title: Monosymptomatic nocturnal enuresis in pediatric patients: multidisciplinary assessment and effects of therapeutic intervention.
abstract: Few studies manage patients with isolated monosymptomatic enuresis (MNE) with multidisciplinary evaluation and pre- and long-term post-intervention monitoring.
  
  
  
  This was a prospective study of MNE patients, aged 6-16 years, diagnosed by multidisciplinary assessment. Of the 140 initial applicants (58.6%) with MNE, 82 were included in the study and randomized for therapeutic intervention in three treatment groups, namely: alarm, desmopressin and alarm + desmopressin. Therapeutic response was evaluated 12 months after treatment withdrawal.
  
  
  
  Of the 82 patients [mean age 9.5 (SD ± 2.6) years, n = 62 males (75.6%)], 91.1% had a family history of nocturnal enuresis (NE) in first-/second-degree relatives, 81.7% had constipation and 40.7% had mild-to-moderate apnea. Prior to randomization, management of constipation and urotherapy led to remission in seven of the 82 patients; 75 patients were randomized to intervention. There were 14/75 (18.7%) dropouts during the intervention, especially in the alarm group (p = 0.00). Initial complete/partial response was achieved in 56.6% of the alarm group, 70% of the desmopressin group and 64% in the combined group (p = 0.26). Continued success occurred in 70% of the alarm group, 84.2% of the desmopressin group and 100% of the combined group (p = 0.21). Recurrence occurred in 3/20 (15%) patients in the alarm group and 1/19 (5.2 %) patients of the desmopressin group. Post-intervention Child Behavior Checklist (CBCL) and PedsQL 4.0 scores showed significant improvement.
  
  
  
  The three therapeutic modalities were effective in managing MNE with low relapse rates; the alarm group showed the highest dropout rate. Therapeutic success was associated with improvement of behavioral problems and quality of life scores.
authors.affiliation: Department of Pediatrics - Instituto da Criança, University of São Paulo Medical School, São Paulo, Brazil. sifagun@terra.com.br.
authors.forename: Simone N
authors.initials: SN
authors.lastname: Fagundes
authors.affiliation: Department of Pediatrics - Instituto da Criança, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Adrienne Surri
authors.initials: AS
authors.lastname: Lebl
authors.affiliation: Pediatric Sleep Laboratory, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Leticia
authors.initials: L
authors.lastname: Azevedo Soster
authors.affiliation: Department of Pediatrics - Instituto da Criança, University of São Paulo Medical School, São Paulo, Brazil.|Clinical Psychology Department of São Paulo University, São Paulo, Brazil.
authors.forename: Guilherme Jorge
authors.initials: GJ
authors.lastname: Sousa E Silva
authors.affiliation: Clinical Psychology Department of São Paulo University, São Paulo, Brazil.
authors.forename: Edwiges Ferreira de Mattos
authors.initials: EF
authors.lastname: Silvares
authors.affiliation: Department of Pediatrics - Instituto da Criança, University of São Paulo Medical School, São Paulo, Brazil.|Pediatric Nephrology Unit, Instituto da Criança Hospital das Clinicas, University of São Paulo Medical School, Rua Lydia Ferrari Magnoli, 300 ap 21, Jardim Avelino, São Paulo, SP, 03227-085, Brazil.
authors.forename: Vera H
authors.initials: VH
authors.lastname: Koch
mesh_terms: D000293:Adolescent; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D056902:Clinical Alarms; D003131:Combined Modality Therapy; D003248:Constipation / Q000628:therapy; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000523:psychology / Q000628:therapy*; D010348:Patient Care Team; D010352:Patient Dropouts; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012076:Renal Agents / Q000627:therapeutic use
chemical_list: D012076:Renal Agents; D003894:Deamino Arginine Vasopressin
keywords: Adolescents; Alarm; Children; Desmopressin; Nocturnal monosymptomatic enuresis; Treatment