• Childhood Kidney Diseases
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• v.16 no.1
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• pp.15-20
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• 2012

Non-neurogenic pediatric voiding dysfunction is defined as a problem during bladder filling or emptying without any neurogenic abnormality in children. The appropriate treatment of non-neurogenic pediatric voiding dysfunction is important because the disorder is frequently seen in clinical practice and might result in damages of the child's bladder or kidney. Urotherapy can be defined as nonsurgical nonpharmacological treatment for voiding dysfunction, categorized into standard urotherapy or specific intervention. Understanding of the underlying pathophysiology of non-neurogenic pediatric voiding dysfunction will lead to a change in management, from expensive and potentially harmful medications and invasive procedures to effective, noninvasive treatment of urotherapy.

• Clinical and Experimental Pediatrics
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• v.51 no.11
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• pp.1140-1146
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• 2008

Nocturnal enuresis is a heterogeneous disorder with various underlying pathophysiological mechanisms and causes a mismatch between the nocturnal bladder capacity and the amount of urine produced during sleep at night. It is associated with a simultaneous failure of conscious arousal in response to the sensation of bladder fullness. Generally, a complete history and physical examination, with a specific focus on the genitourinary, gastrointestinal, and neurologic systems, is sufficient to evaluate a patient with enuresis. The therapeutic focus is directed toward a differential approach based on the underlying mechanism and toward combination therapies such as alarm devices and desmopressin as well as anticholinergic agents and desmopressin. Children with increased nocturnal urine production usually have a good response to desmopressin therapy. Patients with a small bladder generally show a poor response to desmopressin treatment, but they would benefit more from combination therapy with enuretic alarm, urotherapy, and antimuscarinic agents in addition to desmopressin. Different types of bladder dysfunction, which result in a small nocturnal bladder capacity, probably contribute significantly to the pathogenesis of nocturnal enuresis, particularly in those with treatment failure and refractory symptoms. Because different clinical subgroups may show different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made.

• Childhood Kidney Diseases
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• v.28 no.1
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• pp.27-34
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• 2024

Purpose: The ability to concentrate urine becomes an important index in determining nocturnal enuresis (NE) treatment. The aim of our study was to investigate first-morning urine osmolality (Uosm) changes at the end of treatment compared to before treatment in children with NE. Methods: A total of 71 children with NE were divided into two groups according to the level of first-morning Uosm before treatment: high group (≥800 mOsm/kg) and low group (<800 mOsm/kg). Baseline parameters were obtained from uroflowmetry, frequency volume charts for at least 2 days, and a questionnaire for lower urinary tract symptoms. All patients were basically treated with standard urotherapy and medication. The first-morning Uosm was measured twice, before treatment and at the end of treatment. Results: The response rate was higher in the low group after 3 months of treatment than in the high group (P=0.041). However, there was no difference between the two groups at the end of the treatment. In the high group, the first-morning Uosm at the end of treatment did not show a significant change compared to before treatment. In contrast, the first-morning Uosm increased in the low group at the end of treatment (P<0.001). However, it was still lower than that of the high group (P=0.007). Conclusions: The ability to concentrate nocturnal urine improved at the end of treatment compared to before treatment in the low Uosm NE children. In addition, NE improved faster in the low Uosm group before treatment than in the high group.