Diagnosis and treatment of nonorganic enuresis in children: Clinical practice guideline
Resumen
Background: Bedwetting is an involuntary urination during sleep at the age of 5 years or older. Clinical Practice Guidelines (CPG) have been developed to improve decision-making strategies and standardize medical practice. The Ministry of health in Mexico developed the CPG diagnosis and treatment of non-organic enuresis at the first level of prevention in children. Its evidence is evaluated with the USPSTF (United States Preventive Services Task Force). Material and methods: Original articles that justify the evidence of Mexican CPG were sought and identified in virtual libraries: Pubmed, Embase, Cochrane Library plus, and then analyzed with the instrument of the USPSTF.
Results: Sixty articles were reviewed. They’re the basis for evidence formulation of the Mexican CPG. Only nine articles were level I, adequately powered and well conducted trials and recommendation Grade A, with a substantial net profit. Evidences that were substantial fed by these articles obtained the highest scores.
Discussion: The methodological rigor of the original articles that support the CPG is highly variable. This instrument is meant to evaluate the evidence of the guide but is far from being a reflection of the rigor in the development and applicability of Mexican CPG.
Citas
Norgaard JP, Van Gool JD, Hjalmas K, Djurhuus JC, Hellström AL. Standardization and definitions in lower urinary tract dysfunction in children. Br J Urol Int 1998; 81:1-16.
Nevéus T, Von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The Standardization of Terminology of Lower Urinary Tract Function in Children and Adolescents: Report from the Standardization Committee of the International Children’s. The Journal of Urology 2006; 176:314-24.
Diagnóstico y tratamiento de la enuresis no orgánica en la edad pediátrica en el primer nivel de atención. Mexico:Ministry of Health, 2008.
Hussmann DA. Enuresis. Urology 1996; 48:184-93.
Perez Becker R, Garza Elizondo R, Jimenez Gutierrez C. Evaluación de la calidad clínica y metodológica de las guías de práctica clínica acerca de enuresis primaria monosintomática. Tesis 2008, CID, National Institute of Pediatrics.
Gyorkos TW, Tannenbaum TN, Abrahamowicz M, Oxman AD, Scott EA, Millson ME, et al. An approach to the development of practice guidelines for community health interventions. Can J Public Health 1994;85 (Suppl 1): 8-13.
Navarro Puerto MA, Ruiz Romero F, Reyes Dominguez A, Gutierrez Ibarlucea I, Hermosilla Gago T, Alonso Ortiz del Río C, y colaboradores. ¿Las guías que nos guían son fiables? Evaluación de las Guías de Práctica Clínica Españolas. Rev Clin Esp 2005; 205:533-540.
Marzo M, Alonso P, Bonfill X. Guías de Práctica Clínica en España. Med Clin (Barc). 2002; 118 (Supl 3): 30-35.
Scottish Intercollegiate Guidelines Network. SIGN 50: A Guideline developer’s handbook. 2008; [aprox. 101 pp.] -Disponible- In: http://www.sign.ac.uk/guidelines/fulltext/
/
National Institute for Health and Clinical Excellence (January 2009) The guidelines manual. London: National Institute for Health and Clinical Excellence. Available from: www.nice.org.uk
Canadian Task Force on the Periodic Health Examination. The periodic health examination. Can Med Assoc J 1979;121:1193-1254.
Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al; for the Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20:21-35.
Ubeda Sansano MI, Martinez Garcia R, Diez Domingo J. Guía de Práctica Clínica: Enuresis nocturna primaria monosintomática en atención primaria. Revista Pediatría de Atención Primaria 2005;VII (S3).
Fritz G, Rockney R. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Enuresis, 2004;43(12):1540–50.
Hjalmas K, Arnold T, Bower W, Caione P, Chioza LM, von Gontard A. Nocturnal enuresis: An international evidence based management strategy. J Urol 2004; 171: 2545-61.
Meave Cueva LG, Garza Elizondo R, Díaz García L. Evaluación
de las Evidencias con el Instrumento de la USPSTF de la Guía de Práctica Clínica: “Diagnóstico y Tratamiento de la Enuresis Infantil en el Primer Nivel de Atención” Tesis 2010 CID, National Institute of Pediatrics.
Wan J, Greenfield S. Enuresis and common voiding abnormalities. Pediatr Clin North Am 1997; 44:1117-11
Yucel S, Kutlu O, Kukul E, Baykara M. Impact of urodynamics
in treatment of primary nocturnal enuresis persisting into adulthood. Urology2004;64:1020-5.
Chandra M, Saharia R, V Hill, Q Shi. Prevalence of diurnal voiding symptoms and difficult arousal from sleep in children with nocturnal enuresis. J Urol 2004; 172:311-6.
Wolfish N. Sleep arousal function in enuretic males. Scand J Urol Nephrol Supl 1999; 202:24-6.
Medel R, Ruarte AC, Castera R, Podesta ML. Primary enuresis:
a urodynamic evaluation. Br J Urol 1998; 81 Suppl 3:50-2.
Starfield B, David Mellits E. Increase in functional bladder capacity and improvement in enuresis. J Pediatr 1968; 72:483-7
Medel R, Dieguez S, Brindo M, Ayuso S, Canepa C, Ruarte A, et al. Monosymptomatic primary enuresis: differences between patients responding or not responding to oral desmopressin. Br J Urol 1998; 81 Suppl 3:46-9.
Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev
Glazener, CM, Evans JH, Peto RE. Simple behavioral and physical interventions for nocturnal enuresis in children.
The Cochrane Database of Systematic Reviews. The Cochrane
Library volume (1) 2004
Nawaz S, Griffiths P, Tappin D. Parent-administered modified
dry-bed training for childhood nocturnal enuresis: Evidence for superiority over urine-alarm conditioning when delivery factors are controlled. Behavioral Interventions 2002; 17:247-60.
Schulman SL, Stokes A, Salzman PM. The efficacy and safety
of oral desmopressin in children with primary nocturnal enuresis. J Urol 2001;166:2427-2431.Comment in: J Urol 2003;170:550.
Rushton HG, Belman AB, Skoog S, Zaontz MR, Sihelnik S, Skoog S. Predictors of response to desmopressin in children and adolescents with monosymptomatic nocturnal enuresis. Scand J Urol Nephrol 1995;29 (Supl 173):109-10.
Longstaffe S, Moffatt ME, Whalen JC. Behavioral and selfconcept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics 2000;105:935- 40.
Radmayr C, Schlager A, Studen M, Bartsch G. Prospective
randomized trial using laser acupuncture versus desmopressin
in the treatment of nocturnal enuresis. Eur Urol 2001;40:201-205.
Mellon MW, McGrath ML. Empirically supported treatments in pediatric psychology: nocturnal enuresis. J Pediatr Psychol 2000;25:193-214.
Redsell SA, Collier J. Bedwetting, behavior and selfesteem:
a review of the literature. Child Care Health Dev 2001;27:149-62.
Derechos de autor 2015 Acta Pediátrica de México
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
