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Investigating the three systems approach to complex childhood nocturnal enuresis--medical treatment interventions
Richard J Butler1, Joanne C Robinson, Philip Holland
1Child & Adolescent Mental Health Service, East Leeds Primary Care Trust, UK. richard.butler@leedsmh.nhs.uk
Insights
This study validates the three systems model for treating severe nocturnal enuresis. The model helps tailor pharmacological treatments like desmopressin or anticholinergics for better outcomes.
Area of Science:
- Pediatric Urology
- Pharmacology
- Clinical Practice
Background:
- Nocturnal enuresis is a complex condition with diverse treatment approaches.
- A previously proposed three systems model offers a framework for understanding and treatment selection.
- This study evaluates the model's clinical utility in severe nocturnal enuresis, focusing on pharmacotherapy.
Purpose of the Study:
- To investigate the clinical application of the three systems model in severe nocturnal enuresis.
- To assess the effectiveness of pharmacological treatments within this model.
- To identify predictors for successful treatment outcomes.
Main Methods:
- Sixty-six children with severe nocturnal enuresis were assessed.
- Participants received either desmopressin or anticholinergic monotherapy.
- Treatment success was evaluated at 4 weeks, with combination therapy offered for non-responders.
Main Results:
- Monotherapy success rates were 49% for desmopressin and 33% for anticholinergics.
- Overall success, including combination therapy, reached 74.5%.
- Specific clinical indicators predicted successful anticholinergic treatment.
Conclusions:
- The three systems model is validated for clinical use in managing nocturnal enuresis.
- The model aids in selecting appropriate pharmacological interventions.
- This approach enhances treatment efficacy for children with severe nocturnal enuresis.
Objective:
Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment.
Material And Methods:
A total of 66 children were assessed using a schedule for identifying mono- and non-monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5-10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks.
Results:
Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication.
Conclusions:
This study endorses the three systems approach in clinical practice.
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