The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women

ObjectiveOur current knowledge on nocturnal enuresis (NE) in adults is scarce due to its uncommon nature. The present study was designed to investigate symptom characteristics and risk factors of NE in adult women to improve the current clinical understanding and management of this rare disease.MethodsOver a 3-year period, we enrolled 70 adult women who complained of bedwetting, with a frequency of at least once per week and a symptom duration of 3 months or longer. Patients were excluded if they had known pregnancy, current urinary tract infection, untreated malignancies, anatomical abnormalities, and irregular sleep cycle. The International Consultation on Incontinence Modular Questionnaire—female lower urinary tract symptoms and bladder diary were employed to appraise lower urinary tract symptoms and voiding behavior. Urodynamics was performed to assess the bladder function. A linear regression analysis was applied to determine potential risk factors for NE frequency.ResultsAmong the recruited subjects, comorbidities and lower urinary tract symptoms were frequently reported. On bladder diary, patients commonly presented with nocturnal polyuria (NP), reduced nocturnal voided volumes (RNVVs), or both. Urodynamics revealed multiple dysfunctions, namely, detrusor overactivity (DO), urodynamic stress incontinence (USI), reduced compliance, bladder outlet obstruction, detrusor underactivity (DU), and simultaneous DO and DU. Patients with more frequent NE (≥4/week) demonstrated markedly increased body mass index, more comorbid conditions, worse incontinence symptoms, NP or NP plus RNVVs, reduced compliance, and poorer voiding possibly owing to DU. Whereas, RNVVs alone and worse overactive bladder-related parameters were associated with milder NE. Multivariate analysis indicated that frequency/urgency quality of life, incontinence symptom, NP + RNVVs, poor flow, increased bladder sensation, USI, and simultaneous detrusor overactivity plus DU were independent risk factors for NE severity.ConclusionNE in adult women may have both urological and non-urological pathophysiology. Imbalanced circadian urine production, jeopardized continence mechanisms, overactive bladder, and DU-induced poor voiding are major factors that contribute to the pathogenesis of NE in adult women. Focused treatments on restoring these functions should be individually considered.

Topical Use of Saussurea costus (Falc.) Lipsch. (Qost) Oil in Pediatric Nocturnal Enuresis in Comparison with Sesame Oil, A Randomized Double-Blind Clinical Trial

Nocturnal enuresis is one of the most common chronic problems of childhood. It has a significant effect on health and quality of life of children and their families. Despite pharmacological treatments, enuresis in most children relapses after the medication is discontinued. Also available drugs have many side effects that limited their uses. So, we compared the effect of topical use of Saussurea costus (Falc.) Lipsch. (Qost) oil as a Persian Medicine product on pediatric nocturnal enuresis in a parallel randomized double blinded study. Eighty-two patients aged 5 to 15 years who were diagnosed as monosymptomatic nocturnal enuresis were allocated to receive costus oil or sesame oil topically below the navel twice a day for 4 weeks. Patients were evaluated prior to and following end of the study in terms of frequency of enuresis and any observed adverse events. The results were evaluated with valid PLUTSS questionnaire. For evaluation, Chi-square and Fisher's exact tests, Mann-Whitney and Wilcoxon tests were used. Significant p value was < 0.05. A significant decrease in mean scores of the questionnaires was noted in both groups. The results before and after the intervention were significantly different in both groups, but there was no statistically significant difference between the intervention and control groups. At the end of the 4th week, the frequency and volume of enuresis showed a 46.2 percent reduction in costus oil group and a 25.5 percent reduction in sesame oil group. According to this study, the response rate based on PLUTSS questionnaire in costus oil group is 74.5%; while in the sesame oil group is 69%. No drug side effect was noticed in this study. Based on the results of this study, costus oil is effective in children with monosymptomatic nocturnal enuresis; however, there is no significant difference between costus oil and sesame oil.

Nocturnal Enuresis in Primary Schools Children (6-12 Years) of Tabuk City, Saudi Arabia

Background: Regardless of the significance and the disturbing magnitudes of NE, this problem remains under-reported in Tabuk, Saudi Arabia and comprehensive studies in this regard are considerably lacking in that region. This study aimed to discuss the prevalence and associated risk factors of NE among children in Saudi Arabia. Methodology: A cross sectional study design was adopted in Tabuk, KSA using a self-administered questionnaire for data collection distributed online on social media sites to be filled out personally. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for windows (SPSS Inc., Chicago, IL, USA). Results: The study included 431 participants. (37.4%) of children aged between six and seven years old, (32.7%) between eight and nine years old, and (17.2%) between ten and twelve years old. (58.9%) of children were males and (41.1%) females. Average frequency various from (53.8%) one time to two times per week, (31.3%) three times to four times per week, (14.8% five times to seven times per week. Enuresis was at night only in (77.5%) while (22.5%) at day or night. (64.5%) don’t seek to medical advice, while (35.5%) getting medical advice. (48.5%) of children getting behavioral therapy to treat this condition, (15.8%) exercise to strengthen bladder muscles, (14.6%) getting medical treatment, (10%) getting urination alarm, (0.5%) doing surgical intervention. There was a significant relationship between frequency per week of enuresis with mother educational level, number of family member, age of child (6-7) years old, sex of child (female), family history of nocturnal enuresis and delayed growth. Also, there was a significant relation between timing of enuresis during night or day and night with parents suffering from nocturnal enuresis, father’s education level, mother’s education level, and caring of parents to awaken the child. Conclusion: Nocturnal enuresis associated factors and parenteral knowledge of definition and causes of it were among universal reported figures. Referral to a pediatric urologist can be indicated for children with primary enuresis refractory to standard and combination therapies, and for children with some secondary causes of enuresis, including urinary tract malformations, recurrent urinary tract infections, or neurologic disorders.

The Desmopressin melt therapy in children with non-monosymptomatic nocturnal enuresis: a prospective study

Objective: The negative consequences of enuresis in children can be far reaching and an understanding of the impact of these is essential for effective treatment by the clinician. Enuresis can be categorized into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). There have been several studies in treatment of MNE with lyophilizate desmopressin melt but very limited research into the efficacy of desmopressin melt in treating NMME. The objectives of this study were to measure the efficacy and side effects of desmopressin melt in treating children with NMNE. Materials and Methods: Children aged 6 to 18 years with NMNE who visited the outpatient department of pediatric urology were included in this prospective study. Any underlying diseases and lower urinary tract symptoms were corrected then their enuresis was treated with 120-240 mcg of desmopressin melt for 6-8 weeks. Outcomes were defined as complete response, partial response, and no-response as defined by the International Children’s Continence Society guidelines. Results: A total of 25 children with NMNE were included in the study. The results showed 44% complete response, 20% partial response, and 36% no-response. The mean volume of nocturnal enuresis decreased from 159.96 to 115.30 ml in the pre and post treatment periods, respectively (p = 0.012). The mean frequency of enuresis decreased from 4.36 to 2.84 days per week in pre and post treatment periods, respectively (p < 0.001). The mean whole night urine volume decreased from 373.39 to 292.37 ml in pre and post treatment periods (p = 0.061). There were no major side effects in the study. Conclusion: Desmopressin melt is effective and safe in treating NMNE in children. However, to add weight to the findings of this study further research with a larger number of patients should be considered in the near future.

STUDY OF URINARY SYMPTOMS AND SEXUAL DYSFUNCTION IN WOMEN WITH PROLAPSE.

INTRODUCTION in Western society 21 _51% urinary incontinence problem due to pelvic dysfunction various urinary symptoms are stress incontinence, mixed incontinence, dysuria, nocturia, driblling of urine, and later stages nocturnal enuresis. METHODS this study was conducted in 150 patients of prolapse aged 40_70year of age help was taken from King's health questionaare to develop proforma of the patients which included general health, incontinence impact, physical and social limitation, emotional problem with sleep disburtances, demographic characteristics and Obstetrics and medical history. DISCUSSION out of 150 patients, 44 had one or more medical management antimuscarinic drug were given in 20 patients, Mirabin were given in 6, ATT in 2,HRT in 10. Surgical management were done in 70 patients, vault prolapse in 10 and TOT in 3 patients. CONCLUSION our study conrm medical physical psychological and intervention factors were reported as inuential in QoL in women with incontinence and therefore increasing need for intervention for these prolapse patients with urinary dysfunction. AIM :Study of urinary symptoms and sexual dysfunction in women with urinary incontinence in prolapse patients . The present study was conducted from January 28, 2019 to jan20 ,2020 .