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      Alarme noturno e enurese: uma revisão baseada na evidência Translated title: Nocturnal alarm therapy and enuresis: an evidence-based review

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          Abstract

          Introdução: A enurese noturna (EN) é um problema comum em idade pediátrica, atingindo cerca de 15% das crianças entre os cinco e os seis anos de idade. Pela sua elevada prevalência, várias modalidades terapêuticas têm surgido no sentido de atenuar o seu impacto, muitas vezes estigmatizante para a criança e família. Entre as opções disponíveis para o seu tratamento sobressai o alarme noturno (AN), tratamento comportamental com efeito condicionado a nível do sono. Objetivo: Rever a evidência científica existente quanto à eficácia do alarme noturno como opção terapêutica no tratamento da enurese noturna. Metodologia: Foi efetuada uma pesquisa bibliográfica nas principais bases de dados internacionais, utilizando os termos MeSH: Nocturnal enuresis AND Clinical alarms. Foi igualmente consultado o Índex RMP usando os termos de pesquisa (DeCS) “Enurese noturna” e “Alarme”. Como critérios de inclusão foram selecionados: meta-análises, revisões sistemáticas, ensaios clínicos aleatorizados, estudos observacionais e orientações clínicas, tendo sido incluídos artigos em língua inglesa e portuguesa, de janeiro de 2005 a janeiro de 2015. Para atribuição do nível de evidência (NE) foi utilizada a escala Oxford Centre for Evidence-Based Medicine 2011. Resultados: Depois de analisados os 52 artigos resultantes da pesquisa, foram incluídos nove artigos: três revisões sistemáticas, três estudos originais e três normas de orientação clínica. Na maioria da literatura analisada foi identificado benefício acrescido do AN quando comparado com as restantes terapêuticas não farmacológicas. Nos estudos que estabeleceram comparação com a desmopressina, o alarme noturno mostrou resultados equiparáveis, excetuando-se menor risco de recaída com o AN e melhor res-posta na EN com capacidade vesical noturna diminuída. Como aspetos menos positivos enumeram-se os resultados mais tardios do AN, a necessidade de colaboração por parte dos pais e o risco de menor adesão ao tratamento. No que respeita às orientações clínicas elaboradas por entidades reconhecidas, as recomendações são concordantes com os resultados dos restantes estudos. Discussão/Conclusão: Considerando os resultados promissores do alarme noturno (Nível de evidência 1, Força de recomendação A), importa que o médico de família considere a sua potencial indicação nos casos de EN resistentes às medidas iniciais, evitando-se a necessidade de intervenção farmacológica e/ou referenciação hospitalar precoce

          Translated abstract

          Introduction: Nocturnal enuresis is a common problem, affecting about 15% of children between the ages of five and six years. Different treatments have been studied in order to diminish the potentially stigmatizing impact of NE, both for the child and the family. These include nocturnal alarms and behavior modification affecting sleep. Aim: The aim of this review was to assess the evidence for the effectiveness of nocturnal alarms in the treatment of nocturnal enuresis. Methods: A bibliographic review of international databases was conducted, using the MeSH terms ‘Nocturnal enuresis' AND ‘Clinical alarms'. We also consulted the Índex RMP database using the search terms Enurese noturna and Alarme. We selected meta-analyses, systematic reviews, randomized controlled trials, observational studies, and clinical guidelines written in Portuguese and English that were published between January 2005 and January 2015. The Oxford Centre for Evidence-Based Medicine criteria were used to establish the Level of Evidence (LE). Results: From a total of 52 articles found, nine met the inclusion criteria. These included three systematic reviews, three clinical trials, and three guidelines. Most studies found that NA is more beneficial than other non-pharmacologic options. When compared to desmopressin, the use of NA has shown equivalent effectiveness. Its use is associated with less risk of relapse and a better response when NE occurs due to diminished nocturnal bladder capacity. However, beneficial results take longer to appear with NA, parental collaboration is needed, and there is a risk of decreased adherence to this treatment. Clinical guidelines agree with the results of published trials. Discussion: Given the potential benefits of nocturnal alarms in the treatment of nocturnal enuresis (Level of Evidence 1, Strength of Recommendation A), the family doctor should consider this treatment for NE resistant to initial measures, thus avoiding the need for pharmacologic intervention or premature referral

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          Most cited references 21

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          The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society.

          We updated the terminology in the field of pediatric lower urinary tract function. Discussions were held of the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society as well as other experts in the field. New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results.
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            The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society.

            The impact of the original International Children's Continence Society terminology document on lower urinary tract function resulted in the global establishment of uniformity and clarity in the characterization of lower urinary tract function and dysfunction in children across multiple health care disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric lower urinary tract function.
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              Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children's Continence Society.

              We provide updated, clinically useful recommendations for treating children with monosymptomatic nocturnal enuresis. Evidence was gathered from the literature and experience was gathered from the authors with priority given to evidence when present. The draft document was circulated among all members of the International Children's Continence Society as well as other relevant expert associations before completion. Available evidence suggests that children with monosymptomatic nocturnal enuresis could primarily be treated by a primary care physician or an adequately educated nurse. The mainstays of primary evaluation are a proper history and a voiding chart. The mainstays of primary therapy are bladder advice, the enuresis alarm and/or desmopressin. Therapy resistant cases should be handled by a specialist doctor. Among the recommended second line therapies are anticholinergics and in select cases imipramine. Enuresis in a child older than 5 years is not a trivial condition, and needs proper evaluation and treatment. This requires time but usually does not demand costly or invasive procedures. Copyright 2010 American Urological Association. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Affiliations
                Porto orgnameACeS Porto Ocidental orgdiv1USF S. João do Porto
                Porto orgnameACeS Porto Ocidental orgdiv1USF Garcia de Orta
                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rpmgf
                Revista Portuguesa de Medicina Geral e Familiar
                Rev Port Med Geral Fam
                Associação Portuguesa de Medicina Geral e Familiar (Lisboa, , Portugal )
                2182-5173
                July 2017
                : 33
                : 3
                : 200-208
                S2182-51732017000300005

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                Counts
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 9
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                Product Information: SciELO Portugal

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