Research Progress on the Pathogenesis of Primary Enuresis in Children

Nocturnal enuresis(NE)is a common disease in children,commonly known as bedwetting.The International Children's Continence Society(ICCS)defines intermittent urinary incontinence during nighttime sleep in children aged 5 and above as enuresis.Enuresis can be divided into two types:primary nocturnal enuresis(PNE)and secondary nocturnal enuresis(SNE).PNE refers to nocturnal urinary control ability that has never been achieved for more than 6 months in children aged 5 and above with enuresis;SNE refers to the recurrence of enuresis symptoms after a period of more than 6 months of continuous nocturnal urinary control ability.SNE is relatively rare in clinical practice and is often caused by sudden stress events or other diseases such as snoring.Its pathogenesis and treatment are different from PNE.PNE is a multifactorial disease related to genetics,and its pathogenesis is not fully understood.There are not many research and review articles on its pathogenesis.In recent years,there has been significant progress in the epidemiology and pathogenesis of PNE.The following is a summary.

Phallic rubber band application to prevent enuresis unusual cause of urethral stricture in a child:A case report

BACKGROUND Urethral stricture is the abnormal narrowing of the urethra due to spongiofibrosis.The established aetiological factors for urethral stricture abound in our environment.However,the application of a penile rubber band to prevent enuresis thereby causing this pathology is not a familiar occurrence.Patients with enuresis can suffer psycho-social challenges and trauma,especially for a child due to peer stigmatization.This has a great impact on the child's psyche and may affect even his performance at school.The aim of this paper is to highlight the psychosocial impact and management challenges of a child with enuresis(nocturnal urinary incontinence).CASE SUMMARY This is the case of a 10-year-old boy who presented with a history of nocturnal urinary incontinence since birth and lower urinary tract symptoms(LUTS)for 3 years culminating in chronic urinary retention.He maintained a normal urge to micturate and continent of urine during the daytime before the onset of LUTS.He had an antecedent longstanding history of tying a rubber band to the penile shaft mostly before going to the bed at night to prevent enuresis due to his peer stigmatization.He was acutely ill-looking,with distended suprapubic region.The phallus and scrotum were enlarged and oedematous with a circumferential proximal penile shaft scar and ventral penile shaft urethrocutaneous fistula.He was diagnosed to have complete short segment bulbopenile stricture and right ectopic ureter.He subsequent had augmented anastomotic urethroplasty and bilateral non-refluxing ureteroneocystostomy at different sitting.CONCLUSION The adherence to surgical principles of urethral stricture and enuresis management where surgically correctable in a child is associated with the resolution of enuresis and social reintegration.

The post-treatment effects of enterobiasis on the occurrence of enuresis among children in Calabar,Nigeria

Objective:To investigate the relationship between enterobiasis and enuresis before and after albendazole therapy among 632 children,aged,5-14 years,in Calabar,Nigeria.Methods:The scotch tape(cellotape) technique was used for the detection of eggs of Enterobius vermicularis (E.vermicularis) while questionnaire-based interviews were used for screening for anal itching and/or enuresis among study participants.All subjects found positive for Enterobius infection as confirmed by the presence of eggs and those with persistent anal itching(both enuretic and nonenuretic) were treated with 400 mg of albendazole given as a single dose.The treated subjects were re-assessed post-treatment to ascertain whether they were cured and also to determine their enuretic status(for the entireties).Results:The overall prevalences of Enterobius infection, anal itching,and enuresis prior to albendazole therapy were 6.8%,42.9%,and 35.6%respectively. There was no statistically significant difference in the prevalence of these parameters by the socio-economic class of subjects(P = 0.462,P - 0.647,and P = 0.610,respectively).The pretreatment prevalences of enuresis among Enterobius and anal itching-positive subjects were 53.5%and 49.8%,respectively versus 34.3%and 24.9%,respectively among their negative counterpart(P = 0.012 and P 【 0.001,respectively).Four(20%) out of the 20 enuretic children found Enterobius egg-negative after albendazole therapy were equally cured while 8(40%) had reduction of their enuresis,thus giving a total resolution rate of 60%.Similarly,64.2%resolution (25%cure and 32.8%reduction) of enuresis was observed amongst 120 anal itching-cured/ enuretic children.Enuretic status of the Enterobius-lanal itching-uncured subjects,on the other hand,remained unchanged post-treatment.Conclusions:This study is suggestive of the involvement of E.vermicularis in the aetiology of enuresis in Calabar.Children presenting with, especially,uncomplicated enuresis should be screened for enterobiasis.

Management of nocturnal enuresis-myths and facts

Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.

CLINICAL OBSERVATION ON 32 CASES OF FUNCTIONAL ENURESIS TREATED WITH ACUPUNCTURE AT BAIHUI(GV 20)

Acupuncture at Baihui（GV 20）was employed in treating 32 cases of functionalenuresis.As a result,the curative rate reached 81.25％,but that in control group of 32 cases withoutneedling Baihui point was 56.25％.There was a significant difference in statistics（P【0.05）.It indi- cates that Baihui can enhance the therapeutic effect of acupuncture on treating enuresis.

CLINICAL OBSERVATION ON 68 CASES OF ENURESIS TREATED BY MOXIBUSTION COMBINED WITH FINGER-MASSAGE METHOD

The therapeutic effect of moxibustion combined with finger-massage method was observed in 68 patients suffering from enuresis. The results showed that (1) The present therapy is effective for enuresis with cure rate of 66.18% and total effective rate of 92. 65 %; (2) The curative effects was related with the syndrome differentiation (P <0. 01), e. g. it is effective for deficiency of kidney-Yang and deficiency of Qi in lung and spleen types, but ineffective for the type of downward flow of damp-heat; (3) The therapeutic effect was also closely related with the course of disease. The shorter the course of illness lasted, the more effective the therapy was, indicating that such patients should be treated in the early stage. This method is not only comparable to other conventional acupuncture methods in respects of the cure rate and total effective rate, but is also simple to apply, safe to use, easy to be accepted by children and adverse-effect free. It is deserved to be popularized as a effective therapy for enuresis in children patients.

No Correlation between <i>AVPR</i>1A Promoter Polymorphisms and Prepulse Inhibition in Patients with Nocturnal Enuresis

Introduction: A correlation between AVPR1A promoter polymorphisms and prepulse inhibition (PPI) of startle reflexes has been described in healthy adults. Many children with nocturnal enuresis (NE) have a reduced PPI and treatment with desamino arginine vasopressin (dDAVP), a ligand of the arginine vasopressin receptor 1A (AVPR1A), and both improve clanical symptoms and significantly increase PPI. Methods: In 17 children (median 9.1 years, range 6.4-17.3) with NE, promoter repeats within the RS1 and RS3 regions of AVPR1A were quantified and correlated to PPI (native and age-adjusted). Results: No direct correlation was found between the number of promoter repeats at RS1 and PPI (correlation coefficient—0.240, p = 0.346) or RS3 and PPI (correlation coefficient—0.0192, p = 0.936), with no change through age-adjustment of PPI. The different RS3 length subgroups did not show differences in PPI, nor did differentiation of NE according to clinical subtype or treatment response to dDAVP show differences in the number of promoter repeats. Conclusion: The missing reproducibility of the correlation between AVPR1A promoter polymorphisms and PPI in a group with wide range of PPI suggests a more complex interaction. Therefore, further investigations are needed to analyze this very plausible interaction. Conditions with a reduced PPI, such as enuresis, schizophrenia or autism, are particularly interesting for this research.

Enuresis and sleep disordered breathing:An old and new link

The causes of nocturnal enuresis(NE) are likely multifactorial.It has been related to several(urologicalnephrological-hormonal) reasons but clear and univocal pathogenesis remains mostly undetermined.Sleep disordered breathing(SDB) is a syndrome of upper airway dysfunction that occurs during sleep and is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility.Adenotonsillar hypertrophy is the main cause of SDB in children.To date,several studies have associated childhood NE with coexistent SDB.Adenotonsillectomy was successful for both SDB and NE in about half of patients.Unfortunately,practical consensus guidelines for the management of primary NE do not mention,or marginally concern,SDB in these children,particularly in those who have treatment resistance and comorbidities.The concerns regard the concomitant presence of two relatively frequent sleep disorders,raising the question whether they are really coincidental problems of childhood.

Mechanism of Xingshen Zhiyi prescription in the treatment of enuresis based on network pharmacology

Objective:To explore the mechanism of Xingshen Zhiyi Recipe(XSZYF)in the treatment of Nocturnal Enuresis(NE)based on network pharmacology.Methods:TCMSP,DrugBank databases,PubMed and CNKI were used to obtain the active ingredients and corresponding targets of XSZYF.NE targets were obtained from GeneCard and OMIM databases.Cytoscape software was used to construct a drug-disease-target network model.The analysis was performed.The protein interaction network(PPI)was constructed using the STRING database.The gene ontology functional annotation(GO)and the Tokyo Genomic Encyclopedia(KEGG)pathway enrichment analysis were performed on key targets using the DAVID online tool.Surflex docking software was used for the analysis.Docking of key active ingredients and key targets to verify the results of network analysis.Results:199 gene targets of XSZYF were obtained,and 2486 gene targets of NE.Network analysis results showed that the key targets of XSZYF for treating NE include CHRM3,CHRM2,ADRB3,etc.Involved in regulating neuroactive ligand-receptor interactions,calcium signaling pathways,etc.Conclusion:This study revealed the material basis and action mechanism of XSZYF in treating NE from the perspective of network pharmacology.

Acupuncture Treatment of Enuresis

Case HistoryYang××,a male middle school student aged16 years,paid his first visit on March 5,1990,withthe chief complaint of bed-wetting for more than tenyears.The patient had got this problem since hischildhood.In better conditions,the bed-wettingoccurred once in several nights;while in worseconditions,it might happen several times a night.Heused to sleep so soundly that was difficult to wakehim up.The condition would tend to become

《中医儿科临床诊疗指南·小儿遗尿症》的多中心一致性评价

[目的]从中医诊断、治疗、预防与调护及临床疗效等多个维度,对《中医儿科临床诊疗指南·小儿遗尿症》的方案进行临床一致性评价。[方法]选取不同地域10家三级医院作为评价单位,收集205例小儿遗尿症患儿病例,采用病例调查分析法,进行统计和分析。[结果]小儿遗尿症的临床应用与指南内容具有较高一致性,与非指南方案相比,选择指南方案进行治疗的患儿取得的疗效更好,差异有统计学意义(P<0.05)。[结论]小儿遗尿症的指南与临床实际情况相符,对遗尿症患儿的诊断与治疗具有指导意义,值得临床推广。

遗尿儿童发生膀胱功能障碍的危险因素分析

目的探讨遗尿患儿发生膀胱功能障碍的危险因素。方法本研究为回顾性研究,选取2020年9月至2022年9月在重庆医科大学附属儿童医院泌尿外科排尿障碍诊治中心进行尿动力压力-流率检查的343例遗尿患儿为研究对象,根据尿动力检查结果将患儿分为有膀胱功能障碍组(n=157)和无膀胱功能障碍组(n=186),比较两组一般情况(性别、父母文化、居住环境、睡前饮水、遗尿史、大便情况、日间症状、每周遗尿次数、膀胱容量、尿流率、残余尿、脊柱裂)、尿常规、泌尿系超声、X线骶尾椎平片、自由尿流率。结果343例遗尿患儿中,男性200例、女性143例,就诊年龄(7.85±2.36)岁。男性(OR=2.156,95%CI:1.085~4.285)、伴有日间症状(OR=4.471,95%CI:2.229~8.967)、功能性膀胱容量减小(OR=20.651,95%CI:9.094~46.895)、遗尿次数每周超过4次(OR=2.339,95%CI:1.131~4.838)、尿流率降低(OR=3.196,95%CI:1.360~7.510)、隐性脊柱裂(OR=2.359,95%CI:1.160~4.794)是儿童发生膀胱功能障碍的独立危险因素。结论男性、伴有日间症状、隐性脊柱裂、遗尿次数>4次、生理性膀胱容量减小以及尿流率降低可能与遗尿儿童发生膀胱功能障碍有关,这些遗尿患儿有必要常规行尿动力学检查了解膀胱功能,为规范诊疗提供依据。

周耀庭教授治疗儿童原发性单症状性夜间遗尿症经验

文章介绍周耀庭教授治疗儿童原发性单症状性夜间遗尿症(PMNE)的经验。周教授认为,PMNE总属肾与膀胱虚寒,下元不固,与肺、脾、肾密切相关,不存在下焦湿热、肝胆湿热的病因病机;治疗应采用温肾、益气、固摄、调神、开肺之法,可取得较好临床效果。

缩泉丸加减治疗小儿遗尿症作用机制的研究进展

小儿遗尿症是儿科临床上常见的疾病之一,近年来其患病率逐渐上升。遗尿症不仅可能影响患儿神经发育,而且会对患儿身心成长造成不利影响。缩泉丸是临床治疗小儿遗尿疗效较为显著的方剂之一。本文简要说明缩泉丸主要通过调节患儿异常激素分泌、改善患儿膀胱功能异常、减少患儿逼尿肌过度活动以及平衡患儿钠钾离子异常排泄机制来实现温化肾气、缩尿止遗的功效,为缩泉丸的临床疗效机制提供一定的客观依据。

重构本草——金樱子

通过古籍文献调研、中医药现代研究成果的梳理,结合中医临床及中药学等学科领域内知名专家学者的认识及应用经验,归纳出金樱子:功效主要为固精缩尿,固崩止带,涩肠止泻。症靶为遗精滑精、遗尿尿频、腹泻。标靶为蛋白尿。现代药理发现,金樱子及其有效成分具有改善肾功能、抑菌、抗炎、抗氧化、保肝等作用。本品无毒,但是有实火、邪实者慎服。临床常用剂量为6~45 g,内服时当根据不同疾病,或同一疾病的不同阶段进行辨证使用,并积极探索金樱子用量与症靶、标靶的量效关系构建。

盐酸甲氯芬酯胶囊联合醒脾养儿颗粒治疗小儿遗尿的临床疗效观察

目的:分析盐酸甲氯芬酯胶囊联合醒脾养儿颗粒治疗小儿遗尿症的临床效果,为临床推广提供科学依据。方法:选取于2020年5月至2022年7月我院收治的小儿遗尿患儿共148例,按照随机数法并根据治疗方法不同将入组患儿分为研究组和对照组,每组各74例。对照组给予口服盐酸甲氯芬酯胶囊治疗,研究组给予口服盐酸甲氯芬酯胶囊+醒脾养儿颗粒治疗,连续治疗4周。评价两组临床疗效并对比两组患儿治疗前后中医症候积分、遗尿次数、睡眠觉醒障碍评分、唤醒阈、膀胱容量以及尿渗透压和抗利尿激素(ADH)水平。记录治疗后3个月内两组患儿复发率。结果:研究组治疗总有效率(85.14%)高于对照组(64.86%);治疗后两组中医症候积分、两组遗尿次数、睡眠觉醒障碍评分以及唤醒阈指标均降低,且研究组低于对照组;治疗后两组膀胱容量、尿渗透压和ADH的浓度水平均增加,且研究组高于对照组,上述差异均有统计学意义(P<0.05)。随访3月,研究组复发率(8.11%)低于对照组(20.27%),该差异有统计学意义(P<0.05)。结论:醒脾养儿联合盐酸甲氯芬酯胶囊可以显著改善小儿遗尿的临床疗效并降低复发率,值得临床推广。

麻黄激发阳气的临床应用探讨

基于文献梳理及对产后尿频、小儿遗尿、高龄尿毒症并发缓慢型心律失常等具体病案的分析,探讨麻黄激发阳气之功效在临床的应用。麻黄归属肺、膀胱经,辛温发散,走窜透达,为治疗外感第一要药,具有发汗、平喘、利水之功,广泛用于外感、咳喘、水肿等病症。对于因产后气血大伤,或因先天禀赋不足,或因年老久病而肾中精气逐渐衰惫,致使肾阴阳俱虚但阴阳虚损偏颇不明显的患者,治疗时可在温肾阳的基础上,予少量麻黄,以激发阳气,有助于药力达膀胱经循行部位所属脏腑之背俞穴,从而促进脏腑功能恢复正常。麻黄发汗力强,作用峻猛,用于激发阳气时,一般以3~9 g为宜,同时需配合温阳药;使用疗程不宜过长,以防其累积剂量过大,损伤元气。

温肾止遗方联合热敏灸对膀胱虚寒型小儿遗尿患者的临床疗效观察

目的研究温肾止遗方+热敏灸运用于膀胱虚寒型小儿遗尿中的价值。方法选择我院2020年3月-2021年4月纳入的膀胱虚寒型小儿遗尿患儿78例,以随机数字表法划分成两组,分别39例,研究组采取温肾止遗方+热敏灸,对照组使用常规治疗,干预前后对比两组症状积分、生活质量(SF-36)、功能性膀胱容量、尿流率、膀胱残余尿量、遗尿次数,评价两组干预后的总有效率,统计两组不良反应(腹痛、面色潮红、浮肿)情况,比较两组治疗结果。结果干预前两组症状积分无差异(P>0.05),干预后研究组夜尿频、全身乏力、畏寒肢冷、腰膝酸软积分低于对照组(P<0.05)。研究组总有效率89.74%高出对照组66.67%(P<0.05)。干预前两组膀胱功能及遗尿次数无差异(P>0.05),干预后研究组功能性膀胱容量、尿流率高出对照组,但膀胱残余尿量、遗尿次数低于对照组(P<0.05)。研究组不良反应7.69%低于对照组28.21%(P<0.05)。干预前两组SF-36无差异(P>0.05),干预后研究组健康状况、生理机能、精神健康、生理职能、精力评分均高出对照组(P<0.05)。结论温肾止遗方+热敏灸的效果更好,能够促进症状消失,减少遗尿次数,同时改善膀胱功能,不良反应少,安全性高,提升生活质量。

排尿日记对醋酸去氨加压素和遗尿报警器治疗原发性单症状夜遗尿症疗效的预测作用

目的评估排尿日记(VD)预测醋酸去氨加压素(DDAVP)或遗尿报警器(EA)治疗原发性单症状夜遗尿(PMNE)效果。方法2018年1月—2022年10月对100例门诊诊断为PMNE的6~14岁患儿进行前瞻性随访分析。以两周VD划分膀胱类型。使用丹麦的REDCap系统对患者进行伪随机化处理分组,分为随机选取治疗方案组(随机组)与根据VD选取治疗方案组(VD组),治疗周期为8周。结果共82名患儿符合统计要求。VD组有效率为82.50%(33/40),随机组有效率为59.52%(25/42),两者的治疗效果存在显著性差异(χ^(2)=5.224,P=0.022)。在随机组中,不考虑患儿VD的前提下,随机DDAVP组与随机EA组治疗有效率分别为81.82%(18/22)和25.00%(5/20),两种治疗方案存在显著性差异(χ^(2)=13.625,P=0.000)。结论VD可以预测PMNE的治疗效果,患者选定治疗方案前有必要记录两周VD。不依靠VD选择治疗方案的患者,DDAVP的治疗效果优于EA,但是停药后的复发率需要进一步随访。

小儿遗尿症指南和专家共识质量评价

背景小儿遗尿症是儿科常见病之一,有效的小儿遗尿症诊疗指南有助于症状的规范化控制和缓解,而制定高质量的临床实践指南是提高小儿遗尿症诊疗水平的重要方式。目的基于AGREEⅡ和RIGHT工具,评价2010年以来国内外发布的小儿遗尿症指南和专家共识的质量,以期为临床实践及后续指南的制订提供参考。方法检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed(补充检索医脉通、世界卫生组织以及英国国家临床示范研究所等数据库)2010-01-01至2022-01-31公开发表的小儿遗尿症相关的诊疗指南和专家共识。采用AGREEⅡ和RIGHT工具评价纳入文献的方法学和报告质量。根据AGREEⅡ工具评价结果,将各指南/共识推荐等级评定为“推荐(A级)”“更新后推荐(B级)”和“不推荐(C级)”。使用组内相关系数(ICC)进行一致性评价。结果纳入8部指南和5部专家共识。共形成推荐意见185条,其中44条为诊断评估方面的意见,140条为治疗方面的推荐意见,1条为随访推荐意见。AGREEⅡ工具评价结果显示,范围和目的、参与人员、严谨性、清晰性、应用性和独立性6个领域的总得分(报告率)分别为(66.99%±16.73%)、(46.26%±21.56%)、(34.42%±26.73%)、(60.36%±32.13%)、(39.82%±20.14%)、(45.35%±37.93%),纳入的13篇文献中,无推荐等级为A的文献,推荐等级为B和C的文献分别为8篇和5篇。RIGHT工具评价结果显示,基本信息、背景、证据、推荐意见、评审和质量保证、资助与利益冲突声明和管理、其他方面7个领域的总得分(报告率)分别为(60.58%±12.19%)、(50.72%±20.18%)、(30.77%±26.88%)、(32.97%±27.53%)、25.00%(40.63%)、(25.96%±24.00%)、16.67%(33.33%)。AGREEⅡ工具评估结果中指南的范围和目的领域得分高于专家共识得分(P<0.05)。RIGHT工具评估中指南各领域得分与专家共识得分比较,差异均无统计学意义(P>0.05)。AGREEⅡ工具各领域一致性评价ICC均大于0.750,一致性较高;RIGHT工具各领域一致性评价ICC为0.736,一致性较好。结论本研究纳入的指南和专家共识总体方法学和报告质量均有待提高,纳入文献的推荐等级为B级和C级,缺少A级的文献,建议临床决策中优先参考高质量诊疗指南。目前尚无面向我国基层医师制定的小儿遗尿症诊疗指南,且现有的小儿遗尿症中医药管理指南证据质量有待提高,建议参照AGREEⅡ和RIGHT标准制定相关指南以指导小儿遗尿症的临床管理。