Efficacy and safety of multimodal treatment in nocturnal enuresis - A retrospective cohort study

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Abstract

Introduction and aim of the study: Most treatments of nocturnal enuresis (NE) are targeting the main pathophysiological mechanisms, i.e., excess nocturnal urine production, bladder reservoir dysfunction and inability to awaken to a full bladder. Although many children can be effectively treated with only one treatment modality, there is a significant number of treatment-refractory cases. We experience an increasing tendency to combine treatment modalities in those children. However, there is limited evidence regarding the efficacy and safety of such strategies. Materials and methods: We reviewed files from all NE children seen in our outpatient incontinence clinic between January 1st and December 31st 2017 and identified children refractory to first line treatment receiving a combination of at least two treatment modalities concurrently. Age, gender, wet nights per week before treatment, follow-up time, previous treatment with desmopressin or alarm, phenotype of NE, number of simultaneous treatments tried and response as well as registered side effects during treatment was noted. We registered the outcomes and safety of the treatment modalities and evaluated prognostic factors. Results: We identified 59 children (13 girls) aged 6–15 yrs (mean 9.6 yrs) of whom 30 were monosymptomatic NE (MNE) and 29 were non-monosymptomatic NE (NMNE) patients. They all suffered at least three wet nights per week before treatment. In total, 38 children (61%) became dry on multimodal therapy. Eighteen children (30%) became dry on a combination of two treatment modalities, 16 (27%) on three modalities, and two (3%) on four modalities. Nine children (15%) achieved partial response whereas three (5%) showed no response despite multiple tries with combination therapies. A total of 18 children (30%) reported side effects to one or more of the modalities tried. Side effects that led to discontinuation of the treatment were uncommon (three patients). Conclusions: Treatment refractory NE represents a challenge for the clinician. Although it seems possible to adequately treat refractory NE patients with multimodal treatment one should be aware of side effects as well as inform the families of the challenges in the treatment of refractory enuresis patients. Future RCT's should focus on providing further evidence for the role of multimodal therapy in NE treatment.[Formula presented]

Original languageEnglish
JournalJournal of Pediatric Urology
Volume17
Issue4
Pages (from-to)447.e1-447.e7
Number of pages7
ISSN1477-5131
DOIs
Publication statusPublished - Aug 2021
EventInternational Children Continence Society Conference - Rome, Italy
Duration: 26 Sept 201829 Sept 2018

Conference

ConferenceInternational Children Continence Society Conference
Country/TerritoryItaly
CityRome
Period26/09/201829/09/2018

Keywords

  • Children
  • Combination therapy
  • Multimodal treatment
  • Nocturnal enuresis
  • OXYBUTYNIN
  • STANDARDIZATION
  • OUTPUT
  • BLADDER CAPACITY
  • IMIPRAMINE
  • RHYTHM
  • CHILDREN
  • Enuresis
  • Humans
  • Male
  • Combined Modality Therapy
  • Nocturnal Enuresis/therapy
  • Adolescent
  • Deamino Arginine Vasopressin/therapeutic use
  • Female
  • Retrospective Studies
  • Child
  • Urinary Bladder

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