title: Outcome of a standardized approach to childhood urinary symptoms-long-term follow-up of 720 patients.
abstract: OBJECTIVE
  To investigate the relevance of enuresis subtyping for selection of treatment modality and for long-term outcome in a large consecutive patient cohort.
  
  
  METHODS
  We included all patients referred for urinary incontinence during a 5-year period but excluding recurrent urinary tract infections (UTI). Type and severity of incontinence, prior history, results of examinations performed, number of visits, and effect of all treatments provided, were included in a clinical database.
  
  
  RESULTS
  Seven hundred twenty children aged 4-16 years (mean 8.5 ± 2.2 years, 239 girls) were included in the analysis (42% with monosymptomatic (MNE), 55% with non-MNE, and 3% with isolated daytime incontinence). Initial evaluation revealed only few underlying causes (one neurological and eight anatomical). Investigations showed significant differences between MNE and non-MNE patients as both maximal voided volume and nocturnal urine volume was lower in non-MNE patients (P < 0.001). Follow-up for average 1,587 days (3.4 years) was performed in 660 (92%) patients. A higher number of visits and a longer treatment period were needed for non-MNE patients (on average 4.7 ± 2.8 visits) than MNE patients (3.1 ± 1.6 visits, P < 0.001). The most common treatment regimen that resulted in dryness in both MNE (40%) and non-MNE (36%) was the alarm system. Interestingly, of the 539 patients who initially were referred due to desmopressin resistance 177 (33%) of these were dry on desmopressin monotherapy.
  
  
  CONCLUSIONS
  The study indicated that MNE and non-MNE are two distinct disease entities with different optimal treatments and showed that the latter patients are more difficult and time-consuming to manage.
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Rittig
authors.forename: Søren
authors.initials: S
authors.lastname: Hagstroem
authors.forename: Birgitte
authors.initials: B
authors.lastname: Mahler
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kamperis
authors.forename: Charlotte
authors.initials: C
authors.lastname: Siggaard
authors.forename: Mette Marie
authors.initials: MM
authors.lastname: Mikkelsen
authors.forename: Wendy Fiona
authors.initials: WF
authors.lastname: Bower
authors.forename: Jens C
authors.initials: JC
authors.lastname: Djurhuus
authors.forename: Søren
authors.initials: S
authors.lastname: Rittig
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D050034:Antidiuretic Agents / Q000627:therapeutic use*; D001676:Biofeedback, Psychology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D053207:Diurnal Enuresis / Q000150:complications / Q000628:therapy*; D004775:Enuresis / Q000145:classification / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D008333:Mandelic Acids / Q000627:therapeutic use*; D053206:Nocturnal Enuresis / Q000150:complications / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000628:therapy; D064804:Urological Agents / Q000627:therapeutic use*
chemical_list: D018759:Adrenergic Uptake Inhibitors; D050034:Antidiuretic Agents; D008333:Mandelic Acids; D064804:Urological Agents; D003894:Deamino Arginine Vasopressin; C005419:oxybutynin; D007099:Imipramine
keywords: daytime incontinence; nocturnal enuresis; outcome; treatment; ultrasound; uroflowmetry