• The Journal of Pediatrics of Korean Medicine
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• v.18 no.2
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• pp.77-91
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• 2004

Objectives : In evaluating a child with enuresis, an organized approach to the history leads to a working diagnosis and an appropriate treatment plan. but, there's no study about history taking in enuretic children. This article was undertaken to evaluate the enuretic child exactly and to study nocturnal enuresis systematically. Methods : It was conducted a computerized literature search in following database: Medline (via Pubmed), NDSL, EBSCO. Korean articles via oriental pediatric association homepage, KISS. Key words to search were 'nocturnal enuresis', 'bedwetting', 'enuresis', 'incontinence', 'management', 'evaluation', 'assessment', 'questionnaire', 'guideline', 'voiding dysfunction'. Results : Questions are grouped in eight categories: primary history(sex, age, height, weight), family history, enuresis history(primary/secondary, frequency, time of enuresis, nocturia), voiding history(average number, frequency, pattern, volume, posture, daytime enuresis), medical history, constipation/encopresis, sleep(OSA). Conclusion : A careful, complete history taking will help to plan treatment properly and to study.

• International Neurourology Journal
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• v.22 no.4
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• pp.295-304
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• 2018

Purpose: To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods: Ninety children of both sexes aged 8-12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results: After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions: Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.

• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.23-30
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• 1995

Bedwetting is the most common urologic complaint among children. Wetting frequency decreases from birth to adolescence. Etiology is multifactorial : genetic, neuromuscular or urologic maturation, psychosocial stressors, toilet training, or biologic aspects. Treatment has been also multimodal : drugs to depress bladder activity, increase urethral resistance, or modulate sleep. and recently urine reduction modulation. All of these approaches reflect a lack of sufficient knowledge of the underlying pathophysiology of nocturnal enuresis. Recent researches have focused on sleep disturbances, bladder reservoir function, urine output, and a combination of the three. Sleep studies indicate that enuretic patients are normal sleepers, and enuresis can take place during any stage of sleep, but generally occurs when the bladder is filled to the equivalent of maximal daytime functional capacity. Bladder reservior capacity appears to be normal, and bladder instability is somewhat related with the pathology of nocturnal enuresis. However, enuretic patients have shown the lack of normal nocturnal increase in antidiuretic hormone levels, and nocturnal urine production increases up to 2-4 times volume of functional bladder capacity, which explains the need for bladder emptying. But behavioral approaches, especially Bell-alarm method, remain important in the treatment of primary enuresis.

• Childhood Kidney Diseases
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• v.15 no.2
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• pp.146-153
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• 2011

Purpose : Hypercalciuria has been suggested to be involved in the pathogenesis of nocturnal enuresis associated with polyuria. We have measured the amount of calcium excretion in the urine from children with monosymptomatic nocturnal enuresis and studied the association with enuresis. Methods : Thirty-six children (20 males and 16 females, age 5 to 15.6 years) presenting with monosymptomatic nocturnal enuresis were recruited for this study. Results : Among 36 patients, 6 patients had hypercalciuria, providing a 16.7% frequency. The mean Ca/Cr ratio of hypercalciuria group showed $0.23{\pm}0.10$ on daytime, and $0.33{\pm}0.10$ on nighttime showing higher values in nighttime, but it was not statistically significant. Average 24 hour calcium excretion was 8.95 mg/kg. Night/day time urine volume ratio in hypercalciuria group was $0.87{\pm}0.20$, and that in normocalciuria group was $0.81{\pm}0.33$, also showing no difference. Daytime Ca/Cr ratio and nighttime Ca/Cr ratio from all enuresis patients showed a significant correlation (P=0.0001). However, Ca/Cr ratio between daytime and nighttime urine volume had no significant correlation, respectively (daytime P=0.08; nighttime P=0.07). Also, daytime and nighttime Na concentration, urea concentration, and osmolality also had no significant correlation with urine Ca/Cr ratio, respectively. Conclusion: Hypercalciuria shown in some of enuresis patients is not directly caused by primary monosymptomatic nocturnal enuresis.

• The Journal of Pediatrics of Korean Medicine
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• v.19 no.1
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• pp.103-115
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• 2005

Objectives : Nocturnal enuresis is common disorder in children and has important negative effects on the self-image and performance of children. Thus Successful treatment needed to increase self-esteem. Many studies of this symptoms were reported. But electro-acupuncture treatment not reported in Korea. Methods : We treated three cases enuretic children with different types. Their diagnosis were non-monosymptomatic primary, monosymptomatic primary, monosymptomatic secondary nocturnal enuresis. We used electro-acupuncture on Zhongji(CV3), Guanyuan(CV4) for 20 min. To investigate relapse. at least for 4 months after the end of the therapy we followed-up by telephone. Results : After treatment, diurnal urinary symptoms, such as increased frequency of urination, urgency, incontinence were dramatically improved. And the number of wet night decreased with nocturia and delayed wetting time. Compared to pre-treatment, findings, the number of wet nights decreased 80% or more. Conclusion : All of them tolerated electro-acupuncture well and kept reduction at least for 4 months follow-up. Further study is needed with more cases.

• The Journal of Pediatrics of Korean Medicine
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• v.18 no.1
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• pp.179-191
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• 2004

Objective: The aim of this study was to investigate enuretic children attending oriental hospital and classify subtypes and evaluate possible factors that enhance or hamper of continence. Methods: Children attending kyeongju dongguk oriental hospital pediatrics between January 2000 and December 2003 with chief complaint of nocturnal enuresis were enrolled. The data of present symptoms and improvement progress was collected via telephone interviews with their parents. Results: The total number of children was 61. 32 of them were male and 29 female. Sex ratio was 1.1:1. Patient under 6 years of age was 68.8%. Using acupuncture, acupressure or chimsband with herb medicine, treatment frequency was increased. Patients with nocturnal enuresis(NE) was 48, and primary nocturnal enuresis(PNE) 39, secondary (SNE) 9. 13 was impossible to diagnose. The ratio of male to female was 1:1.09. PNE was 4 times as many as SNE. Male was predominent in PNE, and female in SNE. In the progress of PNE, male and female were similiar. but SNE, male was all cured, female remained 50%. And elapsed time of male to improve was longer than that of female. In the progress of improvement, many parents mentioned that their child was improved spontaneously regardless of subtype. Conclusion: We consider age, sex distinction, subtype, bladder symptoms, frequency, time of progress as influencing factor of prognosis, but failed to verify significance. To develop guideline of NE and find influencing factor of prognosis, more prospective study through taking history carefully and using questionnaire is needed.

• Childhood Kidney Diseases
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• v.5 no.1
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• pp.51-58
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• 2001

Purpose : Treatment of primary nocturnal enuresis (PNE) includs folk remedies and various treatments based on pathogenesis. We assessed the therapeutic effect of nocturnal water restrict ion as the primary treatment of PNE. Materials and methods : From October 1998 to June 1999, 41 children with PNE (>3 wet nights per week) who visited Ewha Womans University Mokdong hospital and who had good compliances to nocturnal water restriction for 2 months were included. Before and during nocturnal water restriction, daily fluid intake and urine volume were recorded for 2 days every 2 weeks. Responses to nocturnal water restriction were classified according to the decrease of wet nights as complete (>90$\%$), partial (50-90$\%$) and no (<50$\%$) response. Predictors such as age, sex, daytime voiding dysfunction, fluid intake, urine volume, maximum urine volume per void and fasting urine osmolality were evaluated. Results . The response rate to nocturnal water restriction fir 2 month was 82.9$\%$(34/41) [complete response 39.0$\%$(16/41), partial response : 43.9$\%$(18/41)]. The response rate to nocturnal water restriction was significantly higher in monosymptomatic PNE than polysymptomatic PNE and more effective in PNE with or nocturnal fluid intake, nocturnal urine volume, and maximum urine volume than lower nocturnal fluid intake, nocturnal urine volume and maximum urine volume per void (P<0.05). Nocturnal urine volume, maximum urine volume per void and luting urine osmolality after nocturnal water restriction has significantly increased higher in complete response and partial response group than in no response group (P<0.05). Conclusion : The nocturnal water restriction was effective in monosymptomatic PNE with nocturnal polydypsia, nocturnal polyuria and high bladder capacity. (J, Korean Soc Pediatr Nephrol 5 : 51- 8, 2001)

• Childhood Kidney Diseases
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• v.4 no.1
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• pp.69-76
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• 2000

Purpose: The Pathogenesis of primary noctllrnal enuresis(PNE) is still controversial. Genetic factor and maturational delay of micturition reflex including arousal disorder, lack of nocturnal Arginine Vasopressin(AVP) release and functional bladder capacity have been suggested. We analyzed the risk factors of PNE. Methods: Fifty five children with PNE (20 enuretics diagnosed at school physical examination of the first grade students at Mok-Dong Elementary School and 35 enuretics (Age 6-7 year) diagnosed at Ewha Womans University Mok Dong Hospital) and 221 control students without PNE at school physical examination were included. Genetic, stress and developmental factors, arousability, water intake, urine volume, maximun voiding volume and daytime voiding dysfunction were compared. Results: 1) There was no significant difference between PNE and control group in sex ratio, birth order, percentage of working mothers, parental and child personality, age to start walking, school record and duration of sleep. 2) Family history in the PNE group was significantly higher than control group ($20.0\%\;vs\;2.7\%$)(P<0.05). 3) The difficulty in arousal in the PNE group was significantly more common than the control group ($70.9\%\;vs\;54.3\%$)(P<0.05). 4) Nocturnal water intake in the PNE group was significantly greater than the control group ($330{\pm}158.2\;mL\;vs\;235{\pm}129.5\;mL$). Nocturnal urine volume in the PNE group was significantly greater than the control group ( $390{\pm}61.5\;mL\;vs\;140{\pm}43.2\;mL$)(P<0.05). Daily water intake and daily urine volume did not significantly differ between the two groups. 5) Maximum urine volume per void in the PNE group was significantly lower than the control group ($107{\pm}35.9\;mL\;vs\;236{\pm}41.3\;mL$). Daytime voiding dysfunction in the PNE group was significantly more common than the control group ($80.0\%\;vs\;57.9\%$). The voiding frequency in the PNE group was significantly greater than the control group ($7.0{\pm}3.6\;vs\;5.4{\pm}1.6$)(P<0.05). Conclusion: In addition to genetic factors and maturational delay of micturition reflex (difficulty in arousal, nocturnal polyuria and decreased functional bladder capacity) nocturnal polydypsia was found to be the important risk factors fur PNE. So nocturnal fluid restriction should be encouraged as the first-line management of PNE.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.78-87
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• 2008

Purpose: Recently, the conception and cognition that enuresis was resolved spontaneously, have changed. We reviewed the attitudes of the primary care physicians who make diagnose and treat nocturnal enuresis. Methods: From January 2006 to February 2007, a total of 293 primary care physicians in Daegu city participated in this survey. Questionnaires included questions about physicians' opinions on the appropriated age for diagnosis of enuresis, the likely causes of enuresis, etc. Physicians are grouped in two according to whether enuresis is major field of their subspecialty; the pediatrician & urologist group and the other physician group. Results: 59.2% of pediatricians and urologists thought that enuresis is defined as the nightly involuntary release of urine by children of the age of 5 to 6, while 49.6% of other physicians did. For the causes of enuresis, most of clinicians checked "yes" to the question that "Under-developed bladder and nerve" and "Emotional problems". In the patient's behavioral reactions related to enuresis, "Lack of concentration in home and school" and "Frequent urination" were most responded. Attendance to the education program of enuresis in last five years and willing to participate in education program was statistically different among pediatricians-urologists and other physicians. Regarding the treatment of enuresis, most physicians used imiprarnin widely, but pediatricians and urologists preferred desmopressin. Alarm was the last one in treatment modality. Conclusion: This study revealed that pediatricians and urologists are attending more to the educational places and knowing much about the recent information on enuresis when compared to other primary care physicians, regarding the diagnostic age and treatment modality of enuresis. The education of enuresis for primary physicians is more needed.

• Childhood Kidney Diseases
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• v.8 no.2
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• pp.129-137
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• 2004

Purpose : Nocternal enuresis is a common disorder. Tricyclic antidepressant and desmopressin have been accepted pharmacological treatment for this disorder We conducted a cooperative study to investigate the efficacy and adverse reactions of imipramine, desmopressin and combination treatment in children with primary monosymptomatic nocturnal enuresis(PMNE). Methods: Data from a large multicenter study were analysed. In the period of 8 months in 2002, the study comprised of 168 children(78 boys and 90 girls, 5 to 15 years old) with PMNE for imipramine, desmopressin or combination treatment. Before treatment a history, physical examination and laboratory tests were performed and the children were observed for 2 weeks. Response rate, adverse reactions and enuresis episodes after stopping drug administration were evaluated after 12-weeks of imipramine, desmopressin or combination of both. Results: After 4 weeks, the frequency of bed wetting in all treated patients decreased during treatment significantly Even though a 30-50%, reduction in the number of wet nights were 68.6%, 74.4% and 86.1% during 12 weeks treatment by imipramine, desmopressin and both of them respectively, there was no significant difference between them. The most common adverse reaction was decreased appetite from imipramine administration. But no serious drug-related adverse events were reported. Conclusion: Efficacy of the combination therapy of imipramine and desmopressin in PMNE appears not to be better than either drug alone. It is necessary to pay attention on account of adverse reactions during imipramine treatment even though imipramine and desmopressin were generally well tolerated.