The brain mechanism of awakening dysfunction in children with primary nocturnal enuresis based on PVT-NAc neural pathway: a resting-state fMRI study

Primary nocturnal enuresis (PNE) affects children’s physical and mental health with a high rate. However, its neural mechanism is still unclear. Studies have found that the paraventricular thalamus (PVT) is among the key brain regions implicated with awakening regulation and its control of the transition between sleep and wakening is dependent on signaling through the PVT-nucleus accumbens (NAc) pathway. So this study analyzed the function of brain regions and their connectivity of PVT and NAc. A total of twenty-six PNE and typically developing (TD) children were involved in the study and the methods of amplitude of low frequency fluctuation (ALFF), degree centrality (DC) and functional connectivity (FC) based on resting-state functional magnetic resonance imaging (rs-fMRI) were used to analyze the brain functions. Results showed that there was no statistical significant difference in ALFF and DC between PNE and TD children in bilateral PVT and NAc. And there was statistical significant difference of the comparison of the FC of left PVT (lPVT) and left NAc (lNAc) between PNE and TD children. Meanwhile, there was negative correlation between awakening score and the FC of rPVT and lNAc, and no obvious correlation between awakening score and the FC of lPVT and lNAc in PNE children. Meanwhile, there was both negative correlation between awakening score and the FC of lPVT, rPTV and lNAc in TD children. Therefore, the FC between rPVT and lNAc was more reliable in assessing the degree of awakening ability in PNE children. This finding could help establish the evaluation index of PNE.

Prevalence, Risk Factors, and Psychological Effects of Primary Nocturnal Enuresis in Chinese Young Adults

Purpose: This study aimed to investigate the prevalence, risk factors, and effects of primary nocturnal enuresis (PNE) on physical and mental health in young adults in mainland China.Methods: An anonymous questionnaire was used to collect information including the sociodemographic characteristics, history of PNE, family history, daytime voiding symptoms, Pittsburgh Sleep Quality Index (PSQI) scores, Self-Esteem Scale (SES), and Self-Rating Depression Scale (SDS). A total of 22,500 university students from 23 provinces and 368 cities in mainland China were included.Results: In total, 21,082 questionnaires were collected, and 20,345 of them qualified for statistical analysis. The PNE prevalence was 1.17%, and the distribution of monosymptomatic nocturnal enuresis (MNE) and nonmonosymptomatic nocturnal enuresis (NMNE) was 66.1% and 33.9%, respectively. In total, 28% of respondents with PNE reported bedwetting daily, 31.6% between 1 and 7 times weekly, and 40.4% between 1 and 4 times monthly; 80% of PNE cases had no history of treatment. The prevalence of PNE in patients with a family history, frequency, urgency, urinary incontinence, and recurrent urinary tract infections was significantly higher than in those without these conditions (P<0.001). PNE was significantly correlated with the PSQI total score (sleep quality) (P=0.011). The SES score was lower and the SDS was higher (P<0.001) in the PNE group than in those without PNE.Conclusions: In mainland China, the PNE prevalence among young adults was found to be high, and PNE had significant effects on physical and mental health. Risk factors included a family history, daytime voiding symptoms, and lack of treatment.

The impact of adenotonsillectomy on monosymptomatic primary nocturnal enuresis in children with obstructive sleep apnea syndrome

Objectives: To analyze the outcome of monosymptomatic primary nocturnal enuresis (MPNE) after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Methods: The study included 74 MPNE children with OSAS qualified for an adenotonsillectomy procedure. MPNE was assessed prior to surgical procedure as well as 3 and 6 months after surgery. In addition to polysomnographic parameters, serum antidiuretic hormone (ADH) and brain natriuretic peptide (BNP) levels were measured preoperatively and 3 months postoperatively. Results: The mean age was 9.8 years and the mean number of nocturnal wetting weekly was 4.1. Thirty-eight percent of patients had family history of MPNE. All the patients underwent a successful adenotonsillectomy. Nocturnal enuresis was still reported in 18% of children 6 months after adenotonsillectomy. An increased risk of MPNE was significantly demonstrated in children with high obstructive apnea-hypopnea index (O-AHI), high oxygen desaturation index (ODI), high frequent nocturnal enuresis and family history. After surgery, ADH levels were significantly lower, whereas BNP levels were significantly higher in non-resolution children. Univariate analysis showed that higher O-AHI, higher ODI, severe enuresis, low serum ADH and higher serum BNP levels were indicative of persistent nocturnal enuresis. Multivariate analysis showed that higher ODI and higher BNP levels are independent prognostic markers for MPNE. Conclusions: Adenotonsillectomy in MPNE children with OSAS is an effective treatment for resolution of MPNE. Also, higher ODI caused by apnea and elevated serum BNP levels are the most important factors affecting the outcome of MPNE patients. Level of evidence: Not applicable for this multicentre audit.

A Randomized Clinical Trial on Imipramine and Oxybutynin for the Treatment of Children With Primary Nocturnal Enuresis

Background: Nocturnal enuresis is a common childhood problem. There are several treatment options for the treatment of children with primary enuresis including behavioral modification, drug therapy like tricyclic antidepressant, vasopressin analog and anticholinergic drugs. Objective: To observe the efficacy of oxybutynin and imipramine for the treatment of children with primary nocturnal enuresis in terms of symptom relief and disease control. Materials and methods: A randomized clinical trial was conducted in urology outpatient department, Sir Salimullah Medical College Mitford Hospital, Dhaka from May 2015 to April 2016. Total 70 patients with primary nocturnal enuresis were selected according to selection criteria. After duly taking informed written consent, patients were randomly divided into 2 groups by lottery method. In this way 35 patients were selected as group- A and 35 patients were selected as group-B. Patients of group-A were treated with imipramine and Group-B were treated with oxybutynin. Results: Age range of the subjects was from 5-16 years. Among them 30% of the subjects in the imipramine group were between 7-9 years of age and 30% of the subjects in the oxybutynin group were between 5-7 years of age. The male-female ratio was 1.2:1.Thirty five percent of the subjects had positive family history while remaining 65% did not have such history. At the base line study, 80% of the subjects did not show satisfactory result following 2 weeks of behavioral modification while 20% showed improvement. Before starting drug therapy, 60% patients had 4-5 bed-wetting nights/week. Following treatment, frequency of bed wetting dropped sharply to <3 at the end of month 3 and begin to rise again after discontinuation of therapy. At the end of month 3, imipramine cured in 46.7% cases with adverse effects like insomnia, nausea, anxiety, palpitation, lethargy while oxybutynin cured 40% patients with more adverse effects like headache, palpitation, dry mouth, constipation, tiredness, nervousness and fever. Early relapse of nocturnal enuresis 3 months after withdrawal the drugs and it was higher in the imipramine treated group than oxybutynin treated group which was 47.8% and 45% respectively. Conclusion: Outcome of imipramine is better than oxybutynin and side effects are significantly higher in oxybutynin. I Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.76-82

Self-Concept in Children with Primary Nocturnal Enuresis and Related Influencing Factors

The article's abstract is no available.