Enuresis, Nocturnal, 2 (Disorder) Clinical Trial
Official title:
The Ability to Awaken Can be Improved With Control of Lower Urinary Tract Symptoms in Children With Nonmonosymptomatic Enuresis
To evaluate the effect of controlling lower urinary tract symptoms (LUTS) with anticholinergics on improving the ability to awaken (AA) in children with nonmonosymptomatic enuresis and evaluate the potential implication of improved AA for treatment response prediction.
Nocturnal enuresis is associated with three main etiologies, including nocturnal polyuria
secondary to abnormal anti-diuretic hormone levels, low bladder capacity related to lower
urinary tract dysfunction, and sleep disorders causing problems in arousal. Among them, the
association between enuresis and lower urinary tract symptoms (LUTS) has gained importance.
If these two conditions coexist, the diagnosis is nonmonosymptomatic enuresis (NME). The
reported prevalence of LUTS among enuretic patients ranges widely from 21% to 99%. Moreover,
it was reported that spontaneous resolution can be prolonged, and some cases of NME are
likely to become refractory if treated like monosymptomatic enuresis (ME) cases. A possible
explanation for this may be the presence of bladder dysfunction that is not addressed
properly by the standard treatment of ME. However, this explanation is only speculative.
By showing a paradoxical increase in light sleep and higher cortical arousal index in
enuretic children with reduced bladder capacity, one of the reason for impaired ability to
awaken (AA) in enuretic patients may lie in the chronic stimulation of the bladder. This
kind of bladder dysfunction leading to an abnormal bladder-brain dialogue has been further
elaborated by an experiment showing brain dysfunction in the ventrolateral periaqueductal
gray matter as a result of the experimental reduction of the bladder capacity. If this is
true for enuretic children, we may be able to improve arousal (improved AA) by increasing
their bladder capacity.
Based on this hypothesis, the present study aimed to evaluate to the effects of
anticholinergic therapy with standard urotherapy on improvement of AA and show the effect of
improved AA on treatment response in children with NME.
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Observational Model: Cohort, Time Perspective: Retrospective