Skip to main content
Top
Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Bed-Wetting | Study protocol

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

Authors: Janet Schloss, Kimberley Ryan, Rebecca Reid, Amie Steel

Published in: BMC Pediatrics | Issue 1/2019

Login to get access

Abstract

Background

Nocturnal enuresis (NE), or ‘bedwetting’, is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child’s water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE.

Methods

This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion.

Discussion

This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition.

Trial registration

Australian and New Zealand Clinical Trials Registration Number: 12618000288224.
Protocol: 23 February 2018, version 1.1.
Literature
1.
go back to reference Culbert TP, Banez GA. Wetting the bed: integrative approaches to nocturnal enuresis. Explore (NY). 2008;4(3):215–20.CrossRef Culbert TP, Banez GA. Wetting the bed: integrative approaches to nocturnal enuresis. Explore (NY). 2008;4(3):215–20.CrossRef
2.
go back to reference Ring JI, Neveus T, Markstrom A, Arnrup K. Bazargani Nocturnal enuresis impaired children’s quality of life and friendships. Acta Paediatr. 2017;106(5):806–11.CrossRef Ring JI, Neveus T, Markstrom A, Arnrup K. Bazargani Nocturnal enuresis impaired children’s quality of life and friendships. Acta Paediatr. 2017;106(5):806–11.CrossRef
3.
go back to reference Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S, et al. Practical consensus guidelines for the management of enuresis. Eur J Pediatr. 2012;171(6):971–83.CrossRef Vande Walle J, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S, et al. Practical consensus guidelines for the management of enuresis. Eur J Pediatr. 2012;171(6):971–83.CrossRef
4.
go back to reference Haid B, Tekgul S. Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment. European urology focus; 2017. Haid B, Tekgul S. Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment. European urology focus; 2017.
5.
go back to reference Lv ZT, Song W, Wu J, Yang J, Wang T, Wu CH, et al. Efficacy of Acupuncture in Children with Nocturnal Enuresis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Altern Med. 2015;2015:320701. Lv ZT, Song W, Wu J, Yang J, Wang T, Wu CH, et al. Efficacy of Acupuncture in Children with Nocturnal Enuresis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Altern Med. 2015;2015:320701.
6.
go back to reference National Clinical Guideline C. National Institute for Health and Clinical Excellence: Guidance. In: Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. London: Royal College of Physicians (UK), National Clinical Guideline Centre; 2010. National Clinical Guideline C. National Institute for Health and Clinical Excellence: Guidance. In: Nocturnal Enuresis: The Management of Bedwetting in Children and Young People. London: Royal College of Physicians (UK), National Clinical Guideline Centre; 2010.
7.
go back to reference Hamed A, Yousf F, Hussein MM. Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: an epidemiological study. World J Urol. 2017;35(3):459–65.CrossRef Hamed A, Yousf F, Hussein MM. Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: an epidemiological study. World J Urol. 2017;35(3):459–65.CrossRef
8.
go back to reference Sureshkumar P, Jones M, Cumming R, Craig J. A population based study of 2856 school-age children with urinary incontinence. J Urol. 2009;181(2):808–15 discussion 15–6.CrossRef Sureshkumar P, Jones M, Cumming R, Craig J. A population based study of 2856 school-age children with urinary incontinence. J Urol. 2009;181(2):808–15 discussion 15–6.CrossRef
9.
go back to reference Sarici H, Telli O, Ozgur BC, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol. 2016;12(3):159.e1–6.CrossRef Sarici H, Telli O, Ozgur BC, Demirbas A, Ozgur S, Karagoz MA. Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children. J Pediatr Urol. 2016;12(3):159.e1–6.CrossRef
10.
go back to reference Huang T, Shu X, Huang YS, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2011;(12):Cd005230. Huang T, Shu X, Huang YS, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2011;(12):Cd005230.
11.
go back to reference Helmer R. Treating Paediatric Bed-wetting with Chinese Medicine. J Chinese Med. 2007;(83):25-9. Helmer R. Treating Paediatric Bed-wetting with Chinese Medicine. J Chinese Med. 2007;(83):25-9.
12.
go back to reference Sureshkumar P, Jones M, Caldwell PH, Craig JC. Risk factors for nocturnal enuresis in school-age children. J Urol. 2009;182(6):2893–9.CrossRef Sureshkumar P, Jones M, Caldwell PH, Craig JC. Risk factors for nocturnal enuresis in school-age children. J Urol. 2009;182(6):2893–9.CrossRef
13.
go back to reference Bower WF, Sit FK, Bluyssen N, Wong EM, Yeung CK. PinQ: a valid, reliable and reproducible quality-of-life measure in children with bladder dysfunction. J Pediatr Urol. 2006;2(3):185–9.CrossRef Bower WF, Sit FK, Bluyssen N, Wong EM, Yeung CK. PinQ: a valid, reliable and reproducible quality-of-life measure in children with bladder dysfunction. J Pediatr Urol. 2006;2(3):185–9.CrossRef
14.
go back to reference Bachmann C, Ackmann C, Janhsen E, Steuber C, Bachmann H, Lehr D. Clinical evaluation of the short-form pediatric enuresis module to assess quality of life. Neurourol Urodyn. 2010;29(8):1397–402.CrossRef Bachmann C, Ackmann C, Janhsen E, Steuber C, Bachmann H, Lehr D. Clinical evaluation of the short-form pediatric enuresis module to assess quality of life. Neurourol Urodyn. 2010;29(8):1397–402.CrossRef
15.
go back to reference Thibodeau BAM. Voiding dysfunction and quality of life in children; 2009. Thibodeau BAM. Voiding dysfunction and quality of life in children; 2009.
16.
go back to reference Schlomer B, Rodriguez E, Weiss D, Copp H. Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care. J Pediatr Urol. 2013;9(6 Pt B):1043–8.CrossRef Schlomer B, Rodriguez E, Weiss D, Copp H. Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care. J Pediatr Urol. 2013;9(6 Pt B):1043–8.CrossRef
17.
go back to reference Thurber S. Childhood Enuresis: Current Diagnostic Formulations, Salient Findings, and Effective Treatment Modalities. Arch Psychiatr Nurs. 2017;31(3):319–23.CrossRef Thurber S. Childhood Enuresis: Current Diagnostic Formulations, Salient Findings, and Effective Treatment Modalities. Arch Psychiatr Nurs. 2017;31(3):319–23.CrossRef
18.
go back to reference Tai BT, Tai TT, Chang YJ, Huang KH. Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: A follow-up study. J Pediatr Urol. 2017;13(1):44.e1–9.CrossRef Tai BT, Tai TT, Chang YJ, Huang KH. Factors associated with remission of primary nocturnal enuresis and changes of parental perception towards management strategies: A follow-up study. J Pediatr Urol. 2017;13(1):44.e1–9.CrossRef
19.
go back to reference Brownrigg N, Pemberton J, Jegatheeswaran K, DeMaria J, Braga LH. A pilot randomized controlled trial evaluating the effectiveness of group vs individual urotherapy in decreasing symptoms associated with bladder-bowel dysfunction. J Urol. 2015;193(4):1347–52.CrossRef Brownrigg N, Pemberton J, Jegatheeswaran K, DeMaria J, Braga LH. A pilot randomized controlled trial evaluating the effectiveness of group vs individual urotherapy in decreasing symptoms associated with bladder-bowel dysfunction. J Urol. 2015;193(4):1347–52.CrossRef
20.
go back to reference Arlen AM. Dysfunctional Voiders-Medication Versus Urotherapy? Curr Urol Rep. 2017;18(2):14.CrossRef Arlen AM. Dysfunctional Voiders-Medication Versus Urotherapy? Curr Urol Rep. 2017;18(2):14.CrossRef
21.
go back to reference Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005;(2):Cd005230. Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005;(2):Cd005230.
22.
go back to reference Kajbafzadeh A-M, Sharifi-Rad L, Mozafarpour S, Ladi-Seyedian S-S. Efficacy of transcutaneous interferential electrical stimulation in treatment of children with primary nocturnal enuresis: a randomized clinical trial. Pediatr Nephrol. 2015;30(7):1139–45.CrossRef Kajbafzadeh A-M, Sharifi-Rad L, Mozafarpour S, Ladi-Seyedian S-S. Efficacy of transcutaneous interferential electrical stimulation in treatment of children with primary nocturnal enuresis: a randomized clinical trial. Pediatr Nephrol. 2015;30(7):1139–45.CrossRef
23.
go back to reference Jørgensen CS, Kamperis K, Borch L, Borg B, Rittig S. Transcutaneous Electrical Nerve Stimulation in Children with Monosymptomatic Nocturnal Enuresis: A Randomized, Double-Blind, Placebo Controlled Study. J Urol. 2017;198(3):687–93.CrossRef Jørgensen CS, Kamperis K, Borch L, Borg B, Rittig S. Transcutaneous Electrical Nerve Stimulation in Children with Monosymptomatic Nocturnal Enuresis: A Randomized, Double-Blind, Placebo Controlled Study. J Urol. 2017;198(3):687–93.CrossRef
24.
go back to reference Van Herzeele C, De Bruyne P, Evans J, Eggert P, Lottmann H, Norgaard JP, et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther. 2014;31(12):1306–16.CrossRef Van Herzeele C, De Bruyne P, Evans J, Eggert P, Lottmann H, Norgaard JP, et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther. 2014;31(12):1306–16.CrossRef
25.
go back to reference Anderson B, Cranswick N. The placebo (I shall please) – is it so pleasing in children? Paediatr Anaesth. 2005;15(10):809–13.CrossRef Anderson B, Cranswick N. The placebo (I shall please) – is it so pleasing in children? Paediatr Anaesth. 2005;15(10):809–13.CrossRef
26.
go back to reference Glicklich LB. Special reviews. an historical account of enuresis. Pediatrics. 1951;8(6):859–76.PubMed Glicklich LB. Special reviews. an historical account of enuresis. Pediatrics. 1951;8(6):859–76.PubMed
27.
go back to reference Robinson N, Lorenc A. Responding to patient demand: community pharmacists and herbal and nutritional products for children. Phytother Res. 2011;25(6):892–6.CrossRef Robinson N, Lorenc A. Responding to patient demand: community pharmacists and herbal and nutritional products for children. Phytother Res. 2011;25(6):892–6.CrossRef
28.
go back to reference Ma Y, Liu X, Shen Y. Effect of traditional Chinese and Western Medicine on Nocturnal Enuresis in Children and Its Influencing Factors: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2017. Ma Y, Liu X, Shen Y. Effect of traditional Chinese and Western Medicine on Nocturnal Enuresis in Children and Its Influencing Factors: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2017.
29.
go back to reference Sharifi H, Minaie MB, Qasemzadeh MJ, Ataei N, Gharehbeglou M, Heydari M. Topical use of Matricaria recutita L (Chamomile) oil in the treatment of monosymptomatic enuresis in children: a double-blind randomized controlled trial. J Evid Based Complementary Altern Med. 2017;22(1):12–7.CrossRef Sharifi H, Minaie MB, Qasemzadeh MJ, Ataei N, Gharehbeglou M, Heydari M. Topical use of Matricaria recutita L (Chamomile) oil in the treatment of monosymptomatic enuresis in children: a double-blind randomized controlled trial. J Evid Based Complementary Altern Med. 2017;22(1):12–7.CrossRef
30.
go back to reference Schoendorfer N, Sharp N, Seipel T, Schauss AG, Ahuja KDK. Urox containing concentrated extracts of Crataeva nurvala stem bark, Equisetum arvense stem and Lindera aggregata root, in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo controlled trial. BMC Complement Altern Med. 2018;18:42.CrossRef Schoendorfer N, Sharp N, Seipel T, Schauss AG, Ahuja KDK. Urox containing concentrated extracts of Crataeva nurvala stem bark, Equisetum arvense stem and Lindera aggregata root, in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo controlled trial. BMC Complement Altern Med. 2018;18:42.CrossRef
31.
go back to reference Schauss AG, Spiller G, Chaves S, Gawlicka AK. Effectiveness of UroLogic™ in reducing the symptoms of overactive bladder and urinary incontinence. FASEB J. 2006;20(5):LB102. Schauss AG, Spiller G, Chaves S, Gawlicka AK. Effectiveness of UroLogic™ in reducing the symptoms of overactive bladder and urinary incontinence. FASEB J. 2006;20(5):LB102.
32.
go back to reference Schauss AG, Steels E. Preliminary evidence of the safety and efficacy of Urologic™, an herbal formulation for the treatment of urinary incontinence and overactive bladder. FASEB J. 2006;20(5):A990. Schauss AG, Steels E. Preliminary evidence of the safety and efficacy of Urologic™, an herbal formulation for the treatment of urinary incontinence and overactive bladder. FASEB J. 2006;20(5):A990.
33.
go back to reference Bone K. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Herbal Practitioner. Warwick: Phytotherpay Press; 1997. Bone K. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Herbal Practitioner. Warwick: Phytotherpay Press; 1997.
34.
go back to reference Bensky DGA. Chinese Herbal Materia Medica. USA: Washington Eastland Press; 1993. Bensky DGA. Chinese Herbal Materia Medica. USA: Washington Eastland Press; 1993.
35.
go back to reference Katzung B, Trevor AJ. Basic & Clinical Pharmacology. 13th ed. USA: McGraw-Hill Education; 2015. Katzung B, Trevor AJ. Basic & Clinical Pharmacology. 13th ed. USA: McGraw-Hill Education; 2015.
36.
go back to reference Bower WF. In: Ryan K, editor. PINQ permission email ed PinQ; 2017. Bower WF. In: Ryan K, editor. PINQ permission email ed PinQ; 2017.
37.
go back to reference Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. 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. J Urol. 2006;176(1):314–24.CrossRef Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W, et al. 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. J Urol. 2006;176(1):314–24.CrossRef
38.
go back to reference Ghasemi K, Esteghamati M, Mohammadzadeh M, Zare S. Desmopressin versus Oxybutynin for Nocturnal Enuresis in Children in Bandar Abbas: A Randomized Clinical Trial. Electron Physician. 2016;8(3):2187–93.CrossRef Ghasemi K, Esteghamati M, Mohammadzadeh M, Zare S. Desmopressin versus Oxybutynin for Nocturnal Enuresis in Children in Bandar Abbas: A Randomized Clinical Trial. Electron Physician. 2016;8(3):2187–93.CrossRef
39.
go back to reference Olesen JD, Kiddoo DA, Metcalfe PD. The association between urinary continence and quality of life in paediatric patients with spina bifida and tethered cord. Paediatr Child Health. 2013;18(7):e32–8.PubMedPubMedCentral Olesen JD, Kiddoo DA, Metcalfe PD. The association between urinary continence and quality of life in paediatric patients with spina bifida and tethered cord. Paediatr Child Health. 2013;18(7):e32–8.PubMedPubMedCentral
40.
go back to reference Varni JW, Limbers CA, Burwinkle TM. How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8591 children across age subgroups with the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007;5:1.CrossRef Varni JW, Limbers CA, Burwinkle TM. How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8591 children across age subgroups with the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007;5:1.CrossRef
42.
go back to reference Council NHaMR. Chapter 4.2: Children and young people. 2014. Council NHaMR. Chapter 4.2: Children and young people. 2014.
43.
go back to reference Liauw WS, Day RO. Adverse Event reporting in clincial trials: room for improvement. Med J Aust. 2003;179:426–8.CrossRef Liauw WS, Day RO. Adverse Event reporting in clincial trials: room for improvement. Med J Aust. 2003;179:426–8.CrossRef
44.
go back to reference Caldwell PHY, Murphy SB, Butow PN, Craig JC. Clinical trials in children. Lancet. 2004;364(9436):803–11.CrossRef Caldwell PHY, Murphy SB, Butow PN, Craig JC. Clinical trials in children. Lancet. 2004;364(9436):803–11.CrossRef
45.
go back to reference Caldwell PHY, Butow PN, Craig JC. Parents’ attitudes to children’s participation in randomized controlled trials. J Pediatr. 2003;142(5):554–9.CrossRef Caldwell PHY, Butow PN, Craig JC. Parents’ attitudes to children’s participation in randomized controlled trials. J Pediatr. 2003;142(5):554–9.CrossRef
Metadata
Title
A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children
Authors
Janet Schloss
Kimberley Ryan
Rebecca Reid
Amie Steel
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1797-8

Other articles of this Issue 1/2019

BMC Pediatrics 1/2019 Go to the issue