Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: A follow-up study.
OBJECTIVE
To understand the remission rates, shifts in treatment methods used by parents, and parents' attitudes towards their children with primary nocturnal enuresis (NE).


METHODS
A total of 408 children aged 6-12 years and diagnosed with primary nocturnal enuresis from a 2004 epidemiological study in Taiwan were enrolled. After a 5.5-year follow-up period, the remission rates of the children of each age group were evaluated, and the corresponding treatment methods were employed daily. Furthermore, the major risk factors that influenced the remission rates in these children were investigated.


RESULTS
The overall remission rate was 93.1% among all age groups, and the median age of remission was 9.9 years (95% CI 9.5-10.2 years). Comparing the previous and after results of this study, the treatment methods utilized by the parents in response to enuresis were significantly different. More parents chose combination therapy and sought medical attention as the children grew older, particularly the parents of children with severe NE. Few parents still continued to use punishment method. A Cox proportional hazards regression model revealed that girls, young children, those with low enuresis frequency, and light sleepers had higher remission rates than did their counterparts.


CONCLUSIONS
Parents' attitudes towards enuresis influence their choice of therapy for their children. In most cases, parents chose a combination of therapies, particularly combining limited fluid intake and regular voiding. Only 37 (9.1%) children received medicine. The older the enuretic child, the more likely the parents were to seek medical treatment for their children. Enuresis might disappear spontaneously but not always. A small proportion of children will continue to wet till adulthood. The treatment of NE at this age would be challenging. Children who were deep sleepers or affected by severe enuresis had a low probability of achieving dryness. However, girls and young children had a higher probability of achieving remission than did their counterparts.
Department of Biology, College of the Holy Cross, Worcester, MA, USA.
Brent T
BT
Tai
Department of Neuroscience, Hamilton College, Clinton, NY, USA.
Thomson T
TT
Tai
Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: june@cch.org.tw.
Yu-Jun
YJ
Chang
Department of Surgery, Erlin Christian Hospital, Changhua, Taiwan; Division of Urology, Changhua Christian Hospital, Changhua, Taiwan.
Kuo-Hsuan
KH
Huang
D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D053206:Nocturnal Enuresis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D010465:Perception; D016016:Proportional Hazards Models; D011678:Punishment / Q000523:psychology*; D012075:Remission, Spontaneous; D012720:Severity of Illness Index; D012737:Sex Factors; D013624:Taiwan; D016896:Treatment Outcome
Management strategy; Nocturnal enuresis; Parental attitude; Remission rate