Disease relevance of Enuresis

• We have investigated two unrelated families, in which two children had inherited primary nocturnal enuresis, and nephrogenic diabetes insipidus caused by new mutations in the aquaporin-2 gene (AQP2) [1].
• A hypothesis is proposed suggesting that dopamine agonists could be viable therapeutic alternatives to tricyclics in treating enuresis and urinary incontinence [2].
• PURPOSE: Desmopressin is widely used in primary nocturnal enuresis, bleeding disorders, central diabetes insipidus and diagnostic urine concentration testing [3].
• Use of D-penicillamine was associated with an adverse reaction in 28 cases (33%); transient leukopenia occurred in eight, rash in seven, transient platelet count depression in seven, enuresis in three, and abdominal pain in two [4].
• CONCLUSIONS: Desmopressin is successful in treating nocturnal enuresis in the spina bifida patient with diurnal continence [5].

Psychiatry related information on Enuresis

• CONCLUSIONS: The prevalence of attention deficit disorder or ADHD in nocturnal enuresis is significantly increased, especially in older children [6].
• The effect of desmopressin on short-term memory in children with primary nocturnal enuresis [7].
• There are five major approaches to therapy of enuresis: psychological, psycho-physiological, medication (particularly imipramine HC1), conditioning therapy, and dietary restrictions [8].
• We reviewed 14 articles that reported data on serum sodium in patients treated with DDAVP for nocturnal enuresis and 11 articles that reported patients who developed a seizure or altered level of consciousness during treatment with DDAVP for nocturnal enuresis [9].
• Nearly all studies on the co-morbidity between enuresis and psychopathology in children suggest an increased prevalence of behavioural disorders in general and of attention-deficit hyperactivity disorder (ADHD) in particular [10].

High impact information on Enuresis

• Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q [11].
• Two young school-aged boys took an overdose of imipramine hydrochloride to help their enuresis [12].
• However, treatment with desmopressin resolved primary nocturnal enuresis completely [1].
• Urapidil and enuresis [13].
• Nocturnal enuresis associated with sodium valproate [14].

Chemical compound and disease context of Enuresis

• In contrast, thioridazine administration was associated with appetite increase and enuresis [15].
• Pimozide-induced enuresis [16].
• This pilot study tests the hypotheses that a dopamine agonist would be beneficial in childhood enuresis [17].
• Although the data are limited, reports suggest that imipramine, which may control nocturnal enuresis, a stage 4 sleep disorder, and diazepam, which suppresses stage 4 sleep, may effectively treat the condition [18].
• Preliminary report: amantadine hydrochloride in childhood enuresis [17].

Biological context of Enuresis

• PURPOSE: Formal studies of the genetics of enuresis have been performed since the 1930s and molecular genetics since 1995, both highlighting the importance of hereditary factors in the etiology of nocturnal enuresis [19].
• The pharmacokinetics of desmopressin (1-desamino-8-D-arginine vasopressin) were investigated in 8 patients with nocturnal enuresis, of whom 4 were known to respond completely to desmopressin and 4 were nonresponders [20].
• Recently, linkage analysis revealed a 2-point lod score of 4.2 in 6 families with dominant primary nocturnal enuresis around the aquaporin-2 (AQP2) water channel locus [21].
• Comparison of urodynamic findings and response to oxybutynin in nocturnal enuresis [22].
• CONCLUSION: Im comparison with pharmacological therapy using desmopressin, our study shows that laser acupuncture should be taken into account as an alternative, noninvasive, painless, cost-effective, and short-term therapy for children with primary nocturnal enuresis in case of a normal bladder function and high nighttime urine production [23].

Anatomical context of Enuresis

• This finding indicates the central nervous system as a target involved in the pathogenesis of nocturnal enuresis as well as the therapeutic benefit of desmopressin treatment [7].
• Plasma membrane fluidity of platelets (PLT) obtained from subjects with primary nocturnal enuresis (PNE) and healthy controls was investigated before and after addition of desmopressin (DDAVP) [24].
• RESULTS: Dysfunctional voiding was present in 75.7% of the children with detrusor overactivity, in 73.3% of the children with VUR, in 63% of the children with urinary incontinence, in 77% of the children with episodic urinary tract infection, and in all of the children with diurnal enuresis [25].

Gene context of Enuresis

• This study clearly demonstrates that urinary calcium levels modulate AQP2 excretion and is likely to be useful for treatment of children with enuresis [26].
• The polyuria and urinary concentrating defects associated with an abnormal nightly-increase in AVP in patients with nocturnal enuresis may partly be due to a lack of vasopressin-mediated AQP2 expression since treatment with desmopressin in these patients have normalised their nocturnal urine production [27].
• This effect was attributed primarily to the reduction of amplitude inhibition following the 120-ms prestimulation interval regardless of whether or not enuresis was associated with ADHD [28].
• MATERIALS AND METHODS: Urine was collected for 24-hour periods from 44 children with monosymptomatic nocturnal enuresis, 10 children with other forms of enuresis/incontinence (nonmonosymptomatic nocturnal enuresis) and 25 controls, and its aMT6s concentration was estimated using a commercially available radioimmunoassay [29].
• Adult onset nocturnal enuresis [30].

Analytical, diagnostic and therapeutic context of Enuresis

• The prostaglandin synthesis inhibitor indomethacin (used as a suppository) was compared to placebo in the treatment of primary nocturnal enuresis in a double-blind crossover study [31].
• MATERIALS AND METHODS: A multicenter study was done comparing oral dosages (200 and 400 micrograms.) of desmopressin (4-week, randomized, double-blind phase followed by 12 weeks of open label treatment with 400 micrograms.) to 20 micrograms. nasal spray in 66 adults and adolescents 12 to 45 years old with primary nocturnal enuresis [32].
• The effectiveness of oxybutynin in the treatment of primary enuresis was evaluated in a double-blind study [33].
• We conclude from this preliminary retrospective study that a high rate of success may be predicted when desmopressin is used in patients with familial nocturnal enuresis, whereas less optimism is warranted when no family history of nocturnal enuresis can be elicited [34].
• SETTING: West-Mine Region in the Netherlands. SUBJECTS AND METHODS: Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region [35].

References