Physiological and pharmacological basis for the chemotherapy of enuresis

Stephenson, John

doi:10.1017/s0033291700030749

Cited by 20 publications

(7 citation statements)

References 67 publications

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“…Kales and Rapaport [57] have shown that the enuretic effects of imipramine appear to be independent of its effects on sleep stage. Imipramine also has a weak peripheral anticholinergic and antispasmodic effect as well as having an effect on the sympathetic nervous system input to the bladder [58]. The bladder capacity of enuretics was increased by 34% in one study, which supports this mechanism of imipramine action in enuretics.…”

Section: Pharmacotherapymentioning

confidence: 69%

Nocturnal enuresis

Mark

Frank

1995

British Journal of Urology

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Nocturnal enuresis is common. Although its aetiology remains unclear recent evidence increasingly supports the lack of a normal nocturnal increase in ADH leading to nocturnal polyuria exceeding functional bladder capacity. Sleep patterns are probably normal although an arousal disorder might be a factor. Treatment should follow careful evaluation to determine if one is dealing with 'uncomplicated' or 'complicated' enuresis. Complicated enuresis requires further investigation. 'Uncomplicated enuresis' always requires reassurance and patient and parent education. Resource centres such as ERIC can provide information and advice. Active treatment should be tailored to the patients age, motivation and parental wishes. Behavioural modification techniques yield the highest long-term cure rate but require the most commitment and are rarely successful before the age of 7-8 years. Pharmacotherapy has been revolutionized by DDAVP which gives a response rate of up to 70% relatively free from side-effects but at the price of a high relapse rate after medication. Imipramine is less expensive than DDAVP but may be fatal in overdose. Anticholinergics should be reserved for those patients with significant diurnal symptoms or those who fail first-line pharmacotherapy. Overall patients and parents should be reassured by the high spontaneous cure rate.

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Section: Pharmacotherapymentioning

confidence: 69%

Nocturnal enuresis

Mark

Frank

1995

British Journal of Urology

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“…Hunsballe et al [13] reported that the antidiuretic effect of imipramine can be attributed primarily to increased ·-adrenergic stimulation in the proximal tubules with a secondary increased urea and water re-absorption more distally in the nephron. A peripheral anticholinergic action and a blocking effect on amine of norepinephrine and serotonin re-uptake at sympathetic nerve terminals have been suggested as possible mechanisms for the anti-enuretic properties of imipramine [13,14]. Re-uptake inhibition leads to accumulation and increased availability of neurotransmitter substances at the postsynaptic membrane [15,16].…”

Section: Discussionmentioning

confidence: 99%

Combination Therapy of Imipramine with Oxybutynin in Children with Enuresis Nocturna

Tahmaz

Kïbar²,

Yıldırım³

et al. 2000

Urol Int

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Purpose: The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna. Patients and Methods: This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998. Results: Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective. Conclusions: We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.

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“…Historically, tricyclic antidepressants were the drugs of choice for the treatment of enuresis, and imipramine was the most frequently prescribed drug treatment (Blackwell & Currah, 1973;Foxman et al, 1986;Stephenson, 1979). The mechanism by which imipramine reduces bedwetting is still, for the most part, unknown (Stephenson).…”

Section: Medications and Their Mechanisms Of Changementioning

confidence: 99%

Enuresis and Encopresis

Friman

Freeman

2010

Handbook of Clinical Psychology Competencies

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Abstract:In this chapter, we describe the assessment and treatment of enuresis and encopresis. We first review literature on the symptoms, causes, and evidence-based treatments of each condition separately. We also incorporate a discussion of the mechanisms of change underlying effective intervention. Then, using Ryle's (1949) distinction between "knowing how" and "knowing that" as a framework, we discuss the basic competencies one should possess to address these clinical issues. A major reason for distinguishing between the "knowing how" and "knowing that" skill sets is that some clinicians teach and others practice. Based on this framework, we argue that demonstration of basic competency entails the clinician having the skills to conduct effective assessment and treatment of enuresis and/or encopresis, or the skills necessary to tell others (e.g., supervisees) how to do so. These skills include a thorough knowledge of the physiology of urination and defecation, potential pathophysiology of elimination disorders, the ability to effectively interface with medical providers regarding their treatment, and a strong working knowledge of evidence based treatments and their mechanisms of change. In our discussion of expert competency, we use no such distinction between "knowing how" and "knowing that", as an expert should be skilled in both. Further, expert competency in enuresis and encopresis entails the verbal and performance knowledge base to make scholarly contributions to the field, either by conducting one's own research or serving as a consultant to other research programs. Thus, an expert in this area is well poised to contribute to the field of elimination disorders as a master clinician, a specialty supervisor, and/or as a contributing researcher. OverviewChild clinical and pediatric psychologists confront a diverse set of problems that challenge children and their families. Often overlooked, but critically important, is the ability to successfully evaluate and intervene the challenges that may, at first glance, seem either medically based or within the realm of "typical" child behavioral problems. Among the most common, persistent, and stressful presenting complaints in primary medical care for children are two disorders involving developmentally inappropriate elimination of waste -enuresis (urine) and encopresis (feces). Evidence of their commonality and persistence is found in prevalence and age-range estimates. Prevalence estimates range as high 2% of 5-year-old children for encopresis and 25% of 6-year-old children for enuresis and, although both are much less prevalent by the teenage years, they are not rare. For example, as many as 8% of boys and 4% of girls are still enuretic at the age

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Physiological and pharmacological basis for the chemotherapy of enuresis

Cited by 20 publications

References 67 publications

Nocturnal enuresis

Nocturnal enuresis

Combination Therapy of Imipramine with Oxybutynin in Children with Enuresis Nocturna

Enuresis and Encopresis

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