Insights
This systematic review evaluates treatments for nocturnal enuresis (bedwetting). It found evidence for acupuncture, alarms, desmopressin, and tricyclic antidepressants, among others.
Area of Science:
- Pediatric Urology
- Sleep Medicine
- Evidence-Based Medicine
Background:
- Nocturnal enuresis impacts a significant percentage of children and young adults.
- Spontaneous resolution occurs in 15% of affected children annually.
- Treatment is generally not recommended for children under 7 years old.
Purpose of the Study:
- To systematically review the effectiveness and safety of various interventions for nocturnal enuresis.
- To answer the clinical question regarding the effects of interventions for symptom relief.
Main Methods:
- Systematic review of 19 studies including systematic reviews, randomized controlled trials (RCTs), and observational studies.
- Searched major databases (Medline, Embase, Cochrane Library) up to February 2010.
- Included safety alerts from regulatory agencies like the FDA and MHRA.
Main Results:
- The review identified and evaluated evidence for multiple interventions.
- A GRADE evaluation was performed to assess the quality of evidence for each intervention.
Conclusions:
- The review presents data on the effectiveness and safety of interventions including acupuncture, anticholinergics, desmopressin, dry bed training, enuresis alarms, hypnotherapy, and tricyclic antidepressants.
- Information on specific medications like oxybutynin, tolterodine, hyoscyamine, imipramine, and desipramine is provided.
Introduction:
Nocturnal enuresis affects 15% to 20% of 5-year-old children, 5% of 10-year-old children, and 1% to 2% of people aged 15 years and over. Without treatment, 15% of affected children will become dry each year. Nocturnal enuresis is not diagnosed in children younger than 5 years, and treatment may be inappropriate for children younger than 7 years.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions for relief of symptoms? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions:
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, anticholinergics (oxybutynin, tolterodine, hyoscyamine), desmopressin, dry bed training, enuresis alarm, hypnotherapy, standard home alarm clock, and tricyclics (imipramine, desipramine).
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