Primary Monosymptomatic Nocturnal Enuresis in Children and Correlation with Sleep Disorders in Arak, Iran

Background: Nocturnal enuresis is a symptom defined as enuresis in children over 5 years of age that might have mutual connection to sleep disturbances. This condition might be a stressful factor for children and their families. Objectives: This study aimed to find the correlation between primary monosymptomatic nocturnal enuresis (PMNE), as a stressful factor and sleep disorders. Methods: This case-control study was conducted on 132 children, including 66 children with nocturnal enuresis as the case group and 66 healthy children as the control group. The two groups were homogenous in age, gender, and other demographic characteristics. The organized sleep disorder questionnaire based on sleep disorder diagnostic criteria (using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) was used in this study. The correlation between PMNE and sleep disorders was investigated based on the Chi-square test on SPSS software (version 23). Results: The mean scores of the subjects with sleep disorders in the control and case groups were 0.38 ± 0.78 and 2.24 ± 1.73, respectively. Therefore, there were significant differences between the two groups in sleep disorders (P = 0.001). In addition, primary insomnia, hypersomnia, circadian sleep rhythm, and sleep terror disorders in the case group were higher than the control group (P = 0.001). Conclusions: The PMNE has been defined as a risk factor for sleep disorders.

Low compliance contribute to insufficient Desmopressin response of primary monosymptomatic nocturnal enuresis and the role of voiding school

Aims To evaluate the impact of compliance on the therapeutic effects of Desmopressin, as well as the importance of establishing the voiding school for low-compliance children in primary monosymptomatic enuresis treatment. Methods Eighty-nine patients with primary monosymptomatic enuresis treated with Desmopressin were observed during the 2017–2020 at University Children’s Hospital Belgrade, Serbia. The average patients age was 7.7 ± 2.4 years; 65 (73%) were boys and 24 (27%) % were girls. After the 3 months of Desmopressin treatment, the effect of therapy was evaluated according to the compliance. After the treatment, low-compliance patients and their parents were suggested to visit a voiding school. Results A significant decrease in the median enuresis frequency was noticed during the Desmopressin treatment (25.0 (20.0–26.0) vs 10.0 (2.0–17.0) per month, before vs after treatment, respectively) (p < 0.001). Patients with low compliance had a poorer response to Desmopressin (p < 0.001). An median enuresis reduction in the good compliance group was 92.3% (86.7 -95%), while in the low compliance group was 28.6% (16.7–43.3%). After attending voiding school, there was a significant increase in compliance (p < 0.001), associated with an median percent decrease in enuresis of 84.0% (75.0–95.5%) (p < 0.001). Conclusion Compliance considerably influences the beneficial effects of Desmopressin. Patients with poor therapeutic effects should be evaluated for compliance and introduced to voiding school.

Abnormal Degree Centrality in the Right Inferior Frontal Gyrus During Urine Holding in Children With Primary Monosymptomatic Nocturnal Enuresis

Background: Primary monosymptomatic nocturnal enuresis (PMNE) is a common disorder among school-age children. Previous research has suggested that the prefrontal cortex (PFC) is essential to maintain urine storage in bladder control. We hypothesized that children with PMNE have functional deficits in several brain regions, especially the PFC, during urine storage. In this work, we investigated 30 children with PMNE and 28 controls in a state of natural urine holding to evaluate dysfunction in the bladder control network by applying degree centrality (DC) analysis methods based on resting-state functional magnetic resonance imaging. And seed-based functional connectivity (FC) analysis was used to investigate whether the dysfunctional areas exhibited altered FC with other brain regions.Results: Compared with the typical healthy children, the children with PMNE showed increased DC in the right inferior frontal gyrus (IFG). Also, the right IFG showed increased connectivity with the left middle and inferior frontal gyri and the right precuneus extending to the cuneus in the children with PMNE.Conclusion: The children with PMNE showed abnormal neural activity during urine storage and exhibited increased DC in the right IFG and increased connectivity with the left PFC and right precuneus during urine storage. These results suggest that compensatory effects may be associated with the right IFG combined with the precuneus and left PFC working together to maintain high vigilance and improve micturition's inhibition function to preserve the state of urine holding in children with PMNE.

Enuresis

Key Points Primary monosymptomatic nocturnal enuresis (PMNE) is common in and often outgrown by children. Psychological effects on the child are the main reason for treatment.A thorough history and physical examination are needed to accurately characterize the type of nocturnal enuresis in order to form the most effective treatment plan.Both the bedwetting alarm and desmopressin are widely considered first-line therapy in the treatment of PMNE.