ICCS & ESPU-Nurses Meeting on Friday 5, September 2025, 14:30 - 15:00
16:00 - 16:06
ICCS-S05-1 (OP)
Ana Luisa AMARAL ALVES 1, Felipe SANTOS MARIMPIETRI 1, Ana Cecília B. CASTRO 1, Ubirajara BARROSO JR 2, Glicia ESTEVAM DE ABREU 1, Ana Aparecida MARTINELLI BRAGA 1, Maria Luiza VEIGA 1 and Taynna COSTA 1
1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BRAZIL - 2) Escola Bahiana de Medicina e Saúde Pública and Hospital Universitário Professor Edgar Santos, Salvador, BRAZIL
PURPOSE
Enuresis is a common symptom in children and adolescents, often associated with lower urinary tract symptoms (LUTS). Although this relationship is well documented, few studies investigate the factors associated with the occurrence of enuresis in children and adolescents with urinary symptoms. Objective: To analyze the presence of associated factors for enuresis in children and adolescents with LUTS.
MATERIAL AND METHODS
This is a retrospective cross-sectional study that included children and adolescents with LUTS. To assess the presence and intensity of urinary symptoms, a structured questionnaire, the Dysfunctional Voiding Scoring Symptom (DVSS), was used, while the Rome IV Criteria for constipation were employed to evaluate intestinal symptoms.
RESULTS
342 patients were included in the study, of which 195 (57%) were female, with a median age of 9 (IQR 7-11). Enuresis occurred in 237 (69.3%) children, x 175 (51.2%) were constipated. The DVSS scores for patients with LUTS associated with enuresis and those without enuresis were 10 (IQR 6.5-14) and 9 (IQR 7-13), respectively. Univariate analysis identified factors associated with enuresis, including urgency (p<0.01), urge incontinence (p<0.01), giggle incontinence (p=0.01), stress incontinence (p=0.038), holding maneuvers (p=0.002), DVSS score (p=0.017) and fecal incontinence (p<0.01). The multivariate binary logistic regression maintained associations of enuresis with giggle incontinence (OR 2.405, 95% CI [1.286-4.498], p=0.006) and fecal incontinence (OR 3.533, 95% CI [1.733-7.201], p=0.001).
CONCLUSIONS
Giggle incontinence and fecal incontinence are associated with enuresis in children and adolescents with LUTS.
16:06 - 16:12
ICCS-S05-2 (OP)
Tryggve NEVEUS
Uppsala University, Uppsala University Children's Hospital, Uppsala, SWEDEN
PURPOSE
Some children with enuresis will not respond to any recognized first-, second-, or third-hand therapy. Their treatment will have to be based on experience and expert opinion. Our strategy has been to combine the recommended drugs and including mirabegron into the therapeutic arsenale. The aim of this report is to communicate our experiences with this very challenging group.
MATERIAL AND METHODS
This a retrospective evaluation. We report results for all our patients who have been followed for at least three months given combinations of 3-4 of the following: desmopressin, anticholinergics, mirabegron and amitriptylin. All had previously unsuccessfully tried the following: the enuresis alarm, desmopressin, anticholinergics + desmopressin, and amitriptylin + desmopressin.
RESULTS
So far 48 subjects (5 girls) aged 7-40 years (median 12, two adults) are included. They have been given three (n=41) or four (n=7) drugs, including anticholinergics (n=45), antidepressants (n=15) and/or mirabegron (n=41).
28 are full, 13 partial, and 7 nonresponders. The current situation for the 32 subjects who have been followed for at least 6 months is that 23 are dry and 9 still suffer occasional wet nights. Of the 23 dry subjects 6 need no drugs, 7 need one, 3 need two and 7 need the full combination. There have been no severe side effects. The adults are dry.
CONCLUSIONS
Most children with severely therapy-resistant enuresis become dry using combination therapy addressing several pathogenetic mechanisms simultaneously, and most of them can then reduce the number of drugs given while staying dry at night.
16:12 - 16:18
ICCS-S05-3 (OP)
Suhaib ABDULFATTAH 1, Zoe S. GAN 1, Jennifer LEGE-MATSUURA 2, Katherine M. FISCHER 1 and Jason P. VAN BATAVIA 1
1) Children's Hospital of Philadelphia, Urology, Philadelphia, USA - 2) University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
PURPOSE
Tibial nerve stimulation (TNS) is used to treat monosymptomatic nocturnal enuresis (NE) in children, but its efficacy is not well-defined. Therefore, we systematically reviewed the literature to evaluate the efficacy of TNS for NE in children.
MATERIAL AND METHODS
A comprehensive search of PubMed, EMBASE, CENTRAL, and Scopus was conducted for studies published up to 11/5/2023. Studies with pediatric patients treated with TNS percutaneously (PTNS) or transcutaneous (TTNS) for NE were included. Data on treatment protocols, outcomes, and quality of evidence (using the Mixed Methods Appraisal Tool) were synthesized.
RESULTS
Eight studies including 311 children with mean age 8-12 years met inclusion criteria, including 4 randomized controlled trials (RCTs). Compared to sham treatment, PTNS led to more overall symptom improvement (80% vs. 3.7%), greater reduction in wet nights (4.7 to 2.6, vs. 5.1 to 4.7 for sham), and increased bladder capacity, although improvements were similar to desmopressin. TTNS led to greater improvements in quality of life and the frequency of wet nights than a bedwetting alarm in one trial. However, TTNS efficacy was not statistically different from that of parasacral transcutaneous nerve stimulation or sham treatment in another trial. Quality of evidence ranged from low to moderate.
CONCLUSIONS
TNS reduces wet nights and improves quality of life and bladder capacity in children with NE, although there is limited data on the efficacy of TNS compared to other treatments. While PTNS may be more efficacious compared to TTNS, larger, high-quality randomized trials are necessary to establish the role of TNS for pediatric NE.
16:18 - 16:24
ICCS-S05-4 (OP)
Tuğçe ATALAY 1 and S. Kerem OZEL 2
1) PelvicKids Pelvic Rehabilitation Center, Pediatric Physiotherapy, İstanbul, TÜRKIYE - 2) Demiroğlu Bilim University Faculty of Medicine, Pediatric Surgery, Istanbul, TÜRKIYE
PURPOSE
Aim of the study was to delineate the clinical effects of body awareness therapy (BAT) during pelvic floor rehabilitation (PFR) in children with nocturnal enuresis.
MATERIAL AND METHODS
Children with the diagnosis of nocturnal enuresis were studied. Patients received behavioral therapy, diaphragmatic breathing, core stabilization exercises, and perineal sensory training in PFR. Two groups were formed; patients who received BAT with PFR or only PFR. Age, gender, body awareness status, weekly enuresis episodes per day, pelvic floor EMG activity at rest and work, and no of sessions to reach partial clinical response were noted together with DVSS scores before and after treatment. Results were analyzed statistically.
RESULTS
There was a total of 32 patients (19 boys, 13 girls, 8.34±2,7 years) with nocturnal enuresis. 18 patients received BAT and PFR, 14 patients received only PFR. There was no difference in age, gender, body awareness status, and pelvic floor EMG activity between groups. DVSS score after BAT+PFR was lower than only PFR patients (0,27±0,7 vs. 2,5±1,65, p<0,001). Weekly enuresis episodes per day was lower after BAT (0,17±0,51 vs. 0,78±0,8, p=0,03). No of sessions to reach partial clinical response was lower after BAT when compared to only PFR (3,28±0,75 vs. 5,21±0,58, p<0,001).
CONCLUSIONS
BAT added to the standard PFR seems to achieve better and relatively earlier clinical response in children with nocturnal enuresis.
16:24 - 16:30
ICCS-S05-5 (OP)
Jason VAN BATAVIA, Marissa KILBERG, Maria VOGIATZI, Connie TAN, Thomas KOLON and Katherine FISCHER
Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Children with congenital adrenal hyperplasia (CAH) have an altered hypothalamic-pituitary-adrenal axis that can lead to alterations in hormones including ACTH and CRH. CRH may be elevated in CAH because of the lack of ability to synthesize cortisol and lack of negative feedback. Recent studies have found lower CRH levels in bedwetting children compared to controls; suggesting that CRH levels may play a role in nocturnal enuresis (NE). We hypothesized that CAH children would have lower rates of NE than historical controls.
MATERIAL AND METHODS
We retrospectively reviewed our EMR for children with CAH and recorded secondary diagnoses including NE. The charts of each CAH patient with NE were reviewed. Prevalence rates in CAH children were determined and compared to historical controls (Byrd et al. Pediatrics 1996;98:414-4019).
RESULTS
128 CAH patients (80F, 48M) were included. NE prevalence rates in CAH children were 6% (8/128; 5F, 3M) at age 5-8 years (vs. 25% for historical controls), 6% (5/88; 4F, 1M) at age 9-12 years (vs. 10% for historical controls), 7.7% (5/65; 4F, 1M) at age 13-17 years (vs. 2% for historical controls), and 6.7% (2/30; 2F) at age 18+years. For three patients with regularly obtained hormone levels, ACTH levels did seem to fluctuate inversely with NE symptoms.
CONCLUSIONS
CAH children have an overall lower prevalence of NE earlier in life (<12 years old) when compared to historical controls. Those CAH children with NE, however, seem to have a more persistent and difficult to treat NE as most did not have resolution of NE until teenage years.