SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We studied 115 consecutive cases of primary enuresis. Excretory urography, urodynamic testing and endoscopy are needed only in children with enuresis and concomitant urinary infection. A detailed urologic history was the most important factor in deciding upon a treatment program. Children with diurnal and nocturnal enuresis or nocturnal enuresis and daytime urgency and frequency of urination are started on anticholinergic medication. Girls with enuresis and urinary infection also are started on anticholinergic medication. Significant improvement occurs in up to 90% of the patients. Children with only nocturnal enuresis and no other symptoms are started on imipramine with a 70% improvement rate.
Enuresis is not a disease, but rather a benign clinical disorder that is very common in young children. In considering the many facets of enuresis, physicians caring for children with this disorder should always remember the dictum "Primum non nocere". Most children with enuresis will be found to have primary enuresis, that is, no organic disease or psychopathology will be found. Physicians should proceed cautiously and should avoid costly, harmful and unnecessary workups. Treatment of few disorders is more dependent on the art and skill of clinical medicine than that of childhood enuresis. All of the physician's talents and compassionate nature enter into the proper evaluation of and therapy for this disorder. Physicians must keep in mind the high spontaneous cure rate. This factor alone should encourage them to be extremely optimistic about the outcome of enuresis in their pateints.
INTRODUCTION: Nocturnal enuresis (NE) is a common neurodevelopmental condition, yet its underlying neural mechanisms remain unclear. This study leverages the large-scale Adolescent Brain Cognitive Development (ABCD) dataset to identify structural and functional brain correlates associated with active symptoms and the resolution of bedwetting. METHODS: Using cross-sectional data from 3472 participants aged 9-10 years, children were categorized into three groups: active nocturnal enuresis (ANE, n = 225), history of nocturnal enuresis (HNE, n = 1171), and healthy control groups (CG, n = 2076). Multimodal neuroimaging protocol evaluated macrostructural properties via structural MRI (sMRI), microstructural white matter integrity via diffusion MRI (dMRI), and functional connectivity via resting-state fMRI (fMRI). Group differences were evaluated using linear models within an ANCOVA framework, adjusting for intracranial volume and handedness with False Discovery Rate (FDR) correction. RESULTS: Compared to controls, the ANE group exhibited a significant volume deficit in the right caudate, decreased sulcal depth in the left insula, and lower internal correlation within the Cingulo-Opercular Network (CON). Conversely, the dry HNE group demonstrated significant structural adaptations, including bilaterally larger putamen volumes and increased right caudate volume compared to the ANE group. The HNE group also showed increased microstructural density (decreased mean diffusivity) in the bilateral hippocampus and an increased cortical surface area in the left insula. Both NE groups demonstrated persistently reduced functional coupling within the CON. CONCLUSIONS: Nocturnal enuresis appears to be associated with a potential complex central signaling deficits. Reduced internal correlation within the CON across both active and former bedwetters indicates a potential for impairment in processing internal homeostatic bladder signals during sleep.
The authors present their observations on treatment with Noveril of nocturnal enuresis in 49 children aged from 6 to 16 years. The drug is a derivative of dibenzodiazepine belonging to the group of thymoleptic agents with an action similar to that of imipramine. Noveril was given in doses from 20 to 100 mg daily during 3 to 9 weeks. In the final evaluation of the drug the frequency of enuresis before, during and after treatment was taken into account. In 25 cases an improvement was observed, usually in psychogenic nocturnal enuresis. Side effects included oral dryness, headaches and dizziness, and sleep disturbances observed in 4 cases. The tolerance of the drug was good. Noveril has a favourable effect in children with nocturnal enuresis, particularly of psychogenic origin.
Ninety one patients with urinary tract infection, infection with enuresis or enuresis alone, but without any malformation of the lower urinary tract have been examined clinically as well as by cystomanometric und uroflow-metric studies. It could be shown that the most important parameters to evaluate blader function were the bladder compliance and the detrusor contraction during the filling of the bladder. The bladder compliance was estimated from the volume pressure relationship under resting conditions, at the first urgency to voide and at the moment when the maximal bladder capacity was reached, Concerning the detrusor contraction we distinguished partial isovolumetric detrusor contractions with an amplitude of 1--8 mm Hg and uninhibited detrusor contractions with an amplitude of more than 10 mm Hg. According to these two parameters it was possible to differentiate cystomanometrically seven different types of irritable and non irritable bladder, and to introduce a new theory of the pathogenesis of enuresis. According to this theory we suppose that enuresis in childhood is mostly caused by neurovegetative psychogenic disorders similar to anorectal sphincter achalasia in patients with overflow encopresis.
Over a one-year period 216 children had a radiographic survey of their urinary tracts performed for the evaluation of enuresis with many of these having a precedent history of urinary infection as well. Significant urinary tract abnormalities were found in 27 per cent of the children. Clinical correlation was obtained in 135 of these children with 19.3 per cent requiring surgery. The groups of children with a history of diurnal enuresis or urinary infection were quite different from the group with nocturnal enuresis alone. These differences are discussed.
Enuresis is a common problem of childhood, but both a theoretical understanding and an etiologically based clinical approach to the symptom are lacking. The present descriptive study was undertaken to delineate subgroups within large, heterogeneous populations of enuretic children between the ages of four and 14. A number of variables were assessed through a detailed parental history for 116 enuretic children. Several relevant and significant correlations were identified, but overall no clinically useful patterns involving sleep stages, psychopathology, environmental events, or medical or family history were discovered. The results of this study confirm recent work in the field of enuresis and emphasize the need for new research directions.
Oxybutynin chloride (Ditropan), a tertiary amine possessing anticholinergic and papaverine-like, direct muscular antispasmodic effects, has been used in controlled clinical studies in patients with neurovesical reflex activity, uninhibited bladders, enuresis, and primary muscle spasm. The cystometrically documented, synergistic, anticholinergic, and muscle relaxant activity of oxybutynin observed in these studies indicates that the drug can be highly effective in the management of reflex neurovesical dysfunction, enuresis, and bladder spasm.
Enuresis is a disorder of micturition occuring in the absence of an organic urinary tract lesion. To understand its possible causation, the mechanisms controlling micturition are described together with the possible sites of action of various anti-enuretic agents, particularly imipramine. It is concluded that further research into the central control of micturition is required before the precise actions of centrally-acting anti-enuretic agents can be elucidated. Knowledge of these may give insight into the nature of the defect causing enuresis.
1. To evaluate the mechanism of action of imipramine in enuresis nocturna, we compared the effects of imipramine with those of scopolamine butylbromide in fourteen children suffering from this condition. A double-blind, cross-over design was used. 2. Imipramine, 10--20 mg, was superior to scopolamine butylbromide (10--20 mg), in eleven of the fourteen subjects (P less than 0.01), and the latter drug was no better than the placebo. 3. As scopolamine butylbromide does not cross the blood-brain barrier, it is concluded that peripheral antimuscarinic effects are not important in the beneficial effects of imipramine in enuresis nocturna. 4. The therapeutic effects of imipramine in depression frequently take 3 to 4 weeks to develop. Such a delay was not seen in our enuretic patients. Thus the mechanism of the drug in the two conditions is probably different.
A double-blind study of 18 children aged 6--12 years suffering from primary nocturnal enuresis without signs of underlying organic disease is reported. 20 microgram of DDAVP (desamino-D-arginine vasopressin, Minirin) was given intranasally at bedtime. The effect was prompt and satisfactory in 8 children and relatively good in another 8 children. No adverse effects were noted. DDAVP is advocated for temporary use in children with nocturnal enuresis needing immediate help.
The authors followed 29 young adults who had been treated for enuresis with imipramine hydrochloride 10 years earlier. To test beliefs that enuresis is symptomatic of severe psychopathology or of urological conditions, they studied whether the treatment had been followed by psychological decompensation; an inhibition of learning; a predisposition to drug abuse; negative effects on health, growth, weight, and development; or continued urinary symptoms. None of these negative effects was present; in general the subjects were active, well-motivated, and sociable and showed no significant psychiatric symptoms. One patient still wetted but only occasionally.
The treatment of enuresis has had a long and colorful history in world medical literature. Although some reasonable approaches to the problem exist, there are many conflicting theories about its etiology and consequently there are many recommended therapies. A perspective of literature encompassing the diverse fields of psychoanalysis, behavioral psychology, urology, pharmacology and sleep physiology is provided for the psychiatrist consultant dealing with the problem of enuresis.
The enuresis alarm described is a portable device designed for 'toilet training' of mentally sub-normal children. It weighs 70 gm with battery, has dimensions of 90 x 60 x 30 mm and conforms to DHSS recommendations. The battery life is over 1000 hours (6 weeks) in continuous use. Total component cost is is pounds 6.20 (in 1978), construction is simple and the circuit may be used as a conventional nocturnal enuresis alarm.
Desmopressin (1-desamino-[8-D-Arg]-vasopressin) (DDAVP) was given by nose drops to 22 children with persistent nocturnal enuresis (mean age, 6.6 +/- 2.9 years; range, 4 to 12 years) the evening before sleep. With saline alone as placebo and with comparison to enuretic frequency before the onset of the trial, fortnightly periods were compared under double-blind conditions with the children at home. Pretreatment and placebo fortnights showed wetting frequencies (nights per fortnight) of 10.6 +/- 4.9 and 11.0 +/- 4.4, respectively. The value of the fortnight during desmopressin therapy was 4.2 +/- 4.5, which was significantly different from either of the previous means (P less than .01). Of the 22 subjects, four failed to react to therapy at all. There was decreased enuretic frequency in the remaining 18, of whom 12 decreased markedly or ceased wetting. One month after the trial, seven of the respondents were dry with desmopressin therapy. There was clear evidence of a large nocturnal volume of dilute urine before treatment in six of the respondents in whom such measurements could be reliably made. These children responded to dehydration with urine concentration, however, so that the suggestion can be made that a failure to develop a normal diurnal pattern of urine volume and concentration may underly some cases of enuresis.
OBJECTIVE: To evaluate the efficacy and safety of Ginkgo biloba extract (GBE) compared with Desmopressin and their combination in children with monosymptomatic nocturnal enuresis (MNE). METHODS: In this double-blind, randomized, placebo-controlled trial, 398 children aged 5-14 years with MNE were assigned to four groups: placebo, GBE (60 mg daily), Desmopressin (0.2 mg daily), or GBE plus Desmopressin for 3 months. Primary outcomes included the number of wet nights per week. Secondary outcomes assessed sleep quality using the Sleep Disturbance Scale for Children (SDSC), arousal by the Disorders of Arousal (DA) score, and quality-of-life using the Pediatric Incontinence Questionnaire (PinQ). RESULTS: After 3 months, the combination group demonstrated the greatest improvement in wet nights (median 0 [IQR 0-2]) compared to GBE (6 [0.5-6.5]) and Desmopressin (2 [0-6]) (p < 0.001). Full response rates (≥90% reduction in wet nights) were highest with combination therapy (88.3%), followed by Desmopressin (46.5%), GBE (24.8%), and placebo (9.5%) (p < 0.001). GBE-containing groups showed significantly increased DA and SDSC scores, indicating enhanced arousal and lighter sleep. Quality-of-life (PinQ) score decreased in all treatment groups denoting improvement, with the best outcomes observed in the combination arm. Adverse effects were mild and comparable across groups, and serum sodium levels remained stable. CONCLUSION: GBE is a safe and effective novel therapy for MNE, improving sleep arousal and symptom control. Its combination with Desmopressin offers superior efficacy, better quality of life, and lower relapse rates than either agent alone.