Transmission of primary nocturnal enuresis and attention deficit hyperactivity disorder

Primary nocturnal enuresis (PNE) is a prevalent disorder among children with a complex mode of inheritance. Family, twin, and linkage studies have provided evidence that genetic factors underlie the familiality of PNE. Linkage investigations support the hypothesis that PNE is heterogeneous, and the genetic heterogeneity may be reflected in co-morbid clinical conditions such as attention deficit hyperactivity disorder (ADHD). This study used a family study method and examined the transmission of PNE in relatives of PNE and control probands with and without ADHD, to determine if these disorders co-occur due to common genetic susceptibilities or other, i.e. non-genetic, reasons. This study concluded that the pattern of inheritance found is consistent with the independent transmission of PNE and ADHD.     

Going Dutch in nocturnal enuresis

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.     

Prepulse inhibition of startle, intelligence and familial primary nocturnal enuresis

Previous studies have shown a significant reduction of prepulse inhibition of startle in boys with primary nocturnal enuresis. Those enuretic boys who had higher IQs showed less prepulse inhibition. This study evaluates the association of prepulse inhibition and IQ in primary nocturnal enuresis in respect to family history of primary nocturnal enuresis. Prepulse inhibition of startle was studied in 83 boys with primary nocturnal enuresis and 57 non-enuretic boys using an interval of 120 ms between the onset of a 75 dB 1000 Hz tone and a 104 dB noise burst. Of the boys with primary nocturnal enuresis, 56 had a family history of primary nocturnal enuresis and 27 had no family history (no first-degree relative). Of the 57 non-enuretic boys, 42 also had no family history (no first-degree relative) of primary nocturnal enuresis, while 15 did have a positive family history. Associations between prepulse inhibition and IQ scores were compared among these four groups. Strong and significant associations between prepulse inhibition deficit and higher IQ scores in the enuretic group with familial primary nocturnal enuresis were unique in comparison to the other groups. Conclusions: The strong heritabilities of primary nocturnal enuresis, intelligence and prepulse inhibition suggest genetic mediation of the association of prepulse inhibition with intelligence in familial primary nocturnal enuresis.     

Family and segregation studies: 411 Chinese children with primary nocturnal enuresis

BACKGROUND: The aim of the present paper was to determine the incidence of primary nocturnal enuresis (PNE) among relatives of Chinese children with PNE, the inheritance pattern, and to identify the characteristics of PNE with positive family history. METHODS: From July 2003 to June 2004, an epidemiological survey on PNE children was carried out by self-administered questionnaires to parents of 5-18-year-old Chinese students in Henan Province, central China. A detailed family history was recorded in order to determine the presence of familial PNE as defined as any close relative with PNE beyond the age of 5 years. RESULTS: The response rate was 88% (10 383/11 799), and 411 children (235 boys and 176 girls) with PNE were identified. A positive family history was found in 94 families (22.87%) of 411 probands with PNE, including 48.94% of fathers, 8.51% of mothers, 6.38% of both parents, 6.38% of the siblings and 29.79% of grandfathers or (and) mothers. Among the probands the ratio of male to female was 1.3:1 excluding sex-linked inheritance. Autosomal dominant inheritance was in 14.60%, and autosomal recessive inheritance was consistent in 1.46% of families. In PNE children with positive family history, the proportion of adolescents, with associated daytime symptoms, marked PNE and seeking professional help were significantly higher than those in PNE children without positive family history. CONCLUSIONS: PNE has a significant family clustering, and all modes of inheritance can occur in different families on the basis of a formal genetic analysis. Those with positive family history often manifest marked PNE, and have daytime symptoms.     

尿渗透压检测在小儿遗尿症中的应用

目的探讨尿渗透压检测在儿童遗尿症诊治中的应用价值。方法50例原发性遗尿儿童,于治疗前测定夜间尿量及尿渗透压、夜间血清抗利尿激素（AVP）,并给予口服去氨加压素（DDAVP）治疗,根据DDAVP的治疗反应分为有效（DR）35例,无效（DNR）15例。30例正常儿童对照组,测定夜间尿量和尿渗透压。结果遗尿儿童夜间尿渗透压与夜间尿量呈负相关（r=-0.506,P〈0.05）,与夜间AVP呈正相关（r=0.725,P〈0.05）。DR儿童夜间尿渗透压水平为（682.71±213.95）mOsm/L,尿量为（265.14±164.48）ml,血清AVP浓度为（4.06±1.66）pg/ml;DNR患儿夜间尿渗透压水平为（1085.00±88.88）mOsm/L,尿量为（125.33±50.97）ml,血清AVP浓度为（7.27±1.48）pg/ml。两者比较差异均有统计学意义（P〈0.001）。结论遗尿儿童夜间尿渗透压与尿量、血清AVP浓度有相关性。夜间尿渗透压可反映遗尿儿童夜间AVP的分泌水平。夜间尿渗透压降低的遗尿儿童夜间AVP分泌不足,对DDAVP治疗疗效好,尿渗透压的测定对选择DDAVP治疗有参考价值。     

Retarded skeletal maturation in children with primary enuresis

Primary nocturnal enuresis (PNE) is a common paediatric problem of multifactorial aetiology. Growth and skeletal maturation were studied in 35 otherwise healthy children with PNE, 26 boys and 9 girls aged 6–14 years, and comparison was made with a control (CTR) group of 19 boys and 3 girls aged 6–13 years of similar ethnic origin. There was no significant difference between the mean height and weight centiles of the two groups. Bone age (BA) determined by the TW-2 method showed a significant lag behind chronological age (CA); the CA-BA difference being 1.46±1.56 years in the PNE group and -0.08±0.8 years in the CTR group (P<0.001). In 11 of the PNE group (31%) the BA retardation was greater than 24 months: in 4 it was between 24 to 36 months and in 7 the difference was greather than 36 months. In all these children T4 and TSH were found to be normal.It is hypothesised that the retarded bone age in children with PNE may reflect delayed maturation of regulatory CNS functions.Abbreviations PNE Primary nocturnal enuresis - CTR Control group - BA Bone age - CA Chronologic age     

DNA damage in children treated with imipramine for primary nocturnal enuresis

BACKGROUND: Despite the fact that primary nocturnal enuresis (PNE) is self-limited and pathologically benign, the emotional stress and inconvenience that it produces, warrants treatment. Imipramine is one of the widely used drugs in PNE treatment. Although some mutagenic effects were suggested in imipramine administration, this toxicity has never been investigated in enuretic patients. The aim of this study was to evaluate the association of exposure to imipramine with DNA damage. METHODS: Thirty-five children treated with imipramine for at least 4.5 months who were in otherwise good health were accepted into the investigation. Twenty healthy sisters or brothers of the patients who did not use any long-term drugs were studied simultaneously as the control group. Comet assay was used to evaluate DNA damage. RESULTS: Damaged (limited and extensive migrated) cells of the enuretic children who were taking imipramine were statically higher than that of the control group (P < 0.05) indicating a detectable DNA damaging effect of imipramine in human lymphocytes. CONCLUSIONS: Our finding suggests that the difference in comet scores between two groups was induced by the imipramine treatment. The other possibility to be considered is the psychological stress of the children who were concerned by the symptoms and their parent's anxiety. As our preliminary data were based on a limited number of children, further research is needed considering the importance of this possible toxic effects which may be associated with mutagenicity.     

遗尿报警器治疗学龄前儿童原发性单症状性夜遗尿症的临床研究（附95例报告）

目的　探讨遗尿报警器治疗学龄前儿童原发性单症状性夜遗尿症的疗效。方法　选取2017年1月至2018年7月在首都儿科研究所附属儿童医院收治的中重度原发性单症状性夜遗尿症患儿95例，年龄3.5～6.0岁。按照随机分组的方法，其中治疗组53例采用遗尿报警器治疗，对照组42例采用基础治疗。治疗3个月或达到连续干床14d（治疗成功）停止。治疗成功者停止治疗1个月，记录复发例数。重新报警器治疗3个月，观察疗效。结果　治疗组7例（13.2%）未达疗程退出，余46例中治疗完全有效（FR）29例，部分有效（PR）7例，治疗无效（NR）10例。其中FR组25例治疗成功，治疗成功所需疗程最短42d。治疗成功者停止治疗1个月，复发例数11例。8例重新使用报警器治疗3个月，均可达到治疗完全有效。对照组3例（7.1%）失访，39例观察3个月，均未达到连续干床14 d。对照组FR 0例，PR 17例，NR 22例。两组治疗完全有效率采用Fisher精确概率法检验，差异有统计学意义（χ2＝55.10，P＝0.00）。报警器治疗NR组，5例（50%）患儿年龄＜4岁，而FR+PR组，仅有3例（8.3%）年龄＜4岁，采用P earson卡方检验，差异有统计学意义（χ2＝9.457，P＝0.007）。入组患儿均未发现严重不良反应。结论　遗尿报警器治疗学龄前儿童原发性单症状性夜遗尿症患儿安全、 有效，报警器干预的年龄以4岁以上为宜。报警器是逐渐起效的，获得成功治疗的时间＞1个月。     

原发性遗尿症患儿治疗前后自我意识变化的初探

目的 分析评估儿童原发性遗尿症（PNE）自我意识评价状况以及遗尿治疗对自我意识的影响。方法 选择2005年7月至2006年1月在复旦大学附属儿科医院确诊的8~16岁PNE患儿为研究对象。排除患有可引起尿床的器质性疾病、治疗前存在高血压、单亲家庭、父母离异、有其他家庭问题及慢性疾病的患儿。指导PNE患儿自己填写Piers Harris儿童自我意识量表(PHCSS)。随后患儿分3组接受不同方法治疗遗尿:生物反馈治疗组、口服醋酸去氨加压素治疗组和口服中药治疗组，疗程均为1个月。治疗结束3个月后再次指导患儿自己填写PHCSS。通过心理分析软件分析两次自我意识评价结果。结果 研究期间共纳入PNE患儿54例，男29例，女25例，平均年龄（10.0±0.6）岁。其中轻度遗尿15例，中度遗尿20例，重度遗尿19例。治疗遗尿前54例患儿自我意识评价结果中焦虑得分显著低于常模（P<0.01）；并且轻、中和重度PNE患儿焦虑得分均显著低于常模（P<0.01），不同遗尿严重程度患儿得分差异无统计学意义。其中12例接受生物反馈治疗，14例接受醋酸去氨加压素治疗，28例接受中药治疗。治疗后有44例接受了自我意识评价随访，治疗遗尿后患儿焦虑得分较治疗前明显增加（P<0.05），其中口服醋酸去氨加压素组治疗后焦虑得分明显提高（P<0.05）。遗尿治疗有效的患儿得分明显高于治疗前（P<0.05），而治疗无效的患儿治疗前、后自我意识各项得分差异无统计学意义。结论 治疗前PNE患儿自我意识评价结果中焦虑得分低下，通过治疗遗尿其自我意识评价也可得到改善，并且临床疗效好的患儿自我意识改善明显。     

遗尿症儿童感觉统合能力的研究

目的：分析原发性夜间遗尿症(PNE)儿童的感觉统合能力,探讨感觉统合失调在原发性遗尿症发生中的作用。方法：采用感觉统合能力发展量表对46例PNE组儿童及46例正常对照组儿童进行感觉统合功能测试,对两组结果采用t检验和χ2检验进行统计分析。结果：PNE组与对照组儿童感觉统合失调的发生率分别为82.6%和43.5%,其中重度失调的发生率分别为36.9%和2.1%,两组间差异有显著性（P﹤0.01）;PNE组所有感觉统合功能因子得分均明显低于对照组,差异有显著性(P﹤0.01)。结论：PNE组儿童存在感觉统合失调现象,感觉统合功能失调在PNE发生中可能有一定作用。     

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??Objective To investigate self-consciousness and its relevant factors in children with primary nocturnal enuresis??PNE???? to know the characteristics of children with PNE who may appear self-consciousness disorders?? and to analyze the related influencing factors of self-consciousness disorders in those children who have primary nocturnal enuresis. Methods In Beijing Children’s Hospital??Capital Medical University??a total of 158 children with primary nocturnal enuresis were recruited to the enuretic group from August 2011 to August 2014. Subjective questionnaire was used to collect the general information??get the medical history of enuresis. Piers-Harris Children’s Self-Concept Scale??PHCSS?? was used to test the patients’ self-consciousness??and compare with the general norm data of healthy children so as to evaluate the patients’ self-consciousness. Results The detection rate of PNE children with low self-consciousness was significantly higher than the general norm data of healthy children. In children with PNE??the scores of behavior??intelligence and school situation??physical appearance and attributes and the total score in boys were much lower than girls??and boys had higher incidence of self-consciousness disorder than those of girls. All factor scores and the total score in the older group were much lower than those in the younger group. The factor score of happiness and satisfaction in PNE children of single parent family was lower than that in core family and large family. All factor scores and the total score in PNE children with poor family relationship were lower than those with harmonious family relationship. The factor scores of physical appearance and attributes??gregariousness??happiness and satisfaction and the total score in PNE children with moderate or poor family economic status were much lower than those with good family economic status. The worse the academic performance and peer relations??the lower the self-consciousness scale factor scores and total score of PNE children. Those results were statistically significant??P??0.05??. Conclusion PNE children have lower self awareness than healthy children. Pediatricians should treat enuresis actively and reduce the occurrence of self-consciousness dysfunction.     

Epidemiology of childhood nocturnal enuresis in Malaysia

OBJECTIVES: To estimate the prevalence of nocturnal enuresis in primary school children in Malaysia and to determine the factors associated with primary nocturnal enuresis. METHODS: This was a cross-sectional survey. A total of 3371 self-administered questionnaires were distributed to parents of children aged 7, 9 and 12 years attending four primary schools in the city. The ICD-10 definition of enuresis was used. RESULTS: From an overall response rate of 73.8%, nocturnal enuresis was reported in 200 children (8%), primary nocturnal enuresis in 156 children (6.2%) and secondary nocturnal enuresis in 44 children (1.8%). Fifty-three percent of those with primary enuresis had a positive family history, and 54% had two or more wet nights per week. Eighty-seven percent had not sought any form of treatment despite 74% admitting to being embarrassed. Using logistic regression analysis, only three factors were significant predictors of primary nocturnal enuresis. These were: (i) younger age (P < 0.001); (ii) male sex (P < 0.033); and (iii) Indian ethnic group (P < 0.044) compared to Chinese. CONCLUSION: The prevalence of nocturnal enuresis in urban-dwelling Malaysian children is similar to that reported from Korea and Taiwan but appears to be lower than that reported from developed countries. Predictive factors associated with primary nocturnal enuresis included lower age group, male sex and Indian ethnicity.     

原发性遗尿症儿童感觉统合能力的对照研究

目的：探索儿童原发性夜间遗尿症（PNE）与感觉统合能力的关系。方法：采用儿童感觉统合能力发展量表,对70例PNE患儿进行感觉统合功能测试,并与74例正常儿童进行对照研究。结果：PNE组感觉统合失调发生率 (76% vs 35%)、重度感觉统合失调发生率(39% vs 18%) 明显高于对照组,差异有统计学意义（P<0.01）。PNE组儿童所有感觉统合功能因子得分均明显低于对照组,差异有统计学意义（P<0.01）。结论：PNE患儿普遍存在感觉统合失调,并且是多方面的,故对PNE患儿进行感觉统合功能测试,并针对性地对伴发的感觉统合失调问题进行训练很有必要。［中国当代儿科杂志,2010,12（5）：341-343］     

遗尿症患儿智力水平和智力结构分析

目的：有文献报道原发性夜间遗尿症 (PNE) 患儿存在注意力/记忆力缺陷,并认为这种缺陷可能与患儿的智力情况有关,因此该研究对PNE患儿的智力水平和智力结构进行分析。方法：采用中国韦氏儿童智力量表（C-WISC）对40例PNE患儿的智力结构进行测试,并与40例年龄和性别相匹配的正常儿童进行对照研究。结果：PNE组的总智商（FIQ）、言语智商（VIQ）和操作智商（PIQ）均在正常范围,与对照组比较差异无显著性（P＞0.05）,但数字广度、编码、知识与算术分测验量表分与对照组比较差异有显著性 (P＜0.05);记忆/不分心因子（M/C）与对照组比较差异有显著性 (P＜0.05);两组PIQ与VIQ差值比较,差异无显著性（P＞0.05）。结论：PNE患儿智力水平正常,但智力结构中的记忆/不分心因子存在一定缺陷,提示可能与大脑额叶执行功能异常有关。［中国当代儿科杂志,2007,9（5）：433-435］     

Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Swedish Enuresis Trial Group

The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long-term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4-wk observation period, a 6-wk dose titration period (with 20-40 microg desmopressin) and a 1-y, long-term treatment period. A treatment-free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6-12 y with PMNE were recruited. Of these, 245 patients (61%) experienced > or = 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long-term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3-7.0) during the observation period to a median of 0.8 (range 0.0-5.0) during the last 3-mo period. Seventy-seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6-7-y-olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug-related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long-term treatment of PMNE, with a significant therapeutic effect also in children of 6-7 y of age.     

原发性遗尿症与血浆ADH的相关性研究

为探讨抗利尿激素 (ADH)和原发性遗尿症 (PNE)发病的相关性 ,用放免法测定PNE患儿和健康正常儿童的白天及夜间血浆ADH水平 ,并测定同时点的血和尿渗透压。结果表明 ,正常对照组凌晨1时的ADH水平明显升高 ,达87.79ng/L±22.45ng/L ,较下午3时ADH水平 (55.49ng/L±15.97ng/L)上升了58.2 % ,差异具有显著性 (P<0.001) ;病例组在凌晨1时和下午3时ADH水平分别为59.11ng/L±35.45ng/L和66.84ng/L±42.82ng/L ,差异无显著性 (P>0.05) ;与正常对照组相比 ,病例组在下午3时的ADH水平差异无显著性 (P>0.05) ,而凌晨1时则明显降低 (P<0.001)。提示广东地区健康儿童夜间ADH分泌明显升高 ,而PNE患儿没有发现夜间ADH分泌高峰 ,即广东地区PNE患儿的发病与夜间ADH分泌不足有关     

The occurrence of primary nocturnal enuresis and associated factors in 5-year-old outpatients in Slovenia

Aim:  To determine the occurrence of primary nocturnal enuresis in 5-year-old outpatients in Slovenia and the possible correlations with different factors.
Methods:  The epidemiological study was conducted in Slovenia between 2005 and 2007. A special questionnaire was distributed randomly among the parents of 1846 5-year olds in children's outpatient clinics in all regions of Slovenia.
Results:  The response rate was on average 71.0%, which means that 7% of all Slovenian 5-year olds were included in the study. The occurrence of primary nocturnal enuresis was 8.7% and was higher in families with many siblings (χ² test, p < 0.01). The boy:girl ratio was 1.4 (Student t -test, p = 0.024). Parents were found to be more disturbed by the problem than their children (χ² test, p < 0.01). The maternal and paternal education levels of children with primary nocturnal enuresis did not differ from the Slovenian adult population (χ² test, p > 0,05).
Conclusion:  The occurrence of primary nocturnal enuresis in 5-year-old outpatients in Slovenia is comparable with data from other countries. Primary nocturnal enuresis is more frequent in boys than in girls, with higher occurrence in families with more siblings, and parents are more disturbed by the problem than their children.