The evaluation and treatment of therapy-resistant enuresis: a review

Children with enuresis that neither responds to the alarm or to desmopressin medication usually have nocturnal detrusor over-activity combined with high arousal thresholds as a cause for their bedwetting. The evaluation of these children is focused on 1) excluding underlying pathology such as kidney disease, urinary tract infection or neurogenic bladder, 2) looking for concomitant day-time bladder problems or constipation, and 3) detecting possible reasons for failure of alarm treatment. A bladder diary is essential, but blood tests, radiological examinations or invasive procedures are seldom informative. The non-pharmacologic treatment of these children consists of eradication of constipation, if present, and the provision of advice regarding sound drinking and toilet habits. Such treatment is essential but not uniformly sufficient by itself. The first-line pharmacologic treatment of therapy-resistant enuresis is anticholinergic medication, although this is, as yet, not evidence-based. Anticholinergics can be combined with desmopressin for better efficiency. For children failing all these measures there is still a place for tricyclic antidepressant therapy, provided that adequate safety precautions are strictly observed.     

Nocturnal enuresis in normal Jamaican children. Implications for therapy.

The prevalence of nocturnal enuresis has been investigated in 477 children (243 boys, 234 girls) attending government Basic Schools in Kingston, Jamaica. Enuresis, defined as wet at least 2 nights a week, occurred in 62%, 48%, 42% and 40% at 2, 3, 4 and 5 years of age, respectively. Enuresis, defined as wet at least one night a month, occurred in 68%, 58%, 53% and 52%, respectively. There was no significant difference between the sexes. Children with a family history of enuresis (first degree relatives wet beyond 8 years of age) were more likely to be enuretic than those with no family history, the difference reaching statistical significance for girls (less than 0.001) and for the sexes combined (p less than 0.001) but not for boys alone (p = 0.06). The prevalence of nocturnal enuresis in Jamaican children is higher than reported for Black children elsewhere, which in turn is higher than in their White counterparts. Cultural attitudes to bedwetting contribute to this variation and have implications for choice of therapy, both in Jamaica and elsewhere.     

儿童睡眠呼吸状况调查以及睡眠呼吸障碍相关症状分析

目的调查分析学龄前儿童的睡眠呼吸状况,了解学龄前儿童经常打鼾、睡眠呼吸困难或障碍的发病率。方法对1964名3～7岁儿童父母发送儿童睡眠呼吸情况调查表,收回完整填写的调查表1514份,返回率为77．08％。结果1514名儿童中,睡眠中经常打鼾为93名（6．14％）,不经常打鼾（包括偶尔打鼾和从不打鼾）为1421名（93．86％）。经常打鼾儿童中夜间睡眠呼吸困难或暂停等呼吸障碍症状的发病率为31．2％,显著高于不经常打鼾儿童的1．2％（P〈0．01）。经常打鼾儿童夜间睡眠不稳定的发生率为57．0％,显著高于不经常打鼾儿童的20．1％（P〈0．01）。经常打鼾儿童好动、学习成绩和学习能力差的发生率为64．5％,显著高于不经常打鼾儿童的14．8％（P〈0．01）。结论经常打鼾儿童有较高的呼吸障碍发病率,其日间症状好动以及学习能力和学习成绩较差,夜间较容易出现惊醒和遗尿。     

Etiology and pathology of enuresis among primary school children in Isfahan, Iran

OBJECTIVE: To determine the etiology and pathogenesis of enuresis among primary school children by using a special ultrasound (US) protocol for the assessment of bladder dysfunction and to compare excretion of urinary sodium and calcium in enuretic children. METHODS: We conducted this cross sectional study on 66 enuretic children aged 6-12 years from September 2005 to January 2006 in Isfahan University of Medical Sciences, Iran. Ultrasound (US) was designed for the evaluation of bladder parameters using bladder volume and wall thickness index (BVWI%), and expected percentage bladder volume index for kidney volume. RESULTS: Sixty children (90.9%) had nocturnal enuresis, 5 (7.5%) had diurnal enuresis and one child (1.6%) had nocturnal and diurnal enuresis. Urinary infection was detected in one child (1.5%). The incidence of urinary system abnormalities was 10.6% in all enuretic children. Hypercalciuria was seen in 9.2% and natriuresis in 20.3%. Normal bladder function (BVWI 70% to <130%) was seen in 67%, small bladder with a thick wall (BVWI <70%) in 27% and large bladder capacity with a thin wall (BVWI >130%) was seen in 6% of children with primary nocturnal enuresis (PNE). There was a significant difference in BVWI between children with PNE and secondary nocturnal enuresis (p=0.01). CONCLUSION: Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Our results show that US measured bladder parameters can provide useful clues for the underlying bladder dysfunction and may help to guide clinical management.     

神经源性夜遗尿与单症状性夜遗尿尿动力学表现

目的 :探讨神经源性夜遗尿与单症状性夜遗尿的尿动力学表现。方法 :对 36例神经源性夜遗尿患者和14例单症状性夜遗尿患者进行尿动力学测定。结果 :神经源性夜遗尿患者除表现为夜遗尿症状外 ,多伴有白天排尿异常。单症状性夜遗尿患者排尿后残余尿量、逼尿肌功能过度活跃发生率、逼尿肌收缩乏力发生率显著低于神经源性夜遗尿患者 (P <0 .0 5 ) ;单症状性夜遗尿患者膀胱顺应性、最大尿道压和最大尿道闭合压显著高于神经源性夜遗尿患者 (P <0 .0 5 )。结论 :对于夜遗尿患者应区分是否存在神经损害 ,并进行尿动力学检查 ,了解膀胱尿道的功能状态 ,从而进行针对性治疗     

The treatment of primary nocturnal enuresis in Malaysia

To determine treatment outcomes in Malaysian children with primary nocturnal enuresis using both non-pharmacological methods and oral desmopressin. Data was collected prospectively from children aged 6-18 years who were referred to the Hospital UKM Enuresis Clinic. Treatment was given to those with a baseline wetting frequency of at least six wet nights/14 nights. Three modalities were offered: fluid management, reward system and oral desmopressin. Response was recorded as partial (> or = 50% reduction in WN from baseline) or full (completely dry). Seventy-one healthy children completed 12 weeks of therapy. Twenty-three children (32.4%) responded to non-pharmacological methods alone (4 full and 19 partial). Another 37 children (51.2%) responded to oral desmopressin (32 to 0.2mg, 4 to 0.4mg and 1 to 0.6mg). Thirty-two percent became dry whilst on therapy. The mean wetting frequency during treatment was significantly reduced (p < 0.01) compared to the baseline mean for both the non-pharmacological group and the desmopressin group. Discontinuation of desmopressin after 12 weeks increased the wetting frequency but this was still significantly lower than at baseline (p < 0.01). No adverse ents were recorded. Treatment of primary nocturnal enuresis in Malaysian children is both effective and well tolerated using fluid management strategies, reward systems and oral desmopressin.     

布地奈德雾化吸入治疗小儿咳嗽变异性哮喘的临床分析

目的观察布地奈德雾化吸入治疗小儿咳嗽变异性哮喘（cough variant asthma,CVA）的效果.方法选择30例确诊为CVA的患儿进行为期7周的布地奈德雾化吸入治疗（0.5 mg,Bid）,分别于治疗后1周、3周、5周、7周随访,记录患儿日间咳嗽均分和夜间咳嗽均分,评价治疗效果.结果治疗7周后CVA患儿临床控制26例（86.7%）,部分控制4例（13.3%）;治疗1周、3周、5周后患儿日间咳嗽情况均分及夜间咳嗽情况均分均逐渐降低,组间比较差异均有统计学意义（P〈0.05）,治疗5周后和治疗7周后咳嗽情况均分无统计学意义（P〉0.05）.结论布地奈德雾化吸入治疗小儿CVA可明显改善患儿咳嗽症状.     

儿童功能性遗尿症的人格分析

目的分析小儿功能性遗尿症的人格个性特点。方法对41例功能性遗尿症儿童和30例正常对照组儿童采用艾森克人格问卷(少年)进行对照分析。结果功能性遗尿症组患儿的E维度和N维度平均得分与正常对照组儿童比较,差异有显著性意义(P<0.01);两组儿童的P维度和L维度平均分比较则差异无显著性意义(P>0.05)。结论对于排除器质性因素以外的功能性遗尿症儿童,焦虑或抑郁等的不良心理因素起重要的作用,心理行为的干预治疗是该类患儿的主要治疗方法之一。     

Enuresis: A Three-Year Study of the Value of a Waking Apparatus

Over a three-year period (1959-1962), 122 children with essential nocturnal enuresis, observed at The Hospital for Sick Children, Toronto, used a waking apparatus for an average time of 3½ months. All were wet almost every night before the trial.

At follow-up, the average duration of which was nine months, 50% were dry more than 7.5 nights out of 10. Thirty patients (40%) were completely dry.

Since essential enuresis is probably due to an isolated maturational lag, progress in so-called “failures” of treatment can be measured in terms of an increasing initial dry interval between initiation of sleep and first voiding.

     

儿童功能性遗尿症的人格分析

目的 分析小儿功能性遗尿症的人格个性特点。方法 对41例功能性遗尿症儿童和30例正常对照组儿童采用艾森克人格问卷（少年）进行对照分析。结果 功能性遗尿症组患儿的E维度和N维度平均得分与正常对照组儿童比较,差异有显著性意义（P〈0.01）;两组儿童的P维度和L维度平均分比较则差异无显著性意义（P〉0.05）。结论 对于排除器质性因素以外的功能性遗尿症儿童,焦虑或抑郁等的不良心理因素起重要的作用,心理行为的干预治疗是该类患儿的主要治疗方法之一。     

儿童原发性夜间遗尿症的临床分析

[摘要]目的 了解儿童原发性遗尿症（PNE）的临床特点。方法 对112 例确诊为PNE的患儿临床表现及其相关因素进行问卷调查, 并进行描述性统计分析。结果 患儿遗尿发生次数1 ～3夜/周25例（22.3%）,4 ～6夜/ 周54例（48.2%）,7夜/周33例（29.5%）；0 ～1次/夜24例（21.4%）,1 ～2次/夜60例（53.6%）,2 ～3次/夜24例（21.4%）,>3次/夜4例（3.57%）。 遗尿发生时间:前半夜（12时前）54例（48.2％）,后半夜（12时后）36例(32.1%),不定时者22例（19.6%）。其中后半夜中1 ～3Am 24例（66.7%）。其中夜间经常自行起床排尿10例( 8.9 %) ；偶尔自行起床排尿32例( 28.6 %) ；从不自行起床排尿70例( 62.5 %).尿湿后仍沉睡，较难唤醒者81.3％。 60例（53.6%）患儿因尿床而不愿或拒绝户外野营、学校寄宿、亲朋家住宿；其中8 ～13岁患儿39例(79.6％)，5 ～8岁患儿21例(33.3％)。结论 多数PNE患儿缺乏夜间排尿控制技能, 可能存在睡中觉醒障碍。遗尿可导致患儿沮丧、自卑，影响其社会活动，随年龄增大其影响愈明显。     

南宁市学龄前儿童打鼾现患状态调查研究

目的调查南宁市学龄前儿童打鼾及相关症状的发生情况。方法采取随机整群分层抽样方法对12个幼儿园3~6岁的3 200名学龄前儿童进行调查。应用由家长完成的问卷调查表确定打鼾和相关症状。实际发放调查问卷总数为3 200份,应答2 892份,回收率为90.4%。有效问卷2 863份。结果本组学龄前儿童打鼾现患率36.57%。睡眠频繁打鼾8.98%,间歇性打鼾91.02%。睡眠呼吸暂停2.20%。与打鼾相关症状按发生率由高到低排列为:夜间多汗66.57%,注意力不集中64.85%,夜醒及夜惊48.14%,张口呼吸45.37%,口干咽痛44.79%,食欲减退44.60%,慢性咳嗽37.15%,体重不增34.19%,生长迟缓25.60%,夜间遗尿25.60%,呼吸恶臭25.50%,白天困倦17.96%。睡眠打鼾儿童相关疾病1047例,其中反复呼吸道感染40.11%,扁桃体肥大32.86%,过敏性鼻炎12.61%,体重超重9.36%。鼻部疾病包括中耳炎和/或副鼻窦炎8.40%,支气管哮喘8.98%,肥胖3.53%。1047例睡眠打鼾学龄前儿童有家族史占56.83%。结论学龄前儿童睡眠打鼾有较高的发生率,睡眠打鼾不仅影响孩子睡眠质量同时影响生长发育和生活质量。     

30例遗尿症儿童的个性特征与生活质量调查

目的探讨遗尿症儿童的个性特征及生活质量。方法采用儿童艾森克个性问卷(EPQ)及儿少生活质量问卷(ISLQ)，对30例遗尿症儿童及32例健康儿童进行对照研究。结果患儿组的E量表分、N量表分与对照组间差异有显著性意义，生活质量各维度均分及总体满意度患儿组与对照组问差异有显著性意义。结论遗尿症儿童个性特征倾向于内向性，有忧虑、抑郁及自卑感，生活质量受到明显损害。     

Nocturnal activity and the enuresis alarm device

The effect on nocturnal activity of the wire mesh element within the 'buzzer and pad' enuresis alarm device was studied using healthy adult volunteers in a single or double cross-over design. On the nights when the mesh was in the bed there was less activity, supporting the finding of improved polygraphic sleep on the mesh and suggesting an unexpected therapeutic mechanism.     

肥胖儿童睡眠呼吸暂停的高危因素及其性别差异分析

目的分析影响肥胖儿童睡眠呼吸暂停的高危因素并探讨其性别差异。方法对笔者医院收治120例肥胖儿童可能影响睡眠呼吸暂停（OSA）的因素进行单因素分析和Logistic多元回归分析。结果单因素分析显示男孩、严重打鼾、张口呼吸、晨起头痛、白天嗜睡、夜间多汗、夜间遗尿、睡眠不安、高脂血症、影像学显示上气道狭窄,在OSA和非OSA组间有统计学差异。Logistic回归分析显示,男孩发生OSA的高危因素有严重打鼾、张口呼吸、夜间多汗和影像学显示上气道狭窄;女孩发生OSA的高危因素有严重打鼾、张口呼吸、夜间遗尿和影像学显示上气道狭窄。脂代谢分析显示,中重度OSA肥胖患JLN固醇和低密度脂蛋白较轻度组明显增高。结论不同性别肥胖儿童OSA的高危因素有所不同,但严重打鼾、张口呼吸、白天嗜睡和影像学显示上气道狭窄是共同的主要危险因素,中重度OSA患儿存在较明显脂代谢紊乱。     

Nocturnal enuresis and obstructive sleep apnoea in two children

Nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed.     

小学生蛲虫感染与遗尿的相关性研究

目的 探讨小学生蛲虫感染与遗尿的相关性。方法 采用透明胶纸法检查蛲虫感染，采用问卷调查方式了解有无遗尿现象以及每周遗尿次数等情况，并与正常人比较遗尿的发生率。结果 蛲虫感染者和正常小学生，其遗尿的发生率分别为4．71％和1．78％，两者之间有显著性差异。结论 有蛲虫感染的小学生其遗尿的发生率明显高于正常小学生，因此，对原因不明的遗尿者，应检查是否有蛲虫感染。     

盐酸妥洛特罗和班布特罗治疗儿童支气管哮喘的疗效和安全性比较

目的 对盐酸班布特罗片和盐酸妥洛特罗片治疗儿童支气管哮喘的安全性和有效性进行比较分析,为临床提供用药参考.方法 选取在某院就诊的3～9岁患儿92例,随机分成两个治疗组：妥洛特罗组和班布特罗组,分别给予妥洛特罗贴剂（阿米迪）和盐酸丙卡特罗口服液（帮备）,疗程均为2周.比较两组患儿咳嗽、胸闷、呼吸困难等日间症状、夜间症状和体征的改善率;比较两组患儿咳嗽、喘憋、喘鸣音的治疗时间,观察两组药物不良反应发生率.结果 妥洛特罗组缓解日间症状、夜间症状和体征的效果优于比较班布特罗组（P＜0.05）;妥洛特罗组和班布特罗组治疗哮喘的总有效率分别为71.8%和60.9%（P＜0.05）;两组咳嗽、喘憋、喘鸣音的平均消失时间差异无统计学意义（P〉0.05）.结论 与盐酸班布特罗口服液相比,妥洛特罗贴剂治疗儿童支气管哮喘临床疗效较好.     

SURVEY OF PSYCHOSOCIAL PROBLEMS OF PRESCHOOL CHILDREN

An investigation on psychosocial problems was carried out in 2 groups of children in Shanghai. Group l was composed of 643 children of 3 and 5 years old selected randomly from two districts of Shanghai, and Group 2 0f 413 children aged 3 and 5 years from an area in a district. Symptoms of the two age groups were identified separately. Symp- toms of 5 year olds which upset the parents or might hamper the child's future personality develop ment including disobedience, shouting, quarrelsome- ness, difficulty in separating from the mother, fears and ovcrdependence occurred in more than 10To. Three-year-old symptoms included hitting others, shouting, aggressiveness, destructiveness, difficulty in separating from mother, quarrelsomeness and dis- obedience. There was a tendency for aggressive symptoms and developmental immaturity to cluster. While the symptoms listed for 3-year olds persisted to the age of 5, there were significant decreases in occurrence of aggressive symptoms, and significant increases in nail-biting, tooth grinding and nose picking at 5. When an excessive number of symp toms is used as a criterion of abnormality, the frequeney was 6.4% and 6% in 3-years olds and 51 year olds.     

河南省儿童和青少年单一症状原发性夜遗尿发生情况调查

目的：了解河南省儿童和青少年单一症状原发性夜遗尿(PMNE)的发生情况。方法：随机选择郑州和安阳16所学校的8500名6～18岁无白天排尿异常的正常小学和中学生及其家长进行问卷调查。调查内容包括过去1个月内是否夜间睡眠时尿床1次或以上;白天有无排尿异常。结果：实际回收问卷8006份,有效问卷7896份,其中男3979份,女3917份。各年龄段PMNE发生率随着年龄的增长而降低,男性由6岁10．2％下降为18岁的1．4％;女性由6岁的9．7％逐渐下降为18岁的0．9％。遗尿发生率男性16岁和女童14岁以后降为l％左右。结论：学龄儿童遗尿的发生率仍很高,青春期后稳定在1％左右。