EFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS
Basrah Journal of Surgery,
Volume 23, Issue 2, Pages 47-52
AbstractEFFICACY OF DIFFERENT THERAPEUTIC MODALITIES FOR PRIMARY MONOSYMPTOMATIC PEDIATRIC NOCTURNAL ENURESIS
Murtadha M Almusafer@ & Aymen Adel*
@FICMS, Professor of Urology, University of Basrah, College of Medicine, Department of Surgery. *FICMS, Urology Specialist, Basrah General Hospital, Basrah, IRAQ.
Primary monosymptomatic nocturnal enuresis (PMNE) is still a common bothersome complaint that makes the children and their families looking for help. Primary MNE is defined as abnormal urination that occurs involuntarily during sleep. Its incidence varies with age, with 15%-20% at 5 year old and fades with increasing age to reach 1-2% at 15 year old. Owing to its complicated pathophysiology and sharing of different body systems, multiple lines of treatment were attempted.
This study aimed is to explore the efficacy of different treatment modalities for PMNE in the study patients.
Ninety two patients were enrolled in this prospective randomized trial and divided into 4 groups; group A instructed to use the behavioral measures, group B given intranasal Desmopressin, group C given Oxybutynin and group D given combination of the 3 treatments. Fourteen participants were excluded because they were lost during followup and the remaining 78 patients' data were analyzed. Patients were reassessed at 4th and 12th weeks.
Wet nights/week significantly reduced in all treatment groups as compared to baseline. Percentage reduction of wet nights/week for behavioral group was 38.9%, Desmopressin was 83%, Oxybutynin was 78% and for Combination was 87.8% at 12th week. According to the ICCS definitions of success there is no full response in behavioral group with partial response of 42.1%, for Desmopressin group the full response was 57.1% and partial response 28.6%, for Oxybutynin group was 50%, and 33%, for combination group 60%, 30% at 12th week of treatment.
In conclusion, although behavioral therapy reduces wet nights but not reaching to a full improvement and its use is preferably combined with other treatment modalities. Desmopressin, Oxybutynin, and Combination treatment significantly decreases wet nights with high full response rate.
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