Primary Monosymptomatic Nocturnal Enuresis Clinical Trial
Official title:
Posterior Tibial Nerve Stimulation Vs Desmopressin In Children With Primary Monosymptomatic Nocturnal Enuresis
Nocturnal enuresis is a worldwide health problem frequently encountered in childhood . It affects 18 % of younger school- age children in Egypt. It is the most frequent (85%) type of enuresis in children (Eberdt-GoĊabek et al, 2013), . Nocturnal enuresis includes monosymptomatic nocturnal enuresis with no day time urinary symptoms and non monosymptomatic nocturnal enuresis that accompanied by day time urinary symptoms . It can cause severe psychological and social distress to children and their parents . The currently recommended treatment such as alarms , antidiuretic hormone and anticholenergics are not effective in all children with significant relapse rate . Although it's mechanism of action is not fully elucidated , posterior tibial nerve stimulation is safe and acceptable, with evidence of potential clinical effect for both bladder and bowel dysfunction (Bellette et al, 2009). This study will investigate the effect of posterior tibial nerve stimulation on primary monosymptomatic nocturnal enuresis in children.
Nocturnal enuresis is a worldwide health problem frequently encountered in childhood. 85% of
cases of nocturnal enuresis are primary mono-symptomatic nocturnal enuresis that can cause
substantial psychological impact on children and their families. The currently recommended
treatment for NE are not effective in all children with high relapse rate. Posterior tibial
nerve stimulation was introduced with early promising results as neuro-modulative therapy for
both bladder and bowel dysfunction, although it's mechanism of action is not fully
understood.
This study aims to assess the efficacy and role of posterior tibial nerve stimulation versus
Desmopressin in primary mono-symptomatic nocturnal enuresis.
80 patients with PMNE were included, over a period of 6 months, at Urology department of Abou
ElRish Children's Hospitals, Cairo University. The patients were divided into 2 groups, first
group underwent posterior tibial nerve stimulation ( one session per week for 12 weeks ) and
the other group of patients received medical treatment (Desmopressin 0.2 mg, single evening
dose) for 12 weeks. Both groups are constructed to be adherent to behavioral therapy. The two
groups were statistically evaluated regarding the frequency of nocturnal enuresis before,
after treatment, and after one month of follow up.
A statistical significant improvement in frequency of NE in both groups being more in group A
but there is no statistically significant difference was detected between the two groups. A
significant relapse rate after one month of follow in both groups but there is no
statistically significant difference was detected between the two groups. Also, there was a
statistical significant difference regarding improvement of frequency of NE more with
patients with positive surgical history of tonsillectomy in both groups.
This study concluded that both Posterior tibial nerve stimulation and Desmopressin are viable
treatment options in patients with primary mono-symptomatic nocturnal enuresis. PTNS is a
good option if Desmopressin is contraindicated, fear of it's side effects or ineffective. We
should tailor the treatment according to the child and caregiver's condition. Relapse in some
responders in both groups with time suggests the need for maintenance therapy.
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