[Primary enuresis in children. Which treatment today?]
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Pediatric enuresis affects many school-aged children. Desmopressin (DDAVP) and acupuncture show promise in reducing wet nights, with long-term success rates of 50% and 40% respectively.
Area of Science:
- Pediatric Urology
- Sleep Medicine
- Complementary Medicine
Background:
- Enuresis affects 15-30% of school-aged children, often as monosymptomatic nocturnal enuresis.
- The multifactorial pathophysiology includes genetic, psychological, sleep, and urinary factors, making treatment controversial.
- Current treatments like behavioral therapy and pharmacotherapy yield variable results.
Purpose of the Study:
- To evaluate the efficacy of Desmopressin (DDAVP) and acupuncture in treating pediatric enuresis.
- To compare short-term and long-term success rates of DDAVP and acupuncture.
- To discuss the pathophysiology of enuresis and the importance of patient selection.
Main Methods:
- A retrospective analysis of 54 enuretic children treated over one year.
- Assessment of treatment effectiveness based on the reduction in wet nights per week.
- Evaluation of short-term and long-term success rates for DDAVP and acupuncture therapies.
Main Results:
- DDAVP reduced wet nights by 79% in the short term.
- Acupuncture yielded good results in 55% of treated patients.
- Long-term success rates were 50% for DDAVP and 40% for acupuncture.
Conclusions:
- DDAVP and acupuncture are effective treatment options for pediatric enuresis.
- Accurate patient selection and understanding pathophysiology are crucial for successful enuresis management.
- Further research into the multifactorial causes of enuresis is warranted.
Abstract:
Nowadays enuresis is a problem that pediatric urologists are often called to treat, since it affects 15 to 30% of school-age children. In 85% of affected children bedwetting is monosymptomatic, not accompanied by other voiding disorders or daytime incontinence. Treatment of choice is still highly controversial, as the physiopathology is not yet fully understood and the pathogenesis is multifactorial: genetic and psychological factors, sleep disorders, urinary reservoir abnormalities, urine production disorders can all play a part. Behavioural treatments (psychotherapy, bladder training and biofeedback, electric alarm) and pharmacological therapy (tricyclic antidepressants, anticholinergics, DDAVP) have been used with variable results. In our 1 year experience (54 enuretic children) DDAVP proved to be effective in reducing the number of wet nights per week in 79% of cases. Acupuncture, which we have been using for many years, also gave good results in 55% of treated patients. Long term success of DDAVP and acupuncture was respectively 50 and 40%. We discuss the probable pathophysiology and present our own results and those reported in the literature. It has to be stressed that an accurate diagnostic selection of patients and a better understanding of physiopathology are the basis of effective treatment of enuresis.