Nocturnal Enuresis Clinical Trial
Official title:
A New Check-list Method Enhances the Treatment Compliance and Response of Simple Behavioral Therapy for Primary Monosymptomatic Nocturnal Enuresis. Prospective Randomised Controlled Trial.
The study is aimed to demonstrate the benefits of newly formed written check-list of
behavioral instructions and investigate its effects on parent's awareness, consciousness and
motivation toward MNE.
The parents with children who complain of bed-wetting 3 or more nights per week for at last
14 days, they was randomly divided into three groups. The parents in Group I were instructed
only a verbal behavioral therapy, the parents in Group II were instructed a behavioral
therapy with a written formed check-list for parents to fulfill and the children in Group III
will received desmopressin treatment plus verbal behavioral therapy. All participants were
analysed the compliance and response rate of treatment over time period of 8 week.
Monosymptomatic Nocturnal Enuresis (MNE) is defined as involuntarily nighttime bed-wetting
after the age of 5 years without any other lower urinary tract symptoms and without a history
of bladder dysfunction. MNE can lead to developmental and psychosocial problems on child and
negative impact of the family life. It has been recommended that consisting of collaboration
with children and their parents is very crucial point to tackle this disturbing condition.
Behavioral therapy can be effective and these should be first-line treatment for MNE on the
basis of the attitude of the child and parents. The behavioral therapy is composed of a lot
of verbal recommendations including urination before going to sleep at night, a
monitorisation daily fluid intake, a restriction of fluid volume before bedtime, rewards for
dry nights, etc. However, we have noticed that these instructions have not been documented as
a written list yet. We have analysed the literature and composed several recommendations were
formed as a written check-list for parents to instruct.
In this present study, we aimed to investigate the efficiency of check-list that are newly
formed by a number of written behavioral instructions and demonstrate whether this rises
awareness, consciousness and motivation of child's parents toward MNE.
This study was conducted as a prospective randomized study at the Urology Department, Ankara
Training and Research Hospital, Medical Science University, Ankara, Turkey Of ninety six
children and their parents, seventy-five were randomly selected from the Urology outpatient
clinic complaining of MNE. They were divided into three groups according to the therapy which
were defined by the investigators before recruitment. Twenty-five children and their parents
were instructed only a verbal behavioral therapy, 25 were instructed a behavioral therapy
with a written check-list form and 25 children received desmopressin treatment plus verbal
behavioral therapy were randomly included in the study. Each participants in this study was
recorded medical history, demographic data including age of children and parents, number of
children, educational and economic status of parents, wet nights. Economic status of family
was defined by the hunger and the poverty limits from data of Turkish Statistical Institute
All children were done detailed physical examination to rule out abnormal physical
development, presence of genitourinary or neurological diseases. Urine analysis, serum
creatinine, blood urine nitrogen, sodium, potassium, complete blood count, ultrasonography or
plain X ray if necessary were measured.
The parents in Group I were received verbal behavioral instruction. 25 parents in Group II
were instructed to fulfill a check-list that were composed of written instructions during a 8
week period. Also children had to register their wet nights via daily voiding diary. 25
children in Group III were received desmopressin melt form 120 μg (Minirin, Ferring
International center, Switzerland) once daily before going to bed for 2 months plus verbal
behavioral instructions. Details and instructions about the drug and its use were given to
the all children and their parents. All participants were checked every 2 weeks to control
compliance rate of behavioral therapy (written or verbal) or medical treatment and analyse
the response of the children with daily voiding diary.
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