Predicting treatment outcome in nocturnal enuresis

Article Abstract:

Childhood nocturnal bedwetting (enuresis) affects up to 10 percent of children. It is associated with several disorders, with family factors, and with emotional stress. Some drug therapies have been used, but may have adverse side effects. The effectiveness of drug treatment is generally no better than the use of the enuresis alarm, which sounds when bedwetting occurs. Factors associated with favorable outcome following the use of the enuresis alarm are unclear. To identify and better understand these factors, 127 children who were referred to an enuresis clinic were studied. The average age was 8.8 years old, and most of the children were considered to have severe enuresis, having been already unsuccessfully treated. One-third of the subjects' fathers and 70 percent of mothers were unemployed, and 41 percent of parents acknowledged environmental stress such as financial or marital discord, or serious illness or death in the family. Of the 127 children, 22 became dry when star charts were used to reward their behavior. Nine children either did not return for further treatment or required surgery. Eighty-one of the remaining 96 children had an initial success of 42 consecutive dry nights. Eleven children relapsed, and nine achieved dryness after further treatment, while the remaining two showed significant improvements in their bedwetting behavior. Failure to achieve dryness for six months was strongly associated with psychiatric disorders in the subjects, family stress, and the absence of concern by child and parents. Successful outcome was also decreased by developmental delay or the presence of a urological disorder. The study suggests that the high success rate in these children is related to close supervision by clinic personnel, encouragement of the family, and by giving the child almost complete responsibility for following the program. Careful identification of associated factors like medical illness, family stress, and other problems such as housing must be addressed as part of an effective enuresis program. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Prognosis, Behavior modification

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Determinants of nocturnal enuresis in homozygous sickle cell disease

Article Abstract:

Sickle cell disease (SSD) is an abnormal condition of the blood in which red blood cells have an abnormal shape and do not carry oxygen adequately. Children afflicted with SSD often urinate in their bed at night (nocturnal enuresis). This may result from a high accumulation of urine in the bladder (which stores urine). Although SSD patients with nocturnal enuresis often come from large families, the severity of their disease has no bearing on the frequency of nocturnal enuresis. A recent study of 16 enuretic children with SSD and 16 age-matched non-enuretic children with SSD examined the causes of nocturnal enuresis. When these children were deprived of fluid overnight, no differences were found in urine concentration or volume. However, the capacity of the bladder to store urine was lower in the SSD children who were enuretic. The families of enuretic children were more likely to characterize their children as being deep sleepers. These results suggest that high urine volumes may contribute to the enuresis observed in SSD children, but additional factors may also be involved. A main determinant seems to be the low capacity of the bladder to store urine, but further research is needed to clarify this hypothesis. Nocturnal enuresis may be treated by using alarms that sound when the child urinates; this conditions the child to awaken and empty the bladder instead of wetting the bed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sickle cell anemia in children, Pediatric diseases, Sickle cell anemia

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Nocturnal enuresis in sickle cell haemoglobinopathies

Article Abstract:

Nocturnal enuresis (bedwetting) is a common pediatric problem, and is believed to be more common in children with homozygous sickle cell (HSC) disease. Cases for study were drawn from a cohort of Jamaican children participating in a study of sickle cell disease where umbilical cord blood obtained from all normal deliveries between July 1973 and December 1981 in Kingston, Jamaica was examined for the presence of hemoglobinopathies (defects in hemoglobin, the pigmented iron-containing component of blood). The study group was selected from the 314 children with HSC disease identified during this period. Each child included was matched with two children with normal hemoglobin. The children were reviewed regularly and when ill, and cases of enuresis were identified. When each child was eight years old, his or her history was reviewed in detail and any nocturnal enuresis or other pertinent clinical data was noted. Nocturnal enuresis was significantly more prevalent among children with HSC disease than those in the control group. At eight years old, the prevalence was at least twice that of the normal genotype group. A significantly positive association was identified for boys and a clear trend for girls between enuresis and increasing family size. Relationships to socioeconomic status were not found. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Hemoglobinopathy, Hemoglobinopathies

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