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ESPU 2016 Annual Meeting in Barcelona, Spain
By Konstantinos Kamperis
Transcutaneous electrical nerve stimulation in children with monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo controlled study
CV Siggaard, K Kamperis, L Borch, B Borg, S Rittig, Aarhus University Hospital, Aarhus, Denmark
Siggaard e al investigated the effect of parasacral transcutaneous electrostimulation in children with nocturnal enuresis and no daytime symptoms such as urgency daytime incontinence or frequency. The authors recruited 52 children and of those 47 children completed the 3-month treatment consisting of two daily sessions, one in the evening and one during sleep. Half of the children were randomized to placebo treatment using TENS machines that did not deliver any form of stimulation. The authors were not able to demonstrate any effect of the treatment in the frequency of wet nights, or any bladder function parameters such as volumes voided, number of voids maximal voided volumes etc.
The study questions the efficacy of parasacral TENS in the treatment of nocturnal enuresis at least in those children with no evidence of bladder dysfunction during daytime.
Improved sleep quality following adenotonsillectomy is associated with enuresis resolution in children with sleep-disordered breathing
L Kovacevic, Hong LU, Myreia Diaz-Insua and Yegappan Lakshmanan
Children’s Hospital of Michigan, Pediatric Urology, Detroit, USA and Henri Ford Hospital, Urology, Detroit, USA
The authors have previously reported that adenotonsillectomy leads to complete resolution of NE in about 50% of children with SDB, but the mechanism is not entirely clear. In this study we assessed the effect of TA on sleep quality, night time urinary volume (NUV) and secretion of antidiuretic hormone (ADH) and
brain natriuretic peptide (BNP) in children with NE and SDB.
For this study 40 children 5-18 years of age diagnosed with SDB
on polysomnography, and monosymptomatic primary NE were prospectively followed. Arousal score, nocturia, nocturnal urine, and plasma levels
ADH and BNP were measured pre and 1 month post-surgery.
The authors demonstrate a decrease in arousal score and plasma BNP level, and an increase in plasma ADH level were seen post-surgery. Interestingly children remaining dry after TA improved significantly in terms of sleep quality. Following TA, nearly all dry children reported nocturia and significant decrease in BNP levels without significant change in their nocturnal urine production.
The study suggests that the resolution of enuresis seen in children after adenotonsillectomy may not be the result of changes in nocturnal diuresis as believed but in changes in arousability leading to a conversion of enuresis to nocturia. Further prospective studies are needed to test this hypothesis.
The influence of compliance on the therapeutic effects of desmopressin in monosymptomatic enuresis treatment
S Miliojevic and Z Radojicic
University Children’s Clinic Belgrade, Urology department, Belgrade, SERBIA and University Children’s Clinic Belgrade, Urology department, Belgrade, SERBIA
The purpose of this study was to investigate the importance of compliance on the therapeutic effects of desmopressin in the treatment of monosymptomatic enuresis nocturna.
During the years 2014-2016 the authors followed patients treated with desmopressin for nocturnal enuresis.
The average age of the patients was 8.8 years +/- 2.4 SD, out of whom 61.5% were boys and 38.5% girls. After the 3-month desmopressin treatment, the effect of medication therapy was compared with compliance. Poor compliance was considered infrequent drug intake, arbitrary discontinuation of therapy, improper dosage, drug administration against the instructions, or not following the given advice regarding fluid intake in the evening.
The authors demonstrate a significant reduction in the number of wet nights following desmopressin therapy. There was a significant difference between children with compliance and those with poor compliance n terms of the reduction in wet night frequency (90% compared to 30%). The authors conclude that compliance considerably influences the beneficial effects of desmopressin, and physicians should be aware of that and motivate the children appropriately.
The annual meeting of the European Society of Pediatric Urology was held in Barcelona Spain from April 19th to 22d. In this report we offer a synopsis of the most important new research on nocturnal enuresis presented.