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Introduction: Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spina bifida. It is associated with urinary incontinence (UI), nocturnal enuresis, urgency, intermittency, and recurrent urinary tract infections (UTIs). The Aim of this Study: It aims to assess the efficacy of biofeedback (BF) for achieving perineal synergy and improving symptoms in thirty children with refractory DSD who failed to improve with medical treatment in the last 2 to 3 years. Material and Methods: Thirty children (20 girls and 10 boys) aged 6–18 years (mean: 9.2 ± 2.2 yrs) with refractory DSD who failed to show improvement after 2–3 years of medical treatment with recurrent UTI and failure to emptying completely their bladder using urodynamic study. After patients understood the concept of BF pelvic floor training were regularly scheduled twice weekly for up to 3 months. Improvement was assessed using interview with parents after 3 months with measurement of manomeric pelvic floor muscles (PFMs) during straining and urodynamic study. Results: Seven (23.3%) of the 30 children had daytime UI and 11 (36.7%) had nighttime incontinence. 4/30 (13.3%) children had increased urgency and 5 (16.7%) had straining intermittency and 3% (10%) had Dysuria. After 3 months of BF pelvic floor training 7/30 (23.3%) of children were fully responsive 100% decrease of symptoms, 14/30 (46%) responded more than 90% decrease of their symptoms, 7/30 (23.3%) of children responded partial decrease of symptoms and 2/30 (0 to 49%) decrease of symptoms to BF pelvic floor training. Conclusions: BF pelvic floor training is an effective therapeutic option for children with refectory DSD. It improves symptoms of children with DSD with decreased UTIs through decreasing pressure of PFMs during urination. [ABSTRACT FROM AUTHOR]

Purpose: To outline the prevalence of vitamin D and vitamin B12 deficiencies in enuretic children. Methods: An analytical descriptive study was conducted on enuretic children who were followed up at the outpatient clinic for nocturnal enuresis at the Children's Hospital, Cairo University. Sociodemographic and clinical data were recorded. The levels of vitamin D and vitamin B12 were assessed and correlated with the severity of enuresis. Results: Two hundred and eighty-eight children were enrolled. Insufficiency of Vitamin D predominated (n=139; 48.3%). Vitamin D deficiency was present in 31.3%, n=90 and it was normal in 20.5%, n=59). Vitamin B12 deficiency was observed in 25% of the studied children, n=72). The one-sample Wilcoxon signed-rank test was significant for both vitamins (P value =0.001). Vitamin D showed a stronger inverse correlation with the number of enuresis episodes per day than vitamin B12 (-0.680 vs. -0.219 respectively). A cut-off of 13.7 ng/ml for vitamin D was detected, below which the child was predicted to have failed dry nights. Using multivariate logistic regression, higher vitamin D levels and behavioural treatment coexistence were significant protective factors for the absence of dry nights. Conclusion: Low levels of vitamin D and B12 were detected in children with primary nocturnal enuresis, which could be considered a burden on the clinical severity of enuresis. [ABSTRACT FROM AUTHOR]

Diffuse intrinsic pontine glioma (DIPG) is a rare aggressive brainstem lesion, affecting mainly young children. This report describes sixth cranial nerve palsy as the initial ophthalmic presentation in children with this pathology. Case series and literature review. All children presented with sixth nerve palsy were consecutively recruited from the pediatric clinic at the East Sussex NHS Healthcare Trust within the last 10 years. Full ophthalmic examination, orthoptic assessment, and refraction check were done in three patients. Magnetic Resonance Imaging was carried out using 1.5 Tesla (Siemens Symphony, Erlangen, Germany) to establish the diagnosis. The patients’ age ranged from 5 to 14 years at the time of presentation. All presented with sudden onset esotropia and limited abduction, suggestive of presence of sixth nerve palsy, requiring urgent medical attention. On detailed questioning and assessment, all children showed various neurological symptoms including nystagmus, liquid dysphagia, balance problems, and nocturnal enuresis. Two out of three patients died within 7 months following diagnosis. Sudden onset esotropia, especially due to sixth nerve palsy in children, should be considered a red flag symptom, prompting proper urgent specialist assessment. Sixth nerve palsy in patients with DIPG was associated with severely reduced life expectancy in this case series of three patients, shorter than in reported non-ophthalmic presentations. [ABSTRACT FROM AUTHOR]

The aim of this prospective study is to investigate the presence of anxiety and depression in children with PMNE and their mothers. This is a cross-sectional study of outpatients who are diagnosed with PMNE at a nephrology clinic. The study included 79 children with PMNE and their mothers (patient group), and 80 randomly selected healthy non-enuretic children and their mothers (control group). Depression and anxiety levels of mothers were measured using the Turkish versions of the Beck Depression Inventory, Beck Anxiety Inventory, and Anxiety Sensitivity Index-3. The Turkish version of the Revised Child Anxiety and Depression Scale-Child Version was used to measure depression and anxiety in children. Patients with PMNE had significantly higher Child Anxiety and Depression Scale scores than controls (p <.001). Beck Depression Inventory, Beck Anxiety Inventory, and The Anxiety Sensitivity Index-3 scores of the mothers of children with PMNE were significantly higher than controls (p <.001 for all). We showed that PMNE was associated with depression and anxiety in mothers and their children. These findings underpin the necessity for clinical screening of anxiety and depression in children with PMNE and their mothers. [ABSTRACT FROM AUTHOR]

Investigation of the effects of sloping dry and wet immobile beds on downstream dam-break flows is of great importance given the destructive power of these flows. Such investigation can lead to the adoption of appropriate measures and timely control strategies. In this study, numerical simulations of experimental wave propagation were carried out using four models, i.e. k − ω -SST-RANS, realizable k − ε -RANS, Smagorinsky-LES, and k − ω -SST-DES on sloped beds, for the first time as its novelty, with respect to upstream water and different downstream tail-water depths. The k − ω -SST-DES exhibited the best performance in the simulation of wave peak patterns and mean velocities. Taylor diagrams showed that all models were similar in estimating the highest R values and lowest centered root-mean-square errors for dry beds. However, for wet beds with higher downstream tail-water depths, the CRMSE were higher. For lower depths, the standard deviations of the models were generally closer to those of the flume experimental measurements conducted by the experimental study. The present study has shed light on the levels of turbulence models' accuracy in simulation of dam-break flows on dry and wet sloping beds, and can be taken as a basis for further understanding of the flood flow behavior in future studies. [ABSTRACT FROM AUTHOR]

To describe the prevalence of bladder and bowel dysfunction (BBD) in 8–10-year-old children with cerebral palsy and its association with motor, cognitive, and autonomic dysfunction. A cross-sectional, random sample study of parents of 8–10-year-old children with cerebral palsy. Tools: The Enuresis/Urinary Incontinence Parental Questionnaire, the Functional Independence Measure children's version, the autonomic signs questionnaire, and the Gross Motor Function Classification System. 39 out of 59 parents consented to participate, whereas 25.64% reported complete continence. Of the 29 children with BBD, 21 (72.4%) had lower urinary tract symptoms and bowel problems. Only two of the children received conservative and noninvasive treatments. Lastly, motor, cognitive and autonomic impairments were associated with incontinence. BBD is common in 8–10-year-old children with cerebral palsy at all levels of functioning. Most having both lower urinary tract symptoms and bowel problems. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify associations between nocturnal asthma awakenings and functional health outcomes in a cohort of teenagers with asthma. Methods: We analyzed baseline data from teenagers enrolled in SB-ACT, an NIH-funded RCT. During an at-home baseline survey, teenagers with asthma answered questions about demographics, recent asthma symptoms, and functional health outcomes. We conducted regression analyses to explore the relationship between persistent nocturnal asthma symptoms (≥2 nights of nocturnal asthma awakenings in the past 14 days) and functional health measures. Results: Of the 430 teens enrolled (Participation rate = 79%, Mean Age = 13.4), 30% reported persistent nocturnal asthma symptoms. Compared to teens with intermittent nocturnal asthma symptoms, teens with persistent nocturnal asthma symptoms were more likely to report physical limitation during strenuous activities (OR = 1.9, 1.3–3.0), moderate activities (OR = 1.9, 1.2–3.1), and school gym (OR = 2.4, 1.5–3.8). They were also more likely to report depressive symptoms (OR = 2.3, 1.5–3.6), more asthma-related school absenteeism in the past 14 days (0.81 vs 0.12, p < 0.01) and poorer quality of life (4.6 vs 5.9, p < 0.01). These findings remained significant when controlling for daytime asthma symptoms, weight status, race, ethnicity, gender, age, and smoke exposure. Conclusions: In this cross-sectional study, persistent nighttime asthma symptoms were associated with poor functional health outcomes among teens, independent of day-time symptoms. Identifying nighttime symptoms and improving asthma control at night may positively impact daily functioning for these teens. [ABSTRACT FROM AUTHOR]

The use of Python spp. for traditional medicine purposes has been recorded, but there is a dearth of information on the versatility of body parts used for the treatment of human ailments. This study aimed to determine the medicinal knowledge and level of agreement among traditional medicine practitioners in Ghana on the use of pythons for the treatment of human ailments. Ethnozoological data on the use of pythons for the treatment of human ailments were gathered from 45 traditional medicine practitioners using semi-structured interviews. The use value index and informant agreement ratio were calculated to ascertain the most sought after python body part and the level of agreement of a python body part for the treatment of human ailments. The python head, bones, and skin were the body parts found to be used for traditional medicine purposes together with the fat and eggs. Python fat had the highest use value and informant agreement ratio. Rheumatism, headache, bedwetting, diabetes, and spiritual protection were among the human ailments that were treated with python. Overall, python medicinal use was mainly for spiritual ailments rather than medical ailments. Although the python is currently of less international conservation importance, there is a need to reconcile the high use values of species by traditional medicine practitioners with their conservation status to evaluate their current threats. [ABSTRACT FROM AUTHOR]

Introduction: Desmopressin was widely used to treat nocturnal polyuria in adults under the age of 65 due to the well-established risk of hyponatremia. Since the prevalence of nocturia increases with age, and with an aging population, those most affected were excluded from treatment. Recently, a new lower dose sublingual tablet formulation that optimizes the balance between efficacy and tolerability has been licensed for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults of any age, with the caveat of regular serum monitoring for those over 65. This newer formulation aims to achieve the same clinical outcomes as previous formulations while reducing the risk of hyponatremia. Areas covered: This review will look at the pharmacology of the newly formulated desmopressin and examine the results of the clinical trials that would support its treatment of adult nocturia with idiopathic nocturnal polyuria. Expert opinion: When reporting on the clinical efficacy of desmopressin on nocturia, it is important for clinical trials to publish their complete data on nocturnal and 24-hour urine voided volumes. Further research examining the physiological reasoning behind this gender-specific dosing for desmopressin and the optimal recommended treatment duration of desmopressin for those over 65 is needed. [ABSTRACT FROM AUTHOR]

This article discusses the conceptualisation of enuresis nocturna by Dutch experts between c.1950 and 1990, years in which across the West new child sciences rapidly developed. Today, bedwetting is conceived as a mental illness caused by a mixture of nature- and nurture-bound factors. Have organic and environmental causes always figured as twins, even in the post-war decades of predominant environmentalism in psychological theory and clinical practice? Or is only the more recent biological turn in psychiatry responsible for a revaluation of organicism in expert discourses on the aetiology and treatment of childhood mental illnesses such as enuresis nocturna? Using Ian Hacking's dynamic nominalism as interpretive framework, the article shows that, in the Dutch case, environmental factors continued to be referred to after the biologising of children's mental problems, alongside an increasingly important role for brain-related, physiological and genetic causes of enuresis nocturna. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 22-year-old male patient, prison inmate, consulting a physician with nocturnal enuresis and 19-years-old male patient, been in prison for two years. Topics include the anticholinergic substances have been used in general medical practice since the 1950's, and the used for spasmodic disorders, antipsychotic-induced extrapyramidal symptoms and cholinergic substance toxicity.

Children with developmental disabilities (DD) are more likely than typically developing peers to have issues with enuresis. Past research has shown the success of behavioral treatments consisting of scheduled sits and reinforcement for continent voids. However, this research has included small sample sizes, while studies with larger numbers have lacked key information (i.e., baseline rates and follow-up data to evaluate maintenance and generalization). The current study conducted a consecutive case series analysis of 44 individuals with developmental disabilities who completed a 2-week program for enuresis. Results showed significant improvement in continent voids and follow-up data suggested positive results maintained when treatment was implemented by caregivers in a home environment. [ABSTRACT FROM AUTHOR]

Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies—18 for nocturnal enuresis and 7 for encopresis—over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified aswell-establishedtreatments, Full Spectrum Home Therapy wasprobably efficacious, lifting waspossibly efficacious, and hypnotherapy and retention control training were classified astreatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders. [ABSTRACT FROM PUBLISHER]

Enuresis affects up to 20% of children of 5 years old, enuretic children present arginine vasopressin secretion deficiency, compared to normal children. To keep the level of antidiuretic hormone in the body, the aim of this work was to develop natural rubber latex membranes loaded with desmopressin peptide and characterize itsin vitrorelease. Results demonstrated that 60% of desmopressin incorporated in natural latex was released up to 96 h. Furthermore, hemolysis tests showed no detectable disturbance of the red blood cell membranes. Based on the results, it was possible to conclude that natural latex membranes are able to load desmopressin. [ABSTRACT FROM PUBLISHER]

Repeated surveys of prostate cancer (PCa) patients indicate that their prevalence of depression is well above that for their non-PCa peers. Although standard first-line treatments for depression are only about 35% effective, some recent comments have suggested that a focus upon the possible correlates (factors that aggravate or mediate depression) might help improve treatment efficacy. To investigate this issue, 144 10 year PCa survivors were asked about the frequency of urinary incontinence, a common side effect of some PCa treatments. The 53 patients who suffered urinary incontinence had significantly higher depression scores on the Zung Self-rating Depression Scale than those patients who did not report urinary incontinence. Using mediation analysis, patients' psychological resilience (PR) significantly mediated the depressive effects of urinary incontinence, but those effects were confined to just one of the five components of PR—a sense of control over the things that happen to oneself. Implications for treatment models of psychosocial oncology support for PCa survivors are discussed. [ABSTRACT FROM AUTHOR]

Background:Enuresis results in behavioural disorder in children. This study investigated the behavioural disorders in children possessing primary enuresis. Materials and methods:In this cross-sectional study, 100 children with primary enuresis were referred to children’s hospital Khorramabad; the census method was used in this study. Data were collected using a short screening instrument for enuresis psychological problems, the reliability and validity of which have been confirmed in previous studies. First, a questionnaire was used to assess academic failure, anxiety, behavioural disorders, sleep, and psychological disorders. Results obtained were compared in terms of gender and age. Statistical analyses using inferential and descriptive statistics including Chi-square and Fisher test were employed. Results:The average age of children was 8.46 years. Sixty-six per cent of participants were male and the rest of them were female. Ninety per cent of subjects were between the age range of 1–9 years, and 10% were over 10 years old. Forty-three per cent of children suffered from anxiety disorders and 34% had sleep disorders, 4% also suffered from academic failure. Among behavioural disorders, hyperactivity and restlessness were the most common disorders, and they were significantly higher in nine boys. Headache, obsessive, and sleep disorders were more common in children above 10. There was a significant correlation between eating disorders, headache, sleep disorders, and strange movements in males, while feelings of sadness were more common in females. Conclusion:Social personality development in children with enuresis can be improved by informing parents of enuresis. [ABSTRACT FROM PUBLISHER]

Introduction: To investigate autonomic nervous system function in enuretic children by performing ambulatory blood pressure monitor (ABPM) for 24 h.Methods: Twenty-eight children ranging in age from 6 to 15 years with primary nocturnal enuresis and 27 age-matched healthy controls were enrolled and they get 24 h ABPM. Hypertension was defined as standard deviation score (SDS) > 1.64 (i.e., >95th percentile) adjusted for gender and height. Urinalysis, urine electrolyte levels, urinary culture, and urinary system ultrasound were carried out in all children. They have also requested to have a diary about daily fluid intake and urine volume.Results: Although the mean 24-h and daytime diastolic blood pressure (BP) did not differ between the groups, systolic BP (SBP) was significantly higher in enuretic children (p < 0.05). The mean night-time SBP, DBP values, SDS and BP loads were found to be significantly higher than those in the controls (p < 0.01). A lack of nocturnal decrease was more prevalent in the enuretic children compared with the control subjects, the difference was statistically significant for DBP but not for SBP. Patients with elevated night-time BP load was found to have higher frequency of urinary incontinence per week as well as per night when compared with enuretic children with normal night-time BP load (r = 0.72,r = 0.69,p < 0.01, respectively).Conclusion: Subtle abnormalities of circadian BP regulation in enuretic children indicated by a selective elevation of nocturnal SBP, DBP, and MAP, and attenuated nocturnal dipping may reflect sympathetic hyper activation and its possible role in pathogenesis of enuresis. [ABSTRACT FROM PUBLISHER]

Backround: Enuresis implies severe stress in affected children, and impairs quality of life and sleep. Children with enuresis experience difficulties in their arousal from sleep, possibly associated with disturbances of the circadian rhythm. In this study, we aimed to evaluate the sleep–wake cycle and sleep disturbances in children with monosymptomatic enuresis nocturna (MEN).Method: The study comprised 70 children with MEN who were admitted to the pediatrics and urology outpatients department and 94 age-matched healthy controls. Parents completed “Strengths and Difficulties Questionnaire,” Children’s Sleep Habits Questionnaire (CSHQ), Children’s Chronotype Questionnaire scale.Results: Children with enuresis had significantly more sleep and psychological problem. Enuresis group reported higher bedtime resistance, parasomnias, breathing-related problems, and daytime sleepiness in CHSQ (p < 0.05). Although circadian preference did not differ statistically between the groups (p > 0.05), sleep duration on school days and awakening and mid-sleep points, both on scheduled and free days, were found to be significantly different in the enuretic group (p < 0.05). In logistic regression analysis, age, sleep period on scheduled days, sleep inertia on scheduled and free days were significant predictor for enuresis.Discussion: Children with enuresis were more likely to experience problematic sleep. This may reflect that enuretic children have impaired sleep–wake cycles, leading to dysregulation of daily functional changes of bladder capacity and related hormones such as ADH. These findings might imply a sleep–wake disturbance in enuresis. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to investigate the effects of urinary incontinence (UI) on Turkish women's sexual functioning. Methods: We evaluated 396 women and divided them into 4 groups: reproductive-aged women without UI (Group A), reproductive-aged women with UI (Group B), menopausal-aged women without UI (Group C), and menopausal-aged women with UI (Group D). Results: The mean Female Sexual Function Index (FSFI) score was significantly higher and the Beck's Depression Inventory scores were significantly lower in Group A. FSFI scores showed a strong negative correlation with age and parity and a strong positive correlation with years of education. Conclusions: Our findings suggest that UI is an independent risk factor for female sexual problems. [ABSTRACT FROM AUTHOR]

Background: Bruxism is the involuntary grinding of teeth that occurs during sleep or wake time. The prevalence of bruxism in children and adolescents is high when compared to the adult population. Clinical presentation: This article presents a case report of sleep bruxism in a 6-year-old child. The interesting finding here was its association with nocturnal enuresis (NE)/bedwetting. Conclusion/clinical relevance: NE could be a predisposing factor for sleep bruxism in children, as it causes emotional stress and has a negative impact on a child's self esteem. Psychological support and techniques for overcoming NE, like a scheduled waking program at night helps children with these problems by alleviating the associated stress. In addition, NE and bruxism are often associated with other sleep disorders, such as obstructive sleep apnea syndrome, and hence, child bruxers require careful medical evaluation to rule out such potential interactions. [ABSTRACT FROM AUTHOR]

Objective. Monosymptomatic nocturnal enuresis (MNE) is a common sociomedical problem affecting children that may persist until adulthood despite various lines of therapy. The aim of this study was to assess the efficacy of combined laser acupuncture and desmopressin in managing patients with resistant MNE, compared with their efficacy when used as monotherapy. Material and methods. The study included 186 patients with a mean age of 15.7 years (range 10-21 years) presenting with persistent MNE. All patients were evaluated clinically and investigated with urine analysis, plain X-ray of the urinary tract and abdominal ultrasonography. They were randomized into three equal groups based on the line of management: group A, managed with laser acupuncture alone; group B, managed with desmopressin alone; and group C, managed with a combination of laser acupuncture and desmopressin, with a treatment course of 3 months and follow-up period of 6 months to record the efficacy of therapy, side-effects and bladder capacity. Results.A statistically significant higher cure rate was reported in group C patients, being reported in 33, 35 and 46 patients in groups A, B and C, respectively. Improvement was reported in 18, 17 and 13 cases in groups A, B and C, respectively, but the difference was not statistically significant. Bladder capacity significantly increased only in patients receiving acupuncture (groups A and C). Conclusion. Combined laser acupuncture and desmopressin is a promising and valid option to manage resistant cases of MNE. [ABSTRACT FROM AUTHOR]

Objective. Monosymptomatic nocturnal enuresis (MNE) and attention deficit and hyperactivity disorder (ADHD) are multifactorial disorders and biological, social, and psychological factors may play significant roles in the development of both. Children with enuresis display a higher prevalence of ADHD compared to the normal population. This study aimed to evaluate the relationship between MNE and ADHD. Methods. A total of 64 children between the ages of 6 and 13 years who were referred due to primary MNE, their parents, and 42 healthy control cases, were evaluated in terms of attention deficit and hyperactivity by a child psychiatrist using the DSM-IV-2000-TR diagnosic scale. Results. Of the children with enuresis, 17 had predominantly inattentive type (26.6%), nine had predominantly hyperactive-impulsive type (14.1%), and eight had combined type (12.5%). In the control group, two cases had predominantly inattentive type (4.8%), two cases had predominantly hyperactive-impulsive type (4.8%), and one had combined type (2.4%). Conclusions. The prevalence of ADHD is higher in children with MNE compared to the normal population. As attention deficit may also negatively effect the treatment of enuresis, children with MNE should be evaluated in terms of attention deficit and those with positive symptoms should be provided with psychosocial support. [ABSTRACT FROM AUTHOR]

Research suggests a higher prevalence of coexisting behavioural disorders, particularly Attention-Deficit Hyperactivity Disorder (ADHD), among children with enuresis in comparison to the general population. Studies generally have consisted of participants attending general paediatric medical clinics as opposed to facilities specialising in the treatment of psychiatric disorders. This descriptive investigation examined the frequency of enuresis and its psychiatric comorbidities among 363 children and adolescents referred for outpatient clinical psychological evaluation during a 12-month period. Results revealed that 16% of participants met diagnostic criteria for enuresis and that of these 98% had at least one comorbid psychiatric disorder. Mood disorders were the most common coexisting diagnoses, followed by ADHD and Oppositional Defiant Disorder. No association was found between a diagnosis of enuresis and participant intelligence. Implications for mental health providers are discussed. [ABSTRACT FROM AUTHOR]

Objective. To demonstrate a relationship between enuresis and nocturia. Material and methods. The study investigated 250 mothers (average age 34.6 ± 3.3 years) whose children attended the Department of Pediatrics of the Second University of Naples because they suffered from enuresis. Data were collected by self-reported questionnaire and personal interview. All women provided written informed consent with guarantees of confidentiality. Both the presence of nocturia in adulthood and enuresis in childhood were taken into account. Results. The overall prevalence of nocturia was 38% ( n = 95). There was a history of childhood bedwetting in eight mothers (5%) without nocturia and in 61 mothers (65%) with nocturia; the difference was significant (χ2 p < 0.01). Moreover, among the 110 enuretic children of nocturic mothers, 69 (62%) suffered from non-monosymptomatic nocturnal enuresis (NMNE), and 34 (56%) of their mothers suffered from NMNE in childhood. Nocturic mothers suffering from non-monosymptomatic enuresis during their childhood had offspring with a higher risk of developing non-monosymptomatic enuresis (odds ratio 4.3 95%, confidence interval 2.6–7.1, p < 0.01). Conclusions. These findings enabled a close connection between nocturia in adulthood and enuresis in childhood to be hypothesized. Furthermore, this analysis provided evidence of the link between suffering from nocturia, and previously from enuresis, and having children affected by enuresis. [ABSTRACT FROM AUTHOR]

Objective. To investigate a possible association between enuresis in childhood and premature ejaculation in adult life. Methods. The authors conducted a retrospective study, with two cohorts, consisting of 60 men with premature ejaculation, and 60 comparison subjects who were asked to assess their enuresis in childhood, a history of psychological problems. Results. While 20 (33.3%) subjects with premature ejaculation reported a history of enuresis in childhood, only seven (11.6%) subjects without premature ejaculation had this problem in childhood. Enuresis in childhood was significantly more common in men with a premature ejaculation than controls. While 35 (58.3%) patients with premature ejaculation reported a history of psychological problems, only four (6.6%) controls reported this kind of problems. There was a significant difference between these groups regarding psychological problems. Conclusion. The results of this study suggest that the history of enuresis in childhood seems to increase the risk of having premature ejaculation and psychological problems in adult life. These results lead to a premise that these disorders may share a common etiology and/or neurological pathophysiology. [ABSTRACT FROM AUTHOR]

Objective. Imipramine is the only evidence-based treatment available for enuretic children resistant to standard therapy. The drug's antienuretic effect is probably due to noradrenergic facilitation. The drug is, however, potentially cardiotoxic. In this study, the non-cardiotoxic noradrenergic antidepressant reboxetine was tested as an alternative to imipramine. Patients and methods. 61 patients, aged 7–19 years, with enuresis-resistant to desmopressin, the alarm, urotherapy and anticholinergics, were given 4–8 mg reboxetine at bedtime, if necessary combined with desmopressin. Results. 32 patients became dry on reboxetine treatment, although 21 of them required combination treatment with desmopressin to achieve this. Eighteen children did not respond and eight children discontinued because of side-effects before treatment could be evaluated. No serious adverse events occurred. Conclusions. These results need to be confirmed with randomized controlled studies, but indicate that reboxetine will become a safe and efficient treatment alternative for enuretic children resistant to standard therapy. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the long-term success of the enuretic alarm device in patients with monosymptomatic primary nocturnal enuresis. Material and methods. Sixty-two patients who had significant monosymptomatic primary nocturnal enuresis were included. They used an enuretic alarm for 3 months. At the end of the treatment, 15 of the patients did not have benefit from the enuretic alarm. Overall, 47 patients benefited from the enuretic alarm. The long-term follow-up was conducted prospectively. Results. The mean age was 9.3 (range 5-16) years and mean follow-up time was 19.2 (range 12-30) months. In the follow-up period, relapse was observed in 46.8% (n=22/47) of these patients. Twenty-two patients reused the enuretic alarm device for 3 months after relapse occurrence and 13 patients (59%) recovered. Although re-relapse was observed in seven of them in the 6 months, six patients had a full response. In total, 65.9% of the patients (n=31/47) maintained a full response after enuretic alarm treatment in the long-term follow-up. Thirty-one of the 62 patients underwent combination treatment (enuretic alarm plus medical therapy) for unsuccessful enuretic alarm treatment. The overall full response rate for combination treatment was 16.1%. Conclusion. In the long-term follow-up, the enuretic alarm device provided an acceptable full response rate in patients with primary nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the efficacy of two drugs: the anticholinergic agent oxybutynin (Ditropan) and the calcium channel blocker verapamil (Isoptin) in the management of nocturnal enuresis in patients with orthotopic ileal reservoirs. Material and methods. The study population comprised 20 male enuretic patients who had undergone radical cystoprostatectomy and formation of an orthotopic ileal reservoir (hemi-Kock or W-neobladder). All patients were clinically evaluated regarding their continence state. Basal medium-fill enterocystometry was performed for every patient. The patients were randomized on entry into one of the two arms of the study: oxybutynin followed by verapamil (n=10); or verapamil followed by oxybutynin (n=10). Each group received both drugs for a period of 2 weeks each. After administration of each drug, patients were re-evaluated both clinically and urodynamically. Results. Oxybutynin and verapamil improved continence status in 70% and 55% of the patients, respectively. Both drugs significantly increased the bladder volume at first desire, at normal desire and at the maximum enterocystometric capacity. The maximum enterocystometric capacity increased from 585±148.6 ml at baseline to 667.5±180.8 and 621.05±170.5 ml after administration of oxybutynin and verapamil, respectively. Despite this, there was no significant change in any of the pressure parameters with the exception of the basal pressure at maximum enterocystometric capacity, which decreased significantly from 20.1±8.3 cmH2O at baseline to 16.07±5.1 cmH2O after administration of verapamil. The number of uninhibited contractions in the last 5 min of filling decreased significantly from 3.6±0.7 at baseline to 1.9±1.2 after administration of oxybutynin and to 2.1±1.26 after administration of verapamil. The amplitude of maximum uninhibited contraction decreased from 41.15±9.1 cmH2O at baseline to 34.95±12.77 and 33.25±11.52 cmH2O after treatment with oxybutynin and verapamil, respectively. Neither drug significantly changed the initial, late or total compliance of the pouch. No significant side-effects occurred with either drug. Conclusions. Both drugs used in this study had beneficial effects on the continence status of our patients, with minimal side-effects. Both drugs clinically improved nocturnal incontinence after radical cystoprostatectomy and formation of orthotopic ileal reservoirs, which was verified by the associated improvements in urodynamic characteristics. [ABSTRACT FROM AUTHOR]

Objective. Although epidemiological surveys generally indicate declining rates of bedwetting with age, recent studies show that children with severe nocturnal enuresis have lower prevalence rates, which persist into adolescence. This study reports prevalence rates of both infrequent bedwetting (IB) and nocturnal enuresis (NE) at five time points during childhood with a large cohort of children. Material and methods. The Avon Longitudinal Study of Parents and Children provided a cohort of 13 973 singleton/twin infants alive at 12 months. These were followed up at 54, 65, 78, 91 and 115 months with a questionnaire relating to frequency of bedwetting and other variables. The prevalences of IB and NE were derived from these measures with missing data imputation being used to correct for possible loss-to-follow-up bias. Results. The overall prevalence rate of bedwetting declined from 30% (54 months) to 9.5% (115 months), being most pronounced between 54 and 65 months. Children with NE (wet at least twice a week) had lower prevalence rates at all ages but were more likely to persist with the problem over time and to have the non-monosymptomatic type of bedwetting compared to children with IB. Conclusions. Children with the severest form of bedwetting are likely to persist with the problem and to have the more complex form (non-monosymptomatic). The results are discussed in relation to the clinical importance of early identification. [ABSTRACT FROM AUTHOR]

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Enuresis is considered to be the most prevalent of all childhood problems with important psychosocial consequences. Thorough research by both medical and psychological disciplines has resulted in a lack of agreement concerning definitions and terminology. Psychiatric classification systems stress phenomenological aspects such as age, frequency and duration of wetting episodes, but are not based on pathophysiologic aspects, whereas the International Children's Continence Society recommend distinguishing between monosymptomatic enuresis and complex/non-monosymptomatic enuresis depending on the absence or presence of bladder dysfunctions. Several epidemiological and cross-sectional studies show higher scores for behavioral problems in children with enuresis. Parental reports suggest more externalizing problems, attention/hyperactive problems and anxious/withdrawn behavior, however, no difference has been demonstrated in children's self-report concerning internalizing problems. Four different viewpoints relating to the association between enuresis and psychopathology are described, including their clinical implications. In conclusion, enuresis and daytime wetting is seen as a 'biopsychosocial' problem with evidence for pathophysiologic causes and is often associated psychiatric/psychological problems. [ABSTRACT FROM AUTHOR]

Objective. To analyse the urinary excretion of glycosaminoglycans (GAGs) in patients with either urinary incontinence or nocturnal enuresis. Material and methods. The study population comprised 65 patients with either nocturnal enuresis (n=34) or urinary incontinence (n=31) and 67 controls. Excretion of urinary GAGs was assessed using the sodium tetraborate-carbazole method. Results. GAG excretion in patients with urinary incontinence was significantly higher than that in controls (p<0.000129) and in children with nocturnal enuresis (p<0.016). There were no age or sex differences in GAG excretion in the three groups studied. Conclusion. Increased GAG excretion in patients with urinary incontinence suggests an association with urothelial/detrusor pathology. [ABSTRACT FROM AUTHOR]

Aims. Recent studies demonstrated some differences in urinary electrolytes of enuretic children. Intrarenal nitric oxide (NO) serves as a major regulator of renal sodium and water excretion like an endogenous diuretic. This study aimed to investigate endothelial (eNOS), and neuronal (nNOS) NO synthase gene polymorphisms in children with primary nocturnal enuresis (PNE). Materials and Methods. The eNOS gene polymorphism was investigated in 171 Turkish children (57 PNE cases and 114 healthy, non-enuretic controls), and nNOS gene polymorphism was determined in 158 Turkish children (83 PNE cases and 75 healthy, non-enuretic controls). The glu298asp (G/T) polymorphism of the eNOS and C276T (C/T) polymorphism of nNOS genes were genotyped using PCR. Results. The distribution of GG, TG, and TT genotypes for eNOS gene was 48%, 33%, and 19% in PNE, compared with 61%, 26%, and 13% in the controls (p > 0.05). The distribution of CC, TC, TT and genotypes for nNOS gene was 31%, 29%, and 40% in PNE compared with 10%, 43%, and 47% in the controls. CC genotype was found higher in enuretic children (p = 0.002). The eNOS and nNOS gene polymorphisms were not associated with positive family history, frequency of enuresis, and clinical response to desmopressin. Conclusions. This study is the first to search the NOS gene polymorphisms in children with PNE. It was determined that eNOS gene polymorphism may not be associated with PNE, while nNOS gene polymorphism, a predominantly CC genotype, may be associated with PNE in Turkish children. Further studies with larger samples together with the detection of enuresis gene may help determine the exact role of nNOS gene polymorphism in enuresis. [ABSTRACT FROM AUTHOR]

Objective. Recently the heterogeneity of nocturnal enuresis has been manifest in the distinction between mono- and polysymptomatic forms, based on the absence or presence of bladder overactivity, respectively. Although this classification has important clinical implications, there is a lack of empirical work relating to associated symptom expression and psychological functioning. The aim of this study was to identify variables associated with the two forms of nocturnal enuresis by means of a large population survey. Material and methods. From a cohort of 11 021 parents surveyed as part of the Avon Longitudinal Study of Parents and Children when their children were aged 7½ years, 8242 questionnaires were returned, with 7935 children meeting the inclusion criteria. Parents were invited to complete a questionnaire containing items relating to bedwetting, toileting behaviour, day-time wetting, bowel functioning and psychological variables. Results. A total of 194 children met the Diagnostic and Statistical Manual of Mental Disorders-IV definition of nocturnal enuresis, of whom 133 (68.5%) were classified as monosymptomatic and 61 (31.5%) as polysymptomatic. Those with the polysymptomatic form were significantly more likely to have multiple episodes of bedwetting, to show signs (such as fidgeting) of needing to urinate during the day, to need a reminder to toilet during the day and to have day-time wetting and soiling. Conclusions. The proportion of mono- to polysymptomatic nocturnal enuresis was 2:1. Children with the polysymptomatic form had a number of associated bladder and bowel problems. Clinically it is important to distinguish between the two types of nocturnal enuresis in order to identify the most appropriate treatment intervention. [ABSTRACT FROM AUTHOR]

Desmopressin is a synthetic agonist of the natural pituitary hormone vasopressin acetate, with enhanced antidiuretic properties. In fact, owing to its selectivity for the V2 receptor, it has a greater antidiuretic activity, but lower pressure effects compared with natural antidiuretic hormone. Desmopressin is used in the diagnosis and treatment of cranial diabetes insipidus, in the treatment of monosymptomatic enuresis and for tests of renal function. [ABSTRACT FROM AUTHOR]

Objective . To investigate whether the norepinephrine reuptake inhibitor reboxetine is effective as a non-cardiotoxic alternative to imipramine in the treatment of therapy-resistant enuresis. Material and methods . Twenty-two children with severely socially handicapping enuresis resistant to urotherapy, the enuresis alarm, desmopressin and anticholinergics (all children had tried all these treatments) were given reboxetine, 4–8?mg at bed-time, for compassionate reasons. Results . Thirteen of the children (59%) achieved complete dryness with reboxetine, either as monotherapy or combined with desmopressin. Side-effects were minor and did not lead to discontinuation of treatment. Conclusions . Although the results of this study need to be confirmed in randomized, placebo-controlled trials, reboxetine may prove to be a useful treatment for therapy-resistant nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Objective . Nocturnal polyuria is considered a major pathogenetic factor in nocturnal enuresis, and the antidiuretic drug desmopressin, given at bed-time, is consequently recognized as a first-line treatment alternative. The aim of this open, non-randomized study was to see whether diuretic medication, given in the afternoon, could give similar therapeutic benefit. Material and methods . Sixty-three children suffering from primary, monosymptomatic, nocturnal enuresis were included in the study by their primary care paediatrician. After 14 days without any treatment and 14 days for which 0.4 mg of desmopressin was given orally at bed-time, the children were given furosemide 1 mg/kg in the afternoon for 14 consecutive days. The numbers of wet and dry nights were recorded. Results . The numbers of wet nights at baseline, during desmopressin treatment and during furosemide treatment were 10.2±3.5, 6.4±4.6 and 8.2±4.5, respectively. Both drugs were significantly better than no treatment, but only a small proportion of patients became completely dry: 24% on desmopressin and 12% on furosemide. Desmopressin was significantly better than furosemide. Three children who showed no therapeutic effect on desmopressin treatment had a favourable response to furosemide. Conclusion . Furosemide, given in the afternoon, has minor therapeutic potential in nocturnal enuresis. [ABSTRACT FROM AUTHOR]

Objective . Treatment for childhood nocturnal enuresis emphasizes either a psychological or pharmacological approach. The enuresis alarm, in comparative studies, has emerged as the most effective psychological treatment. In this review we investigate both outcome rates and influential factors from recently published studies. Material and methods . A search of papers published between 1980 and 2002 in the English language involving at least 10 children in which the enuresis alarm was employed as a stand-alone intervention revealed 38 studies. Results . Heterogeneity in terms of inclusion and outcome parameters made comparison between studies problematic. The most frequently adopted definitions were “wet at least 3 times a week” in terms of severity at inclusion, “14 consecutive dry nights” as a success criterion and “> 1 wet night a week” as a relapse criterion. Success rates across all studies ranged from 30% to 87% and were influenced by the type of enuresis, the treatment duration and the success criteria adopted. In an homogenous subset of 20 studies, 65% success with alarm treatment was found. Further analysis revealed equivalence between different forms of alarm, pre- and within-treatment predictors of outcome and possible mode of action. Relapse rates (ranging between 4% and 55%) were reported in 20 studies, with an homogeneous subset indicating that 42% of children relapsed following alarm treatment. Conclusions . The enuresis alarm is an effective intervention for children with nocturnal enuresis. There are a number of factors, both pre- and within-treatment, that appear to influence its effectiveness and may assist clinical decisions concerning its appropriateness for any particular child. [ABSTRACT FROM AUTHOR]

The prevalence of enterobiasis and its relationship with anal itching and enuresis were investigated among 799, randomly selected children aged 5–14 years, who lived, either in an area of high population density or one with a much lower population density, in Calabar, Nigeria. The eggs of Enterobius vermicularis were found in anal swabs (collected with transparent adhesive tape) from 60 (7.5%) of the subjects tested, with the prevalence of infection appearing markedly higher in the 403 children from the area with a high population density than in the 396 from the less densely populated area (11.7% v. 3.3%; P<0.05). Questionnaire-based interviews were used to determine which of the children suffered from anal itching, enuresis or both. Compared with the egg-negative subjects, the 60 children who were egg-positive for Enterobius were found to be much more likely to be suffering from anal itching (78.3% v. 28.3%; P<0.05) or enuresis (53.3% v. 36.4%; P<0.05). Enterobiasis is therefore not a problem that is restricted to the temperate regions of the world, and may be a cause of enuresis or at least a contributory factor in the development of this complaint. [ABSTRACT FROM AUTHOR]

Objective. To verify the safety of desmopressin treatment and its associated side-effects in a large number of patients. Material and methods. The study was conducted in accordance with the guidelines of the Italian Club for Nocturnal Enuresis, whose criteria are: age >5 years; absence of malformations and infections of the urinary tract; absence of psychological disorders or neurological alterations; number of "wet nights" >5-7; control of liquid intake during the afternoon and evening; monitoring of serum electrolytes before beginning treatment; control of body weight before the beginning of treatment and during the first 4-5 days of therapy; and the informed consent of the parents. The therapeutic regimen provided for a maximum dose of desmopressin of 40 mg/day (four puffs/nostril or two tablets), starting from an initial dosage of 20 mg/day (two puffs/nostril or one tablet) 1 h before going to bed. The study involved two groups of patients with monosymptomatic enuresis: some of them had been administered desmopressin in the form of a spray and others in the form of tablets. Results. A small percentage of patients presented mild, transient side-effects; in no case were severe side-effects verified. Conclusion. Desmopressin is a safe drug with a low incidence of side-effects. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether an interaction exists between nocturnal enuresis and allergy. Material and methods. Thirty-seven (20 boys, 17 girls) children with monosymptomatic nocturnal enuresis were recruited. We studied an allergy panel that included total IgE, 10 examples of inhalant-specific IgE, 10 examples of food-specific IRE, eosinophilic cationic protein (ECP) and Phadiotop. The same panel was studied in a control group of 18 children without monosymptomatic nocturnal enuresis. Results. We did not determine statistically significant differences between the enuretic group and the control group in terms of levels of total IgE, the 10 examples of inhalant-specific IgE and Phadiotop. However, two (soybean and hazelnut) of the 10 food-specific IgE and ECP levels did differ significantly between the two groups. Conclusions. This first specific IgE study showed that there may be a relationship between nocturnal enuresis and soybean and hazelnut food allergens. Our findings may explain some cases of nocturnal enuresis. However, further studies are necessary to explain the underlying mechanisms and management of this disorder. [ABSTRACT FROM AUTHOR]

Objective To assess functional day-time bladder capacity (DBC) and urine osmolality in children with primary monosymptomatic nocturnal enuresis (PMNE) according to age and sex. Material and methods A total of 263 children with PMNE were divided into two groups: Group I, 160 children (63 girls, 97 boys) aged 5-9 years (mean age 7.14&PlusMinus;1.47 years); and Ggroup II, 103 children (25 girls, 78 boys) aged 10-15 years (mean age 12.26&PlusMinus;1.52 years). DBC (milliliters) was the largest void of the day measured over four 24-h periods, irrespective of the diet applied. Urine osmolality was determined three times: in the evening before bed-time; at night, 2-4 h after falling asleep; and in the morning in the nocturnal void. Results DBC was smaller in Group I than in Group II (151.27 vs 199.46 ml; p <0.05). No statistically significant differences were found in relation to sex ( p >0.05). The mean osmolality of the nocturnal void in the morning was 854.15 and 909.22 mOsmol/kg H 2 O in Groups I and II, respectively ( p >0.05). Differences between boys and girls were not statistically significant ( p >0.05). No correlation was found between DBC and urine osmolality ( p >0.05). A detailed analysis of the results revealed DBC below the 5th percentile or above the 95th percentile in 23/263 cases (8.7%), reduced osmolality (< 800 mOsmol/kg H 2 O) in 76/263 (28.8%), a familial nature of nocturnal enuresis in 124/263 (47.1%) and difficulty waking in 86/263 (32.7%). Conclusions In children with PMNE aged 5-15 years, functional DBC increases with age and does not differ between the sexes; the mean nocturnal urine osmolality is neither age- nor sex-dependent. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis is a common problem and occurs in 15 to 20 percent of 5-year-old children. The etiology of nocturnal enuresis remains unknown and is probably multifactorial. In this study 52 children aged between 6–17 years with tuberculosis were questioned for nocturia and nocturnal enuresis, retrospectively. Nocturnal, enuresis was found in 12 (23%) and nocturia in 22 (42%) of the children, respectively. After specific treatment with antituberculosis drugs nocturnal enuresis and nocturia were improved in 5 and 21 children, respectively. However, it could not be explained why these disorders were much higher in children with tuberculosis than healthy children. The findings suggest that nocturnal enuresis and nocturia may be in a high frequency in children with tuberculosis; however, the authors think that prospective and more extensive studies should be performed to clarify these preliminary findings. [ABSTRACT FROM AUTHOR]

Objective: Despite a great number of studies, very little is known about the mechanism of action of enuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wake up before urination occurs and then, in time, to sleep through the night without voiding. The aim of this study was to investigate the effect of enuresis alarms on bladder storage capacities. Material and Methods: A total of 28 children aged >7 years who were not polyuric but who voided once every night, slept alone in their own bedroom and who were willing, along with their family members, to cooperate were recruited. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days. After these records and the results of physical and laboratory examinations were taken into consideration, treatment was instituted with the bell-and-pad (alarm) system for a period of 12 weeks. At the end of this period, patients were asked to complete another frequency/volume chart. Results: The pre- and post-treatment maximum functional bladder capacity was 178.35 ± 87.86 ml and 243.03 ± 102.84 ml, respectively and the pre- and post-treatment mean day-time bladder capacity was 111.11 ± 45.87 and 148.445 ± 7.68 ml. Both of these differences were statistically significant (p < 0.0001 and <0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from 177.85 ± 84.95 to 255.25 ± 124.52 ml after treatment (p < 0.0001). Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with a significant increase in bladder storage capacities (maximum nocturnal bladder capacity, maximum functional bladder capacity and mean day-time bladder capacity). [ABSTRACT FROM AUTHOR]

Objective: Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment. Material and Methods: A total of 66 children were assessed using a schedule for identifying mono- and non-monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5-10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks. Results: Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication. Conclusions: This study endorses the three systems approach in clinical practice. [ABSTRACT FROM AUTHOR]

Childhood nocturnal enuresis, affecting up to 15-20% of young children, has a significant impact upon a child's development and interpersonal relationships. Current etiological explanations and treatment approaches are limited by the biases of those who have attempted to understand this complex problem. A biopsychosocial systems model is proposed as an integrative and more comprehensive framework for enuresis. It is suggested that explicit attention to enhancing a child's sense of personal agency and mastery be included in treatment approaches for this problem. A case example illustrates this biopsychosocial, personal agency-enhancing approach. [ABSTRACT FROM AUTHOR]

Objective: This study assesses the impact of monosymptomatic nocturnal enuresis (MSNE) on the child's perception of quality of attachment to a caregiver and the caregiver's perception of dissociative behavior. Material and Methods: The study group comprised 47 boys and 63 girls (mean age 11.7 years; range 9-18 years). Subjects were classified into two groups as follows: Group I (normal children without nocturnal enuresis); or Group II (children with MSNE). MSNE was defined as more than three wet episodes per week without day-time enuresis, urge incontinence, frequency or dysuria. The Adolescent Attachment Questionnaire (AAQ) was administered to the children and the Child Dissociative Checklist (CDC) to the caregiver. Comparison groups were divided by gender, feeding method and type of caregiver. The AAQ and CDC scores in each subgroup were compared between the enuretic and non-enuretic groups. Results: Mean scores for attachment pathology were significantly higher in the enuretic ( n = 50) than the non-enuretic group ( n = 60) ( p < 0.05). The most significant attachment pathology was evident for the AAQ Angry Distress dimension in the nocturnally enuretic group. Caregivers' CDC scores did not differ significantly between the two groups. Highest mean dissociation scores were evident for those children whose caregiver was not a biologic parent or grandparent. Conclusions: MSNE may negatively impact the child's perception of the quality of attachment. Caregivers reported no significant dissociative behavior in nocturnally enuretic children. With prolonged nocturnal enuresis, physicians should be aware of the possibility of anger and distress within the child-caregiver relationship. In such cases, the modified treatment protocol should include psychologic counseling and support. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the frequency of an increased hyperventilation (HV) response in the electroencephalogram and to compare the results of psychometric assessments and electroencephalography (EEG) patterns in children with and without primary monosymptomatic nocturnal enuresis and in dry siblings of enuretics. We also compared the results of psychometric assessments and EEG patterns between enuretic and non-enuretic children. Material and Methods: The study included 89 children divided into three groups: 41 with primary monosymptomatic nocturnal enuresis, their 29 dry siblings and 19 with no history of voiding dysfunction (controls). Resting EEG changes were evaluated in all children. In addition to a psychiatric evaluation, the Maudsley Obsessive Compulsive Questionnaire, the Beck Child Depression Inventory and the State and Trait Anxiety Inventory for Children were used to assess obsessive--compulsive disorder, depression and anxiety, respectively. Results: The time at which real words were first spoken occurred significantly later in enuretic children ( p < 0.01). The frequency of EEG abnormalities was significantly higher in the enuresis group and in their dry siblings than in the control group ( p < 0.01). Additionally, as an indicator of cortical dysmaturity, an increased HV response was observed more often in enuretic children and their dry siblings than in the control group ( p < 0.001). Anxiety scores for the enuretic children were higher than those for the controls ( p < 0.01). There was no significant difference in psychiatric problems between the enuresis and control groups ( p > 0.05). Conclusions: The increased frequency of a high-level HV response in resting-state EEG recordings and the anxiety scores suggested that delayed cortical maturity and high anxiety may be important factors in the pathogenesis of primary monosymptomatic nocturnal enuresis. The HV responses in the dry siblings of the enuretic children may emphasize the relationship between insufficient cerebral maturation and the genetic origin of nocturnal enuresis. [ABSTRACT FROM AUTHOR]