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

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Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank Dr JW Varni for permission to use the Peds QL 4.0 questionnaires and the MAPI Institute for their support, Dr Clarice Tanaka and Rita Pavione from the Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo Medical School.

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Authors and Affiliations

  1. Department of Pediatrics - Instituto da Criança, University of São Paulo Medical School, São Paulo, Brazil

    Simone N. Fagundes, Adrienne Surri Lebl, Guilherme Jorge Sousa e Silva & Vera H. Koch

  2. Pediatric Sleep Laboratory, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil

    Leticia Azevedo Soster

  3. Clinical Psychology Department of São Paulo University, São Paulo, Brazil

    Guilherme Jorge Sousa e Silva & Edwiges Ferreira de Mattos Silvares

  4. Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, Rua Lydia Ferrari Magnoli, 300 ap 21, Jardim Avelino, São Paulo, SP, 03227-085, Brazil

    Vera H. Koch

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  1. Simone N. Fagundes
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  2. Adrienne Surri Lebl
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Corresponding author

Correspondence to Simone N. Fagundes.

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Funding

Financial support for this study was provided by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant # 2011/17589-1.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Fagundes, S., Lebl, A., Azevedo Soster, L. et al. Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention. Pediatr Nephrol 32, 843–851 (2017). https://doi.org/10.1007/s00467-016-3510-6

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  • DOI: https://doi.org/10.1007/s00467-016-3510-6

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