title: Refractory monosymptomatic nocturnal enuresis: a combined stepwise approach in childhood and follow-up into adolescence, with attention to the clinical value of normalizing bladder capacity.
abstract: OBJECTIVE
  To assess the importance of normalizing bladder capacity to the age-expected capacity in children with refractory monosymptomatic nocturnal enuresis (MNE), and to evaluate the long-term results when these children grow into adolescence.
  
  
  METHODS
  The study included 34 children with refractory MNE; all were treated > 5 years earlier for their MNE using a combined stepwise approach, consisting of retention control training, oxybutynin and an enuresis alarm. Data were obtained on their enuretic state, night-time voiding behaviour and bladder capacity, from a questionnaire and a voiding chart.
  
  
  RESULTS
  Before starting treatment, all patients had a bladder capacity that was too small for their age. After the combined stepwise approach, MNE improved in all patients and 24 (71%) were cured. Although the bladder capacity was increased to the age-expected capacity in 26 (76%), most woke at night to void. Currently, at a mean of 7.7 years after the primary treatment, 28 (82%) of the patients are completely dry at night, of whom 15 (54%) arouse to void for 35% of the nights. Six patients (18%) still have some enuretic episodes. Only those who were dry after primary treatment and remained dry had a normal age-expected increase in bladder capacity. For all others there was a decrease in age-related bladder capacity.
  
  
  CONCLUSIONS
  In patients with refractory MNE, a combined stepwise approach improves and may even eliminate enuresis, but normal night-time bladder behaviour in adolescence and adulthood is only achieved in some. Furthermore, about a fifth still have some enuretic episodes.
authors.affiliation: Department of Urology, University of Antwerpen, Edegem, Belgium.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Vermandel
authors.forename: Stefan
authors.initials: S
authors.lastname: de Wachter
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Wyndaele
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004775:Enuresis / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology*; D014554:Urination
chemical_list: D018680:Cholinergic Antagonists; D008333:Mandelic Acids; C005419:oxybutynin