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Tryggve Nevéus - One of the best experts on this subject based on the ideXlab platform.
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management and treatment of nocturnal Enuresis an updated standardization document from the international children s continence society
Journal of Pediatric Urology, 2020Co-Authors: Tryggve Nevéus, Akihiro Kawauchi, Stephen Shei-dei Yang, Serda Tekgul, Eliane Fonseca, Israel Franco, Larisa Kovacevic, Anka Nieuwhofleppink, Ann Raes, Soren RittigAbstract:Summary Background Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with Enuresis. Methods The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. Results The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic Enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic Enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the Enuresis Alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
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Management and treatment of nocturnal Enuresis—an updated standardization document from the International Children's Continence Society
Journal of pediatric urology, 2020Co-Authors: Tryggve Nevéus, Akihiro Kawauchi, Stephen Shei-dei Yang, Serda Tekgul, Eliane Fonseca, Israel Franco, Larisa Kovacevic, Ann Raes, Anka J. Nieuwhof-leppink, Soren RittigAbstract:Summary Background Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with Enuresis. Methods The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. Results The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic Enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic Enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the Enuresis Alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
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reboxetine in therapy resistant Enuresis a randomized placebo controlled study
Journal of Pediatric Urology, 2016Co-Authors: Elisabet Lundmark, A Stenberg, Bruno Hagglof, Tryggve NevéusAbstract:IntroductionA significant minority of children with Enuresis do not respond to either desmopressin or the Enuresis Alarm. Anticholinergics have not proven as successful as expected. The fourth evid ...
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No effect of basic bladder advice in Enuresis: A randomized controlled trial.
Journal of Pediatric Urology, 2015Co-Authors: Maria Cederblad, Anna Sarkadi, Gunn Engvall, Tryggve NevéusAbstract:BackgroundThere are two firstline, evidence-based treatments available for nocturnal Enuresis: desmopressin and the Enuresis Alarm. Prior to use of these therapies, international experts usually re ...
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No effect of basic bladder advice in Enuresis: A randomized controlled trial.
Journal of pediatric urology, 2015Co-Authors: Maria Cederblad, Anna Sarkadi, Gunn Engvall, Tryggve NevéusAbstract:There are two firstline, evidence-based treatments available for nocturnal Enuresis: desmopressin and the Enuresis Alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal Enuresis. To explore whether basic bladder advice has any effect against nocturnal Enuresis. The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated Enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then Alarm therapy (group A) or just the Alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15. The basic bladder advice did not reduce the Enuresis frequency in group A (p = 0.089) and the end result after Alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during Alarm therapy. This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of Enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent Alarm therapy. The recommendation that all children with Enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the Enuresis Alarm or desmopressin without delay. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Premala Sureshkumar - One of the best experts on this subject based on the ideXlab platform.
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A randomised controlled trial of a code-word Enuresis Alarm
Archives of disease in childhood, 2015Co-Authors: Patrina H Y Caldwell, Premala Sureshkumar, Marianne Kerr, Sana Hamilton, Armando Teixeira-pinto, Petra Macaskill, Jonathan C. CraigAbstract:Objective To compare a novel code-word Alarm with a commercially available wireless Alarm for treating Enuresis. Setting A tertiary paediatric centre. Patients Children aged 6–18 with at least 3 wet nights per week in the previous 6 months referred by doctors. Outcomes Primary outcome: the proportion who achieved a full response (14 consecutive dry nights) by 16 weeks. Secondary outcomes: change in frequency of wetting, duration of Alarm training, percentage of wet nights that the child woke to the Alarm, adherence to treatment, adverse events and satisfaction with treatment. Results Of the 353 participants, 176 were assigned to the code-word Alarm and 177 to control. At 16 weeks, 54% (95% CI 47% to 61%) in the experimental group and 47% (95% CI 40% to 55%) in the control group had achieved a full response (p=0.22), with 74% and 66%, respectively, attaining a 50% or more reduction in wetting frequency (p=0.14). The experimental group woke more often than the control group (median percentage of waking 88% vs 77%, p=0.003) and had a greater reduction in wet nights (median reduction of 10 vs 9 nights per fortnight). Fewer in the experimental group discontinued therapy before achieving a full response (27% vs 37% discontinued, p=0.04). There were no significant differences in relapse rates at 6 months, adverse events or satisfaction between the two Alarms. Conclusions Although the code-word Alarm increased waking, no difference in full response rates was demonstrated between the two Alarms. Trial registration number ACTRN12609000070235.
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simple behavioural interventions for nocturnal Enuresis in children
Cochrane Database of Systematic Reviews, 2013Co-Authors: Patrina H Y Caldwell, Gail Nankivell, Premala SureshkumarAbstract:Background Nocturnal Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into: (a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and (b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including Enuresis Alarm therapy. This review focuses on simple behavioural interventions. Simple behavioural interventions are often used as a first attempt to improve nocturnal Enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and Enuresis Alarm therapy are considered elsewhere. Objectives To determine the effects of simple behavioural interventions in children with nocturnal Enuresis. The following comparisons were made: 1. simple behavioural interventions versus no active treatment; 2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, Enuresis Alarm therapy or complex behavioural interventions); 3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched. Selection criteria All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal Enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal Enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal Enuresis were excluded. Data collection and analysis Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer. Main results Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus Enuresis Alarm therapy which included two studies and demonstrated that Alarm therapy was superior to bladder training. In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as Enuresis Alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another. Authors' conclusions Simple behavioural methods may be superior to no active treatment but appear to be inferior to Enuresis Alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering Enuresis Alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.
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The Cochrane Library - Simple behavioural interventions for nocturnal Enuresis in children
The Cochrane database of systematic reviews, 2013Co-Authors: Patrina H Y Caldwell, Gail Nankivell, Premala SureshkumarAbstract:Background Nocturnal Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into: (a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and (b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including Enuresis Alarm therapy. This review focuses on simple behavioural interventions. Simple behavioural interventions are often used as a first attempt to improve nocturnal Enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and Enuresis Alarm therapy are considered elsewhere. Objectives To determine the effects of simple behavioural interventions in children with nocturnal Enuresis. The following comparisons were made: 1. simple behavioural interventions versus no active treatment; 2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, Enuresis Alarm therapy or complex behavioural interventions); 3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched. Selection criteria All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal Enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal Enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal Enuresis were excluded. Data collection and analysis Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer. Main results Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus Enuresis Alarm therapy which included two studies and demonstrated that Alarm therapy was superior to bladder training. In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as Enuresis Alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another. Authors' conclusions Simple behavioural methods may be superior to no active treatment but appear to be inferior to Enuresis Alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering Enuresis Alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.
Patrina H Y Caldwell - One of the best experts on this subject based on the ideXlab platform.
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A randomised controlled trial of a code-word Enuresis Alarm
Archives of disease in childhood, 2015Co-Authors: Patrina H Y Caldwell, Premala Sureshkumar, Marianne Kerr, Sana Hamilton, Armando Teixeira-pinto, Petra Macaskill, Jonathan C. CraigAbstract:Objective To compare a novel code-word Alarm with a commercially available wireless Alarm for treating Enuresis. Setting A tertiary paediatric centre. Patients Children aged 6–18 with at least 3 wet nights per week in the previous 6 months referred by doctors. Outcomes Primary outcome: the proportion who achieved a full response (14 consecutive dry nights) by 16 weeks. Secondary outcomes: change in frequency of wetting, duration of Alarm training, percentage of wet nights that the child woke to the Alarm, adherence to treatment, adverse events and satisfaction with treatment. Results Of the 353 participants, 176 were assigned to the code-word Alarm and 177 to control. At 16 weeks, 54% (95% CI 47% to 61%) in the experimental group and 47% (95% CI 40% to 55%) in the control group had achieved a full response (p=0.22), with 74% and 66%, respectively, attaining a 50% or more reduction in wetting frequency (p=0.14). The experimental group woke more often than the control group (median percentage of waking 88% vs 77%, p=0.003) and had a greater reduction in wet nights (median reduction of 10 vs 9 nights per fortnight). Fewer in the experimental group discontinued therapy before achieving a full response (27% vs 37% discontinued, p=0.04). There were no significant differences in relapse rates at 6 months, adverse events or satisfaction between the two Alarms. Conclusions Although the code-word Alarm increased waking, no difference in full response rates was demonstrated between the two Alarms. Trial registration number ACTRN12609000070235.
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simple behavioural interventions for nocturnal Enuresis in children
Cochrane Database of Systematic Reviews, 2013Co-Authors: Patrina H Y Caldwell, Gail Nankivell, Premala SureshkumarAbstract:Background Nocturnal Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into: (a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and (b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including Enuresis Alarm therapy. This review focuses on simple behavioural interventions. Simple behavioural interventions are often used as a first attempt to improve nocturnal Enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and Enuresis Alarm therapy are considered elsewhere. Objectives To determine the effects of simple behavioural interventions in children with nocturnal Enuresis. The following comparisons were made: 1. simple behavioural interventions versus no active treatment; 2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, Enuresis Alarm therapy or complex behavioural interventions); 3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched. Selection criteria All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal Enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal Enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal Enuresis were excluded. Data collection and analysis Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer. Main results Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus Enuresis Alarm therapy which included two studies and demonstrated that Alarm therapy was superior to bladder training. In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as Enuresis Alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another. Authors' conclusions Simple behavioural methods may be superior to no active treatment but appear to be inferior to Enuresis Alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering Enuresis Alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.
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The Cochrane Library - Simple behavioural interventions for nocturnal Enuresis in children
The Cochrane database of systematic reviews, 2013Co-Authors: Patrina H Y Caldwell, Gail Nankivell, Premala SureshkumarAbstract:Background Nocturnal Enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds and up to 2% of adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Behavioural interventions for treating bedwetting are defined as interventions that require a behaviour or action by the child which promotes night dryness and includes strategies which reward that behaviour. Behavioural interventions are further divided into: (a) simple behavioural interventions - behaviours or actions that can be achieved by the child without great effort; and (b) complex behavioural interventions - multiple behavioural interventions which require greater effort by the child and parents to achieve, including Enuresis Alarm therapy. This review focuses on simple behavioural interventions. Simple behavioural interventions are often used as a first attempt to improve nocturnal Enuresis and include reward systems such as star charts given for dry nights, lifting or waking the children at night to urinate, retention control training to enlarge bladder capacity (bladder training) and fluid restriction. Other treatments such as medications, complementary and miscellaneous interventions such as acupuncture, complex behavioural interventions and Enuresis Alarm therapy are considered elsewhere. Objectives To determine the effects of simple behavioural interventions in children with nocturnal Enuresis. The following comparisons were made: 1. simple behavioural interventions versus no active treatment; 2. any single type of simple behavioural intervention versus another behavioural method (another simple behavioural intervention, Enuresis Alarm therapy or complex behavioural interventions); 3. simple behavioural interventions versus drug treatment alone (including placebo drugs) or drug treatment in combination with other interventions. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 15 December 2011). The reference lists of relevant articles were also searched. Selection criteria All randomised or quasi-randomised trials of simple behavioural interventions for treating nocturnal Enuresis in children up to the age of 16. Studies which included children with daytime urinary incontinence or children with organic conditions were also included in this review if the focus of the study was on nocturnal Enuresis. Trials focused solely on daytime wetting and trials of adults with nocturnal Enuresis were excluded. Data collection and analysis Two reviewers independently assessed the quality of the eligible trials and extracted data. Differences between reviewers were settled by discussion with a third reviewer. Main results Sixteen trials met the inclusion criteria, involving 1643 children of whom 865 received a simple behavioural intervention. Within each comparison, outcomes were mostly addressed by single trials, precluding meta-analysis. The only exception was bladder training versus Enuresis Alarm therapy which included two studies and demonstrated that Alarm therapy was superior to bladder training. In single small trials, rewards, lifting and waking and bladder training were each associated with significantly fewer wet nights, higher full response rates and lower relapse rates compared to controls. Simple behavioural interventions appeared to be less effective when compared with other known effective interventions (such as Enuresis Alarm therapy and drug therapies with imipramine and amitriptyline). However, the effect was not sustained at follow-up after completion of treatment for the drug therapies. Based on one small trial, cognitive therapy also appeared to be more effective than rewards. When one simple behavioural therapy was compared with another, there did not appear to be one therapy that was more effective than another. Authors' conclusions Simple behavioural methods may be superior to no active treatment but appear to be inferior to Enuresis Alarm therapy and some drug therapy (such as imipramine and amitriptyline). Simple behavioural therapies could be tried as first line treatment before considering Enuresis Alarm therapy or drug therapy, which may be more demanding and have adverse effects, although evidence supporting their efficacy is lacking.
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Treatment of Enuresis: Alarm monotherapy versus a multi-modal treatment approach in a multi-disciplinary clinic
The Australian and New Zealand Continence Journal, 2009Co-Authors: Patrina H Y Caldwell, Denise Edgar, Michael P. Jones, Elisabeth M Hodson, Jonathan C. CraigAbstract:The objective of this study was to compare outcomes between Alarm monotherapy and multi-modal treatment for Enuresis and to identify predictors of treatment failure. Consecutive children with Enuresis were referred to an Alarm clinic or a multi-disciplinary clinic and followed over 1 year. In the Alarm clinic, children received bed Alarm therapy for 3 months. In the multi-disciplinary clinic, children were assessed and advised regarding fluid consumption, with treatment of daytime bladder symptoms and bowel dysfunction. Persisting Enuresis after daytime symptoms were addressed were treated with Alarm therapy. From January 2003 to December 2004, 269 children were referred - 86 to the Alarm clinic and 183 to the multi-disciplinary clinic (of which 56% received Alarm therapy). Groups were similar at baseline (mean age 9 years, 65% boys and 86% primary monosymptomatic nocturnal Enuresis), but more from the multi-disciplinary clinic had previously received Enuresis treatment (79% vs 59% p=0.001). There was no difference in outcomes between groups at completion of treatment (51% versus 66% dry, p=0.07) and at 12 months (65% versus 60%, p=0.7), but more from the multi-disciplinary clinic were lost to follow-up. Those who received multi-modal treatment incorporating Alarm therapy had improved outcomes compared with Alarm monotherapy (78% versus 51% dry, p=0.01). Children previously treated with desmopressin (OR 0.11), bladder training (OR 0.35) or who had a history of soiling at presentation (OR 0.28) were less likely to respond to treatment. It was concluded that, in a multi-modal treatment approach, delayed commencement of Alarm therapy may affect treatment outcomes.
W De Weerdt - One of the best experts on this subject based on the ideXlab platform.
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LONG-TERM EFFICACY AND PREDICTIVE FACTORS OF FULL SPECTRUM THERAPY FOR NOCTURNAL Enuresis
The Journal of Urology, 2004Co-Authors: M Van Kampen, G Bogaert, E A Akinwuntan, L Claessen, H Van Poppel, W De WeerdtAbstract:Purpose: We determine the effect and predictive factors of relapse 1 year after combination therapy of an Enuresis Alarm, bladder training, motivational therapy and retention control training for nocturnal Enuresis. Materials and Methods: In 68 of 77 children the relapse rate 1 year after full spectrum therapy for nocturnal Enuresis was investigated. Gender, age, sleep arousal, family history, monosymptomatic, bladder capacity, overactive bladder, nighttime polyuria, duration of treatment, over learning and psychosocial factors were investigated. Results: The relapse rate during the whole year was 50%, with 33.8% of subjects being dry and 16.2% sometimes wet. The relapse rate after 1 year was 16%. Nine patients could not be reached and, thus, were considered dropouts. Only overactive bladder and psychosocial problems were significantly related to relapse. Conclusions: The relapse rate during the year was high while the relapse rate after 1 year was low. Psychosocial problems and overactive bladder were the only 2 predictive factors for relapse.
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Long-term efficacy and predictive factors of full spectrum therapy for nocturnal Enuresis.
The Journal of urology, 2004Co-Authors: M Van Kampen, G Bogaert, E A Akinwuntan, L Claessen, H Van Poppel, W De WeerdtAbstract:We determine the effect and predictive factors of relapse 1 year after combination therapy of an Enuresis Alarm, bladder training, motivational therapy and retention control training for nocturnal Enuresis. In 68 of 77 children the relapse rate 1 year after full spectrum therapy for nocturnal Enuresis was investigated. Gender, age, sleep arousal, family history, monosymptomatic, bladder capacity, overactive bladder, nighttime polyuria, duration of treatment, over learning and psychosocial factors were investigated. The relapse rate during the whole year was 50%, with 33.8% of subjects being dry and 16.2% sometimes wet. The relapse rate after 1 year was 16%. Nine patients could not be reached and, thus, were considered dropouts. Only overactive bladder and psychosocial problems were significantly related to relapse. The relapse rate during the year was high while the relapse rate after 1 year was low. Psychosocial problems and overactive bladder were the only 2 predictive factors for relapse.
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High initial efficacy of full‐spectrum therapy for nocturnal Enuresis in children and adolescents
BJU international, 2002Co-Authors: M Van Kampen, G Bogaert, Hilde Feys, Luc Baert, I. De Raeymaeker, W De WeerdtAbstract:Objective To investigate the initial efficacy and predictive factors of full-spectrum therapy in the treatment of children and young adolescents with nocturnal Enuresis (NE). Patients and methods Combined therapy for NE comprises an Enuresis Alarm, bladder training, motivational therapy and pelvic floor muscle training, and is more effective than each of the components alone or than medical intervention. A total of 60 children and adolescents (aged 4–20 years) with NE were treated once a week with full-spectrum therapy for a maximum of 6 months. Results Overall the therapy was successful (14 consecutive dry nights) in 52 of 60 patients. At 30 days the cure rate was 33%, after 60 days 72% and after 98 days, 87%. The remaining 13% did not achieve 14 consecutive dry nights; seven patients improved, having fewer dry nights/week. One patient discontinued the treatment because of lack of motivation. In children with an initial maximum bladder capacity less than normal for age, the capacity increased from 53% of the normal maximum bladder capacity in week 1 to 88% at the end of treatment. Neither age, gender, sleep arousal, bladder capacity, family history and pathophysiological profile had any association with the success rate. Conclusion The short-term success rate of full-spectrum therapy for NE is high. Age, gender, sleep arousal, bladder capacity, family history and pathophysiological profile of Enuresis are unrelated to the success of the intervention.
Soren Rittig - One of the best experts on this subject based on the ideXlab platform.
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management and treatment of nocturnal Enuresis an updated standardization document from the international children s continence society
Journal of Pediatric Urology, 2020Co-Authors: Tryggve Nevéus, Akihiro Kawauchi, Stephen Shei-dei Yang, Serda Tekgul, Eliane Fonseca, Israel Franco, Larisa Kovacevic, Anka Nieuwhofleppink, Ann Raes, Soren RittigAbstract:Summary Background Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with Enuresis. Methods The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. Results The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic Enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic Enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the Enuresis Alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
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Management and treatment of nocturnal Enuresis—an updated standardization document from the International Children's Continence Society
Journal of pediatric urology, 2020Co-Authors: Tryggve Nevéus, Akihiro Kawauchi, Stephen Shei-dei Yang, Serda Tekgul, Eliane Fonseca, Israel Franco, Larisa Kovacevic, Ann Raes, Anka J. Nieuwhof-leppink, Soren RittigAbstract:Summary Background Enuresis is an extremely common condition, which, although somatically benign, poses long-term psychosocial risks if untreated. There are still many misconceptions regarding the proper management of these children. Aim A cross-professional team of experts affiliated with the International Children's Continence Society (ICCS) undertook to update the previous guidelines for the evaluation and treatment of children with Enuresis. Methods The document used the globally accepted ICCS terminology. Evidence-based literature served as the basis, but in areas lacking in primary evidence, expert consensus was used. Before submission, a full draft was made available to all ICCS members for additional comments. Results The enuretic child does, in the absence of certain warning signs (i.e., voiding difficulties, excessive thirst), not need blood tests, radiology or urodynamic assessment. Active therapy is recommended from the age of 6 years. The most important comorbid conditions to take into account are psychiatric disorders, constipation, urinary tract infections and snoring or sleep apneas. Constipation and daytime incontinence, if present, should be treated. In nonmonosymptomatic Enuresis, it is recommended that basic advice regarding voiding and drinking habits be provided. In monosymptomatic Enuresis, or if the above strategy did not make the child dry, the first-line treatment modalities are desmopressin or the Enuresis Alarm. If both these therapies fail alone or in combination, anticholinergic treatment is a possible next step. If the child is unresponsive to initial therapy, antidepressant treatment may be considered by the expert. Children with concomitant sleep disordered breathing may become dry if the airway obstruction is removed.
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Nocturnal Enuresis in children
Ugeskrift for laeger, 2018Co-Authors: Marie Préel, Konstantinos Kamperis, Soren RittigAbstract:Nocturnal Enuresis is the most common type of urinary incontinence in children. The pathophysiology of the condition is complex with excess nocturnal urine production, bladder reservoir dysfunction and failure to wake up to the sensation of a full bladder, being important elements. The condition can be successfully treated in most children; desmopressin and the Enuresis Alarm are both effective first-line treatments. Tailoring the treatment based on the clinical characterisation of the patients can improve the outcome.
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optimizing response to desmopressin in patients with monosymptomatic nocturnal Enuresis
Pediatric Nephrology, 2017Co-Authors: Konstantinos Kamperis, Charlotte Van Herzeele, Soren Rittig, Johan Vande WalleAbstract:Most patients with monosymptomatic nocturnal Enuresis can be effectively treated with an Enuresis Alarm or antidiuretic therapy (desmopressin), depending on the pathophysiology of the condition in the individual patient. Desmopressin is first-line therapy for Enuresis caused by nocturnal polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to desmopressin were subsequently treated effectively with desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response, body weight, adherence, withdrawal strategies and combination therapies are discussed in light of the most recent research on desmopressin and Enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom desmopressin is an appropriate therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements.
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combination of the Enuresis Alarm and desmopressin second line treatment for nocturnal Enuresis
The Journal of Urology, 2008Co-Authors: Konstantinos Kamperis, Soren Rittig, Soren Hagstroem, J C DjurhuusAbstract:Purpose: We sought to evaluate the combination of the Enuresis Alarm and desmopressin in treating children with Enuresis.Materials and Methods: A retrospective analysis was performed on data from 423 children treated at our clinics with the Enuresis Alarm during the years 2000 to 2004. Frequency volume charts and desmopressin titration facilitated characterization of the participants using the current International Children’s Continence Society standardization. Children were treated with the Enuresis Alarm as monotherapy before the addition of desmopressin, which commenced after 6 weeks in patients exhibiting inadequate response to Alarm or after 2 weeks in patients experiencing multiple enuretic episodes per night or showing no indication of improvement.Results: Of the initial population 315 children (74%) were treated only with Alarm, of whom 290 became dry. A total of 108 children (26%) were treated with a combination of Alarm and desmopressin, with 80 being cured. Children dry on Alarm therapy were no...