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Organo Oficial de la Sociedad Mexicana de Urología

2025, Number 4

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Rev Mex Urol 2025; 85 (4)

Lower urinary tract dysfunction in children with attention deficit hyperactivity disorders

Elgohary M, El Gamal O, Abdel-Hakeem M, Elmaadawy M, Nagla S

Language: English
References: 33
Page: 1-11
PDF size: 189.22 Kb.


ABSTRACT

Goal: the aim of this work was to identify the various types of lower urinary tract dysfunctions (LUTD among children with Attention Deficit Hyperactivity Disorders (ADHD) and their responses to treatments.
Methods: this prospective work had been conducted on participants aged 6 -18 years old, who fulfilled criteria for ADHD with any type of LUTD and only naive patients who had no previous urological treatment. All patients were subjected to the standard psychiatric treatment in form of Atomoxetine and/or methylphenidate. The patients were re-evaluated at 1,3,6 months to assess improvement of daytime symptoms and nocturnal enuresis (NE).
Results: in our 60 patients, there was no significant different between recurrence rate of NE and type of ADHD and NE. There was no significant different between type of ADHD according to response of enuresis treatment. Regarding response of treatment of daytime symptoms, 14 (77.7 %) patients showed full response, while 4 (22.2 %) patients did not show response. In patients with NE, 28 (66.7 %) patients showed full response, 8 (19.0 %) patients showed intermediate response, and 6 (14.3 %) 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 nonmonosymptomtic NE.
Limitations: number of cases is small and further multicenter studies are needed to confirm our conclusion.
Originality: this manuscript describes an original work.


REFERENCES

  1. Ito H, Sakamaki K, Young GJ, Blair PS, HashimH, Lane JA, et al. Predicting Prostate SurgeryOutcomes from Standard Clinical Assessmentsof Lower Urinary Tract Symptoms To DerivePrognostic Symptom and Flowmetry Criteria.European Urology Focus. 2024;10(1): 197–204.https://doi.org/10.1016/j.euf.2023.06.013.

  2. Jefferies M, Cox A, Bennett A, Kynaston H.Management of lower urinary tract symptomsin men. British Journal of Hospital Medicine(London, England: 2005). 2013;74(9): 518–522.https://doi.org/10.12968/hmed.2013.74.9.518.

  3. Chapple CR, Wein AJ, Abrams P, DmochowskiRR, Giuliano F, Kaplan SA, et al. Lower urinarytract symptoms revisited: a broader clinicalperspective. European Urology. 2008;54(3): 563–569. https://doi.org/10.1016/j.eururo.2008.03.109.

  4. Abrams P, Cardozo L, Fall M, Griffiths D,Rosier P, Ulmsten U, et al. The standardisationof terminology in lower urinary tract function:report from the standardisation sub-committeeof the International Continence Society. Urology.2003;61(1): 37–49. https://doi.org/10.1016/s0090-4295(02)02243-4.

  5. Reynard JM, Yang Q, Donovan JL, Peters TJ,Schafer W, de la Rosette JJ, et al. The ICS-’BPH’ Study: uroflowmetry, lower urinary tractsymptoms and bladder outlet obstruction. BritishJournal of Urology. 1998;82(5): 619–623. https://doi.org/10.1046/j.1464-410x.1998.00813.x.

  6. Scarpa RM. Lower urinary tract symptoms: whatare the implications for the patients? EuropeanUrology. 2001;40 Suppl 4: 12–20. https://doi.org/10.1159/000049890.

  7. Appell RA, Sand PK. Nocturia: etiology,diagnosis, and treatment. Neurourology andUrodynamics. 2008;27(1): 34–39. https://doi.org/10.1002/nau.20484.

  8. Fowler CJ, Griffiths D, de Groat WC. Theneural control of micturition. Nature Reviews.Neuroscience. 2008;9(6): 453–466. https://doi.org/10.1038/nrn2401.

  9. Gnanavel S, Sharma P, Kaushal P, Hussain S.Attention deficit hyperactivity disorder andcomorbidity: A review of literature. WorldJournal of Clinical Cases. 2019;7(17): 2420–2426.https://doi.org/10.12998/wjcc.v7.i17.2420.

  10. Khazaie H, Eghbali F, Amirian H, MoradiMR, Ghadami MR. Risk Factors of NocturnalEnuresis in Children with Attention DeficitHyperactivity Disorder. Shanghai Archives ofPsychiatry. 2018;30(1): 20–26. https://doi.org/10.11919/j.issn.1002-0829.216088.

  11. Ghanavati PM, Khazaeli D, Amjadzadeh M.A comparison of the efficacy and tolerabilityof treating primary nocturnal enuresis withSolifenacin Plus Desmopressin, TolterodinePlus Desmopressin, and Desmopressin alone: arandomized controlled clinical trial. Internationalbraz j urol. 2021;47(1): 73–81. https://doi.org/10.1590/s1677-5538.ibju.2019.0448.

  12. Amiri S, Shafiee-Kandjani AR, NaghinezhadR, Farhang S, Abdi S. Comorbid PsychiatricDisorders in Children and Adolescents withNocturnal Enuresis. Urology Journal. 2017;14(1):2968–2972.

  13. Okur M, Ruzgar H, Erbey F, Kaya A. Theevaluation of children with monosymptomaticnocturnal enuresis for attention deficit andhyperactivity disorder. International Journal ofPsychiatry in Clinical Practice. 2012;16(3): 229–232. https://doi.org/10.3109/13651501.2011.620129.

  14. Yousefichaijan P, Sharafkhah M, Salehi B,Rafiei M. Attention deficit hyperactivitydisorder in children with primarymonosymptomatic nocturnal enuresis: A casecontrolstudy. Saudi Journal of Kidney Diseasesand Transplantation: An Official Publicationof the Saudi Center for Organ Transplantation,Saudi Arabia. 2016;27(1): 73–80. https://doi.org/10.4103/1319-2442.174077.

  15. Mahjani B, Koskela LR, Mahjani CG, JaneckaM, Batuure A, Hultman CM, et al. Systematicreview and meta-analysis: relationships betweenattention-deficit/hyperactivity disorder andurinary symptoms in children. European Child& Adolescent Psychiatry. 2022;31(4): 663–670.https://doi.org/10.1007/s00787-021-01736-3.

  16. Duel BP, Steinberg-Epstein R, Hill M, LernerM. A survey of voiding dysfunction in childrenwith attention deficit-hyperactivity disorder.The Journal of Urology. 2003;170(4 Pt 2):1521–1523; discussion 1523-1524. https://doi.org/10.1097/01.ju.0000091219.46560.7b.

  17. Woo SH, Park KH. Enuresis alarm treatmentas a second line to pharmacotherapy inchildren with monosymptomatic nocturnalenuresis. The Journal of Urology. 2004;171(6 Pt2): 2615–2617. https://doi.org/10.1097/01.ju.0000113036.13536.29.

  18. McKeown C, Hisle-Gorman E, Eide M, GormanGH, Nylund CM. Association of constipationand fecal incontinence with attention-deficit/hyperactivity disorder. Pediatrics. 2013;132(5):e1210-1215. https://doi.org/10.1542/peds.2013-1580.

  19. Williamson LB, Gower M, Ulzen T. ClinicalCase Rounds in Child and Adolescent Psychiatry.Journal of the Canadian Academy of Child andAdolescent Psychiatry. 2011;20(1): 53–55.

  20. Bahali K, Ipek H, Uneri OS. Methylphenidateand atomoxetine for treatment of nocturnalenuresis in a child with attention-deficithyperactivity disorder. European Child &Adolescent Psychiatry. 2013;22(10): 649–650.https://doi.org/10.1007/s00787-013-0414-x.

  21. Sumner CR, Schuh KJ, Sutton VK, Lipetz R,Kelsey DK. Placebo-controlled study of theeffects of atomoxetine on bladder controlin children with nocturnal enuresis. Journalof Child and Adolescent Psychopharmacology.2006;16(6): 699–711. https://doi.org/10.1089/cap.2006.16.699.

  22. von Gontard A, Vrijens D, Selai C, MosielloG, Panicker J, van Koeveringe G, et al. Arepsychological comorbidities important in theaetiology of lower urinary tract dysfunction-ICI-RS 2018? Neurourology and Urodynamics.2019;38 Suppl 5: S8–S17. https://doi.org/10.1002/nau.24016.

  23. Eliezer DD, Samnakay N, Starkey MR,Deshpande AV. Effectiveness of standardurotherapy (basic bladder advice) andcombination therapies in managing bladderdysfunction in children with treated behavioraldisorders: Results of a prospective cohort(DABBED) study. Lower Urinary TractSymptoms. 2021;13(4): 490–497. https://doi.org/10.1111/luts.12400.

  24. Shain S, Gitlin J, Pantazis A, Fine R, Horowitz M,Friedman S, et al. Management of the refractorynocturnal enuresis patient to desmopressinin a pediatric population: Desmopressin +oxybutynin vs. desmopressin + imipramine.Journal of Pediatric Urology. 2024;20(4): 603.e1-603.e8. https://doi.org/10.1016/j.jpurol.2024.05.024.

  25. Fujinaga S, Nishizaki N, Ohtomo Y. Initialcombination therapy with desmopressin,solifenacin, and alarm for monosymptomaticnocturnal enuresis. Pediatrics International:Official Journal of the Japan Pediatric Society.2017;59(3): 383–384. https://doi.org/10.1111/ped.13212.

  26. Reddy KR, Sripada R. Treatment andmanagement of nocturnal enuresis: a review.International Journal of Pharmaceutical andClinical Research. 2017;9(5): 363–367.

  27. von Gontard A, Equit M. Comorbidity of ADHDand incontinence in children. European Child &Adolescent Psychiatry. 2015;24(2): 127–140.https://doi.org/10.1007/s00787-014-0577-0.

  28. Fritz G, Rockney R, Bernet W, Arnold V,Beitchman J, Benson RS, et al. Practiceparameter for the assessment and treatment ofchildren and adolescents with enuresis. Journalof the American Academy of Child and AdolescentPsychiatry. 2004;43(12): 1540–1550. https://doi.org/10.1097/01.chi.0000142196.41215.cc.

  29. Samir M, Mahmoud MA, Elawady H. Canthe combined treatment of solifenacin andimipramine has a role in desmopressin refractorymonosymptomatic nocturnal enuresis? Aprospective double-blind randomized placebocontrolledstudy. Urologia. 2021;88(4): 369–373.https://doi.org/10.1177/0391560321993587.

  30. Cai T, Yao Y, Sun W, Lei P. Desmopressin incombination with anticholinergic agents in thetreatment of nocturnal enuresis: a systematicreview and meta-analysis. Frontiers in Pediatrics.2023;11: 1242777. https://doi.org/10.3389/fped.2023.1242777.

  31. Ghanavati PM, Khazaeli D, Amjadzadeh M.A comparison of the efficacy and tolerabilityof treating primary nocturnal enuresis withSolifenacin Plus Desmopressin, TolterodinePlus Desmopressin, and Desmopressin alone: arandomized controlled clinical trial. Internationalbraz j urol. 2021;47(1): 73–81. https://doi.org/10.1590/s1677-5538.ibju.2019.0448.

  32. Seyfhashemi M, Ghorbani R, Zolfaghari A.Desmopressin, Imipramine, and Oxybutynin inthe Treatment of Primary Nocturnal Enuresis: ARandomized Clinical Trial. Iranian Red CrescentMedical Journal. 2015;17(7): e16174. https://doi.org/10.5812/ircmj.16174v2.

  33. Gökçe Mİ, Hajıyev P, Süer E, Kibar Y, Sılay MS,Gürocak S, et al. Does structured withdrawal ofdesmopressin improve relapse rates in patientswith monosymptomatic enuresis? The Journalof Urology. 2014;192(2): 530–534. https://doi.org/10.1016/j.juro.2014.01.094.




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