Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow-up into adolescence, with attention to the clinical value of normalizing bladder capacity.

Abstract

OBJECTIVE:

To assess the importance of normalizing bladder capacity to the age-expected capacity in children with refractory monosymptomatic nocturnal enuresis (MNE), and to evaluate the long-term results when these children grow into adolescence.

PATIENTS AND METHODS:

The study included 34 children with refractory MNE; all were treated > 5 years earlier for their MNE using a combined stepwise approach, consisting of retention control training, oxybutynin and an enuresis alarm. Data were obtained on their enuretic state, night-time voiding behaviour and bladder capacity, from a questionnaire and a voiding chart.

RESULTS:

Before starting treatment, all patients had a bladder capacity that was too small for their age. After the combined stepwise approach, MNE improved in all patients and 24 (71%) were cured. Although the bladder capacity was increased to the age-expected capacity in 26 (76%), most woke at night to void. Currently, at a mean of 7.7 years after the primary treatment, 28 (82%) of the patients are completely dry at night, of whom 15 (54%) arouse to void for 35% of the nights. Six patients (18%) still have some enuretic episodes. Only those who were dry after primary treatment and remained dry had a normal age-expected increase in bladder capacity. For all others there was a decrease in age-related bladder capacity.

CONCLUSIONS:

In patients with refractory MNE, a combined stepwise approach improves and may even eliminate enuresis, but normal night-time bladder behaviour in adolescence and adulthood is only achieved in some. Furthermore, about a fifth still have some enuretic episodes.

• Authors: Alexandra Vermandel, Stefan de Wachter, Jean-Jacques Wyndaele
• Journal: BJU international (BJU Int) Vol. 96 Issue 4 Pg. 629-33 (Sep 2005) ISSN: 1464-4096 [Print] England
• PMID: 16104923 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Cholinergic Antagonists
• Mandelic Acids
• oxybutynin

Topics

• Adolescent
• Biofeedback, Psychology
• Child
• Child, Preschool
• Cholinergic Antagonists (therapeutic use)
• Combined Modality Therapy
• Enuresis (drug therapy, pathology, therapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Mandelic Acids (therapeutic use)
• Physical Therapy Modalities
• Prospective Studies
• Treatment Outcome
• Urinary Bladder (pathology)
• Urination