Complementary and miscellaneous interventions for nocturnal enuresis in children

 

Abstract

Background

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15% to 20% of five year olds, and up to 2% of young adults.

Objectives

To assess the effects of complementary interventions and others such as surgery or diet on nocturnal enuresis in children, and to compare them with other interventions.

Search methods

We searched PubMed (1950 to June 2010), EMBASE (1980 to June 2010), the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) (1984 to June 2010), Chinese Biomedical Literature Database (CBM) (1975 to June 2010), China National Knowledge Infrastructure (CNKI) (1979 to June 2010), VIP database (1989 to June 2010), and the reference lists of relevant articles, all last searched 26 June 2010. No language restriction was used.

Selection criteria

All randomised or quasi-randomised trials of complementary and other miscellaneous interventions for nocturnal enuresis in children were included except those focused solely on daytime wetting. Comparison interventions could include no treatment, placebo or sham treatment, alarms, simple behavioural treatment, desmopressin, imipramine and miscellaneous other drugs and interventions.

Data collection and analysis

Two reviewers independently assessed the quality of the eligible trials, and extracted data.

Main results

In 24 randomised controlled trials, 2334 children were studied, of whom 1283 received a complementary intervention. The quality of the trials was poor: 5 trials were quasi-randomised, 5 showed differences at baseline and 17 lacked follow up data.

The outcome was better after hypnosis than imipramine in one trial (relative risk (RR) for failure or relapse after stopping treatment 0.42, 95% confidence interval (CI) 0.23 to 0.78). Psychotherapy appeared to be better in terms of fewer children failing or relapsing than both alarm (RR 0.28, 95% CI 0.09 to 0.85) and rewards (RR 0.29, 95%CI 0.09 to 0.90) but this depended on data from only one trial. Medicinal herbs had better results than desmopressin in one trial (RR for failure or relapse after stopping treatment 0.35, 95% CI 0.14 to 0.85). Acupuncture had better results than sham control acupuncture (RR for failure or relapse after stopping treatment 0.67, 95% CI 0.48 to 0.94) in a further trial. Active chiropractic adjustment had better results than sham adjustment (RR for failure to improve 0.76, 95% CI 0.60 to 0.95). However, each of these findings came from small single trials, and must be verified in further trials. The findings for diet and faradization were unreliable, and there were no trials including homeopathy or surgery.

Authors' conclusions

There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects clearly reported.

 

Plain language summary

Complementary treatments such as hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs for bedwetting in children

Night-time bedwetting is common in childhood, and can cause stigma, stress and inconvenience. Alarms offer the best chance of cure, and desmopressin may be used to reduce or stop wet nights during treatment. Simple behavioural methods such as rewards also help, especially as first line treatment. People often use complementary methods to treat their children, but the review of trials did not provide good evidence to support this. There was no reliable information comparing complementary methods with established effective methods such as alarms and desmopressin. Further research is needed.

 

摘要

背景

輔助性療法和其他各種各樣的的方法對於夜間尿床孩童的治療

夜間尿床會造成社交的破裂和壓力,影響了15 – 20%左右的五歲孩童,甚至上溯到年輕成人也有2%的比率。

目標

評估對於夜間尿床的孩童而言,輔助性治療和其他像是手術介入或飲食療法的價值,並且比較這些療法和其他治療間的差異。

搜尋策略

我們搜尋了考柯藍實證醫學資料庫裡關於失禁的群組,在2006年11月16以前的文章,以及中國中醫藥文獻檢索系統(TCMLARS)中1984年1月到2004年6月的文章,參考來源會列表出相關文獻。

選擇標準

所有的隨機或非完全隨機試驗都是關於兒童夜間尿床的輔助治療或是其他介入療法,會排除那些單純探討白天遺尿的文章。被比較的包括沒有治療,安慰劑,定時鬧鈴起床解尿,簡單的行為療法,迷你寧(desmopressin),益伊神(imipramine),以及他各式各樣的藥物和治療。

資料收集與分析

兩名回顧者獨立地評估合格試驗的的品質,和抽取出數據。

主要結論

在15個包括了1389個病童的隨機試驗中,703個接受了輔助性療法。但是這些試驗的品質都是不良的:有4個試驗是非完全隨機,有5個試驗在一開始的基準上就有差異,而有10個試驗缺少了再追蹤的數據。 有一個試驗中,催眠的效果比imipramine好,治療失敗或是復發的相對危險性(RR)分別是0.42,95%信賴區間(CI)是0.23對0.78。精神性治療在孩童的失敗和復發比起定時鬧鈴起床解尿(相對危險性是0.28,95%信賴區間0.09對0.85)和回饋治療(相對危險性是0.29,95%信賴區間0.09對0.9)的結果都來的好,但是相關數據只來自一個試驗。在進一步的試驗中,針灸組比起對照組(沒有針灸)有較好的結果,失敗或是復發相對危險性是0.67,95%信賴區間0.48對0.94。積極的整脊療法比起對照組有更好的結果(失敗或是復發相對危險性是0.74,95%信賴區間0.6對0.91)。 然而,任何一項發現均來自小型的簡單試驗,而且需要再由進一步試驗證實。飲食療法和感應電流療法的發現都有令人懷疑的結果,而順勢醫療或者手術介入在這些試驗中都沒有探討。

作者結論

微弱的證據支持催眠,精神療法,針灸,和整脊療法的功效,但是證據都分別來自一些簡單的小型試驗,有些試驗在標準化評估後品質令人懷疑。完整健全的隨機試驗要具備效力,經濟效益,還有要謹慎監控副作用發生。

翻譯人

本摘要由中國醫藥大學附設醫院張嘉容翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

輔助療法,像是催眠,精神療法,針灸,和整脊療法對於夜間尿床可能有幫助,但是證據很微弱。 幼年時期的夜間尿床很常見,可能令人感到丟臉,壓力和不便。定時鬧鈴起床解尿對於治療提供了最佳的機會, 迷你寧(desmopressin)也可以在治療期間用來減少或防止尿床發生。簡單的行為療法像是回饋法也有幫助,特別是用在第一線的治療。大部分的人使用輔助療法治療他們的小孩,但是在回顧臨床試驗後發現並沒有足夠的證據來支持。沒有可信賴的資訊去比較輔助療法和現今已建立的有效療法(像是定時鬧鈴起床解尿或是迷你寧(desmopressin)的使用),進一步的研究是必須的。