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

TY - JOUR

T1 - Efficacy and safety of multimodal treatment in nocturnal enuresis - A retrospective cohort study

AU - Meyer, Sonja Izquierdo Riis

AU - Jørgensen, Cecilie Siggaard

AU - Kamperis, Konstantinos

AU - Andersen, René Frydensberg

AU - Pedersen, Malthe Jessen

AU - Faerch, Mia

AU - Rittig, Søren

N1 - Publisher Copyright: © 2021 Journal of Pediatric Urology Company

PY - 2021/8

Y1 - 2021/8

N2 - 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]

AB - 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]

KW - Children

KW - Combination therapy

KW - Multimodal treatment

KW - Nocturnal enuresis

KW - OXYBUTYNIN

KW - STANDARDIZATION

KW - OUTPUT

KW - BLADDER CAPACITY

KW - IMIPRAMINE

KW - RHYTHM

KW - CHILDREN

KW - Enuresis

KW - Humans

KW - Male

KW - Combined Modality Therapy

KW - Nocturnal Enuresis/therapy

KW - Adolescent

KW - Deamino Arginine Vasopressin/therapeutic use

KW - Female

KW - Retrospective Studies

KW - Child

KW - Urinary Bladder

UR - http://www.scopus.com/inward/record.url?scp=85103701791&partnerID=8YFLogxK

U2 - 10.1016/j.jpurol.2021.03.005

DO - 10.1016/j.jpurol.2021.03.005

M3 - Journal article

C2 - 33820712

AN - SCOPUS:85103701791

SN - 1477-5131

VL - 17

SP - 447.e1-447.e7

JO - Journal of Pediatric Urology

JF - Journal of Pediatric Urology

IS - 4

T2 - International Children Continence Society Conference

Y2 - 26 September 2018 through 29 September 2018

ER -