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Evaluation of the effect of 3-month bladder basic advice in children with monosymptomatic nocturnal enuresis
Marcin Tkaczyk1, Michał Maternik2, Anna Krakowska3
1Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland; IV Chair of Pediatrics, Medical University of Lodz, Lodz, Poland.
Insights
Basic bladder training (BBA) showed limited efficacy for children with monosymptomatic nocturnal enuresis, with only 18% achieving full success after three months. Early intervention with desmopressin or alarms may be better for unfavorable cases.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Basic bladder training (BBA) is a recommended approach for managing monosymptomatic nocturnal enuresis (MNE).
- The established duration and efficacy of BBA remain subjects of ongoing clinical discussion and research.
- Recent data suggest a potential lack of efficacy for BBA, prompting further investigation.
Purpose of the Study:
- To prospectively assess the efficacy of BBA in children with primary MNE who have not previously received treatment.
- To evaluate the treatment outcomes at 30, 60, and 90 days of BBA intervention.
Main Methods:
- A prospective, interventional, multicenter trial was conducted.
- Forty-nine treatment-naïve children with MNE (mean age 7.2 years) participated.
- Treatment efficacy was evaluated at 30, 60, and 90 days.
Main Results:
- The mean number of wet nights significantly decreased after 3 months (from 8.9 to 5.9 episodes per 2 weeks).
- Full success rates were low: 2% at 30 days, 12% at 60 days, and 18% at 90 days.
- Partial response rates were 8% (30 days), 20% (60 days), and 34% (90 days), with a high initial non-responder rate decreasing to 47% at 90 days.
Conclusions:
- Basic bladder training demonstrates limited and late efficacy in treatment-naïve children with MNE, with peak effectiveness at three months.
- A favorable initial profile (occasional wetting, high maximal voided volume) may warrant extended BBA therapy up to 3 months.
- For unfavorable initial profiles, earlier introduction of second-line therapies like desmopressin or alarms is suggested.
Introduction:
Advice (BBA) into the standards of patients' care in both monosymptomatic and non-monosymptomatic nocturnal enuresis. Although the idea of this recommendation was clear and reflects clinical experience, duration and efficacy have not been definitely established. Recent data have demonstrated the lack of efficacy of BBA and a fierce discussion has ensued. The present study was aimed to assess the efficacy of BBA in a group of previously untreated children with primary monosymptomatic nocturnal enuresis (MNE).
Study Design:
The study was a prospective interventional multicenter trial in a cohort of previously untreated MNE patients. Forty-nine children (36 males, 13 females, mean age 7.2 years) were included in the analysis. The treatment efficacy was assessed at the 30th, 60th, and 90th days of BBA.
Results:
We discovered that the mean number of wet nights decreased significantly (p < 0.001) only after 3 months of BBA from 8.9 to 5.9 episodes every 2 weeks. BBA was fully successful in 2% o the children after 30 day, 12% after 60 days, and 18% after 90 days (Figure). Partial response (by ICCS) was assessed for 8%, 20%, and 34% of the patients. We noted a relatively high rate of non-responders that decreased from 90% to 47% after 90 days. We detected no differences in BBA efficacy between children with night-time polyuria or decreased maximal voided volume. A lower number of wet nights initially predicted the response to the BBA.
Discussion:
Our study confirmed rather limited efficacy of BBA, similarly to previous observations, but provided more information on isolated MNE, because of a more specific study group and longer period of observation. The limitation of the study was lack of randomization.
Conclusion:
Our study revealed that in treatment-naïve children with monosymptomatic enuresis basic bladder training had a low (18%) and late effect, mostly pronounced after the third month of therapy. It seems that only if the patient presents with a favorable profile of bedwetting, occasionally and with a high maximum voided volume, it is worth maintaining BBA for a longer period of up to 3 months before initiating second-line therapy. In an unfavorable initial profile desmopressin or an alarm may be introduced much earlier.
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