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ICCS 2016 Annual Meeting in Kyoto, Japan

By Konstantinos Kamperis

The annual meeting of the International Children’s Continence society was held in Kyoto Japan from June 30th to July 2d. New research was presented covering all aspects of incontinence and bladder and bowel dysfunction. In this report we offer a synopsis of the most important new research on enuresis presented.

Circadian rhythms vasopressin and disease

 Dr. Hitoshi Okamura dept. of Systems Biology Kyoto University has spend the last decades researching into the genetics of circadian rhythms and offered an excellent and concise review on the subject.

His efforts led to the identification of clock genes, which by oscillating expression, but also through transcription translation feedback loops govern the rhythmicity in physiological processes in the body. Such genes are also found in the bladder (connexin 43) indicating a circadian rhythm in bladder function. This chrono-molecular approach to enuresis may enable us to decode the pathophysiological mechanisms responsible thus offering basis for more efficient treatment options.

Is obesity associated with incontinence and nocturia in kindergarten children?

T Warner, RB Jacobsen, UT Baandrup, C Bundgaard-Nielsen, S Hagstroem Vendsyssel hospital and Aalborg University Hospital Denmark

T Warner et al investigated the relationship between BMI and incontinence in 6-year-old Danish children. Using interviews and measurements of BMI performed by the school nurses were able to collect information from 2725 children. The analysis revealed an association between obesity and fecal incontinence as well as daytime incontinence in girls. No association was seen between BMI and enuresis or nocturia. The authors speculate that such an association may be evident in older children where obesity is more prevalent.

Outcome of urodynamically proven overactive bladder in children who have failed urotherapy and anticholinergic medication

JC Clothier, A Wright, Evelina London Children’s Hospital, UK

Children with OAB refractory to treatment are to be found in all clinical settings. The authors reviewed the outcomes of 91 children with idiopathic OAB who failed urotherapy and anticholinergics with an age range of 5-16 years. The authors found 57% of the children with complete response and only 29% of the children were consistently non-responders or lost to follow up. The average follow up time was 2-3 years. The authors conclude that the majority of the children with idiopathic OAB continue to improve with time with ongoing or additional treatment.  

Evaluation of urinary AQP2 and plasma copeptin as markers of the effectiveness of dDAVP

T Hara, Y Ootomo, M Yasui, Juntedo University and University of Keio, Japan

Nocturnal polyuria is one of the pathophysiological mechanisms leading to nocturnal enuresis. Desmopressin is effective in two thirds of the children and although predictors of efficacy have been identified such as bladder capacity and nocturnal urine production we still lack biomarkers that can differentiate responders from non-responders. Aquaporin 2 is the vasopressin regulated water channel in the collecting duct and copeptin is a byproduct of vasopressin production. This Japanese group measured the urinary AQP2 and plasma copeptin levels in 30 children with nocturnal enuresis and found that the day/night ratio of AQP2 excretion to be related to dDAVP effect. Such a marker could be useful in identifying the children with good response to dDAVP thus optimizing their treatment. 

Psychological stress causes reversal of diurnal and nocturnal urine volume: an animal study on the pathogenesis of secondary enuresis

S Kato, T Koike, T Kitao, S Yamanouchi, T Kimata, S Tsuji, H Yamada, K Kaneko Kansai Medical University Osaka Japan

The authors presented their interesting research approach on the relationship between stress and nocturnal enuresis. Using rats as animal model they were able to show an inversion of the normal circadian diuresis rhythm in stressed rats compared to controls. These findings generate the hypothesis that exacerbation of nocturnal enuresis due to psychological stress may be due to increased nocturnal urine output. Studies in humans are needed to confirm this hypothesis.

Enuresis management in Australian children: retrospective review of 3000 cases treated with bell and pad alarm

S Gibb, S Schuster, S Whitaker, K Murphy, J Golder, B Leiper, L Sullivan, J Reece, E Apos, Multicenter study, Australia.

This is a large multicenter retrospective study concerning the alarm treatment of children with nocturnal enuresis in Australia. Clinical data from 300 children aged 6-16 years was collected.

The presented overall success rate was 73% defined as 14 consecutive dry nights, with a 20% relapse rate (more than 1 enuresis episode per month). According to the authors alarm treatment is initial treatment of enuresis in many settings throughout Australia.

Effectiveness of 3 months standard urotherapy in treatment of monosymptomatic nocturnal enuresis

M Maternik, I Mader-Wolynska, M Miklaszewska, K Zachwieja, K Kilis-Pstrusinska, KK Kozyrska, A Krakowska, D Rataiczak, A Jander, M Tkaczyk Multicenter study, Poland

Standard urotherapy is the first step in the treatment approach of children with monosymptomatic enuresis nocturna (MNE). However this recommendation is merely based on expert opinion and is still debatable. This polish group prospectively evaluated the effect of 3 months of standard urotherapy in treatment naïve children with MNE. The advice included regular voidings, good voiding posture, sound drinking habits, and avoidance of fluids 2 hours before bedtime. The authors found a reduction in the number of wet nights over time and at 3 months 18% of the children were dry just by standard urotherapy. The small number of full responders may indicate the need for adjacent therapy in these children such as the enuresis alarm or desmopressin.  


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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition.