A New Check-list Method for Nocturnal Enuresis
Condition: Nocturnal Enuresis
MeSH terms: Enuresis; Urinary Incontinence; Nocturnal Enuresis
Study type: Interventional
Phase: Phase 4

Summary: 
      The study is aimed to demonstrate the benefits of newly formed written check-list of
      behavioral instructions and investigate its effects on parent's awareness, consciousness and
      motivation toward MNE.

      The parents with children who complain of bed-wetting 3 or more nights per week for at last
      14 days, they was randomly divided into three groups. The parents in Group I were instructed
      only a verbal behavioral therapy, the parents in Group II were instructed a behavioral
      therapy with a written formed check-list for parents to fulfill and the children in Group III
      will received desmopressin treatment plus verbal behavioral therapy. All participants were
      analysed the compliance and response rate of treatment over time period of 8 week.
    

Detailed description: 
      Monosymptomatic Nocturnal Enuresis (MNE) is defined as involuntarily nighttime bed-wetting
      after the age of 5 years without any other lower urinary tract symptoms and without a history
      of bladder dysfunction. MNE can lead to developmental and psychosocial problems on child and
      negative impact of the family life. It has been recommended that consisting of collaboration
      with children and their parents is very crucial point to tackle this disturbing condition.

      Behavioral therapy can be effective and these should be first-line treatment for MNE on the
      basis of the attitude of the child and parents. The behavioral therapy is composed of a lot
      of verbal recommendations including urination before going to sleep at night, a
      monitorisation daily fluid intake, a restriction of fluid volume before bedtime, rewards for
      dry nights, etc. However, we have noticed that these instructions have not been documented as
      a written list yet. We have analysed the literature and composed several recommendations were
      formed as a written check-list for parents to instruct.

      In this present study, we aimed to investigate the efficiency of check-list that are newly
      formed by a number of written behavioral instructions and demonstrate whether this rises
      awareness, consciousness and motivation of child's parents toward MNE.

      This study was conducted as a prospective randomized study at the Urology Department, Ankara
      Training and Research Hospital, Medical Science University, Ankara, Turkey Of ninety six
      children and their parents, seventy-five were randomly selected from the Urology outpatient
      clinic complaining of MNE. They were divided into three groups according to the therapy which
      were defined by the investigators before recruitment. Twenty-five children and their parents
      were instructed only a verbal behavioral therapy, 25 were instructed a behavioral therapy
      with a written check-list form and 25 children received desmopressin treatment plus verbal
      behavioral therapy were randomly included in the study. Each participants in this study was
      recorded medical history, demographic data including age of children and parents, number of
      children, educational and economic status of parents, wet nights. Economic status of family
      was defined by the hunger and the poverty limits from data of Turkish Statistical Institute
      All children were done detailed physical examination to rule out abnormal physical
      development, presence of genitourinary or neurological diseases. Urine analysis, serum
      creatinine, blood urine nitrogen, sodium, potassium, complete blood count, ultrasonography or
      plain X ray if necessary were measured.

      The parents in Group I were received verbal behavioral instruction. 25 parents in Group II
      were instructed to fulfill a check-list that were composed of written instructions during a 8
      week period. Also children had to register their wet nights via daily voiding diary. 25
      children in Group III were received desmopressin melt form 120 μg (Minirin, Ferring
      International center, Switzerland) once daily before going to bed for 2 months plus verbal
      behavioral instructions. Details and instructions about the drug and its use were given to
      the all children and their parents. All participants were checked every 2 weeks to control
      compliance rate of behavioral therapy (written or verbal) or medical treatment and analyse
      the response of the children with daily voiding diary.
    

Intervention name(s): desmopressin melt form 120 μg; Verbal behavioral therapy; Behavioral therapy with written check-list
Intervention type(s): Drug; Behavioral; Behavioral
Intervention description(s): desmopressin melt form 120 μg (Minirin, Ferring International center, Switzerland) once daily before going to bed; Verbal behavioral therapy includes reward system, restriction excessive fluid intake, lifting and waking after sleep to urinate, keeping daily voiding diary; Behavioral therapy with written check-list includes reward system, restriction excessive fluid intake, lifting and waking after sleep to urinate, keeping daily voiding diary, ensuring optimal posture to facilitate good bladder function and bowel movements, avoding holding urine, encouring healthy diet
Intervention MeSH terms: Deamino Arginine Vasopressin
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: All participants were divided into three groups. Twenty-five children and their parents were instructed only a verbal behavioral therapy, 25 were instructed a behavioral therapy with a written check-list form and 25 children received desmopressin treatment plus verbal behavioral therapy were randomly included in the study.
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: behavioural therapy; mono symptomatic nocturnal enuresis; compliance; response