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Medline ® Abstracts for References 13-15

of 'Nocturnal enuresis in children: Management'

13
TI
Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial.
AU
Longstaffe S, Moffatt ME, Whalen JC
SO
Pediatrics. 2000;105(4 Pt 2):935.
 
BACKGROUND: Previous studies have suggested changes in self-concept with successful treatment of primary nocturnal enuresis (PNE), but behavioral changes have not been reported as a consistent associated finding.
OBJECTIVE: To determine if self-concept and behavior change after 6 months of treatment of monosymptomatic PNE by conditioning alarm or desmopressin acetate (DDAVP).
DESIGN: Randomized, controlled trial in an inner-city hospital clinic. Subjects were 182 children referred or recruited through media publicity, randomly assigned both to 1 of 8 pediatricians and 1 of 3 treatment groups (alarm, DDAVP, or placebo). Included were children>7 years old with PNE, no daytime symptoms, bladder capacity>50% expected, and wetting>3 times a week. Excluded were children with central nervous system disorders or developmental delays, and those currently on DDAVP or alarm. Subjects completed the Piers-Harris Children's Self-Concept Scale and Harter's Perceived Competence Scale for Children (PCSC) at initial visit and after 6 months of treatment. Parents completed the Achenbach Child Behavior Checklist (CBCL) at the same times.
RESULTS: After 6 months of treatment the Piers-Harris total score showed a highly significant treatment by period interaction effect for DDAVP, a significant effect for alarm, and no effect for placebo. For children who achieved 75% dryness the CBCL showed a treatment by improvement interaction effect that was highly significant for DDAVP and placebo with no effect for alarm. For the PCSC there were no treatment or outcome interaction effects. After 6 months of treatment there were significant changes over time unrelated to outcome or treatment in the Piers-Harris Subscales and in the CBCL Internalizing and Externalizing Scores, and the Social Thought and Attention Problems Subscales. The PCSC was more stable with no changes in total score, and positive changes over time in only 2 Subscales, Scholastic and Social.
CONCLUSION: Children's self-concept improved with the type of treatment and amount of success. Parents' perceptions of behavior improve with type of treatment and amount of success. Children rate their self-concept and some physical attributes better after treatment with any of DDAVP, alarm, or placebo regardless of outcome. Frequent follow-up with emotional support and encouragement appear to be important components of an efficacious intervention for children with nocturnal enuresis.
AD
Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
PMID
14
TI
Clinical practice. Evaluation and management of enuresis.
AU
Robson WL
SO
N Engl J Med. 2009;360(14):1429.
 
AD
Childrens' Clinic, Calgary, AB, Canada. wlmrobson@gmail.com
PMID
15
TI
Self-esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment.
AU
Hägglöf B, Andrén O, Bergström E, Marklund L, Wendelius M
SO
Eur Urol. 1998;33 Suppl 3:16.
 
A study of self-esteem before and after medical treatment was performed in children with primary nocturnal enuresis (NE) and urinary incontinence (UI). The NEUI children and the controls were recruited from the normal population in the town of Umeå, Sweden. In total, 66 NEUI children and 64 controls entered the study. Clinical examination, laboratory and psychological tests were performed before the start of treatment. Follow-up investigations were done 3 and 6 months after the start of treatment. To assess self-esteem we used the Swedish self-esteem questionnaire 'I think I am'. Compared to controls, the NEUI children had significant impairment of self-esteem before the start of treatment. Within the NEUI group, boys had lower self-esteem than girls. After 6 months of treatment, the NEUI children had the same levels of self-esteem as the control group. The NEUI children that had become totally dry had significantly better self-esteem at 6-month follow-up as compared to the NEUI children with persisting NEUI problems. In conclusion, the study shows that NEUI children have low self-esteem and that their self-esteem may be normalized with proper treatment.
AD
Department of Child and Adolescent Psychiatry, University of Umeå, Sweden. bruno.hagglof@psychiat.umu.se.
PMID