ESPU Meeting on Saturday 6, September 2025, 12:15 - 13:20
12:15 - 12:18
S39-1 (OP)
Ahmed ELKASHEF 1, Mohamed HUSSINY 1, Abdelwahab HASHEM 1, Hesham TORAD 2 and Hesham EL-HELALY 3
1) Urology and nephrology center, Pediatric Urology, Mansoura, EGYPT - 2) Kasr Alainy medical school, Urology, Cairo, EGYPT - 3) Fayoumn University, Urology, Fayoum, EGYPT
PURPOSE
Tachyphylaxis was a major problem of selective serotonin reuptake inhibitor (SSRI) drug as fluoxetine, like other anti-enuresis medications. To evaluate the efficacy of fluoxetine 20 mg, SSRI, versus the standard treatment, desmopressin 0.2 mg, in primary monosymptomatic nocturnal enuresis (PMNE) treatment.
MATERIAL AND METHODS
This was a single-blinded randomized clinical trial. Children ≥ 7 years old on urotherapy and still had severe PMNE were screened for eligibility. Children were maintained on 20 mg of fluoxetine or desmopressin 0.2 mg orally once daily in for 3-months. The primary outcome for this trial was to measure the efficacy of both drugs in nocturnal enuresis frequency decrease at three month. The secondary endpoints were treatment-related side effects and nighttime arousal.
RESULTS
The baseline parameters were comparable between Fluoxetine group(N = 29) and Desmopressin group
(N = 28). The response to treatment at 1-month as non-responders (NR), partial responders (PR), complete responders (CR) were 69%, 24.1%, 6.9% versus 57.1%, 32.1%, 10.7% in fluoxetine and desmopressin groups, respectively (p=0.65). At 3rd month, the NR, PR, CR were 69%, 31%, 0% versus 57.1%, 32.1%, 10.7% in fluoxetine and desmopressin groups, respectively (p=0.18). Nighttime arousal was better in fluoxetine (41.4%) versus (14.3%) in desmopressin group, p=0.02, at the 1st month, decreased in a fluoxetine (31%) versus (14.3%) in desmopressin group p=0.13, at the 3rd month.
CONCLUSIONS
Fluoxetine 20 mg was non-inferior to desmopressin 0.2 mg for the management of PMNE. Fluoxetine improved nighttime arousal significantly at the 1st month. This improvement became insignificant at the 3rd month.
12:18 - 12:21
S39-2 (OP)
Ketch COWAN 1, Hayly CARUSO 2, Adam HITTELMAN 3, Therese COLLETT-GARDERE 2, Sarah LAMBERT 2, Kaci FLYOD 1, Mckinley WAUGH 1, Molly BAND 2, Jamille RANCOURT 2 and Israel FRANCO 4
1) Erlanger Hospital, Urology, Chattanooga, USA - 2) Yale school of Medicine, Urology, New Haven, USA - 3) Yale School of Medicine, New Haven, USA - 4) Yale University school of Medicine, Urology, New Haven, USA
PURPOSE
Desmopressin (DDAVP) is widely recognized as the first-line medical treatment for nocturnal enuresis (NE)There is recent work that shows that use of Alpha 2 Agonist may be useful for nocturnal enuresis. Additionally, recent literature points to the locus Coeruleus as a critical area in nocturnal enuresis. Norepinephrine is secreted by LC and it is NE that is raised in the brain with alpha 2 Agonists. Aim of our study was to evaluate the effect of combination therapy for refractory patients to single therapy with DDAVP by adding An alpha 2 Agonist.
MATERIAL AND METHODS
A retrospective chart review of the combined database of 2 institutions for patients with NE was performed. All patients who were initially prescribed DDAVP monotherapy for NE, followed by an alpha 2 agonist, either Guanfacine (G) or Clonidine (C), were included. Effectiveness was examined by comparing pre-and post-treatment wet nights per week and Vancouver Symptom Scores (VSS).
RESULTS
46 patients were identified who were prescribed either G or C in combination with DDAVP after failed monotherapy. Of these patients, the average age was 11.46 years, with 34 males and 12 females. Average wet nights per week while on DDAVP alone was 4.6, which decreased to an average of 3.1 after DDAVP and an alpha 2 agonist. In the 31 patients who were compliant with dual therapy, 32.3% (10) of patients had a complete response (0/7 nights wet), 35.4% (11) had a partial response (<4/7 nights wet), 32.3% (10) had no response. The average pretreatment VSS was 3.8 compared to a posttreatment VSS of 2.9.
CONCLUSIONS
Patients started on a combination of DDAVP and C or G after failed monotherapy had a complete response 32% of the time, with some benefit to treatment at a rate of 68%. Our findings with imipramine and these results with alpha 2 agonists shed further evidence that frontal lobe norepinephrine levels are the likely mechanism to correct refractory NE.
12:21 - 12:24
S39-3 (OP)
Juan OSORIO, Rocio JIMENEZ, Yessica QUIROZ, Roger PUJOL, Anna BUJONS and Erika LLORENS
Fundacion puigvert, Paediatric urology, Barcelona, SPAIN
PURPOSE
Non-monosymptomatic enuresis (NME) is commonly associated with overactive bladder (OAB) and lower urinary tract dysfunction. Standard management includes urotherapy, anticholinergics, and desmopressin, yet a subset remains refractory. OnabotulinumtoxinA (BoNT-A) has been proposed for refractory OAB, but its efficacy in pediatric NME remains unclear. This study evaluates the clinical outcomes and safety of intradetrusor BoNT-A in refractory NME.
MATERIAL AND METHODS
A prospective database of 1,495 NME patients treated between 2017 and 2024 was reviewed. Refractory patientswere defined as those with persistent nocturnal enuresis despite ≥6 months of full medical therapy with confirmed adherence, monitored via an electronic medication dispensing tracker. All underwent urodynamic studies, and those with OAB were offered intradetrusor BoNT-A injections. Treatment response was classified as complete (absence of nocturnal leaks), partial (≥50% improvement), or no response (<50% improvement).
RESULTS
Of the 1,495 patients, 15 were refractory, with a pre-treatment PdetMax of 55.4 cmH₂O. After the first injection, 46% (7/15) achieved complete resolution, 46% (7/15) had partial response, and one patient (6%) did not respond. Three complete responders required a second injection, and one needed a third.
Among partial responders, one required two additional injections. Follow-up urodynamic studies in 80% showed a PdetMax decrease to 22.5 cmH₂O before the second injection. The median interval between injections was 18 months (8-35 months) and 11 months (6-24 months) for third injections. No adverse events or complications were reported
CONCLUSIONS
BoNT-A is a safe and effective option for refractory pediatric NME, achieving 94% symptom relief. Further studies are needed to define its role in pediatric enuresis management
12:36 - 12:39
S39-4 (OP)
Salah NAGLA 1, Osama EL GAMAL 1, Mohammad ABDEL-HAKEEM 2 and Mohamed AL GOHARY 1
1) Tanta university, Urology, Tanta, EGYPT - 2) Tanta university, Neuropsychatry, Tanta, EGYPT
PURPOSE
The aim of this work was to identify the various types of nocturnal enuresis (NE) among children with Attention Deficit Hyperactivity Disorders (ADHD) and their responses to treatments.
MATERIAL AND METHODS
This prospective study had been conducted on children <18 years old, who fulfilled criteria for ADHD with any type of nocturnal enuresis in patients who had no previous urological treatment. All patients were subjected to the standard psychiatric treatment (Atomoxetine and/or methylphenidate). The patients were re-evaluated at 1,3,6 months to assess improvement of enuresis.
RESULTS
the study included sixty patients. There was no significant different between recurrence rate of NE and type of ADHD and NE. The type of ADHD did not affect response of enuresis treatment. Regarding response of treatment of daytime symptoms, 14 patients showed full response, while 4 patients did not show response. In patients with NE, 28 patients showed full response, 8 patients showed intermediate response, and 6 patients did not show response. While in patients with non- monosymptomatic NE, 14(77.8%) Patients with showed full response, while 4(22.2%) did not show response.
CONCLUSIONS
A combination therapy of desmopressin and imipramine is efficient treatment of monosymptomatic NE in ADHD children, while anticholinergic drugs plus desmopressin are effective in non-monosymptomtic NE.
12:39 - 12:42
S39-5 (OP)
Kimberley BURROWS 1, Naomi WARNE 1, Jane HVARREGAARD CHRISTENSEN 2 and Carol JOINSON 1
1) University of Bristol, Bristol Medical School, Bristol, UNITED KINGDOM - 2) Aarhus University, Department of biomedicine, Aarhus, DENMARK
PURPOSE
Cross-sectional studies provide strong evidence for comorbidity between enuresis and behaviour and emotional problems, but the direction of the relationships is unclear. In this study we examined evidence of bidirectional causal relationships between enuresis and behaviour/emotional problems.
MATERIAL AND METHODS
We performed bidirectional two-sample Mendelian Randomization using publicly available GWAS summary statistics to examine evidence for causal bidirectional relationships between enuresis and depression, anxiety, attention deficit hyperactivity disorder (ADHD), ADHD and comorbid disruptive behaviour disorders (DBD), and neuroticism score. Sample sizes ranged from 83,566 to 1,035,760 participants of European ancestry. Causal estimates were calculated using the inverse variance weighted (IVW) method and additional sensitivity analyses were conducted to evaluate the validity of the causal relationships.
RESULTS
Genetic liability to ADHD (IVW OR 1.16, [95% CI 1.02-1.30]) and depression (OR 1.34[1.17-1.53] increased the odds of enuresis. Genetically predicted neuroticism score also increased the odds of enuresis (OR 1.17[1.04-1.32]). Genetic liability to enuresis increased the odds of ADHD (OR 1.11[1.00-1.22] and ADHD/DBD (OR 1.28[1.03-1.59]) but there was no causal effect of enuresis on anxiety, depression, or neuroticism score. Sensitivity analyses were not always concordant with the IVW estimates and results should be interpreted with caution.
CONCLUSIONS
Our findings suggest causal effects of ADHD, depression, and neuroticism on enuresis. Enuresis may also have a causal effect on ADHD and ADHD/DBD. Limitations include the lack of generalisability to other ethnicities, partial sample overlap in some of the exposure and outcome GWAS, and lack of discrimination between enuresis subtypes in the enuresis GWAS.
12:42 - 12:45
S39-6 (OP)
Jae Min CHUNG 1, Han A LEE 1, Jung Yoon KANG 2 and Sang Don LEE 1
1) Pusan National University Children's Hospital, Urology, Yangsan-Si, REPUBLIC OF KOREA - 2) Eulji General Hospital, Eulji University School of Medicine, Department of Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
The treatment of nocturnal enuresis(NE) has been focused on alleviating the symptoms. NE is closely related to mental well-being, and it can result in feelings of shame, anxiety, and low self-esteem, potentially leading to personality development disorders during adolescence. Therefore, proactive treatment for NE is necessary from the age of 5 onwards to foster healthy personality development. This study aimed to determine the effect of psychological stress due to NE on the outcome of treatment in children.
MATERIAL AND METHODS
We collected data on 257 children with NE(mean age, 7.8±2.0years). An interview was performed with a questionnaire to evaluate the presence of psychological stress (shame, upset, anger, depression, and fear) with parents and children, together. Based on the child’s statements, we grouped patients into two groups; with or without psychological stress for NE (the stress group and the non-stress group). All patients were treated in the same standard way. Treatment results were assessed with an enuresis diary.
RESULTS
In the stress group, shame (50.6%), disappointed (40.5%), and anxiety (41.4%) were common. The other conditions, such as mean age, height, weight, BMI, and gender were similar in stress group (206 cases, 80.2%) and non-stress group (51 cases, 19.8%). The severity and type of NE were also similar in both groups. Moreover, the response rate at 3 months and final visit showed statistically no significant differences in both groups (p=0.528 and 0.826). However, the proportion of children with complete response was observed to be higher in the non-stress group at final visit (p=0.205).
CONCLUSIONS
Although almost 80% of children had psychological stress on NE, this psychological stress on NE in children before treatment did not affect treatment outcomes.
12:57 - 13:00
S39-7 (OP)
Huang LIN 1 and Israel FRANCO 2
1) Yale School of Medicine, Urology, New Haven, USA - 2) Yale University school of Medicine, Urology, New Haven, USA
PURPOSE
Nocturnal enuresis (NE) often co-occurs with other mental health conditions, such as anxiety disorders and ADHD, though the prevalence and comorbidity patterns remain unclear. The largest studies on continence problems and mental health issues have been conducted with cohorts of around 7000 patients (Joinson et al., European Urology, 2023; 84: 463-470). This study aims to analyze a large-scale dataset in excess of 10,000 patients to identify mental health diagnoses that co-occur with NE.
MATERIAL AND METHODS
Using the Adolescent Brain Cognitive Development (ABCD) dataset, we formed two groups: one with NE and one control group without NE. We excluded children with incomplete clinical data, severe brain conditions, a history of parental drug use, drug use during pregnancy, symptoms of encopresis, daytime wetting, constipation, or parental mental health issues. Data was collected from patients with reported bedwetting, as reported by parents. Mental health comorbidities were identified using the parental KSADS interview. Chi-squared tests were performed, with results corrected for multiple comparisons.
RESULTS
A total of 1,672 9 YO patients with nocturnal enuresis (NE) were identified, along with 9,586 control participants. Our findings indicate that NE significantly co-occurs with social anxiety (NE = 65; CTL = 631 OR=0.57), phobias (NE = 526; CTL = 3,654, OR=0.75), ADHD (NE = 152; CTL = 1,272, OR=0.65), and self-injurious behavior (NE = 50; CTL = 599, OR=0.46) (all p < 0.001).
CONCLUSIONS
These findings of co-occuring mental health issues along with our prior findings on the same cohorts neurocorrelates is suggestive that NE is an extension of the symptoms of the these aforementioned neuropsychiatric diagnosis. This underscores the importance of improving diagnostics and raising awareness that NE patients may be at increased risk for neuropsychiatric diagnosis and may need in some cases targeted therapy to address the underlying problem and not just NE.
13:00 - 13:03
S39-8 (OP)
Britt BORG 1, Rikke LAMBEK 2, Cecilie SIGGAARD JØRGENSEN 1, Marit OTTO 3, Malthe Jessen PEDERSEN 4, Søren RITTIG 1, Kristian JUUL 5, Per Hove THOMSEN 6 and Konstantinos KAMPERIS 1
1) Aarhus University Hospital, Child and Adolescent Medicine, Aarhus N, DENMARK - 2) Aarhus University, Institute for Psychology, Aarhus C, DENMARK - 3) Aarhus University Hospital, Department of Neurology, Aarhus N, DENMARK - 4) Aarhus University, Public Health, Aarhus N, DENMARK - 5) Ferring Pharmaceuticals, R&D, TA Urology, Kastrup, DENMARK - 6) Aarhus University Hospital, Child and Adolescent Psychiatry, Aarhus N, DENMARK
PURPOSE
The aim of the current study was to investigate whether sleep quality and neurocognitive functioning is impaired in children with nocturnal enuresis compared to continent reference children
MATERIAL AND METHODS
Children with NE (n=60) were clinically assessed for NE and for inclusion and exclusion criteria. Children participated in neurocognitive assessment as well as sleep assessment (i.e., polysomnography), while parents completed questionnaires and voiding diaries during daytime and nighttime. Neurocognitive assessment was carried out prior to sleep assessment at baseline before treatment onset for NE. Continent controls were included for comparison and multiple linear regression was used.
RESULTS
Sleep:
Children with NE had a significantly higher mean CAi compared to reference children, △adj.: 2.1 /hour [95% CI 0.5 to 3.6] and more N1 sleep (% of total sleep time), △adj. was 5.0 % [95% CI 2.5 to 7.5], p<0.05.
Neurocognitive functioning:
Children with NE recalled significantly fewer digits backwards compared to children in the reference group △adj.: -0.6 and 95% CI (-0.9;-0.2), p<0.05. Furthermore, children with NE tended towards lower mean accuracy on the 2-back task than children in the reference group, △adj.: -0.08, 95% CI (-0.16;0.0), p=0.06. Finally, parent ratings on the WM subscale of the CHEXI were significantly higher in the NE group compared to the reference group, △adj.: 6.0 and 95% CI (2.1;9.8), p<0.05, indicating more WM impairment in children with NE.
Children with NE had a significantly higher percentage of choices involving a small reward than children in the reference group, △adj.: 29.2 %; 95% CI (16.3;42.2), p<0.05.
CONCLUSIONS
Children with NE were found to have more cortical arousals and N1 sleep compared to reference children, but group differences were not found with respect to PLMi and sleep apnea. Children with NE had lower working memory function and made more impulsive choices compared to children in the reference group.
13:03 - 13:06
S39-9 (OP)
Jae Min CHUNG 1, Han A LEE 1, Jae Min CHUNG 2 and Sang Don LEE 1
1) Pusan National University Children's Hospital, Urology, Yangsan-Si, REPUBLIC OF KOREA - 2) Pusan National University Yangsan Hospital, Department of Urology, Gyeongsangnam-Do, REPUBLIC OF KOREA
PURPOSE
Loss of circadian rhythm in nocturnal ADH is a primary cause of nocturnal enuresis (NE). The nocturnal ADH effect is measured by the gap in urine specific gravity (SG) between first-morning and daytime urine. This study evaluates treatment response in NE based on the SG gap before treatment.
MATERIAL AND METHODS
We analyzed 256 children with NE (mean age 7.9±2.1 years), dividing them into two groups based on SG: normal group (first-morning urine SG > daytime urine SG, 156 cases) and abnormal group (first-morning urine SG ≤ daytime urine SG, 100 cases). All patients were treated with urotherapy and pharmacological treatment. Enuresis frequency and response rates were assessed at 3 months, 6 months and at the end of treatment.
RESULTS
SG differences (first-morning urine SG - daytime urine SG) between groups were significant (normal: 0.010±0.007 vs. abnormal: -0.007±0.006, p<0.001). Enuresis frequency before treatment was 4.7±1.9 times/week (normal: 4.8±1.9 vs. abnormal 4.4±1.9 times/week, p=0.127). At 3 months, enuresis frequency was lower in the abnormal group (normal: 2.9±2.5 vs. abnormal 2.2±2.2 times/week, p=0.121), with a better treatment response (normal 47.2±37.0% vs. 56.2±31.4%, p=0.092). At 6 months, the abnormal group showed significantly lower frequency (normal: 2.0±2.2 vs. abnormal: 1.2±1.7 times/week, p=0.025) and higher response rate (normal: 63.2±33.0% vs. abnormal: 73.3±24.9%, p=0.057). At the end of treatment, no significant difference was observed in frequency (normal: 1.8±2.2 vs. abnormal: 1.3±1.7, p=0.188) or response rate (normal: 66.3±36.6% vs. abnormal: 71.8±30.6%, p=0.438).
CONCLUSIONS
Children with NE and a lower first-morning urine SG than daytime urine SG showed a better treatment response, suggesting that a disrupted circadian rhythm of nocturnal ADH may improve treatment outcomes. Larger studies are needed to further investigate the etiology.