Comparative evaluation of the efficacy of medical treatment programs of primary multi-symptom enuresis in children
E.S. Zastelo, O.V. Haleckaja, E.V. Tush
SBEI HPE « Nizhny Novgorod State Medical Academy» of the MH of the RF
The purpose of the study: To develop a complex program for the treatment of multi-symptom enuresis in children based on analysis of etiopathogenic factors leading to the formation of the disease.
Material and methods: 107 patients aged 5 to 12 years with complaints of bedwetting with features of primary enuresis, occurring at least 3 times a month and lasting at least 3 consecutive months were enrolled in the study. Exclusion criteria were the presence of malformations of the urinary system, requiring surgical correction; acute infection of the urinary system; chronic kidney disease; acute stage of chronic somatic comorbidities; endocrine diseases; organic pathology of the central and peripheral nervous system; mental disorders. The study used the following methods: clinical signs and history, laboratory tests, urodynamic examination, instrumental radiological and neurophysiological methods, examination of the autonomic nervous system, assessment of quality of life (questionnaire Pediatric Quality of Life Inventory ‒ PedsQLTM4.0).
Results: The most important etiopathogenetical factors of primary multi-symptom enuresis (PME) in children were identified and their role in the development of the disease was established. The role of the autonomic nervous system dysfunction in the development of PES in children depending on the functioning of the bladder was proven. Affected aspects of quality of life were determined and the necessity of early treatment of children with PES was substantiated. Given the findings of the study, combination therapy was proposed and substantiated. Its efficacy was evaluated and compared with monotherapy. The study results showed a significant positive cumulative effect (82.5%) of the combination therapy of multi-symptom enuresis (p≤0.05).
- Rubenwolf P., Gerharz E.W., Kieser W. Therapy of monosymptomatic nocturnal enuresis in childhood and adolescence: What is the evidence? Klin. Padiatr. 2007;219:2–8.
- Брязгунов И.П. Ночной и дневной энурез у детей и подростков. М.: Миклош, 2010. 168 с.
- Chase J., Austin P., Hoebeke P., McKennat P. The Management of dysfunction voiding in children: a report from the standartisation committee of the international children’s continence sotiety. J. Urol. 2010;183:1296–302.
- Neveus T., Eggert P., Evans J. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society. J. Urol. 2010;183(2):441–7.
- Hogg R., Landa H., Kaplan G. Nocturnal enuresis: Evaluation, education, treatment. Contemp. Pediatric. 2000;6:4–22.
- Кузнецова А.А. Ночной энурез у детей. Нефрология. 2012;6(3):16–24.
- Халецкая О.В. Расстройства поведения и развития в детском возрасте: Учебное пособие. Н. Новгород: Изд-во Нижегородской медицинской академии, 2005. 156 с.
- Rittig S., Schaumburg H.L., Siggaard C., Schmidt F., Diurhuus J.C. The circadian defect in plasma vasopressin and urine output is related to desmopressin response and enuresis status in children with nocturnal enuresis. J. Urol. 2008;179(6):2389–95.
- Загайнова Е.В. Этиопатогенетические варианты расстройств мочеиспускания у детей: диагностика и лечение. Дисс. канд. мед. наук. Н. Новгород, 2000. 22 с.
- Баранов А.А., Альбицкий В.Ю., Винярская И.В. Изучение качества жизни в педиатрии. М.: Союз педиатров России, 2010. 272 с.
About the Autors
Information about the authors:
Zastelo E.S. – Doctoral Student of Department of Hospital Pediatrics of SBEI HPE «Nizhny Novgorod State Medical Academy» of the MH of the RF
Haleckaja O.V. – Prof., Head of Department of Hospital Pediatrics of SBEI HPE «Nizhny Novgorod State Medical Academy» of the MH of the RF, Ph.D.
Tush E.V. – Associate Prof. of Department of Hospital Pediatrics of SBEI HPE «Nizhny Novgorod State Medical Academy» of the MH of the RF, Ph.D.