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No effect of basic bladder advice in enuresis: a randomised controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Pediatrisk inflammationsforskning/Alving)ORCID iD: 0000-0002-2760-2015
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnhälsovård och föräldraskap/Sarkadi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk forskning/Ljungman)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.ORCID iD: 0000-0002-4590-4957
2015 (English)In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 11, no 3, 153.e1Article in journal (Refereed) Published
Abstract [en]

Background

There are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.

Aim

To explore whether basic bladder advice has any effect against nocturnal enuresis.

Study design

The study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.

Results

The basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.

Discussion

This was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.

Conclusions

The recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.

Place, publisher, year, edition, pages
2015. Vol. 11, no 3, 153.e1
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-247662DOI: 10.1016/j.jpurol.2015.03.004ISI: 000356357700038PubMedID: 25975733OAI: oai:DiVA.org:uu-247662DiVA: diva2:799233
Available from: 2015-03-30 Created: 2015-03-23 Last updated: 2017-12-04
In thesis
1. The Family and the Wet Bed: The parents’ perspective and the child’s treatment
Open this publication in new window or tab >>The Family and the Wet Bed: The parents’ perspective and the child’s treatment
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this thesis is nocturnal enuresis in the primary care setting. Three aspects have been central: 1) the parental perspective, 2) differences between children with enuresis of varying severity, and 3) to explore whether the universally recommended basic bladder advice have any therapeutic effect.

 

Study I built on qualitative data from interviews with 13 parents of children with enuresis, focusing on family impact and coping strategies. A common consensus among the participants was that they felt frustrated about the perceived lack of information and help they received from the healthcare system. In study II anamnestic data and voiding chart parameters – reflecting renal and bladder function – were compared between 54 children with enuresis of varying frequency. No measurable differences were found. Study III was a randomised controlled study. Forty children with previously untreated enuresis were recruited and randomised to receive either first bladder advice for one month and then alarm therapy (n=20) or just the alarm therapy (n=20). The bladder advice did neither result in a significant reduction in the number of wet nights, nor improve the effect of subsequent alarm therapy.  Study IV was a cross-sectional questionnaire study of 52 parents, including comparison with normative data and with validated instruments evaluating intra-parental stress and satisfaction. The results showed no significant differences between the parents studied and normative data.

  

Study I and IV were the first to look at the parents, as opposed to children with enuresis. The results can be used by healthcare professionals when counselling families about strategies to use and attitudes to avoid. Study II aimed at filling a glaring blank in the field of knowledge: we do not know how children with infrequent enuresis differ from those who wet their beds often or every single night. The fact that no differences in bladder or kidney function was found indicates that they may differ in the way they sleep. Study III will probably have the greatest impact on how we should treat children with enuresis. The recommendation that all of them be given bladder training as a first-line therapy can no longer be supported.

 

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1093
Keyword
Nocturnal Enuresis, Parents, Children, Treatment, Nursing
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-248496 (URN)978-91-554-9223-6 (ISBN)
Public defence
2015-05-22, Universitetshuset Sal IX, Biskopsgatan 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-30 Last updated: 2015-07-07

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Cederblad, MariaSarkadi, AnnaEngvall, GunnNevéus, Tryggve

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