Investigating the three systems approach to complex childhood nocturnal enuresis--medical treatment interventions.
OBJECTIVE
Nocturnal enuresis is a heterogeneous condition with various treatment options of both pharmacological and psychological origin. The three systems model previously proposed by us suggests a framework to facilitate understanding, identify a child's needs and specify the appropriate treatment option. In this study we sought to investigate the model in clinical practice in a group of children with severe nocturnal enuresis, with particular reference to pharmacological treatment.


METHODS
A total of 66 children were assessed using a schedule for identifying mono- and non-monosymptomatic nocturnal enuresis, and were administered either desmopressin (0.4 mg) or anticholinergic medication (5-10 mg), respectively. Children were assessed at 4 weeks, with those failing to meet the success criterion being offered combination treatment for a further 4 weeks.


RESULTS
Success rates for monotherapy were 49% and 33% for desmopressin and anticholinergic medication, respectively, with an overall success rate of 74.5%, including those who went on to combination treatment. Good clinical signs were identified for those successfully treated with anticholinergic medication.


CONCLUSIONS
This study endorses the three systems approach in clinical practice.
Butler
Richard J
RJ
Child & Adolescent Mental Health Service, East Leeds Primary Care Trust, UK. richard.butler@leedsmh.nhs.uk
Robinson
Joanne C
JC
Holland
Philip
P
Doherty-Williams
Diane
D
D000293:Adolescent; D002648:Child; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004775:Enuresis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D012076:Renal Agents / Q000008:administration & dosage; D016896:Treatment Outcome
D018680:Cholinergic Antagonists; D012076:Renal Agents; D003894:Deamino Arginine Vasopressin