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Exploring clinical and urinary factors in treatment-resistant vs. treatment-responsive childhood enuresis: a
Parsa Lorestani1, Alireza Khodadadiyan2, Mohammad Amin Kaviari1
1Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Insights
Understanding factors like deep sleep and medication adherence is key to treating childhood nocturnal enuresis. This study identifies predictors of treatment success and resistance in children using Desmopressin nasal spray.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Urology
Background:
- Nocturnal enuresis is a common pediatric issue with varied treatment responses.
- A significant number of children do not respond to current treatments, necessitating research into resistance factors.
- This study aimed to identify factors contributing to treatment resistance in childhood enuresis.
Purpose of the Study:
- To systematically examine factors influencing treatment outcomes in childhood nocturnal enuresis.
- To differentiate between treatment-controlled and treatment-resistant enuresis cases.
- To identify predictors of Desmopressin nasal spray (DDAVP) efficacy.
Main Methods:
- A cross-sectional study involving 144 children (aged 5-8) with nocturnal enuresis.
- Participants were categorized into treatment-controlled (n=85) and treatment-resistant (n=59) groups.
- Data collected included demographics, clinical data, sleep patterns, urination habits, and ultrasound findings, with DDAVP 10 mcg/spray administered nightly.
Main Results:
- Abnormal residual urine volume, and single or multiple episodes of bedwetting per night were statistically significant factors.
- Deep sleep and daytime urinary control were more prevalent in the treatment-responsive group.
- Treatment-resistant cases showed higher rates of poor medication adherence and high urine volume per episode, though not statistically significant.
Conclusions:
- Deep sleep, daytime urinary control, and fluid management are associated with controlled enuresis.
- Poor medication adherence and high urine volume per episode characterize treatment-resistant enuresis.
- Further research is needed on long-term efficacy and novel management strategies for nocturnal enuresis.
Background:
Nocturnal enuresis represents a persistent pediatric health challenge characterized by variable treatment responses. Despite established therapeutic interventions, a substantial proportion of children fail to achieve successful management, highlighting the critical need for a deeper understanding of treatment resistance mechanisms. This study sought to systematically examine the multifaceted factors underlying differential treatment outcomes in childhood enuresis.
Methods:
A cross-sectional analytical study was conducted in 2017 at Mohammad Kermanshahi Hospital, Iran. The study included 144 children aged 5-8 years with nocturnal enuresis, divided into treatment-controlled (n = 85) and treatment-resistant (n = 59) groups. Participants received Desmopressin nasal spray (DDAVP) at 10 mcg/spray nightly. Demographics, clinical characteristics, sleep patterns, urination habits, and ultrasound findings were analyzed.
Results:
The prevalence of controlled nocturnal enuresis was higher than treatment-resistant cases. Factors, including abnormal residual urine volume (P-value = 0.04), one episode of bedwetting per night (P-value = 0.03) and more than one episode of bedwetting per night (P-value = 0.02) were found to be statistically significant in our findings. Factors more common in the treatment-responsive group included deep sleep (85.9%), daytime urinary control (77.6%). Conversely, treatment-resistant children exhibited higher rates of poor medication adherence (94.9%), high urine volume per episode (86.4%), although these parameters were identified as non-statistically significant in our study.
Conclusion:
This study highlights critical factors differentiating treatment-resistant from treatment-responsive nocturnal enuresis in children. Key factors such as deep sleep, daytime urinary control, and effective fluid management were associated with controlled enuresis, while treatment-resistant cases were marked by poor adherence to medication, high urine volume per episode, and frequent enuresis. Future research should explore long-term efficacy and innovative approaches to enhance the management of nocturnal enuresis.
Clinical Trial Number:
Not applicable (This was a cross-sectional analytical study and did not involve a clinical trial).
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