkiye enürezis çalışma grubu. Türkiye Enürezis Tedavi Kılavuzu 2010;1-16.
3. 3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4rd edn. American Psychiatry Press. Washington DC,1995: 1537-41.
4. 4. Devlin JB. Prevalence and risk factors for childhood nocturnal enuresis. Ir Med J 1991;84(4):118-20.
5. 5. Oge O, Koçak I, Gemalmaz H. Enuresis: point prevalence and associated factors among Turkish children. Turk J Pediatr 2001;43(1):38-43.
6. 6. Feehan M, McGee R, Stanton W, Silva PA. A 6 year follow up of childhood enuresis: prevalence in adolescence and consequences for mental health. J Paediatr Child Health 1990; 26(2):75-9.
7. 7. Serel A, Akhan G, Koyuncuoglu HR, Ozturk A, Dogruer K, Unal S. Epidemiology of enuresis in Turkish children. Scand J Urol Nephrol 1997;31(6):537-9.
8. 8. Gümüs B, Vurgun N, Lekili M, Iscan A, Müezzinoğlu T, Büyüksu C. Prevalence of nocturnal enuresis and acompanying factors in children aged 7-11 years in Turkey. Acta Pediatr 1999; 88(12):1369-72.

9. 9. Gür E, Turhan P, Can G, et al. Enuresis: Prevalence, risk factors and urinary pathology among school children in Istanbul, Turkey. Pediatr Int 2004;46(1):58-63.
10. 10. Hanafin S. Sociodemographic factors associated with nocturnal enuresis. Br J Nur1998;7: 403-8.
11. 11. Eiberg H, Berendt I, Mohr J. Assignment of dominant inherited nocturnal enuresis(ENUR1) to chromosome 13q. Nat Gent 1995;10(3):354-6.
12. 12. Arnell H, Hjalmas K, Jagervall M. The genetics of primary nocturnal enuresis; inheritance and suggestion of a second major gene on chromosome 12q. J Med Genet 1997;34 (5):360-5.
13. 13.Norgaard JP, Djurhuus JC, Watanabe H, Lettbeng B. Experience and current status of research into pathophysiology of nocturnal enuresis. Br J Urol 1997; 79: 825-35.
14. 14. Bader G, Neveus T, Kruse S, Sillen U. Sleep of primary enuretic children and controls. Sleep 2002;25(5):579-83. 15. Koff SA. Estimating bladder capacity in children. Urology 1983;21(2):248-9.
15. 16. Watanabe H, Kawauchi A, Kitamori T, Azuma Y. Treatment system for nocturnal enuresis according to an original classification system. Eur Urol 1994;25:42-50.
16. 17. Norgaard JP, Pedersen EB, Djurhuus JC. Diurnal antidiuretic- hormone levels in enuretics. J Urol 1985;134(5):1029- 31.
17. 18. Rittig S, Knudsen UB, Norgaard JP, Pedersen EB, Djurhuus JC. Abnormal diurnal rhythm of plasma vasopressin and urinary output in patients with enuresis. Am J Physiol. 1989;256 (4pt2):F664-71.
18. 19. Eggert P, Müler-Schlüter K, Müler D. Regulation of arginine vasopressin in enuretic children under fluid restriction. Pediatrics 1999;103(2):452-5.
19. 20. Rushton HG, Enuresis In: Kelalis PP (ed). Clinical Pediatric Urology, 3.rd edn. Philadelphia: W B. Saunders Company, 1992:365-83.
20. 21. Koff SA. Enuresis. In: Koff SA(ed).Campbells Urology, 7rd edn,W.B Saunders Company,1990: 2055-68.
21. 22. Bower WF, Sit FK, Yeung CK. Nocturnal enuresis in adolescents and adults is associated with childhood elimination symptoms. J Urol 2006;176(12):1771-5.
22. 23. Guyton AC, Hall JE. Physiological Anatomy of the Bladder, Micturition.Human Physiology and Mechanisms of the Bladder, Micturation. Human Physiology and Mechanisms of Disease, 6 th ed, 1997:264-5.
23. 24. Ornitz EM, Hana GL, Traversay N. Prestimulation-induced startle modulation in attention deficit hyperactivity disorder and nocturnal enuresis. Psychophysology 1992;29(4):437- 51.
24. 25. Ünal F. Enürezis Nokturna. Katkı Pediatri Dergisi 1996;17(5):789-802.
25. 26. Söhmen MT. Fonksiyonel Enürezis. Türk Psikiyatri Derg 1990;1(1):39-42.
26. 27. Fergusson DM, Horwood LJ. Nocturnal enuresis and behavioral problems in adolescence: a 15 year longitudinal study. Pediatrics 1994;94(5):662-8.
27. 28. Ertan P, Gönülal D, Söğüt A, Yılmaz Ö, Bozgül A, Yüksel H. Monosemptomatik noktürnal enürezisi olan çocuklarda dikkat eksikliği ve hiperaktivite bulguları. Türk Ped Arş 2010;45(1):37-40.
28. 29. Nina VAM Knoers, Leo A H. Nephrogenic Diabetes Incipitus. In: Barratt TM, Enver ED, Harmon WE, eds. Pediatric Nephrology, 4th edn. Baltimore: Lippincott Williams& Wilkins 1999;583-9.
29. 30. Biedermen J, Santangelo SL, Faraone SV, Kiely K, Guite J Mick E. Clinical correlates of enuresis in ADHD and non ADHD children. J Child Psychol Psychiatry 1995;36(5):865-77.
30. 31. Weider DJ, Sateia MJ, West RP. Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg1991;105(3):427-32.
31. 32. Baruzzi A, Riva R, Cirignotta F, Zucconi M, Cappelli M, Lugaresi E. Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome. Sleep 1991;14(1):83-6.
32. 33. Horowitz M, Misseri R. Diurnal and nocturnal enuresis. In:The Kelalis-King-Belman, Textbook of Clinical Pediatric Urology, 5th ed. London: Informa Heathcare UK Ltd, 2007;831-2.
33. 34. Liu X, Sun Z, Uchiyama M, Li Y, Okawa M. Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years. J Am Acad Child Adolesc Psychiatry 2000;39(12):1557-64.
34. 35.Longstaffe S, Moffatt ME, Whalen JC. Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics 2000;105 (4pt2):935-40.
35. 36. Hjalmas K, Arnold T, Bower W et al. Nocturnal enuresis: an international evidence based management strategy. J Urol 2004;171(6pt2):2545-61.
36. 37. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics 1997;100(2pt1):228-32.
37. 38. Devlin JB, O, Cathain C. Predicting outcome in nocturnal enuresis. Arch Dis Child 1990; 65(10):1158-61.
38. 39. Monda JM, Hussmann DA. Primary nocturnal enuresis: a comparison among observation, imipramine, desmopressin acetate and bed-wetting alarm systems. J Urol 1995;154(2):745-8.
39. 40. Glazener C M, Evans J H, Peto R E. Alarm interventions for nocturnal enuresis in children Cochrane Databasen Syst Rev 2005;(2):CD002911.
40. 41. Taneli C, Ertan P,Taneli F at al. Effect of alarm treatment on bladder storage capacities in monosymptomatic nocturnal enuresis. Scand J Urol Nephrol. 2004;38(3):207-10.
41. 42. Rappaport L. Prognostic factors for alarm treatment. Scand J Urol Nephrol 1997;183(1):55-8.
42. 43. Butler RJ, Holland P, Gasson S, Norfolk S, Houghton L, Penney M. Exploring potential mechanisms in alarm treatment for primary nocturnal enuresis. Scand J Urol Nephrol 2007; 41(5):407-13.
43. 44. Neveus T, Lackgren G, Tuvemo T, Olsson U, Stenberg A. Desmopressin resistant enuresis: pathogenetic and therapeutic considerations. J Urol 1999;162(6):2136-40.
44. 45. Van de Walle J, Van Herzeele C, Raes A. Is there still a role for desmopressin in children with primary monosymptomatic nocturnal enuresis?: a focus on safety issues. Drug Saf 2010; 33(4):261-71.
45. 46. Hjalmas K, Bengtsson B. Efficacy, safety, and dosing of desmopressin for nocturnal enuresis in Europe. Clin Pediatr (Phila) 1993;32(1):19-24.
46. 47.Neveus T. Oxybutynin, desmopressin and enuresis. J Urol 2001;166(6):2459-62.
47. 48. Kosar A, Arikan N, Dincel C. Effectiveness of oxybutynin hydrochloride in the treatment of enuresis nocturna--a clinical and urodynamic study. Scandinav J Urol Nephrol 1999;33(2):115-8.
48. 49. Geller B, Reising D, Leonard HL, Riddle MA, Walsh BT. Critical review of tricyclic antidepressant use in children and adolescents. J Am Acad Child Adolesc Psychiatry, 1999;38(5):513-6.
49. 50. Miller K, Atkin B, Moody ML. Drug therapy for nocturnal enuresis. Current treatment recommendations. Drugs 1992;44(1):47-56.
50. 51. Gepertz S, Neveus T. Imipramine for therapy resistant enuresis: a retrospective evaluation. J Urol 2004;171(6pt2):2607- 10.
51. 52. Meneses RP. Monosyptomatic nocturnal enuresis. J Pediatr 2001;77(3):161-8.
52. 53. Natochin YV, Kuznetsova AA. Nocturnal enuresis: correction of renal function by desmopressin and diclofenac. Pediatr Nephrol 2000;14(1):42-7.
53. 54. Bradbury MG, Meadow SR. Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis. Acta Paediatr 1995;84(9):1014-8.
54. 55. Van Kampen M, Bogaert G, Akinwuntan EA, Claessen L, Van Poppel H, De Weerdt W. Long-term efficacy and predictive factors of full spectrum therapy for nocturnal enuresis. J Urol 2004;171(6pt2):2599-602.
55. 56. Van Kampen M, Bogaert G, Feys H, Baert L, De Raeymaeker I, De Weerdt W. High initial efficacy of full-spectrum therapy for nocturnal enuresis in children and adolescents. BJU Int 2002;90(1):84-7.
56. 57. Leebeek-Groenewegen A, Blom J, Sukhai R, Van Der Heijden B. Efficacy of desmopressin combined with alarm therapy for monosymptomatic nocturnal enuresis. J Urol 2001;166(6): 2456-8.
57. 58. Bower W F, Diao M, Tang JL, Yeung CK. Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourol Urodyn 2005;24(3):267-